The COVID-19 pandemic emerged in late 2019. Previous research has shown a significant prevalence of burnout among physician trainees, with concern that the pandemic will increase burnout. We aimed to assess this risk among trainees at a large academic hospital. We performed a cross-sectional study during the pandemic using a survey that included the Maslach Burnout Inventory. The response rate was 94.7%. Among trainees, 58.5% changed their living arrangements to protect family. Psychological well-being was negatively affected in 81.7% and clinical performance in 64.3%; 13.8% were at high risk of burnout. Emotional exhaustion (EE) scores were high in 50% and depersonalization (DP) scores in 28.8%; a sense of personal accomplishment was low in 41.9%. Increased risk of burnout was associated with male gender and increased exposure to suspected COVID-19 cases. Risk of high EE correlated with an increased number of children and risk of high DP with male gender. High EE and DP score correlated with increased exposure to suspected and confirmed COVID-19 patients. Trainees who self-isolated to protect family were more likely to experience high DP and burnout. Trainees in surgical specialties were more likely to feel their clinical performance was negatively affected. The results suggest that a significant percentage of trainees are at high risk of burnout during the pandemic especially those that attempted self-isolation. Training programs should incorporate methods to maintain well-being and coping, including adequate time off between shifts. Future research should evaluate other aspects of trainee well-being in relation to self-isolation and/or changed living arrangements. Key words: Burnout, Medical education, pandemic, coronavirus, psychological wellbeing, medical residents

Background Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study. Results Thirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0–32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive–inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients. Conclusion Cardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).

Background Ductal stenting is the preferred method of securing adequate pulmonary blood flow in patients with duct-dependent pulmonary circulation. The main limitation in most centers is the difficult vertical tubular or convoluted ducts that represent real challenges to interventional pediatric cardiologists. We present our experience in patent ductus arteriosus (PDA) stenting with some technical tips to overcome difficulties, especially in stenting tortuous or long tubular ducts. This study was conducted on all patients with cyanotic congenital heart disease who underwent PDA stenting between January 2011 and December 2018. Results We attempted to stent the PDA in 43 patients, with a success rate of 93% (40 patients) and only one procedural mortality. There was also one stent migration that needed to be treated with urgent surgery. Three-fourths of the patients had difficult ductal morphology and origin. One stent was used to cover the PDA in 27 patients (62.8%), two stents were used in 13 (30.2%), and three stents were used in 2 patients (4.6%). In-stent stenosis rate was 12.5% (5 patients) and the development of progressive left pulmonary artery stenosis was seen in two patients (5%). Pulmonary artery growth was adequate in all patients. Conclusions PDA stenting is an effective method of palliation for patients with duct-dependent pulmonary circulation. It has low morbidity and mortality rates. Stenting difficult ducts have become more feasible with evolving materials and techniques.

Background: We reported our experience in managing patients with single ventricle (SV) physiology and increased pulmonary blood flow (PBF), aiming to assess if it is feasible to proceed with primary Bidirectional Glenn (BDG) without a prior operation to limit PBF. Materials and methods: This is a retrospective study with 51 consecutive patients who underwent BDG operation as a primary operation or a second stage prior to the definitive Fontan operation at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia between 2010 and 2018. Patients were categorized into two groups based on their PBF prior to the operation: Patients who had SV physiology and increased PBF (seven patients) vs. patients with SV physiology and restricted PBF (44 patients). Results: The median age for the increased PBF group was 9.9 months [interquartile range (IQR): 2-16.9 months], and the median age for the restricted PBF group was 15.3 months (IQR: 6.7-42.6 months). Although the length of hospital stay was longer in patients with increased PBF (P = 0.039), we couldn't find a statistically significant difference in early mortality, duration of mechanical ventilation, length of pleural drainage, and length of intensive care unit (ICU) stay between the groups. Conclusion: In our experience, we found that primary BDG could be done safely for patients having SV physiology and increased PBF with acceptable short-term outcomes. It might further reduce the morbidity and mortality for those patients by avoiding the risk of initial pulmonary artery banding or aortopulmonary shunts.

Background: Myocarditis is a leading cause of morbidity and mortality in the pediatric age group and contributes to a wide range of complications, including dilated cardiomyopathy, congestive heart failure, and even death, so early identification and comprehensive management are essential for a favorable outcome.Objectives: Summarize the presenting clinical signs and symptoms of pediatric patients with a diagnosis of myocarditis and a poor outcome and correlate the clinical presentation and laboratory and radiographic findings to identify possible predictors of a poor outcome.Methods: This retrospective cohort study included all patients who were diagnosed with myocarditis and followed up at