Shuqiong Xu, Junru Wang, Jun Yin, Yongyu Cao, Tongyong Luo, Xianmin Wang, Qingsong Wang
West China Hospital Sichuan University Jintang and Jintang First People’s Hospital. Medical Sichuan Provincial Women’s and Children’s Hospital. Affiliated Women’s and Children’s Hospital of Chengdu College.
China
Medicine
Medicine 2026;
DOI: 10.1097/MD.0000000000048937
Abstract
Congenital heart disease (CHD) encompasses a heterogeneous spectrum of anatomical lesions ranging from simple shunts to complex cyanotic malformations, representing the most common congenital anomaly in children with variable clinical outcomes. Red blood cell distribution width (RDW), an indicator of erythrocyte volume heterogeneity, has demonstrated associations with cardiac dysfunction across diverse CHD phenotypes. This review synthesizes evidence (2015-2023) from PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure regarding RDW’s clinical utility in pediatric CHD. Current evidence indicates that elevated RDW correlates with disease severity, particularly in heart failure and pulmonary hypertension cohorts, and shows potential for perioperative risk stratification (e.g., prolonged mechanical ventilation). However, reported cutoff values vary substantially across studies (13.9%-16.0%), likely reflecting the anatomical and physiological heterogeneity of CHD populations – wherein RDW elevation in cyanotic lesions may reflect chronic hypoxia-driven erythropoiesis, while in acyanotic shunts it indicates volume overload-mediated inflammation. Existing data predominantly derive from retrospective, single-center studies lacking anatomical stratification, limiting causal inference. RDW serves as an inexpensive, accessible biomarker for risk assessment in resource-limited settings, though interpretation requires contextualization by specific CHD subtype and confounding factors (anemia, nutritional status). Future prospective multicenter studies must establish anatomy-specific reference ranges and validate temporal predictive utility through stratified analyses of simple versus complex lesions, cyanotic versus acyanotic physiology, and preoperative versus postoperative stages.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Potential Biomarkers Associated with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes