Pediheart: Pediatric Cardiology Today

This week, to end 2022, we delve into the world of personal finance for the final episode of 2022 when we speak with Mr. Paul Merriman of paulmerriman.com. Mr. Merriman is a world-renowned expert in personal finance and investing who reviews how we might go about funding a newborn child's retirement (in 65 years!) through the magic of index investing, low costs and compounding interest. There are...

This week we enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide...

This week we review a recent important work on outcomes of pregnancy in patients with bioprosthetic valves. What percentage of women entering pregnancy have a dysfunctional bioprosthetic valve? Is there a particular position of valve where the risk of dysfunction is greater for cardiac or fetal events? We speak with noted cardio-obstetrical expert, Dr. Barbara Wichert-Schmitt of Johannes Kepler Un...

This week we review a recent report from the team at Children's National Hospital in Washington, DC on their experience with the hybrid approach to high risk infants with ductal-dependent systemic circulation. Some patients get ductal stents and others not. How is this decision made? How difficult was it to change the approach of a center that had a reputation for excellence with a more 'tradition...

This week's episode focuses on gender disparities in salary in the field of congenital electrophysiology. To what degree are female electrophysiologists paid less than their male counterparts despite similar levels of education, work effort and seniority? What interventions could be enacted to help 'mind the gap' and level the playing field in this regard? We speak with the chief of pediatric elec...

This week we review a recent work from the Precision Medicine For Cardiomyopathy (PRIMaCY) study group on the role of stress testing in the pediatric HCM patient. Does stress testing help identify patients at risk for possible SCD or progression to heart transplantation? Should all pediatric HCM patients undergo this form of testing? What risks are associated with its use and how should these stud...

In this week's replay of a most special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and interventional cardiology fellow at Toronto Sick Children's Hospital, speaks with Professor Roberta Williams of USC about her long and illustrious career as a pioneer in both echocardiography as well as pediatric cardiac critical care. Prepare for a lot of wisdom about career and...

This week we review a recent report from China on transcatheter closure of peri-membranous VSD's with the Amplatzer ADO II device. Reported results are outstanding and this week's report is one of several from China demonstrating efficacy and safety to this approach. Despite this, this procedure is rarely performed in the west. Why might that be? Do we need 'local data' to adopt an approach or can...

This week we delve into the world of cardiac critical care when we review a recent report on an attempt to use a multidisciplinary group of hospital professionals plus parents to design an optimal family meeting structure. How should teams prepare for these meetings? What roles should different care providers play in the team meeting? Is there evidence that a better planned meeting can be more eff...

This week we review a recent cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of...

This week we review a recent international review on the topic of life threatening events occurring during electronic gaming. What risks do video games pose for the typical child or child with an arrhythmia condition? What precautions, if any, should be considered? Are there some sorts of games that are potentially more dangerous than others? We speak with the first and senior authors of this inte...

This week we speak with noted cardiovascular surgeon Dr. John J. Lamberti who is presently Associate Professor of Surgery at Stanford University. Dr. Lamberti's career has spanned from the time of Dr. Robert Gross in the 1960's to present day with Dr. Frank Hanley and the team in Stanford. His career perfectly mirrors the transition from the 'old days' of cardiac surgery up until the present moder...

This week we review a recent report on the differences between pulse oximeter Sp02 and arterial Sa02. Are there patient specific factors that may result in inaccuracies of measurement? What single ventricular factors may also result in more significant inaccuracies and how should these data be used at the bedside when assessing a child who is cyanosed? We speak with Dr. Cara Pritchett, critical ca...

This week we review a recent work from the team at Stanford University on post-traumatic stress disorder amongst pediatric patients with ICD's as well as their parents. How common is this diagnosis seen amongst these patients and their parents and what are some of the reasons for this? How should patients receiving devices be properly screened for this and why is identification of PTSD so importan...

This week's episode is a replay of a co-branded 2020 episode with SADS.ORG and is on the topic of pre-participation screening. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm...

This week we review a recent work from NYU-Langone on the topic of cardiac rehab for the ACHD patient. Does enrollment in a formal cardiac rehabilitation program result in meaningful improvements in exercise tolerance in the ACHD patient? Who can benefit from this? How does the impact of this form of therapy compare with more traditional medical interventions? We speak with the senior author of th...

This week we explore the 'basics' when we review a recent report from the team at the Amrita Institute in Cochin, India on the accuracy and precision of the physical examination in identifying heart disease. How did the stethoscope do in comparison to the 'gold standard' of echocardiography? Is it time to 'retire' the stethoscope or does it still have an honored role in the evaluation of children...

This week we review a recent work from Naples, Italy on the use of the GORE Cardioform ASD device to close large atrial septal defects in small children. Are there anatomical 'rules' to help predict who might be a candidate for transcatheter closure? What about this device makes it potentially safer for this indication? Should we be worried about wireframe fractures? We discuss this and other issu...

This week we delve into the world of bovine jugular vein grafts for the treatment of pulmonary valve dysfunction and the possible enhanced risk for infective endocarditis. How commonly are these valves affected by endocarditis and does placement at surgery in comparison to the cath lab confer a lower risk for this dreaded complication? What factor was most highly associated with the risk for endoc...

This week we delve into the world of fetal cardiology to review a recent report on fetal SVT. Are there factors in fetal life that would predict postnatal SVT? How should transesophageal pacing factor into decisions in postnatal life? How does the team at Lurie Children’s choose a 2nd agent for fetal SVT when digoxin is ineffective? Are there differences in the clinical presentation of infants pre...

This week we review a landmark paper reviewing the very large experience of Dr. Hanley and his team at Stanford University in managing VSD/PA with MAPCA's. What advantages are seen with the 'midline unifocalization' approach popularized by this team over the past 20+ years? Is this an approach that can be broadly applied or are the technical operative skills too challenging for most? Why are these...

This week we review a recent work on outcomes of univentricular adult patients who have not been palliated with a Fontan. Do these patients fare better than Fontan patients? What factors are associated with worse or better outcomes? How do these factors inform decision making for the single ventricle adult patient? We speak with adult congenital expert, Dr. Danielle Massarella of University of Tor...

This week we review an important report on possible racial disparities amongst children on waiting lists for heart transplantation in the US. How did the 2016 changes to the Organ Procurement and Transplantation Network criteria for listing impact outcomes in listed children and unexpectedly widen racial disparities? What impact did these changes have on mortality and outcomes for white vs. non-wh...

This week we delve into the world of cardiovascular surgery when we review a recent paper from the team at Texas Children's Hospital about the BTT shunt. How commonly did shunts have serious complications? Does the location on the aorta matter in regards to shunt complications? What size shunt is associated with the least morbidity or mortality? Why might shunt placement via a thoracotomy be super...

This week we review a recent large scale administrative database study assessing racial and socioeconomic disparities in congenital heart disease outcomes in the US. How does patient neighborhood income affect outcomes? How does the presence of Down Syndrome mitigate risk? How does race or socioeconomic status affect length of stay? How can these data inform change to improve outcomes for all chil...