Pediheart: Pediatric Cardiology Today

This week we delve into the world of fetal cardiology to review a recent work on mild aortic stenosis in fetal life. This is a rare finding and the outcomes of this varied. How commonly does this finding result in severe or critical aortic stenosis? Is there a risk for hypoplastic left heart syndrome? Are there findings that would auger and better or worse outcome for this observation? How should...

This week we explore a recent PHIS database study assessing clinical outcomes for transcatheter balloon dilation of the aortic valve in the setting of aortic valve stenosis in early life. Why do critical AS patients fare less well than those with severe AS? Is this an issue of procedural failure or patient characteristics? Is there adequate equipoise for a study comparing surgery to balloon dilati...

This week we replay an episode from 2022 i which we reviewed a then 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?...

This week we note and mourn the passing of pediatric cardiologist and thought leader Dr. Steven Lipshultz who passed on September 4, 2026. Dr. Lipshultz was one of the most significant cardiologists of the past half century and his contributions to the fields of pediatric cardiomyopathy, HIV cardiomyopathy and cardio-oncology were gigantic and meaningful. This week we turn back the clock and revie...

This week we review a recent work assessing the impact of birth day of the week on neurological outcomes amongst newborns undergoing CHD surgery. Why might certain days of the week be associated with higher degrees of white matter injury in the brain of newborns who have had congenital heart surgery? What are the potential mechanisms for this? What might be the unintended consequences of ‘controll...

This week we take a step back in time 4 years ago to recall when we spoke with noted cardiovascular surgeon Dr. John J. Lamberti who is 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'...

This week we review the use of right axillary artery access for aortic valvuloplasty in infants. Why would this approach potentially offer advantages versus the more traditional femoral or even carotid approach? What are the particular dangers of this approach? How should the interventionist pick the approach when planning an aortic valvuloplasty in an infant with valvar aortic stenosis? We speak...

This week we speak with Ms. Sharon Welsh BSN, RN about a novel project she has embarked upon called CLEAR CHD PHYSIOLOGY (on Instagram chdphysiology.icu) which is a physiology-based site intended to teach bedside critical care nurses about CHD physiology. What signs or symptoms are important and what is their meaning? Why is nursing at the bedside of a sick postoperative newborn so much more diffi...

This week we speak with Dr. Ted O'Leary, Co-Director of Adult Congenital Heart Disease Electrophysiology at Boston Children's Hospital about a recent publication he authored on the use of pulsed field ablation (PFA) for the transcatheter ablation management of complex atrial arrhythmias in ACHD patients. How does PFA work and what are some of the potential advantages and disadvantages of this nove...

This week’s replay episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve represent...

This week we review a recent book entitled Reimagining a Child’s Heart: The Lone Pines of Congenital Cardiology which was recently published by Springer and which was authored by Dr. Thomas J. Kulik and Dr. Macdonald Dick. Drs. Kulik and Dick recount the innumerable steps in discovery that led to what the authors view as one of the pinnacles of achievement in our field, namely the palliation of ch...

This week we discuss a recent report from the team at SickKids in Toronto on minimally invasive cardiac surgery. What sorts of operations are most common for this approach? Why are length of ICU and length of hospitalization periods lower in this surgical cohort than more traditional midline sternotomy approaches? How does one train a surgeon to perform these operations if the surgical exposure is...

This week we review a recent report using data from the IMPACT registry assessing the rates of major adverse events during cath of the pediatric cardiomyopathy patient. How commonly are complications encountered and who is at greatest risk? How much additional risk is incurred by performance of an endomyocardial biopsy at the time of catheterization? Pediatric critical care expert, Dr. Alejandro M...

This week we delve again into the world of adult congenital heart disease and specifically the realm of biomarkers when we review a recent report of the proteomics of the adult Fontan patient. What is proteomics and how can this inform our understanding of the pathophysiology and adaptive pathways of the Fontan circulation? Are there meaningful differences in the patterns of protein expression bet...

This week we speak with a true pioneer in pediatric cardiology, Professor Rica Arnon of Mount Sinai in NYC. Dr. Arnon's career has spanned from the mid 1970's right up to the present time where she is still working as a cardiology consultant and educator at Mount Sinai in Pediatrics after more than 50 years. In this episode we learn the travails of a pioneering women in medicine/cardiology as Dr....

This week we review a recent meta-analysis of studies assessing efficacy of adenosine in children to terminate SVT. Does the PALS recommendation of 100 mcg/kg as a starting dose for SVT management make scientific sense given what we know about the efficacy rates of this dose? Why might inadequate doses be potentially dangerous for children with acute SVT? Is there adequate data to consider changes...

This week we review a recent report of a novel form of CPVT (catecholaminergic polymorphic ventricular tachycardia) with associated neurodevelopmental delays. What is the genetic basis for these patients? What is different about the arrhyhthmias seen and how they are triggered in this variant? Should all patients with CPVT be screened for neurodevelopmental delays? Should those with neurodevelopme...

This week we go back 2.5 years and delve into the world of cardiovascular surgery when we review a review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should...

This week we speak with 2 pioneers in the field of pediatric cardiac critical care, Dr. Anthony Rossi and Dr. Gil Wernovsky. Both were present at the very start of the field of cardiac critical care for children. What was it like in an era before transesophageal echocardiography or even postoperative echo? Why was the advent of the bidirectional cavo-pulmonary anastomosis such a game changer in th...

This week we review a recent report from the team at Amrita Institute in Cocchin, India about their use of extended reality and virtual reality as well as heart model printing to aid in planning for complex intracardiac baffles for the treatment of complex congenital heart defects. What was the process used to provide actionable advice in the operating room during surgery? How has the team in sout...

This week we review a landmark paper from the NEJM by the SCOUT-HCM study group assessing the impact of mavacamten on HCM in the adolescent patient. How does this agent work and what impact did it have on the LVOT gradients in obstructed HCM teens? Does this agent affect other biomarkers associated with more obstruction in this setting? Who is a good potential candidate for the use of this agent?...

This week we feature a collaboration episode between the Pediheart Podcas t and the PedsCrit Podcast in which pediatric critical care experts Drs. Alice Shanklin of Northwell Medical Center and Dr. Zac Hodges of UT Southwestern discuss the evaluation and management of heart block in children. What should the clinician be thinking when encountering a previously healthy child with heart block? When...

This week we review a recent work from the CT group at NY Presbyterian assessing the impact of phenylephrine during pediatric congenital CT scans to lower heart rate. Why is a lower heart rate better for CCT's? Should this agent be routinely employed for this indication during CT scans in children? Dr. Yosef Cohen, pediatrics resident at the Children's Hospital at Montefiore shares his insights fr...

In this replay episode from 2 years ago, we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patien...

This week we review a recent Australian prospective assessment of aspirin resistance in children undergoing heart surgery. How common is this seen in this patient group and what are the reasons? What is the best test to perform to assess this and what tests may not be worthwile? Who deserves 'routine' testing for this possible problem? Cardiovascular surgeon Dr. Supreet Marathe of Queensland Child...