Pediheart: Pediatric Cardiology Today

This week we delve again into the controversy regarding optimal newborn management of the symptomatic newborn with tetralogy of Fallot. Does palliation offer a cost savings versus primary repair for the symptomatic TOF patient? What impact does the advent of transcatheter palliative approaches have upon cost? We speak with the first author of this week's work, Assistant Professor of Pediatrics at...

This week we turn back to 2020 and delve once more into the world of mental health and review a new large study from the group at Texas Children's on prevalence of anxiety, depression and ADHD amongst the pediatric CHD patient group. How common are these disorders in the young CHD patient and how does this compare to the general pediatric population? What role does minority or insurance status hav...

This week we review a recent large claims database study on WPW in children that aims to identify the true incidence of life threatening events in children with this condition. What is known about the incidence of life threatening events as well as the actual prevalence of WPW amongst children? What are the strengths and limitations of large claims database studies? How high is the risk for VF in...

This week we speak with Associate Professor of Pediatrics at University of Washington Sujatha Buddhe of Seattle Children's Hospital about a recent survey study she conducted regarding CMR in the pediatric and congenital heart patient. How have volumes of cases changed over the past few years? Who is reading these studies? What is the advantage of a 1.5T vs. 3.0T scanner for congenital scans? What...

This week we delve into the world of heart transplantation to review a recent article on the topic of outcomes of the Down syndrome patient undergoing heart transplantation. Are infections or cancers more common in this patient group following transplantation? What role does intellectual disability play in the present era in decisions regarding transplantation in this patient group? Associate Prof...

This week we play a session of the podcast from SCAI 2022 in Atlanta with Professor of Pediatrics, Columbia University - Dr. Christopher Petit reviewing a recent publication on the topic of systemic sirolimus in concert with catheter interventions for the treatment of pulmonary vein stenosis. Who is a candidate for this sort of therapy? Does systemic sirolimus confer a survival benefit over local...

This week in a live session from SCAI 2022 we hear Assistant Professor of Pediatrics, Dr. Eimear McGovern shares her insights into a recent work she co-authored on changes in Fontan dimensions over time. Who needed interventions and how does the team in Kentucky choose to perform surveillance catheterizations on their Fontan patients? Is there an optimal time? What degree of stenosis or narrowing...

In this replay of episode 92 from 2019, we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if a...

This week we review a recent report from Lurie Children's in Chicago on the impact of fetal diagnosis of vascular rings. Does prenatal knowledge of this problem enhance postnatal outcomes? Who deserves cross sectional imaging after birth if prenatally diagnosed with a ring or sling and when and how should this be performed? We speak with Assistant Professor of Surgery at the Mayo Clinic, Dr. Eliza...

This week we review a recent report from the team at Boston Children's Hospital about a novel approach to avoid heart block during complex congenital heart surgery? Assistant Professor of Pediatrics at Harvard Medical School Elizabeth DeWitt shares with us her insights into a recent report she co-authored by the departments of surgery and cardiology at her institution about intraoperative mapping...

This week we move into the world of cardiac surgery when we review a recent work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai...

This week we delve into two areas of interest - fellowship training and fetal cardiology when we review a multi-center work endorsed by the Fetal Heart Society on the topic of fetal heart disease counseling. How is this skill taught to cardiology fellows and what are the deficiencies that present exist? Is empathy something that can be taught? What efforts are afoot regarding formalized curricula...

In this week's replay episode we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in...

This week we speak with living legend of cardiology, Dr. Michael Freed about his life and also his landmark paper in 1981 on PGE1. How did Dr. Freed come to conduct one of the first multi center trials of an agent in pediatrics? What was life like in the world of pediatric cardiology prior to PGE1? What is Dr. Freed up to today? What advice does he have for the younger generation? This is a rare o...

This week we review a recent work from the team at NY Presbyterian on SVT and a possible role it may rarely play in sudden cardiac arrest in children. When a patient does not have an obvious cause of arrest, is SVT a possible etiology and should invasive EP testing be considered? We speak with the senior author of this work, Dr. Leonardo Liberman about his thoughts on SVT as a possible cause of ar...

This week we review the concept of stenting the pulmonary veins and we speak with Assistant Professor of Pediatrics at Baylor Medical College, Dr. Melissa Webb about a recent work she co-authored on this topic. Dr. Webb reviews a novel approach to shortening Palmaz stents and then reviews for us the rationale for stenting PV's and also discusses how these patients are longitudinally followed at Te...

In this milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work,...

This week's replay episode is co-branded with SADS.ORG and is on the topic of pre-participation screening from 2 years back. 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.2...

This week we delve into cardiac surgery and review a recent paper from Rady Children's Hospital about patch material and outcomes in the CHD surgical patient. What are the reasons that glutaraldehyde is used to treat patches used for surgery and what are the potential benefits and disadvantages? What sorts of patches are best for what indications? Are there data to suggest superiority of one patch...

This week we review a recent work from Utrecht University in The Netherlands on the topic of postoperative pericardial effusion following congenital heart surgery. Some use steroids, some NSAIDs and some colchicine. Are there any data supporting one agent versus the other? We speak with the first author of this work, Poznan University of Medical Sciences student, Nirmiti Somani about this practica...

This week we delve into the world of the single ventricle patient when we speak with Dr. Adam Lubert of Cincinnati Children's Hospital Center about a recent work he co-authored on MRI imaging of the liver in the Fontan patient. Can simple liver metrics help predict hemodynamics or even outcomes in the single ventricle patient with a Fontan? What is the optimal way to image the liver in this patien...

This week we travel back in time to 1991 to review one of the first collaborative projects between Dr. Lisa Hornberger of U. Alberta and the legendary pediatric cardiology investigator, Dr. David Sahn. In this work on tricuspid valve disorders with TR and their diagnosis in fetal life, we learn about our first understandings of this complex physiology and problem and use this as starting point to...

In a replay of episode #90 from 2019, we re-review a recent report from the CTOTC-04 study group assessing the impact of novel anti-rejection approaches which generally markedly reduce or remove steroids in the prevention of rejection. How are rejection rates affected by such an approach? Did incidences of diabetes or PTLD differ when using this form of steroid reduced approach in the 'low immunol...

This week we delve into general pediatric cardiology and discuss those mild abnormalities that are sometimes seen on echo in the newborn nursery. Which of these minor findings in healthy newborns should be monitored and who can be 'discharged' from cardiology follow-up? Are there data to help inform these decisions? Dr. John Hokanson, Professor of Pediatrics, U. Wisconsin, shares his insights this...

This week we review a recent CMR study assessing changes in myocardial fibrosis identified with CMR T1 mapping seen in TOF patients with a single nucleotide polymorphism (SNP) of hypoxia inducible factor 1 alpha. Is myocardial fibrosis in the TOF patient due to hemodynamic factors alone or are there genetic factors that predispose to differences that can be measured on CMR? Professor Lars Grosse-W...