Pediheart: Pediatric Cardiology Today

Melody valves have been demonstrated to be associated with a small but consistent rate of endocarditis. Are there factors that might help predict who would need surgical explantation versus those who can be medically managed without surgery? Dr. Arpine Davtyan, senior cardiology fellow at Rady Children's Hospital shares insights from her recent multicenter, retrospective study on this topic. doi:...

Dr. George Ofori-Amanfo, Division Chief of Pediatric Critical Care Medicine in the Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai and at the Mount Sinai Kravis Children's Hospital, died last week after a very long illness. To honor him, we go back to episode #2 in 2018 in which Professor Ofori-Amanfo shares his insights into the delivery of cardiovascul...

This week's episode, the final of 2021, is on personal finance and we speak with noted personal finance expert Paul Merriman about strategies to improve investing results within a retirement account. Mr. Merriman reviews index funds, the value of these over 'actively managed' funds, and his thoughts on 'target date funds'. Finally, he shares a strategy that may improve the outcome of a target date...

This week we revisit episode 135 where we discussed the topic of mortality attributable to CHD in the US and persistent racial/ethnic disparities over the past 20 years. We speak with Professor Keila Lopez of Texas Children's Hospital about a recent large scale, 'big data' study she co-authored about this topic and review the reasons for these disparities and think about possible remedies. An esse...

This week we delve into the world of congenital heart disease when we review a recent work from the team at Boston Children's Hospital on the long term outcomes of truncal valves in the setting of truncus arteriosus. Who amongst truncus patients is at risk for the development of truncal regurgitation or a need for reintervention? Are there predictors that might help forecast patients who should be...

This week we delve into the coronavirus pandemic and specifically the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection. When there was significant initial cardiac involvement seen in the setting of MIS-C, what findings are common in the CMR of patients 6+ months later? How common is delayed enhancement seen and how does this compare with findings seen in other myo...

This week we turn to a recent work from the group at Texas Children's Hospital about IV sotalol and the treatment of junctional ectopic tachycardia (JET). How did sotalol fair in comparison to IV amiodarone for the treatment of this potentially lethal postoperative arrhythmia? What differences were observed? How should IV sotalol be dosed and who is or is not a candidate? We speak with the first a...

In this week's special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and third year cardiology fellow at Cincinnati 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 life from this giant i...

This week we move into the realm of public health for congenital heart care when we review a recent report on a novel approach to tackling the daunting task of enhancing access to care for congenital heart disease to all who need it in a limited resource region. We speak with Ms. Bistra Zheleva of Children's HeartLink and Professor Krishna Kumar of Amrita Institute in Cocchin, India about a recent...

This week we delve into the world of EP when we review a recent work from the team at Rady Children's Hospital on length of treatment for infant SVT. Is there an optimal length of therapy for the infant with SVT? Are there predictors of recurrence that might suggest benefit to a longer course of medical therapy? We speak with Director of Pacing at Rady Children's Hospital, Dr. Matthew R. Williams...

This week we review a recent important work from Germany about the coronary perfusion in patients with HLHS and possible relations between this flow and clinical outcomes. What factors are associated with abnormalities in microvascular coronary flow in the HLHS patient? What anatomical substrate is more concerning for these sorts of problems? Are there factors that might be modifiable that could p...

This week we replay an episode reviewing a large administrative database study from Sweden on risk for cancer amongst patients with CHD. Why are cancer rates different in the CHD patient? What are the most important factors? What actions should be taken by cardiologists caring for ACHD patients in order to properly screen for cancer? We discuss these issues with Assistant Professor of Pediatrics,...

This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pedia...

This week we delve into the world of cardiovascular surgery to review a recent work on outcomes of arch reconstruction in the newborn and small child. We speak with Dr. Ramana Dhannapuneni, lead cardiac surgeon of Alder Hey Children's Hospital in Liverpool, UK. How often in the present era is re-operation or reintervention required? How common is the recurrent laryngeal nerve or phrenic nerve inju...

This week we enter the world of cardiac critical care to discuss delirium in the postoperative pediatric cardiac patient. We speak with nursing scientist, Professor Sandra Staveski of UCSF about a recent large multicenter study she conducted on this topic. How prevalent is this problem and why is it an important morbidity to tackle and reduce? How can nursing interventions reduce this problem and...

This week we review a recent report from the team at Children's Hospital of Los Angeles about prenatal and neonatal factors that might help predict the need for newborn permanent pacing in the setting of antibody-associated CCHB. We speak with Assistant Professor of Pediatrics at Mount Sinai, Dr. Justin Pick about this work. How important is third trimester fetal heart rate in predicting possible...

This week we review a recent work on the use of bivalirudin on outcomes of pediatric VAD patients. We speak with Dr. Caroline Carly Heyrend of Primary Children's Hospital in Utah about a recent work she co-authored on time in therapeutic range for this agent in children with VAD's. How does bivalirudin work differently than heparin and what are the theoretical benefits or disadvantages of this age...

This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What a...

This week we delve into the world of ACHD when we review a recent large data evaluation from the team at Erasmus University in the Netherlands regarding outcomes of DTGA/Arterial Switch patients who have gone through pregnancy. How do these patients fare in general? What sort of pre-pregnancy evaluation should these patients have? Where should their offspring be delivered? Is a maternal fetal medi...

This week we review a recent work from the team at University of Alabama in Birmingham about clinical outcome disparities amongst Black children with Kawasaki disease. What differences exist in outcomes between these groups and are these differences social or biological in origin? We speak with one of the authors of this work, Assistant Professor of Pediatrics Leslie Collins about this important w...

From August 2020 - This week we delve into the topic of fellow wellness and review a recent work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Ped...

This week we spend the entire episode speaking with Professor Peter Lang of Harvard University about his rich and long career in pediatric cardiology during one of the most exciting times of the field. Dr. Lang's story includes a virtual who's who of important cardiologists and cardiac surgeons for the past 50 years including Dr. Connie Hayes, Dr. Roberta Williams, Dr. Alexander Nadas, Dr. Richard...

This week we review a recent work assessing changes in Fontan conduit cross sectional area over time. What accounts for these changes and how do these affect exercise capacity? What does the future hold for the Fontan procedure? Is there an optimal conduit size for patients? We speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel this week! doi: 10.1016/j.jtcvs.2020.09.140

This week we enter the world of pulmonary hypertension (PH) and review a large multicenter registry study assessing outcomes of the Potts shunt for the management of severe PH. Who is a good or bad candidate for this therapy? Is there an advantage to placement of a valve in the shunt? Does this form of palliation affect lung transplant eligibility? We speak with the first author of this week's pap...

This week we enter the world of CT surgery to review a recent STS database study on outcomes of diaphragm paralysis following congenital heart surgery. How common is a diaphragm paralyzed following surgery and what are the main risk factors for this complication? How commonly are these plicated and how do those who are plicated fare in comparison to those managed more conservatively? Professor Nar...