Pediheart: Pediatric Cardiology Today

This week we review a recent work from the team at Mercy Children's on the variability of sheath outer diameter (OD) amongst various sheaths. Can novel 4Fr adult radial sheaths have similar OD to more standard 3.3Fr pediatric sheaths? What are the trade-offs in using a radial sheath for this indication in a newborn? Senior author Dr. Abhay Divekar of Rocky Mountain Pediatric Cardiology shares his...

On this episode we speak with Professor Edward Walsh of Harvard University about a recent work he co-authored on Ebstein's anomaly. Can review of pathological specimens offer some insights into why ablations in this patient group are so challenging? Is there an optimal age or size to perform an ablation in this patient group? Why are these ablations so difficult? Dr. Walsh, Director of the Arrhyth...

This week we delve into the world of cardiomyopathy and also stress echo to review a recent work from the team at Boston Children's on stress echo and its role in the assessment of the pediatric HCM patient. We speak with Assistant Professor of Pediatrics Ming Hui Chen of Harvard University about a recent work she co-authored on this modality in children with HCM. Are changes in the LVOT gradient...

This week's episode, co-branded with SADS.ORG, reviews a recent guideline paper by the Mayo Clinic on how to improve the safety of potential COVID-19 therapies such as azithromycin or hydroxychloroquine. These agents can both prolong the QT interval and enhance the risk for torsades making the development of a simple protocol to prevent possible life threatening cardiac side effects critical, part...

This week we speak with Professor Candice Silversides of U. Toronto about a recent work she co-authored on the topic of serious cardiac events for women with heart disease. How common are serious cardiac events encountered and what percentage of these are preventable? What is the optimal team for the pregnant patient with heart disease? What are the components of a pre-pregnancy cardiac evaluation...

This week we delve into the world of preventative cardiology and speak with Associate Professor of Pediatrics at The Albert Einstein College of Medicine, Dr. Joseph Mahgerefteh about a recent work he authored on the impact of obesity and obstructive sleep apnea on hypertension. Which of these factors, which often occur together, is more important in the youth with elevated BP? Dr. Mahgerfeteh shar...

This week we speak with Dr. Anne Marie Valente, Associate Professor of Medicine and Pediatrics, Harvard University about a recent work she co-authored on the topic of outcomes following PVR and the relation of the RV volume to these. What is the evidence for using RVEDVi as a rationale to replace the pulmonary valve? Does PVR affect long term survival in the TOF patient? What factors are associate...

This week we review a recent paper from the team at the University of Wisconsin regarding weaning from bypass after the Norwood procedure. If there are difficulties in 'coming off', what are the most common problems encountered and what does this difficulty mean for survival and the general hospital course? We speak with the senior author of this work, congenital heart surgeon Dr. Ronald Woods abo...

This week we delve into the world of heart failure and transplantation and review a recent report from the ACTION Network about the use of the Heartmate 3 VAD for young patients. Does this device offer advantages over prior durable VAD's? What are the patient size limitations for such a device? Why might this device have fewer complications than prior devices? Dr. Matthew O'Connor, Assistant Profe...

This week we review a recent work from the team at Boston Children's Hospital regarding outcomes for patients with complex congenital heart disease who underwent scoliosis repair. We speak with the first author of this work, 2nd year cardiology fellow at Boston Children's, Dr. Robert Przybylski about the work. How should these patients be optimally assessed prior to and then managed during these c...

This week we replay episode # 40 - a discussion with the inspirational figure, Professor Raman Krishna Kumar of the Amrita Institute in Cochin, India. This master of cardiology reviews how, in a limited resource environment, Professor Kumar was able to develop one of the finest pediatric heart centers in all the world. We will be back with a new episode on 3.6.20!

This week we move into the world of the CICU to review a recent work on the use of noninvasive means of ventilation following congenital heart surgery. How often does this form of ventilation prevent a child with respiratory failure avoid reintubation? What is the evidence for the benefit of this? Are we extubating patients too soon? We speak with Ms. Denise Rolim who is a highly experienced pedia...

This week we review a recent work on the prevalence of adverse events when starting sotalol in the pediatric patient with arrhythmias. How commonly were problems encountered? Does initiation always require hospitalization and monitoring in an inpatient setting or are there some patients who might be candidates for an outpatient approach? Is there a level of dysfunction that would preclude its use?...

The innocent heart murmur is the topic of this week's podcast. How important is the echocardiogram in allaying parental fears and anxieties when being evaluated for a murmur? Have the days of auscultation without a secondary test fallen by the wayside? We speak with a highly experienced general pediatric cardiologist, Dr. Jared LaCorte of Staten Island Pediatric Cardiology to offer his thoughts on...

This week we delve into global pediatric cardiology and review a massive and important work from the Global Burden of Disease study group assessing the trends in congenital heart disease in the world from lower income nations to higher. How has the prevalence of congenital heart disease changed over the past 30 years? How are countries faring in their treatment of congenital heart disease? What ar...

This week we speak with Professor of Surgery, Mark Rodefeld of Indiana University about the most recent report of his group on a sub pulmonary pump for Fontan patients. What is different about this pump versus other presently available pumps for other cardiovascular indications? What is known about the thrombogenicity of these devices? How close is the team in Indiana to animal studies? Why is a l...

We review a recent paper on the use of the AED for children who suffer out of hospital arrest. What factors are associated with their use and what barriers exist to their use for children? What should be the next steps to improve AED usage for children? We discuss these and other questions with Professor Peter Aziz of the Cleveland Clinic in our first co-branded episodes with the SADs Foundation i...

This week we review a recent large single center study comparing pulmonary homografts to bioprosthetic valves in the TOF patient requiring valve replacement. Is there a superior choice? Who is a better candidate for one versus the other? Which is technically easier to use and why? Who would benefit from an aortic vs. pulmonary homograft in this pulmonary position? We speak with Professor Massimo C...

Alin Gragossian, DO has an unusual perspective in medicine - she is an emergency room physician but also a cardiac transplant recipient. In this milestone 100th episode Dr. Gragossian shares her experiences of learning that she had dilated cardiomyopathy just one year ago, getting admitted to the ICU, and undergoing a heart transplant - all in < 6 months. She is 'back on the job' and she shares th...

This week we review a recent report on the benefit of 3D imaging and printing in preparing for ductal stenting. This intervention is complex and is fraught with risk. The team at Duke review their experience with the use of 3D modeling prior to intervention and what impact this has on outcomes. We speak with the first author, Dr. Reid Chamberlain, research fellow at Duke University Pediatric Cardi...

This week we review the results of one of the rare placebo controlled double blind trials of an agent in pediatric cardiovascular medicine - specifically, the Fontan Undenafil trial assessing the impact of this agent on parameters of exercise in the single ventricle patient. What measures of exercise were most affected by this agent and why? What side effects were encountered? Who should receive t...

Cardiogenetics is the topic this week as we review a relatively recent report on the topic of LV non-compaction. How often do patients with this finding have positive genetic findings? Who deserves genetic testing with this finding? Should all such patients be seen by a geneticist? How frequently should phenotype positive, genotype negative patients 'check in' with a geneticist? These are amongst...

This week we review a recent report of the PC4 group assessing the impact of inter hospital open communication and collaboration on surgical outcomes. In what manner did participation in this collaborative CICU registry improve outcomes for different hospital surgical outcomes? Why was the improvement not homogeneous between centers? How long did it take for the impact of collaboration to positive...

This week the topic is cardiovascular surgery and we speak with Dr. Ignacio Berra of Buenos Aires Argentina about a recent work he co-authored with the surgical bioengineering team at Boston Children's Hospital regarding a newly developed tool to assess the aortic valve. Can this device safely allow for visualization of the valve under the usual aortic diastolic pressures to aid in anatomical asse...

This week we review a work that aimed to improve the thoughtfulness of echocardiography usage in the postoperative period after congenital heart surgery. Dr. Kelly Cox and colleagues report on the use of a 'checklist' type 'pause' aimed at making certain that the ordering team in the CVICU are making an informed decision regarding the need for a new echocardiogram. How often should postoperative s...