Pediheart: Pediatric Cardiology Today

This week we explore a recent CMR study in Fontan patients assessing the impact of pulmonary blood flow maldistribution and exercise capacity. How closely associated are these differences in relative pulmonary blood flow to functional status and overall outcomes? How aggressively should we intervene for these sorts of problems? We discuss these issues and more with Dr. Rahul Rathod who is the seni...

This week we review a fascinating paper that assesses the direct myocardial effects of IV antiarrhythmic agents upon cardiac muscle function performed by the group at Boston Children's Hospital - Harvard University. We speak with one of the principle authors of this work, Dr. Elizabeth DeWitt, who is an attending electrophysiologist at that large institution about this important work. Which agents...

This week we review a critically important neurodevelopmental issue affecting infants who have single ventricle palliation - namely hearing loss. How common is hearing loss seen and what role does IV furosemide play in this finding amongst single ventricle patients? Are there techniques to avoid this complication and yet still use this commonly used diuretic agent? We discuss this important issue...

This week it's National Pediatric Transplant Week and we review a recent work on ECMO following cardiac transplant and speak with its first author, Assistant Professor of Pediatrics in Vanderbilt University, Dr. Justin Godown. How does the use of ECMO in the postoperative period influence outcomes in the short and long term? Are there differences in outcomes when it is used for patients with cardi...

This week we review a recent report from Duke University regarding the incidence of femoral arterial thrombosis after femoral arterial cardiac catheterization in small infants. How did the use of routine ultrasonography improve identification of this post-cath complication? What are the outcomes of therapy with heparin or enoxaparin for this problem? Are there factors that are associated with femo...

This week we explore the utility of exercise stress echocardiography in pediatric patients. How often were clinical decisions made based upon findings at stress echo? What sort of extra training is needed to perform these studies? How safe was this form of testing? How are stress echo results incorporated into the decision making process for pediatric patients at Emory University? Dr. Soham Dasgup...

This week we review 2 surgical reports. The first is on the Ozaki Procedure for aortic valve repair and we speak with valvular expert David Kalfa, MD PhD of Columbia University. Who is a good candidate for this approach and what evidence exists of its efficacy in children? Dr. Kalfa shares his insights. We also review a recent report from Taormina, Italy on outcomes of repair of anomalous origin o...

This week we review a recent randomized and controlled trial from the NEJM on the use of the novel Medtronic TYRX envelope for the prevention of pacemaker or ICD infections in adult high risk patients. Did the use of this antibiotic envelope result in reduced incidences of infection? Were there complications associated with its use? Should this be used in only in high risk patients? Is this a cost...

This week we review a recent report from the team at the Kravis Children's Hospital at Mount Sinai - Icahn School of Medicine at Mount Sinai on the use of pentobarbital for oral sedation for transthoracic echocardiography. Associate Professor of Pediatrics Rajesh Shenoy shares with us insights into sedation for this indication, the general approach of the echo lab at Sinai and how decisions are ma...

This week we review a recent report on transcatheter pulmonary valve replacement with the Sapien S3 prosthesis. What are the circumstances in which this valve might be preferable versus other valve types? What are the disadvantages of this device? How can patients be effectively screened as candidates for different valves? How can decisions be made between self expanding systems like Harmony or Ve...

This week we review an impressive review of the large Australian/New Zealand registry of Fontan patients assessing the impact of AV valve regurgitation and failure on Fontan outcomes. We discuss this work with the senior author Yves D'udekem, Associate Professor of Surgery at The Murdoch Children's Research Institute and also speak with Professor Frank Cetta of the Mayo Clinic who authored a wonde...

This week we review a recent publication on modern day outcomes for children with dilated cardiomyopathy. It seems as if they are doing better than patients did 10 years earlier - why is this so? What factors may account for the improvements in outcomes? We discuss these questions and more with the first author of this multi center work, Dr. Rakesh Singh, Associate Professor of Pediatrics at UC Sa...

This week we discuss the rationale for intervening for unilateral proximal PA stenosis with a stent or angioplasty. In the setting of normal RV function or pressure, are there exercise data to support intervening and if so, at what degree of maldistribution should such an intervention be considered? How should this decision be made? Is this safe? We review these and other questions with the first...

This week we review a recent paper on the topic of extended ambulatory ECG monitoring in the ACHD patient. Does this form of monitoring provide benefit versus a more traditional 24 or 48 hour "Holter" monitor? How commonly were arrhythmias in ACHD patients found after 48 hours and how commonly were changes made to management based upon these findings? We discuss these issues and more with the seni...

This week we review the topic of pulmonary hypertension and specifically the use of sildenafil for treatment of this difficult problem. Is this agent safe in children? How commonly does it need to be discontinued for side effects? Is it effective? Do patients ever improve to a degree that it can be discontinued? We review all of these questions and more with Dr. Jennifer Cohen who wrote this work...

This week we speak with Associate Professor of Medical Psychology at UNSW, Nadine Kasparian about a recent publication regarding evidence for efficacy for various forms of psychological therapy in the setting of childhood-onset heart disease. What do we know about the efficacy of interventions for this fragile population of congenital heart disease patients? How prevalent are psychological problem...

This week we go back to the world of artificial intelligence and review a recent work from Stanford University on the use of deep neural networks to interpret ECG rhythms. How good did a novel algorithm do in comparison to cardiologists in characterization of rhythm abnormalities? What are some novel uses of AI in medicine today and how can AI potentially identify signs of disease that even human...

This week we delve into the world of fetal cardiology to review a recent work comparing fetal MRI to fetal echo. How did this relatively new technology application fair in comparison to more traditional echocardiography? What role might this technology have in the assessment of congenital heart disease in the fetus? We explore these questions and others with fetal cardiology expert, Professor Lisa...

This week we review a recent work on contrast induced acute kidney injury in the ACHD patient undergoing catheterization. Are there data to suggest what a safe volume of dye might be in this population of patients? Does the renal response to contrast suggest something about the general health of the patient? How does the team in Boston plan catheterizations in the adult congenital population to mi...

This week we review the Fontan and long term issues of surveillance and Fontan failure with 2 articles. The first is a large survey study reviewing practice patterns amongst large Fontan clinics in the US. We review this interesting topic of optimal assessment of the Fontan with Dr. Mike DiMaria who is first author of this recent work and also Associate Professor University of Colorado. We then re...

This week we turn to the world of cardiovascular nursing and review the notion of individualized family centered care for infants in the CICU. What is meant by the term "Individualized Family-Centered Developmental Care" and what are its components? What is the evidence that use of this approach can result in improved neuro-developmental outcomes? We review these important concepts with the first...

This week we review the notion of sports participation in athletes who have ICD's. Is this a safe approach? How do the athletes fare? How do the devices stand up to sport? What are the subtleties of discussing this important topic with a family and how does shared decision making work in this process? We review this serious and complex topic with Dr. Rachel Lampert, Professor of Medicine at Yale U...

This week we enter into the world of cardiac morphology and speak with Professor Leo Lopez of Stanford University about a recent work he wrote with the International Society for Nomenclature of Pediatric and Congenital Heart Disease regarding proper nomenclature for VSD's. Is it defect geography or borders that are most important in naming these structures? How was agreement forged between such di...

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 return to the world of adult congenital heart disease to review 2 related works on the topic of late cardiovascular risks in patients who have undergone prior coarctation repair. Are such patients at elevated risk for early coronary artery disease and stroke? What are the causes for these late complications? What role does hypertension play in the development of these late sequelae? A...