Pediheart: Pediatric Cardiology Today

This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated w...

This week we review a recent report assessing LV function and properties in the Ebstein's anomaly patient using CMR. How often is LV dysfunction observed in the Ebstein's patient who is about to undergo surgical Cone repair? How often did the echo underestimate LV dysfunction in comparison to the 'gold standard' CMR? How often is LV non-compaction observed when using strict criteria in this diseas...

This week we delve into the world of electrophysiology and review a recent report from the team at Primary Children’s hospital on the use of intravascular ultrasound for EP ablation procedures in children. How is this technology useful for ‘routine’ ablations in kids? Are there some forms of tachycardia where its use is more important than others? How does it lower procedural time or improve effic...

This past week marked the passing of the great pediatric cardiology pioneer, Dr. Sylvia Griffiths. Dr. Griffiths was a trainee of Dr. Ruth Wittemore of Yale University and was one of the founders of the pediatric cardiology program at NY Presbyterian Hospital in the mid 1950's with Dr. Sidney Blumenthal. Her career spanned 7 decades, all at NY Presbyterian, Columbia University. She is remembered a...

This week we review a recent paper from last 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method...

This week we go back in time to 20222 to re-review an episode focusing on gender disparities in salary in the field of congenital electrophysiology. To what degree are female electrophysiologists paid less than their male counterparts despite similar levels of education, work effort and seniority? What interventions could be enacted to help 'mind the gap' and level the playing field in this regard...

This week's topic is ductal stenting in a low resource environment. We review a recent report from the team at Amrita Institute in Kerala, India about their large, over 10 year experience in ductal stenting. Why has this approach superceded BTTS in this environment? How does the team determine if a patient is a candidate and what morphologies of duct would be inappropriate for intervention? How do...

This week we review a novel multivariable model used to predict mortality in the repaired tetralogy of Fallot patient. Can this model identify who amongst the repaired TOF patients is at risk for death in the coming years? What are the most important inputs to this model? Why does the use of a validation cohort provide greater strength to this model and is there still room for improvement in the m...

This week we listen in to a wonderful roundtable discussion with 3 of the pioneers in the world of pediatric electrophysiology, namely Dr. John Triedman, Dr. J. Philip Saul and Dr. Edward P. Walsh. All three were 'there at the beginning' and share their memories of how they helped to shape the field of pediatric EP. How did Drs. Walsh and Saul choose to proceed with EP training in a pre-ablation a...

This week we review a recent editorial commentary from multiple congenital heart surgical leaders in the US today. The topic of their expert opinion piece is the concept of public reporting of results and their ' amplification ' through organizations such as US News and World Report, to name one. How has the use of the database from STS been sometimes misinterpreted through public reporting or ran...

In this week's podcast, we discuss a work that tries to challenge convention when we review a recent work from the team at Emory University about anticoagulation following left sided ablation of SVT in children. A short course of aspirin is commonly prescribed in this setting but what is the evidence for this? How do patients who receive aspirin fare vs. those who do not? Are there some patients i...

This week we review a recent large scale, multicenter study of the Pediatric Cardiac Intensive Care Society Investigators on outcomes of pulmonary atresia with intact ventricular septum (PA/IVS) in the present era. How are patients faring in the present era in comparison to the prior 1-2 decades? What are the most important factors to account for improvements observed in survival? Are there subtyp...

In this replay of our 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 auth...

This week we delve into the world of interventional cardiology and congenital heart surgery when we review a recent report from the team at Toronto Sick Children's Hospital about their experience with interventions in the pulmonary arteries following the arterial switch operation. How often are branch or main pulmonary artery narrowings serious enough to warrant intervention? What degree of RV pre...

This week we review a report from Italy regarding the observation of RA disk thrombus formation in some patients following GORE Cardioform ASD closure. How common is this complication seen and are there some patient or device characteristics that would be considered higher risk for this complication? How does this information square with the Assured trial data? Why might there be differences betwe...

This week we delve into the world of antibiotic prophylaxis for dental procedures. What are the data to support its use in the congenital heart patient? Why has this been such a difficult topic to study? What do we now know about this topic and what still remains unanswered? Given the low prevalence but dire consequences of this disease, how can investigators consider studying this topic in the fu...

This week we review a recent work on the use of sodium-glucose cotransporter 2 inhibitors in the ACHD heart failure patient from Europe. Can these agents impact heart failure outcomes in this patient group? What is the mechanism by which they may improve outcomes? Are there data on their effects on the single ventricle patient? What sorts of side effects can be seen and are these more or less comm...

This week we delve into the world of fetal cardiology when we review a recent large, multicenter study on the impact of prental diagnosis of 22.q11 deletion syndrome. How did the prenatally diagnosed patients differ from those diagnosed postnatally in regards to degree of heart disease and postnatal morbidity and mortality? What is the role of cell-free DNA testing in the screening for patients wi...

This week we delve into the world of cognitive bias when we review a recent review of this topic by the team at the University of Arkansas. What are some of the more important common cognitive biases that plague humans and are particularly deleterious for good decision making in 'case management/surgical' conference? What are some approaches to reducing the impact of these biases? How does the adv...

This week we review a recent survey study on the topic of junctional rhythm and sinus node dysfunction in the Fontan. How important is this finding in our Fontan patients? When should a patient with a Fontan undergo pacemaker insertion? Is the loss of AV synchrony the more important hemodynamic effect of junctional rhythm or is it chronotropic incompetence? Who should be considered for a possible...

This week we delve into the world of interventional cardiology and the Fontan when we review a recent report from the Children's Hospital of Philadelphia on the use of the " MitraClip " for the treatment of AV valve regurgitation in the congenital heart patient. Who would be a good candidate for this novel approach? What are the steps in planning or consideration of this technique in a congenital...

This week we review an episode from 2022 in the world of cardiac surgery and pediatric pharmacology when we review a 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...

This week we review a recent work in the artificial intelligence/deep learning space when we review a recent report from the team at Boston Children's Hospital on a novel model trained to predict LV characteristics in children from the ECG. How does such a program identify LV dilation, dysfunction or hypertrophy from a test (the ECG) not designed to provide most of this information? How well did t...

This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expr...

This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expr...