Pediheart: Pediatric Cardiology Today

This week we delve into the world machine learning and decision tree analysis modeling as it is applied to postoperative heart block decisions. Traditional thinking suggests that all congenital heart surgical patients with postoperative heart block should be observed for 7-10 days to allow for possible resolution of conduction block. However, is 7 days truly required in all cases? Are there patien...

This week's episode of the podcast is supported by the SADS Foundation (SADS.ORG) and is on the topic of the overdiagnosis of LQTS. What sorts of conditions can lengthen the QT interval without true congenital LQTS syndrome? What are the most common errors of ECG interpretation that account for misdiagnosis of this condition and are there leads of the ECG that might help or hurt when attempting to...

In this replay episode from 2021, we review a recent work on CMR outcomes pre and post cone reconstruction of the tricuspid valve in Ebstein's anomaly. How durable of a repair is this operation? Is there evidence for ventricular remodeling? Is there an optimal age to perform this surgical procedure? How should arrhythmia risk be assessed prior to surgery? These are amongst the many questions revie...

This week we review a recent report of a new technique to implant SAPIEN valves for transcatheter pulmonary valve replacement in which 1-3 stents are implanted simultaneously with the SAPIEN valve. What are the potential benefits or disadvantages of this approach and who might be a better candidate for this method? Why is a stent needed outside of the relatively strong SAPIEN prosthesis and how do...

This week we delve into the world of adult congenital heart disease when we review a recent research letter from the team at the Harvard Congenital Heart Program about venous insufficiency in the Fontan patient. Why do patients with Fontan circulation develop chronic venous insufficiency and what are the implications of this problem in the Fontan patient? What sort of evaluation should be performe...

In this week's special episode that is a combination of the Pediheart Podcast and PCICS Podcast, we speak for the entire episode with Professor of Pediatrics Dr. Gil Wernovsky of Children's National. Dr. Wernovsky is the Co-Chair of the upcoming World Congress of Pediatric Cardiology and Cardiac Surgery and shares with us all of the exciting plans for this 'meeting of meetings' that will be staged...

This week we delve into the world of electrophysiology when we review a recent multicenter work on the rare topic of atrial standstill. What is atrial standstill and how does it differ from SA node dysfunction? What risks are associated with this condition and how can they be mitigated? Are there factors in an atrial standstill patient that might prompt implantation of a primary prevention ICD? We...

This week we delve into the world of neonatal congenital heart surgery and review a recent work on changes in the incidence of brain injury following congenital heart surgery. How common is it to see brain injury on the MRI's in this patient group? How have incidences changed over time and what is the likely reason for this? Can the types of inotropic agents used in the postoperative period potent...

This week we delve into the world of ACHD when we review a recent work on outcomes of non-cardiac surgery in the ACHD patient. How do ACHD patients fare in comparison to their non-ACHD cohort undergoing non-cardiac surgery? What can be done to improve outcomes in this patient group? We speak with the senior author of this work, Dr. Peyman Benharash, who is Associate Professor of Surgery at UCLA. D...

This week we replay a 2020 episode in which we reviewed a then recent PCCC study assessing outcomes of single ventricle patients who have undergone replacement of the AV or semilunar valve. We speak with Professor Geetha Raghuveer of University of Missouri-Kansas City about this work she co-authored. Outcomes are generally poor in this patient group but are there lessons that can be gleaned from t...

This week we return to the topic of congenital heart surgery when we speak with Dr. John Iguidbashian who is a resident in surgery at U. Colorado. Dr. Iguidbashian reviews a recent paper he co-authored on the topic of the relation of duration of open chest following heart surgery to the development of surgical site infections (SSI). How long is 'too long' when it comes to an open chest and the ris...

This week we delve into the world of partial heart transplantation when we review a recent paper that discusses the rationale for its potential use in children, particularly in infants. We speak with the work's senior author, Dr. T. Konrad Rajab of the Medical University of South Carolina about the potential benefits of this approach. Who might be a candidate for this approach? What are the theore...

This week, to end 2022, we delve into the world of personal finance for the final episode of 2022 when we speak with Mr. Paul Merriman of paulmerriman.com. Mr. Merriman is a world-renowned expert in personal finance and investing who reviews how we might go about funding a newborn child's retirement (in 65 years!) through the magic of index investing, low costs and compounding interest. There are...

This week we enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide...

This week we review a recent important work on outcomes of pregnancy in patients with bioprosthetic valves. What percentage of women entering pregnancy have a dysfunctional bioprosthetic valve? Is there a particular position of valve where the risk of dysfunction is greater for cardiac or fetal events? We speak with noted cardio-obstetrical expert, Dr. Barbara Wichert-Schmitt of Johannes Kepler Un...

This week we review a recent report from the team at Children's National Hospital in Washington, DC on their experience with the hybrid approach to high risk infants with ductal-dependent systemic circulation. Some patients get ductal stents and others not. How is this decision made? How difficult was it to change the approach of a center that had a reputation for excellence with a more 'tradition...

This week's episode focuses 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? We speak with the chief of pediatric elec...

This week we review a recent work from the Precision Medicine For Cardiomyopathy (PRIMaCY) study group on the role of stress testing in the pediatric HCM patient. Does stress testing help identify patients at risk for possible SCD or progression to heart transplantation? Should all pediatric HCM patients undergo this form of testing? What risks are associated with its use and how should these stud...

In this week's replay of a most special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and interventional cardiology fellow at Toronto Sick 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...

This week we review a recent report from China on transcatheter closure of peri-membranous VSD's with the Amplatzer ADO II device. Reported results are outstanding and this week's report is one of several from China demonstrating efficacy and safety to this approach. Despite this, this procedure is rarely performed in the west. Why might that be? Do we need 'local data' to adopt an approach or can...

This week we delve into the world of cardiac critical care when we review a recent report on an attempt to use a multidisciplinary group of hospital professionals plus parents to design an optimal family meeting structure. How should teams prepare for these meetings? What roles should different care providers play in the team meeting? Is there evidence that a better planned meeting can be more eff...

This week we review a recent cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of...

This week we review a recent international review on the topic of life threatening events occurring during electronic gaming. What risks do video games pose for the typical child or child with an arrhythmia condition? What precautions, if any, should be considered? Are there some sorts of games that are potentially more dangerous than others? We speak with the first and senior authors of this inte...

This week we speak with noted cardiovascular surgeon Dr. John J. Lamberti who is presently Associate Professor of Surgery at Stanford University. Dr. Lamberti's career has spanned from the time of Dr. Robert Gross in the 1960's to present day with Dr. Frank Hanley and the team in Stanford. His career perfectly mirrors the transition from the 'old days' of cardiac surgery up until the present moder...

This week we review a recent report on the differences between pulse oximeter Sp02 and arterial Sa02. Are there patient specific factors that may result in inaccuracies of measurement? What single ventricular factors may also result in more significant inaccuracies and how should these data be used at the bedside when assessing a child who is cyanosed? We speak with Dr. Cara Pritchett, critical ca...