Pediheart: Pediatric Cardiology Today

This week we review a recent work from the team at Stanford University on post-traumatic stress disorder amongst pediatric patients with ICD's as well as their parents. How common is this diagnosis seen amongst these patients and their parents and what are some of the reasons for this? How should patients receiving devices be properly screened for this and why is identification of PTSD so importan...

This week's episode is a replay of a co-branded 2020 episode with SADS.ORG and is on the topic of pre-participation screening. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm...

This week we review a recent work from NYU-Langone on the topic of cardiac rehab for the ACHD patient. Does enrollment in a formal cardiac rehabilitation program result in meaningful improvements in exercise tolerance in the ACHD patient? Who can benefit from this? How does the impact of this form of therapy compare with more traditional medical interventions? We speak with the senior author of th...

This week we explore the 'basics' when we review a recent report from the team at the Amrita Institute in Cochin, India on the accuracy and precision of the physical examination in identifying heart disease. How did the stethoscope do in comparison to the 'gold standard' of echocardiography? Is it time to 'retire' the stethoscope or does it still have an honored role in the evaluation of children...

This week we review a recent work from Naples, Italy on the use of the GORE Cardioform ASD device to close large atrial septal defects in small children. Are there anatomical 'rules' to help predict who might be a candidate for transcatheter closure? What about this device makes it potentially safer for this indication? Should we be worried about wireframe fractures? We discuss this and other issu...

This week we delve into the world of bovine jugular vein grafts for the treatment of pulmonary valve dysfunction and the possible enhanced risk for infective endocarditis. How commonly are these valves affected by endocarditis and does placement at surgery in comparison to the cath lab confer a lower risk for this dreaded complication? What factor was most highly associated with the risk for endoc...

This week we delve into the world of fetal cardiology to review a recent report on fetal SVT. Are there factors in fetal life that would predict postnatal SVT? How should transesophageal pacing factor into decisions in postnatal life? How does the team at Lurie Children’s choose a 2nd agent for fetal SVT when digoxin is ineffective? Are there differences in the clinical presentation of infants pre...

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 review a recent work on outcomes of univentricular adult patients who have not been palliated with a Fontan. Do these patients fare better than Fontan patients? What factors are associated with worse or better outcomes? How do these factors inform decision making for the single ventricle adult patient? We speak with adult congenital expert, Dr. Danielle Massarella of University of Tor...

This week we review an important report on possible racial disparities amongst children on waiting lists for heart transplantation in the US. How did the 2016 changes to the Organ Procurement and Transplantation Network criteria for listing impact outcomes in listed children and unexpectedly widen racial disparities? What impact did these changes have on mortality and outcomes for white vs. non-wh...

This week we delve into the world of cardiovascular surgery when we review a recent paper from the team at Texas Children's Hospital about the BTT shunt. How commonly did shunts have serious complications? Does the location on the aorta matter in regards to shunt complications? What size shunt is associated with the least morbidity or mortality? Why might shunt placement via a thoracotomy be super...

This week we review a recent large scale administrative database study assessing racial and socioeconomic disparities in congenital heart disease outcomes in the US. How does patient neighborhood income affect outcomes? How does the presence of Down Syndrome mitigate risk? How does race or socioeconomic status affect length of stay? How can these data inform change to improve outcomes for all chil...

This week we delve again into the controversy regarding optimal newborn management of the symptomatic newborn with tetralogy of Fallot. Does palliation offer a cost savings versus primary repair for the symptomatic TOF patient? What impact does the advent of transcatheter palliative approaches have upon cost? We speak with the first author of this week's work, Assistant Professor of Pediatrics at...

This week we turn back to 2020 and delve once more into the world of mental health and review a new large study from the group at Texas Children's on prevalence of anxiety, depression and ADHD amongst the pediatric CHD patient group. How common are these disorders in the young CHD patient and how does this compare to the general pediatric population? What role does minority or insurance status hav...

This week we review a recent large claims database study on WPW in children that aims to identify the true incidence of life threatening events in children with this condition. What is known about the incidence of life threatening events as well as the actual prevalence of WPW amongst children? What are the strengths and limitations of large claims database studies? How high is the risk for VF in...

This week we speak with Associate Professor of Pediatrics at University of Washington Sujatha Buddhe of Seattle Children's Hospital about a recent survey study she conducted regarding CMR in the pediatric and congenital heart patient. How have volumes of cases changed over the past few years? Who is reading these studies? What is the advantage of a 1.5T vs. 3.0T scanner for congenital scans? What...

This week we delve into the world of heart transplantation to review a recent article on the topic of outcomes of the Down syndrome patient undergoing heart transplantation. Are infections or cancers more common in this patient group following transplantation? What role does intellectual disability play in the present era in decisions regarding transplantation in this patient group? Associate Prof...

This week we play a session of the podcast from SCAI 2022 in Atlanta with Professor of Pediatrics, Columbia University - Dr. Christopher Petit reviewing a recent publication on the topic of systemic sirolimus in concert with catheter interventions for the treatment of pulmonary vein stenosis. Who is a candidate for this sort of therapy? Does systemic sirolimus confer a survival benefit over local...

This week in a live session from SCAI 2022 we hear Assistant Professor of Pediatrics, Dr. Eimear McGovern shares her insights into a recent work she co-authored on changes in Fontan dimensions over time. Who needed interventions and how does the team in Kentucky choose to perform surveillance catheterizations on their Fontan patients? Is there an optimal time? What degree of stenosis or narrowing...

In this replay of episode 92 from 2019, we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if a...

This week we review a recent report from Lurie Children's in Chicago on the impact of fetal diagnosis of vascular rings. Does prenatal knowledge of this problem enhance postnatal outcomes? Who deserves cross sectional imaging after birth if prenatally diagnosed with a ring or sling and when and how should this be performed? We speak with Assistant Professor of Surgery at the Mayo Clinic, Dr. Eliza...

This week we review a recent report from the team at Boston Children's Hospital about a novel approach to avoid heart block during complex congenital heart surgery? Assistant Professor of Pediatrics at Harvard Medical School Elizabeth DeWitt shares with us her insights into a recent report she co-authored by the departments of surgery and cardiology at her institution about intraoperative mapping...

This week we move into the world of cardiac surgery when we review a recent 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 care pharmacy coordinator at Mount Sinai...

This week we delve into two areas of interest - fellowship training and fetal cardiology when we review a multi-center work endorsed by the Fetal Heart Society on the topic of fetal heart disease counseling. How is this skill taught to cardiology fellows and what are the deficiencies that present exist? Is empathy something that can be taught? What efforts are afoot regarding formalized curricula...

In this week's replay episode we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in...