Pediheart: Pediatric Cardiology Today

This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorizatio...

Pulmonary valve replacement following the arterial switch operation is rare. However, when necessary, how do techniques of transcatheter valve replacement fare for this indication? Why would average outcomes in this setting be less good than in the typical TPVR tetralogy of Fallot patient? How does the presence of stents in the pulmonary arteries in this patient group affect candidacy for TPVR? Ar...

This week we review a recent large scale study on catecholaminergic polymorphic ventricular tachycardia (CPVT) in children which is based on two large international registries. How do outcomes differ between those symptomatic CPVT patients treated with or without an ICD? Who amongst symptomatic CPVT pediatric patients likely warrant an ICD? What sort of ICD might be optimal - subcutaneous or trans...

This week we delve into the worlds of cardiac critical care and neurodevelopment when we review a recent report from the team at Children's Hospital of Philadelphia assessing an association between postoperative opioid exposure in infants following CHD surgery and neurodevelopmental outcomes. What might be the biological basis for an association between these 2 factors? How confident can we be tha...

This week we listen in on a lecture by Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Christopher Janson, on the novel agent ivabradine. How does this agent work and in what circumstances can it be used in pediatric arrhythmia management? Is this safe to use for critical arrhythmias despite the fact that it is, at present, only available as an enteral agent? What is the p...

This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fab...

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in...

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine,...

This week we speak with noted interventional cardiologist Dr. Shyam Sathanandam of LeBonheur Children's Hospital in Memphis, TN about novel, 'off-label' uses of the Amplatzer Piccolo device in children. In what sorts of lesions does Dr. Sathanandam believe this device offers distinct advantages for vascular closure? What is the feature of this device that allows it to work for small defect closure...

This week’s episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation i...

This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant...

This week we delve into the world of the single ventricle when we speak with Dr. David Hoganson, Assistant Professor of Surgery at Harvard Medical School about a recent work he co-published with investigators from Boston Children’s Hospital on computational fluid dynamic modeling in the planning of the Fontan operation. Single ventricle heterotaxy patients with interrupted IVC are at enhanced risk...

This week we turn back the clocks to re-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 performed on the Fontan patient presenting w...

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...