Pediheart: Pediatric Cardiology Today

This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What a...

This week we delve into cardiac surgery and genetics as we review a recent large dataset study from Drs. Anita Moon-Grady and Laxmi Ghimire who used the KID database to determine the impact of 22q11.2 deletion syndrome on outcomes of repair of TOF and Truncus. Does this syndrome affect mortality or morbidity? If so, why? Professor Moon-Grady of UCSF and Dr. Ghimire of LRGHealthcare provide many in...

This week we review a fascinating epidemiological study from the University of Ottawa on the impact of assisted reproductive technologies (ART) and twins on the rates of congenital heart disease. What is the more important factor in the development of congenital heart disease - twin pregnancy or ART? Do all ART pregnancies require a fetal echo? We speak with 3 world authorities - epidemiologist Dr...

This week we re-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 wo...

This week we have a very topical episode on the recently identified multi system inflammatory syndrome in children associated with SARS-CoV2 infection (MIS-C). What defines this syndrome and how does it differ from other inflammatory disorders such as toxic shock syndrome or Kawasaki disease? We speak with 2 world authorities - Associate Professor of Pediatrics - Albert Einstein - Dr. Nadine Choue...

This week we review a recent large database study of WPW with particular interest in the patient with intermittent preexcitation. Traditionally, this finding has been considered a sign of low risk. Is this true? Who deserves formal invasive EP testing in this setting? Should all WPW pathways be ablated? These are amongst the many interesting questions discussed with Assistant Professor of Pediatri...

This week we speak with Professor Robert Hamilton of University of Toronto about a recent potentially groundbreaking work on a novel approach to the diagnosis of Brugada syndrome using an immunological test. How accurate is this test for diagnosis of this often elusive syndrome? Is autoimmunity the cause of disease or are the antibodies just a marker of disease. What's the latest on Professor Hami...

This week we speak with Professor Marc Gewillig of Leuven, Belgium about a recent paper he co-authored on the topic of the relation of ductal morphology to success at endovascular stenting. Are there some morphologies that are more difficult than others? How is the length of the ductus optimally estimated when choosing a stent length? Dr. Gewillig shares many pearls this week. doi: 10.1002/ccd.287...

This week we review the outcomes of Fontan palliation in the Down Syndrome patient. We speak with Assistant Professor of Pediatrics Dr. Lauren Sarno of East Carolina University about a recent work she co-authored on a complex statistical analysis she performed from the STS database. What accounts for worse outcomes in this patient population? Prepare to be surprised by the information provided thi...

This week we have the rare opportunity to speak for the entire podcast with a pioneer in pediatric heart transplantation and VAD support - Professor James Kirklan of University of Alabama. Dr. Kirklin shares his experiences in forming the PHTS and other organizations devoted to mechanical assist devices in adults and children and how he started the process of multi-institutional studies to answer...

This week we replay one of the most listened to episodes of the early part of this podcast history - episode 21 with Dr. Anthony Rossi. Professor Rossi is the Director of Pediatric Cardiology at Nicklaus Children's Hospital in Miami, Florida and is one of the leaders and pioneers in the field of pediatric cardiac critical care. We sit down with Dr. Rossi to review his approach to the assessment an...

This week we enter the world of cardiovascular anesthesiology to review a recent work from Duke University on the results of the use of IV methadone during cardiac surgery in children. Does this agent result in reductions in postoperative opioid usage while affording similar analgesia? What are the advantages of this agent in this setting? How much should the cardiologist worry about the impact of...

This week we enter into the worlds of fetal cardiology and preventative cardiology to review a recent work from Professor Paul Leeson of Oxford University on the topic of pregnancy induced hypertension and the impact this plays on the cardiovascular health of the offspring. How does this form of HTN affect the structure of the RV and LV in the offspring and why might this explain the increased rat...

This week we review a recent work from the team at Mercy Children's on the variability of sheath outer diameter (OD) amongst various sheaths. Can novel 4Fr adult radial sheaths have similar OD to more standard 3.3Fr pediatric sheaths? What are the trade-offs in using a radial sheath for this indication in a newborn? Senior author Dr. Abhay Divekar of Rocky Mountain Pediatric Cardiology shares his...

On this episode we speak with Professor Edward Walsh of Harvard University about a recent work he co-authored on Ebstein's anomaly. Can review of pathological specimens offer some insights into why ablations in this patient group are so challenging? Is there an optimal age or size to perform an ablation in this patient group? Why are these ablations so difficult? Dr. Walsh, Director of the Arrhyth...

This week we delve into the world of cardiomyopathy and also stress echo to review a recent work from the team at Boston Children's on stress echo and its role in the assessment of the pediatric HCM patient. We speak with Assistant Professor of Pediatrics Ming Hui Chen of Harvard University about a recent work she co-authored on this modality in children with HCM. Are changes in the LVOT gradient...

This week's episode, co-branded with SADS.ORG, reviews a recent guideline paper by the Mayo Clinic on how to improve the safety of potential COVID-19 therapies such as azithromycin or hydroxychloroquine. These agents can both prolong the QT interval and enhance the risk for torsades making the development of a simple protocol to prevent possible life threatening cardiac side effects critical, part...

This week we speak with Professor Candice Silversides of U. Toronto about a recent work she co-authored on the topic of serious cardiac events for women with heart disease. How common are serious cardiac events encountered and what percentage of these are preventable? What is the optimal team for the pregnant patient with heart disease? What are the components of a pre-pregnancy cardiac evaluation...

This week we delve into the world of preventative cardiology and speak with Associate Professor of Pediatrics at The Albert Einstein College of Medicine, Dr. Joseph Mahgerefteh about a recent work he authored on the impact of obesity and obstructive sleep apnea on hypertension. Which of these factors, which often occur together, is more important in the youth with elevated BP? Dr. Mahgerfeteh shar...

This week we speak with Dr. Anne Marie Valente, Associate Professor of Medicine and Pediatrics, Harvard University about a recent work she co-authored on the topic of outcomes following PVR and the relation of the RV volume to these. What is the evidence for using RVEDVi as a rationale to replace the pulmonary valve? Does PVR affect long term survival in the TOF patient? What factors are associate...

This week we review a recent paper from the team at the University of Wisconsin regarding weaning from bypass after the Norwood procedure. If there are difficulties in 'coming off', what are the most common problems encountered and what does this difficulty mean for survival and the general hospital course? We speak with the senior author of this work, congenital heart surgeon Dr. Ronald Woods abo...

This week we delve into the world of heart failure and transplantation and review a recent report from the ACTION Network about the use of the Heartmate 3 VAD for young patients. Does this device offer advantages over prior durable VAD's? What are the patient size limitations for such a device? Why might this device have fewer complications than prior devices? Dr. Matthew O'Connor, Assistant Profe...

This week we review a recent work from the team at Boston Children's Hospital regarding outcomes for patients with complex congenital heart disease who underwent scoliosis repair. We speak with the first author of this work, 2nd year cardiology fellow at Boston Children's, Dr. Robert Przybylski about the work. How should these patients be optimally assessed prior to and then managed during these c...

This week we replay episode # 40 - a discussion with the inspirational figure, Professor Raman Krishna Kumar of the Amrita Institute in Cochin, India. This master of cardiology reviews how, in a limited resource environment, Professor Kumar was able to develop one of the finest pediatric heart centers in all the world. We will be back with a new episode on 3.6.20!

This week we move into the world of the CICU to review a recent work on the use of noninvasive means of ventilation following congenital heart surgery. How often does this form of ventilation prevent a child with respiratory failure avoid reintubation? What is the evidence for the benefit of this? Are we extubating patients too soon? We speak with Ms. Denise Rolim who is a highly experienced pedia...