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 review a recent study from The University of Toronto on the impact of timing of the arterial switch operation for DTGA on brain growth and neurodevelopmental outcomes. Can the timing of this surgery impact these outcomes? What is the reason for this? Is it rational to perform this surgery early to improve neurological outcomes? How important is the conduct in the OR versus the ICU? Th...

This week we review a recent paper on the topic of durable VAD's in congenital heart patients. Who is a candidate for such a device and what are the outcomes with these in this selected patient group? What are the impediments to their use? What role might public reporting have on the use of these devices and transplantation in general on the congenital heart population? We touch on all of these qu...

This week's episode is our second 'co-branded' episode with the SADS Foundation (SADS.ORG) and we speak with the founder and director of Crediblemeds.org, Professor of Medicine Ray Woosley of the University of Arizona. Dr. Woosley speaks with us about how he started the first website dedicated to assessing the evidence for drugs' impact on the QT interval establishing a reliable and trusted websit...

This week we review a recent Swedish paper that assessed the risk for cancer in patients with congenital heart disease and compared this to normal controls in a large administrative database. Why are cancer rates different in the congenital heart patient? What are the most important factors? What actions should be taken by those cardiologists caring for ACHD patients to properly screen for cancer?...

This week we explore a provocative paper on the use of a femoral vein homograft for Sano shunt for Stage I palliation for HLHS. Does the incorporation of this form of shunt improve outcomes? How does the valve in this graft function over time? Are there demonstrable improvements in RV function or PA growth when using this approach? We speak with Dr. TK Susheel Kumar who is Associate Professor of S...

This week we have a replay of an episode from 9 months ago on T wave inversions in athletes and why their presence may represent possible disease in the athlete. We speak with Professor Sanjay Sharma of the UK who is a world authority on this topic. This is an important episode worth hearing once more. Coming this week in the middle of the week is our 75th episode with Professor Sylvia Griffiths!...

This week we review the topic of transposition of the great arteries and the most common late long term complication of the arterial switch operation - supravalvar pulmonary distortion or stenosis. How effective were interventions for this problem and what complications were encountered? Does balloon dilation alone ever work to help this problem? Are there risk factors for possible catheterization...

This week we jump back into the world of ACHD and review a recent registry study assessing outcomes in adults with ASD and elevated PVR who underwent ASD closure. Who was a good candidate for this approach? What were the long term outcomes of this form of therapy? Did ASD closure in this setting confer a survival benefit? We review these and many other questions in a 'virtual roundtable' discussio...

This week we enter the worlds of cardiovascular surgery and interventional catheterization to review a recent STS dataset analysis of postoperative transcatheter interventions. Who needed these sorts of catheterizations more commonly after surgery and what was the relation between needing such an intervention and overall outcomes? How much variability existed between centers in their use of interv...

In this special episode # 71 co-presented with the SADS Foundation (SADS.ORG) we speak with the president of the foundation, Professor Michael Ackerman of The Mayo Clinic about a recent work he co-authored on a novel approach to assessing patients with possible CPVT. How should the phenotype help to inform genotype results? Can a novel CPVT scorecard help to improve our understanding of genetic te...

This week we review the role that complications have on outcomes in the ACHD patient undergoing cardiac surgery. How commonly do complications occur and if they do occur, what impact do these have on ultimate outcomes? Are there strategies that can be employed to reduce complications amongst this fragile patient population? We discuss these issues and more with the senior author of this work, Dr....

This week we speak with Professor Yoav Dori of Children's Hospital of Philadelphia about a recent paper he co-authored on the topic of lymphatic abnormalities in children with Noonan's syndrome. What are the typical findings in severely affected children and who is a candidate for intervention? Are there patients who are good candidates for 'thoracic duct ligation' or pleurodesis? Is there anyone...

This week we explore a recent CMR study in Fontan patients assessing the impact of pulmonary blood flow maldistribution and exercise capacity. How closely associated are these differences in relative pulmonary blood flow to functional status and overall outcomes? How aggressively should we intervene for these sorts of problems? We discuss these issues and more with Dr. Rahul Rathod who is the seni...

This week we review a fascinating paper that assesses the direct myocardial effects of IV antiarrhythmic agents upon cardiac muscle function performed by the group at Boston Children's Hospital - Harvard University. We speak with one of the principle authors of this work, Dr. Elizabeth DeWitt, who is an attending electrophysiologist at that large institution about this important work. Which agents...

This week we review a critically important neurodevelopmental issue affecting infants who have single ventricle palliation - namely hearing loss. How common is hearing loss seen and what role does IV furosemide play in this finding amongst single ventricle patients? Are there techniques to avoid this complication and yet still use this commonly used diuretic agent? We discuss this important issue...

This week it's National Pediatric Transplant Week and we review a recent work on ECMO following cardiac transplant and speak with its first author, Assistant Professor of Pediatrics in Vanderbilt University, Dr. Justin Godown. How does the use of ECMO in the postoperative period influence outcomes in the short and long term? Are there differences in outcomes when it is used for patients with cardi...

This week we review a recent report from Duke University regarding the incidence of femoral arterial thrombosis after femoral arterial cardiac catheterization in small infants. How did the use of routine ultrasonography improve identification of this post-cath complication? What are the outcomes of therapy with heparin or enoxaparin for this problem? Are there factors that are associated with femo...

This week we explore the utility of exercise stress echocardiography in pediatric patients. How often were clinical decisions made based upon findings at stress echo? What sort of extra training is needed to perform these studies? How safe was this form of testing? How are stress echo results incorporated into the decision making process for pediatric patients at Emory University? Dr. Soham Dasgup...

This week we review 2 surgical reports. The first is on the Ozaki Procedure for aortic valve repair and we speak with valvular expert David Kalfa, MD PhD of Columbia University. Who is a good candidate for this approach and what evidence exists of its efficacy in children? Dr. Kalfa shares his insights. We also review a recent report from Taormina, Italy on outcomes of repair of anomalous origin o...

This week we review a recent randomized and controlled trial from the NEJM on the use of the novel Medtronic TYRX envelope for the prevention of pacemaker or ICD infections in adult high risk patients. Did the use of this antibiotic envelope result in reduced incidences of infection? Were there complications associated with its use? Should this be used in only in high risk patients? Is this a cost...

This week we review a recent report from the team at the Kravis Children's Hospital at Mount Sinai - Icahn School of Medicine at Mount Sinai on the use of pentobarbital for oral sedation for transthoracic echocardiography. Associate Professor of Pediatrics Rajesh Shenoy shares with us insights into sedation for this indication, the general approach of the echo lab at Sinai and how decisions are ma...

This week we review a recent report on transcatheter pulmonary valve replacement with the Sapien S3 prosthesis. What are the circumstances in which this valve might be preferable versus other valve types? What are the disadvantages of this device? How can patients be effectively screened as candidates for different valves? How can decisions be made between self expanding systems like Harmony or Ve...

This week we 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 wonde...

This week we review a recent publication on modern day outcomes for children with dilated cardiomyopathy. It seems as if they are doing better than patients did 10 years earlier - why is this so? What factors may account for the improvements in outcomes? We discuss these questions and more with the first author of this multi center work, Dr. Rakesh Singh, Associate Professor of Pediatrics at UC Sa...