Pediheart: Pediatric Cardiology Today

This week's episode, the final of 2021, is on personal finance and we speak with noted personal finance expert Paul Merriman about strategies to improve investing results within a retirement account. Mr. Merriman reviews index funds, the value of these over 'actively managed' funds, and his thoughts on 'target date funds'. Finally, he shares a strategy that may improve the outcome of a target date fund strategy. Here's to a good 2022.

This week we revisit episode 135 where we discussed the topic of mortality attributable to CHD in the US and persistent racial/ethnic disparities over the past 20 years. We speak with Professor Keila Lopez of Texas Children's Hospital about a recent large scale, 'big data' study she co-authored about this topic and review the reasons for these disparities and think about possible remedies. An essential episode on a critically important topic for CHD care. doi: 10.1161/CIRCULATIONAHA.120.046822

This week we delve into the world of congenital heart disease when we review a recent work from the team at Boston Children's Hospital on the long term outcomes of truncal valves in the setting of truncus arteriosus. Who amongst truncus patients is at risk for the development of truncal regurgitation or a need for reintervention? Are there predictors that might help forecast patients who should be more closely monitored? How do the data in this work help inform the fetal counseling of the team at Boston Children's Hospital? Instructor in pediatrics, Dr. Laura Gellis, the first author of this week's work, shares her deep insights into this topic this week! doi: 10.1161/JAHA.120.019104

This week we delve into the coronavirus pandemic and specifically the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection. When there was significant initial cardiac involvement seen in the setting of MIS-C, what findings are common in the CMR of patients 6+ months later? How common is delayed enhancement seen and how does this compare with findings seen in other myocarditis patients? Who should be referred for a CMR following MIS-C? Dr. David Barris, 2nd year cardiology fellow at Mount Sinai Kravis Children's Heart Center in NYC and the first author of this week's work, provides the answers this week. DOI: 10.1016/j.jpeds.2021.10.009

This week we turn to a recent work from the group at Texas Children's Hospital about IV sotalol and the treatment of junctional ectopic tachycardia (JET). How did sotalol fair in comparison to IV amiodarone for the treatment of this potentially lethal postoperative arrhythmia? What differences were observed? How should IV sotalol be dosed and who is or is not a candidate? We speak with the first author of this work, Assistant Professor of Pediatrics at The Children's Hospital at Montefiore, Dr. Ellis Rochelson. doi: 10.1016/j.hrthm.2021.11.021

In this week's special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and third year cardiology fellow at Cincinnati 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 life from this giant in the field of pediatric cardiology. An inspirational episode to end the month of November, 2021.

This week we move into the realm of public health for congenital heart care when we review a recent report on a novel approach to tackling the daunting task of enhancing access to care for congenital heart disease to all who need it in a limited resource region. We speak with Ms. Bistra Zheleva of Children's HeartLink and Professor Krishna Kumar of Amrita Institute in Cocchin, India about a recent report on how a large group of professionals have used a private/public cooperative approach based on education and novel modern methods to rapidly care for children with congenital heart disease, resulting in meaningful reductions in infant mortality as well as improvements in care throughout the congenital heart patient lifespan. Prepare to be inspired by this extraordinary tale. DOI: https://doi.org/10.5334/gh.1034

This week we delve into the world of EP when we review a recent work from the team at Rady Children's Hospital on length of treatment for infant SVT. Is there an optimal length of therapy for the infant with SVT? Are there predictors of recurrence that might suggest benefit to a longer course of medical therapy? We speak with Director of Pacing at Rady Children's Hospital, Dr. Matthew R. Williams who is the senior author of this week's work. doi: 10.1007/s00246-020-02534-5

This week we review a recent important work from Germany about the coronary perfusion in patients with HLHS and possible relations between this flow and clinical outcomes. What factors are associated with abnormalities in microvascular coronary flow in the HLHS patient? What anatomical substrate is more concerning for these sorts of problems? Are there factors that might be modifiable that could possibly improve outcomes due to coronary microvascular flow problems in the HLHS patient? How practically easy are CMR studies to assess microvascular coronary flow in the HLHS patient? These are amongst the questions posed this week to Professor Carsten Rickers of University Heart and Vascular Center at the University Hospital Hamburg-Eppendorf. DOI: 10.1161/CIRCIMAGING.121.012468

This week we replay an episode reviewing a large administrative database study from Sweden on risk for cancer amongst patients with CHD. Why are cancer rates different in the CHD patient? What are the most important factors? What actions should be taken by cardiologists caring for ACHD patients in order to properly screen for cancer? We discuss these issues with Assistant Professor of Pediatrics, Harvard Medical School, Dr. Michelle Gurvitz. doi:10.1001/jamanetworkopen.2019.6782

This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pediatric echo techs and staff physicians? Professor Jonathan N. Johnson of the Mayo Clinic shares his insights this week. DOI: 10.1016/j.echo.2020.12.009

This week we delve into the world of cardiovascular surgery to review a recent work on outcomes of arch reconstruction in the newborn and small child. We speak with Dr. Ramana Dhannapuneni, lead cardiac surgeon of Alder Hey Children's Hospital in Liverpool, UK. How often in the present era is re-operation or reintervention required? How common is the recurrent laryngeal nerve or phrenic nerve injured or affected by surgery? Dr. Dhannapuneni provides us with the surgical perspective to this complex surgery this week. doi: 10.1017/S1047951121003747

This week we enter the world of cardiac critical care to discuss delirium in the postoperative pediatric cardiac patient. We speak with nursing scientist, Professor Sandra Staveski of UCSF about a recent large multicenter study she conducted on this topic. How prevalent is this problem and why is it an important morbidity to tackle and reduce? How can nursing interventions reduce this problem and how can the ICU team working together identify and manage this problem? Dr. Staveski shares her deep nursing and critical care knowledge with us this week. DOI: 10.1097/PCC.0000000000002591

This week we review a recent report from the team at Children's Hospital of Los Angeles about prenatal and neonatal factors that might help predict the need for newborn permanent pacing in the setting of antibody-associated CCHB. We speak with Assistant Professor of Pediatrics at Mount Sinai, Dr. Justin Pick about this work. How important is third trimester fetal heart rate in predicting possible need for early pacing? Dr. Pick provides many insights this week. doi: 10.1007/s00246-021-02723

This week we review a recent work on the use of bivalirudin on outcomes of pediatric VAD patients. We speak with Dr. Caroline Carly Heyrend of Primary Children's Hospital in Utah about a recent work she co-authored on time in therapeutic range for this agent in children with VAD's. How does bivalirudin work differently than heparin and what are the theoretical benefits or disadvantages of this agent in comparison with unfractionated heparin? Why are thrombotic complications still common amongst those with pediatric VAD's even when anticoagulation is maintained appropriately? What are the factors at work that make safe anticoagulation so difficult in this complex and fragile group of patients? Dr. Heyrend provides the pharmacist's perspective this week. DOI: 10.1097/MAT.0000000000001261

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 areas were particularly well served by this approach? Dr. Brian White, senior cardiology fellow at CHOP provides important insights into this project that he co-authored. doi: 10.1111/echo.14441

This week we delve into the world of ACHD when we review a recent large data evaluation from the team at Erasmus University in the Netherlands regarding outcomes of DTGA/Arterial Switch patients who have gone through pregnancy. How do these patients fare in general? What sort of pre-pregnancy evaluation should these patients have? Where should their offspring be delivered? Is a maternal fetal medicine expert required for all? Do all DTGA/Switch patients require tertiary care centers? Dr. Karishma Ramlakhan, PhD candidate at Erasmus University shares her deep insights this week. doi: 10.1161/JAHA.120.018176

This week we review a recent work from the team at University of Alabama in Birmingham about clinical outcome disparities amongst Black children with Kawasaki disease. What differences exist in outcomes between these groups and are these differences social or biological in origin? We speak with one of the authors of this work, Assistant Professor of Pediatrics Leslie Collins about this important work. doi: 10.1016/j.jpeds.2020.09.052

From August 2020 - This week we delve into the topic of fellow wellness and review a recent work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who is the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness. An important topic for our milestone 130th episode. doi: 10.1007/s00246-019-02276-z. Back next week with a new episode!

This week we spend the entire episode speaking with Professor Peter Lang of Harvard University about his rich and long career in pediatric cardiology during one of the most exciting times of the field. Dr. Lang's story includes a virtual who's who of important cardiologists and cardiac surgeons for the past 50 years including Dr. Connie Hayes, Dr. Roberta Williams, Dr. Alexander Nadas, Dr. Richard Van Praagh, Dr. Aldo Castaneda, Dr. Bill Norwood and many, many more. This is a rare opportunity to hear about the development of the Norwood procedure from someone who was at the bedside of the first 30-50 ever performed as well as someone who helped develop the entire field of cardiac critical care. Prepare to be inspired by this towering figure this week.