Pediheart: Pediatric Cardiology Today

This week we review a recent work assessing changes in Fontan conduit cross sectional area over time. What accounts for these changes and how do these affect exercise capacity? What does the future hold for the Fontan procedure? Is there an optimal conduit size for patients? We speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel this week! doi: 10.1016/j.jtcvs.2020.09.140

This week we enter the world of pulmonary hypertension (PH) and review a large multicenter registry study assessing outcomes of the Potts shunt for the management of severe PH. Who is a good or bad candidate for this therapy? Is there an advantage to placement of a valve in the shunt? Does this form of palliation affect lung transplant eligibility? We speak with the first author of this week's paper, Dr. R. Mark Grady, Professor of Pediatrics at Washington University. doi: 10.1016/j.jacc.2021.05.039. For this interested, the organization mentioned this week is ljshealinghearts.com.

This week we enter the world of CT surgery to review a recent STS database study on outcomes of diaphragm paralysis following congenital heart surgery. How common is a diaphragm paralyzed following surgery and what are the main risk factors for this complication? How commonly are these plicated and how do those who are plicated fare in comparison to those managed more conservatively? Professor Narutoshi Hibino of U. Chicago shares his insights this week. doi: 10.1016/j.athoracsur.2020.05.175.

This week we replay an episode that reviews 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 and study with Dr. Ari Joffe, Professor of Pediatrics University of Alberta - Stollery Children's Hospital who is the senior author of this week's work. doi: 10.1097/PCC.0000000000001807

This week we delve into the world of myocarditis and cardiogenetics when we review a recent work on deleterious cardiomyopathic genes and a possible role for these in patients who have unfavorable myocarditis outcomes. Are cardiomyopathy genes seen more commonly in pediatric patients with myocarditis who die? Is there a role for genetic testing in the myocarditis patient? How might deleterious genetic defects influence outcomes in myocarditis? We speak with Assistant Professor of Medicine at The Icahn School of Medicine at Mount Sinai, Amy Kontorovich who is the first author of this week's work. DOI: 10.1161/CIRCGEN.121.003426

This week we delve into the heart failure and transplantation realm when we review a recent large scale PHIS database study assessing the associations of tracheostomy and outcomes of pediatric heart transplantation. Are tracheostomies associated with worse outcomes or mediastinitis? Who is a good candidate for this therapy? How difficult is it to discuss this option with families and why? These are amongst the questions reviewed with the senior author of this work, Professor Antonio Cabrera of the University of Utah. DOI: 10.1111/petr.13904

This week in our 2nd 'fellow takeover' episode we speak with the inspiring figure, Dr. Elisabeth Martin, who is Assistant Professor of Surgery at Stanford University and one of the cardiovascular surgeons at Lucile Packard Children's Hospital. How did this young surgeon choose to become a cardiac surgeon and what trials and tribulations have accompanied her journey to the highest levels of congenital cardiovascular surgery in the world today? Dr. Sarah Pradhan, 3rd year cardiology fellow at Cincinnati Children's Hospital interviews this up and coming superstar, Dr. Martin. Prepare to be inspired and energized by her story.

This week we review a recent very large scale project from Denmark on the impact of CHD on preterm labor and birth. We speak with Assistant Professor of Pediatrics at Indiana University, Neonatologist Paulomi Chaudhry about the work and her thoughts on what factors may be modifiable in the care of the preterm infant with CHD. What sorts of studies are needed going forward to improve the outcomes of these infants who had CHD but are premature? Dr. Chaudhry provides a number of answers this week! doi: 10.1016/j.jpeds.2020.09.059

This week, in a co-branded episode with SADS.ORG, we speak with Professor Michael Ackerman of The Mayo Clinic about a recent work he published with his team on a novel AI model to assess the ECG for the diagnosis of LQTS. How accurately can this technology identify a patient with LQTS? Can it identify the genetic diagnosis from the ECG alone? What are the implications of this sort of technology in regards to screening patients for LQTS? These are amongst the many topics reviewed with Dr. Ackerman this week on the podcast. doi: 10.1001/jamacardio.2020.7422

This week we delve into the world of noninvasive imaging and review a very novel approach from the team at Stanford University about tele-visits and the use of remote parentally acquired, focused echocardiograms for monitoring of Marfan's patients. Can any parent be trained to perform a focused echocardiogram in their homes? What is the cost associated with this approach? Can this technique be applied to other cardiovascular problems? We speak with Associate Professor of Pediatrics, Seda Selamet Tierney about her recent work on this interesting topic. doi: 10.1016/j.jpeds.2021.01.004

This week's episode is co-hosted by Dr. Sarah Pradhan in our first 'fellow takeover' of the podcast! Dr. Pradhan speaks with Professor Daphne Hsu of Albert Einstein College of Medicine about her career, how she became a heart failure and transplantation authority, how she thinks about mentoring the next generation and also how she balanced a very full life including the highest levels of medicine as well as motherhood. This is an inspirational story by an inspirational figure from whom we all can learn much.

This week we review a recent work from the team at Children's LA about an unusual form of pre-excitation and use this as a place to launch a discussion about pre-excitation. What sorts of pathways cause pre-excitation? Should all pre-excited patients undergo formal testing? Should all pathways be ablated? How can we invasively or non-invasively assess these patients and are these approaches reliable? We have 2 noted experts on this topic - Professor Michael Silka of USC and Professor Steven Fishberger of Spokane, Washington and U. Miami. This is a rare opportunity to hear 2 'gurus' on pediatric electrophysiology 'riff' on a topic about which they each have encyclopedic knowledge. https://doi.org/10.1017/s1047951121000056

This week we review a recent work on CMR outcomes pre and post cone reconstruction of the tricuspid valve in Ebstein's anomaly. How durable of a repair is this operation? Is there evidence for ventricular remodeling? Is there an optimal age to perform this surgical procedure? How should arrhythmia risk be assessed prior to surgery? These are amongst the many questions reviewed by and posed to Professor Pedro DelNido of Harvard University. This is a rare opportunity to speak with one of the finest congenital heart surgeons in the world today and a noted expert on the cone repair. doi: 10.1016/j.jtcvs.2020.10.124

This week we play a live podcast session from SCAI 2021 (April 30, 2021) on the topic of balloon angioplasty for native aortic coarctation in infants aged 3-12 months. We speak with the senior author of this recent work from Toronto Sick Children's Hospital - Professor Rajiv Chaturvedi. How often were complications encountered? How do results compare with surgical repair? Is high pressure required for these dilations? Professor Chaturvedi provides all the answers and more this week! doi: 10.1161/CIRCINTERVENTIONS.120.008938

This week we speak with Professor Eric Rosenthal of Evelina Children's Hospital in London, England from a session at SCAI 2021. Who is a candidate for closure of a superior sinus venosus ASD in the cath lab and how is this determined? If there is a residual shunt, how much is too much? How did Professor Rosenthal embark on this approach and what have been the results? What percentage of these patients are candidates for this novel approach? This is a rare opportunity to have the author present their own data followed by questions from Dr. Pass and Dr. Aimee Armstrong of Nationwide Children's Hospital. https://doi.org/10.1016/j.jacc.2019.12.070

This week we have a special treat in playing a session from the SCAI meeting from today, April 29, 2021! We speak with Professor Julie Vincent of Columbia University and Professor Chuck Mullins of Baylor College of Medicine. Both speak about their early lives, how they chose to become physicians and how life in retirement is treating them. What role did teamwork play in each doctors' professional life? How did Dr. Mullins design the 'Mullins sheath'? These are amongst the many topics we touch upon in this 'slice of life' conversation that was recorded today from the 2021 Scientific Sessions of SCAI which continues through May 1, 2021!

In this replay of episode 80 from 2019, we review a 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? These are amongst the questions we address with Professor Jane Newburger of Harvard University - Boston Children's Hospital this week! doi: 10.1161/CIRCULATIONAHA.118.037495

This week we delve into the world of healthcare disparities and ACHD when we review a recent 'big data' study on levels of insurance coverage amongst ACHD patients and the impact of the affordable care act ("Obamacare") on this metric. To what extent did the enactment of this program increase insurance coverage for ACHD patients? How do their levels of coverage compare with other chronic illness patients such as sickle cell disease or cystic fibrosis? Were all ACHD patients affected similarly from the advent of the ACA? We speak with U. of Michigan ACHD fellow Dr. Katherine Salciccioli about this important work from the group at Texas Children's Hospital. doi: 10.1002/bdr2.1878

This week in a co-branded episodes with the SADS Foundation (SADS.org) we speak with Professor Johannes von Alvensleben of U. Colorado about a recent PACES study on the outcomes of S-ICD's in children and ACHD patients. What are the challenges to their use and who is a good candidate? What is involved in screening patients for an S-ICD and why do children and ACHD patient seem to 'screen out' more than the general population? What are the challenges to their implantation and what is coming down the pipeline in terms of innovation with these devices? Dr. von Alvensleben shares his insights this week. doi: 10.1016/j.jacep.2020.07.010

This week we delve into the world of fetal cardiology to review a recent work on accuracy of fetal echo in the diagnosis of congenital heart disease. We speak with Dr. Namrita Mozumdar of Pediatric Cardiology Of Long Island about her work. What factors are associated with diagnostic discrepancies? DOI: 10.1016/j.echo.2020.06.017 Also joining us is Professor Kenan Stern of Mount Sinai Children's Heart Center to share with us information about the upcoming Mount Sinai Hot Topics In Fetal Cardiology Conference on May 1. Information can be found at: https://mssm.cloud-cme.com/course/courseoverview?P=3000&EID=4460