Pediheart: Pediatric Cardiology Today

This week we review a recent survey study on the topic of aortopulmonary collaterals in single ventricle patients. How often are these occluded in the single ventricle patient and when this is performed, how do interventionalists decide? How should they be occluded? Are there guidelines regarding this? We speak with Professor Ziyad Hijazi of Sidra Cardiovascular Center in Doha, Qatar about this recent work and also briefly discuss the PICS Society for pediatric and adult interventional cardiologists with Dr. Hijazi and Dr. Damien Kenny. doi: 10.1007/s00246-020-02418-8

In this week's replay episode 133, we delve into the world of electrophysiology and ACHD when we review a very recent work on TOF and factors associated with possible risk for sudden death. Can a novel algorithm identify high or low risk patients in this cohort? We speak with Professor Joseph Atallah of The University of Alberta and Dr. Edward Walsh of Harvard University. Both share their deep knowledge in a roundtable discussion this week. DOI: 10.1016/j.amjcard.2020.07.012

This week we explore a recent work assessing the degree of anatomical concordance between neonatologist-performed echocardiograms and those by pediatric cardiology. What is the role of a hemodynamic consultation team in the management of the transitional physiology of the newborn? How do neonatologists use echocardiography in real time to help manage complex physiological problems of the newborn? What training is needed to do this and how does the neonatal team collaborate with cardiology to provide optimal neonatal physiological support and care? We speak with 2 experts to get the perspective of the neonatologist and cardiologist. Senior author and neonatologist Professor Patrick McNamara of University of Iowa and noted cardiac imaging expert, Professor Leo Lopez of Stanford University share their deep insights this week. doi: 10.1016/j.echo.2020.11.005

This week we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in outcome? Are there ways to make the use of warfarin more safe? What about novel anticoagulants - what is their possible role and what evidence exists for their use in this setting? Dr. Attard provides many key 'takeaways' this week! doi: 10.1016/j.jtcvs.2020.12.102

This week's work reviews a recent STS database study on airway anomalies and the impact they have on cardiovascular surgical outcomes for congenital heart disease. To what degree does the presence of a concomitant airway surgery impact the morbidity and mortality of congenital heart surgery? Dr. Kyle Riggs, a PGY4 resident in thoracic surgery at Northwell Health shares his insights from his recent publication. doi: 10.1016/j.jtcvs.2020.10.149

This week we delve into the world of general cardiology and echocardiography to evaluate the role of the echo in the evaluation of a palpitation patient. Which pediatric palpitation patients should undergo an echo? What is the yield of this test in this patient group? What is the appropriate evaluation of a palpitation patient and what testing should such a patient undergo? We speak with Dr. Saloni Sheth, 3rd year resident in pediatrics at Rainbow Babies and Children's Hospital in Cleveland, Ohio about a recent work she published on this topic. DOI: 10.1017/S104795112000325X

This week we review a recent work from the large ACHD team in Sydney, Australia regarding outcomes of ACHD patients at age 50. How are these patients progressing from both a medical and psychosocial perspective? What resources are needed to address this rapidly growing population of middle aged ACHD patients? We speak with Professor Rachael Cordina of the University of Sydney about her recent work. doi: 10.1016/j.hlc.2020.05.114

This week we delve back into the world of the Fontan to discuss the fate of the liver in the Fontan patient. We speak with hepatologist, Professor Dellys Soler Rodriguez of Emory University about a recent work she published on the fate of the liver in patients following heart-only transplantation who were Fontan patients. How should these patients be monitored? How should all Fontan patients be monitored? What is the role of the liver biopsy in this evaluation? Dr. Soler Rodriguez provides the insights this week! DOI: 10.1016/j.jpeds.2020.09.044

This week in a co-branded episode with the SADS Foundation (SADS.ORG), we speak with Professor Peter Schwartz of University of Pavia about a recent work he authored on the topic of changes in repolarization amongst well trained athletes. Can athletic training masquerade as LQTS causing prolongation and/or abnormalities in the QT interval? How can these patients be properly identified and not 'lumped' into the LQTS 'pile'? This is a very important work by one of the foremost authorities on the planet on LQTS and Professor Schwartz also shares with us how he became interested in this topic 50+ years ago as well as some pearls for clinical investigators at the start of their careers. One of the best and most inspirational interviews of the entire 150 episode series! doi: 10.1161/CIRCULATIONAHA.120.048916

This week we delve into the world of general pediatric cardiology as well as EP as we review a recent work from the Boston Children's group on management of SVT in the ED. How often are patients admitted to the hospital after conversion of SVT? How frequently are 2nd agents required to terminate SVT beyond adenosine? Why do differences exist in the management of these patients between hospital systems? Boston Children's Hospital cardiology fellow, Dr. Robert Przybylski shares his insights into this week's important and practical work. doi: 10.1007/s00246-020-02515-8

This week we delve into the world of mental health and review a new large study from the group at Texas Children's on prevalence of anxiety, depression and ADHD amongst the pediatric CHD patient group. How common are these disorders in the young CHD patient and how does this compare to the general pediatric population? What role does minority or insurance status have on diagnosis or treatment of these disorders? Third year cardiology fellow Dr. Vincent J. Gonzalez shares insights from his important work this week. doi: 10.1542/peds.2020-1693

This week we speak with Professor Marc Gewillig of University Hospitals, Leuven, Belgium about a recent work he co-authored on the physiology of the Fontan. What is the most important feature of a Fontan circulation in the initial versus late stages after palliation? What constitutes a 'good Fontan'? What is meant by likening the Fontan to a "dam"? Dr. Gewillig provides us with a number of practical concepts in thinking about our Fontan patients and how we might conceptualize possible therapies to improve Fontan flow. doi: 10.1111/apa.15098

This week we speak have 2 special guests. First we check in with Dr. Alin Gragossian, critical care fellow at Mount Sinai Hospital, NYC and also heart transplant recipient. Dr. Gragossian shares with us the details of the past year, her second, with a new heart and what the special challenges have been. Our second guest is investing authority Paul Merriman who is a nationally recognized figure in the world of personal finance and the author of many books on investing as well as the host of his own podcast, 'Sound Investing'. Mr. Merriman shares some of the basics of how to think about asset allocation in a 401K or 403b retirement account. This is a rare opportunity to speak with such a noted expert on this topic and some of his suggestions can literally mean millions in retirement.

As we move on to 2021 and leave 2020 'in the dust', we check in with some of the frontline warriors in the battle with COVID19 and hear their well wishes of inspiration, resilience, warmth and hope. Here's to a wonderful 2021!

This week we review the topic of heart block in the newborn or fetus and review a novel prospective trial assessment of hydroxychloroquine to reduce recurrences of heart block in the offspring of Anti-SSA/Ro-positive mothers. We speak with Professor Jill Buyon and Professor Peter Izmirly, both of NYU Medical Center about a recent multi center trial assessing the impact of this agent for this purpose. How effective was this drug and what if any complications were encountered? What is next in the study of this topic? Drs. Buyon and Izmirly share many insights this week. doi: 10.1016/j.jacc.2020.05.045

This week we review a recent work in the area of medical ethics specifically focused on the notion of comfort care for congenital heart disease. Which diseases or patients should be offered this option and who should not? What sort of agreement is there amongst congenital heart specialists? Who should be involved in such decisions? We speak with Professor Angira Patel of Lurie Children's Hospital about this very important and uncommonly discussed topic. doi: 10.1007/s00246-020-02367-2

Surgery is on tap this week as we discuss a recent paper from the team at Children's Hospital LA about diaphragm plication in the single ventricle patient. What impact did this intervention have on outcomes? How were hemodynamics impacted and did this change outcomes of the bidirectional Glenn or Fontan? What percentage of patients recovered diaphragm function? Professor S. Ram Kumar of USC shares his insights into his recent work with his team. DOI: 10.1016/j.jtcvs.2020.06.007

This week we review a recent report on the prevalence and types of psychiatric problems that pediatric and adolescent heart failure/transplant patients may have. How common are these illnesses, which are most common and what to do about this? We speak with Assistant Professor of Pediatrics at Vanderbilt University, Dr. Isaura Diaz about her recent work this week. DOI: 10.1016/j.jpeds.2019.10.022

This week we move into the arena of pediatric preventive cardiology and have a somewhat different format to the podcast in that we will be listening to a lecture delivered by Associate Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai - Dr. Joseph Mahgerefteh - speak with us about the topic of familial hypercholesterolemia. He reviews the incidence and consequences of not identifying and managing this properly and many clinical pearls regarding this complex topic. Though a lecture aimed at generalists, this talk is a good introduction to a complex topic. Dr. Mahgerefteh's email is Joseph.Mahgerefteh@mssm.edu for anyone interested in reaching out to ask him any questions they may have regarding this important review this week.

This week we delve into the world of interventional cardiology and speak with Professor Damien Kenny of Children's Hospital, Ireland in Dublin, Ireland about a recent work he co-authored on pre-clinical animal experiments on the use of a novel bioresorbable scaffold/stent. How easy were these to implant? How did these compare with bare metal stents for patency, thrombus or inflammation in the vascular wall? Dr. Kenny shares his insights all the way from Dublin this week!doi: 10.1002/ccd.28893