Pediheart: Pediatric Cardiology Today

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.28725

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 this week! DOI: 10.1016/j.athoracsur.2019.07.085

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 important questions in surgery and medicine. Dr. Kirklin shares his thoughts regarding the future in this field and also offers some general career and life advice. This is a 'not to be missed' chance to learn from one of the greats of our time in medicine!

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 and management of the single ventricle patient following stage I palliation. The clinical 'pearls' come fast and furiously from Dr. Rossi - this is one to have pen and paper available to take notes! An inspiring figure to usher out the month of May!

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 methadone on the QT interval? We speak with the first author of this work, Assistant Professor of Anesthesiology at UNC, Dr. Annika Barnett. doi: 10.1111/pan.13903

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 rates of adult HTN in the offspring of women who were hypertensive during pregnancy? Dr. Leeson provides many interesting insights and context this week. doi: 10.1161/JAHA.119.014586

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 insights this week. doi: 10.1002/ccd.28825

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 Arrhythmia Service at Boston Children's Hospital, shares his deep insights this week. doi: 10.1016/j.hrthm.2020.01.013

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 with exercise associated with differences in medium term outcome? Dr. Chen provides the answers this week. doi: 10.1016/j.echo.2020.01.020

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, particularly in an era before there is strong scientific evidence of efficacy of these agents when used for this indication. Dr. Ackerman shares with us his thoughts on a brief protocol he devised with his colleagues to identify 'at risk' individuals and shares his thoughts on how to thoughtfully consider the risks of these agents when considering their use for COVID-19 therapy. A timely episode with one of the world's greatest authorities on the QT interval in Professor Ackerman. Dr. Ackerman's algorithm is located at https://cdn.prod-carehubs.net/n1/802899ec472ea3d8/uploads/2020/03/2020-COVID-QTc-Algorithm-Internal-and

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? Dr. Silversides provides many insights this week. doi: 10.1016/j.jacc.2020.01.039

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 shares his insights regarding this week's work while also reviewing a general framework to think about the assessment and approach to obesity in the young. doi: 10.1002/ppul.24693

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 associated with worse long term survival and complications? Dr. Valente is one of the foremost ACHD experts in the world and provides deep insights this week. doi: 10.1016/j.amjcard.2019.12.017.

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 about this somewhat common problem in the OR and how his team manages it. doi: 10.1053/j.semtcvs.2019.08.005

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 Professor of Pediatrics at The University of Pennsylvania shares his deep insights with us this week. doi: 10.1016/j.healun.2020.02.007.

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 complex and often challenging surgeries. Dr. Przybylski provides us with great insights this week. doi: 10.1007/s00246-019-02169-1.

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 pediatric physiotherapist in the PICU of Hospital Sirio-Libanes in Sao Paulo, Brazil and who is also the first author of this week's work. A true international episode this week! doi: 10.1007/s00246-020-02290-6

This week we review a recent work on the prevalence of adverse events when starting sotalol in the pediatric patient with arrhythmias. How commonly were problems encountered? Does initiation always require hospitalization and monitoring in an inpatient setting or are there some patients who might be candidates for an outpatient approach? Is there a level of dysfunction that would preclude its use? Assistant Professor of Pediatrics at Northwestern University, Dr. Stephanie Chandler, provides insights into her work from the group at Boston Children's Hospital. Also featured is a brief discussion with Dr. Jack Rychik of Children's Hospital of Philadelphia regarding the CHOP2020 course and next year's CHOP2021. doi: 10.1016/j.hrthm.2020.01.022

The innocent heart murmur is the topic of this week's podcast. How important is the echocardiogram in allaying parental fears and anxieties when being evaluated for a murmur? Have the days of auscultation without a secondary test fallen by the wayside? We speak with a highly experienced general pediatric cardiologist, Dr. Jared LaCorte of Staten Island Pediatric Cardiology to offer his thoughts on this week's work from Melbourne, Australia. doi: 10.1111/jpc.14775