Pediheart: Pediatric Cardiology Today

This week to conclude 2024 we speak with noted investment expert Mr. Paul Merriman to discuss a few topics related to personal finance and investing. First we tackle the notion of having 'enough' to retire. Is there a magic value and how would one think about this? Why is an S&P 500 Index or Total US Stock Market Index a fine 'core' investment and how might one possibly improve upon its performance? What are some of the psychological hurdles we have as investors and potential retirees? Mr. Merriman reviews these and other topics on our end of year episode. Wishing all a happy and healthy new year to you and your families and loved ones. Paul Merriman's Website: https://www.paulmerriman.comPaul's "Quilt" Chart: https://www.paulmerriman.com/12-hidden-lessons-from-investment-history#gsc.tab=0Paul's "Bootcamp" page: https://www.paulmerriman.com/bootcampLast Year's episode of Pediheart was replayed on Mr. Merriman's site: https://www.paulmerriman.com/pediheart-podcast-279-asset-allocation-in-your-retirement-ac

This week we replay episode #203 with Professor Michael Freed of Harvard University, who died this past week. In this episode from 2022 we review his seminal paper on prostaglandin for the treatment of infants with critical congenital heart disease from 1981 and then speak with Dr. Freed about his life, career, the development of PGE1 and more in this wide-ranging interview with this pediatric cardiology pioneer. Dr. Freed shares important career advice as he would to cardiology fellows during his long and illustrious career, advising and shaping the careers of pediatric cardiologists for 5 decades. doi: 10.1161/01.cir.64.5.899.

This week we delve into preventive cardiology with noted world authority, Associate Professor of Pediatrics, Dr. Carissa M. Baker-Smith of Nemours Health. In the present era, what roles do environment and social determinants of health play in cardiovascular disease? How should practitioners take a family history and how has the family history evolved in modern times? How can clinicians be sure that they are not 'missing' factors when they are trying to screen for cardiovascular disease risk in their patients? What are a few practical changes in how we speak with patients that we can all make to improve our understanding of our patients and their families? An important conversation this week with Dr. Baker-Smith.https://doi.org/10.1007/s11883-024-01232-4

This week we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the liver in the Fontan patient? Dr. Yuli Kim, Director of the ACHD program at The University of Pennsylvania shares her deep insights this week into this important topic. DOI: 10.1093/eurheartj/ehad788

This week we celebrate the life and career of Dr. Charles Mullins who passed this past week. Dr. Mullins was Professor of Pediatrics at Baylor College of Medicine and one of the pioneers in the world of congenital heart interventional cardiology. In today's episode we will listen back to an episode from 2021 from the SCAI 2021 meeting in which we interviewed Dr. Mullins and Dr. Julie Vincent (then Professor of Pediatrics at Columbia University). Drs. Mullins and Vincent discuss their lives as interventional cardiologists and also speak about the role that mentorship played in their long careers. Dr. Aimee Armstrong of Nationwide Children's Hospital also participates in this conversation. Following this interview replay with Drs. Mullins and Vincent, we speak with Dr. Frank Ing who is the Director of Pediatric Cardiology at UC Davis and the former director of the catheterization lab at Texas Children's and a former trainee and close friend of Dr. Mullins and his family. Dr. Ing shares his memories of training

This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the notion of social determinants of health? Ms. Meisol reviews this and more in our wide ranging conversation about the extraordinary Professor Helen Taussig. We also share a brief conversation of Dr. Taussig from 1977, speaking about her role in the development of the BTT shunt. For those interested, Ms. Meisel's book is available: https://bookshop.org/p/books/a-heart-afire-helen-brooke-taussigs-battle-against-heart-defects-unsafe-drugs-an

This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the notion of social determinants of health? Ms. Meisol reviews this and more in our wide ranging conversation about the extraordinary Professor Helen Taussig. We also share a brief conversation of Dr. Taussig from 1977, speaking about her role in the development of the BTT shunt. For those interested, Ms. Meisel's book is available: https://bookshop.org/p/books/a-heart-afire-helen-brooke-taussigs-battle-against-heart-defects-unsafe-drugs-an

This week we enter the world of cardiac CT for congenital heart disease reviewing a recent report of a survey of congenital cardiologists who perform congenital heart CT scans. What have been the important trends seen in the past decade beyond expansion in the field in general? Why has the use of the CT scan grown at such a rapid clip? How much radiation does a present day CT scan represent for a patient? How are cardiology fellowships responding to the growing role of this modality in the field? How can we more properly assign accurate relative value units (RVU's) to the significant work effort involved in the performance and reporting of this novel modality. We speak with the first author of this week's work, Assistant Professor of Pediatrics at Weill Cornell, Dr. Rebecca Epstein.  doi: 10.1016/j.jcct.2024.02.002. Epub 2024 Feb 15.

This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorization improves outcomes? What is the impact of this process on healthcare equity? These are amongst the questions reviewed this week with Dr. Brian Marcus who is a cardiologist and critical care fellow at Children's Wisconsin. DOI: 10.1007/s00246-023-03255-1

Pulmonary valve replacement following the arterial switch operation is rare. However, when necessary, how do techniques of transcatheter valve replacement fare for this indication? Why would average outcomes in this setting be less good than in the typical TPVR tetralogy of Fallot patient? How does the presence of stents in the pulmonary arteries in this patient group affect candidacy for TPVR? Are there ways to predict who might be a candidate for a TPVR vs. surgical PVR before coming to the catheterization lab? These are amongst the questions reviewed and posed to Dr. Stephen Nageotte who is the director of the cardiac catheterization laboratory at Loma Linda Children's Hospital in Loma Linda, California.  DOI: 10.1002/ccd.31152

This week we review a recent large scale study on catecholaminergic polymorphic ventricular tachycardia (CPVT) in children which is based on two large international registries. How do outcomes differ between those symptomatic CPVT patients treated with or without an ICD? Who amongst symptomatic CPVT pediatric patients likely warrant an ICD? What sort of ICD might be optimal - subcutaneous or transvenous? Are there ways to program ICD's in CPVT patients that may reduce inappropriate shocks? Why should the ICD be rarely employed in the CPVT pediatric patient? These are amongst the questions reviewed this week on the podcast. We speak with the work's senior author, Dr. Shubhayan Sanatani who is the chief of pediatric cardiology at BC Children's Hospital in Vancouver, British Columbia, Canada. doi: 10.1016/j.hrthm.2024.04.006. Epub 2024 Apr 7.

This week we delve into the worlds of cardiac critical care and neurodevelopment when we review a recent report from the team at Children's Hospital of Philadelphia assessing an association between postoperative opioid exposure in infants following CHD surgery and neurodevelopmental outcomes. What might be the biological basis for an association between these 2 factors? How confident can we be that opioid exposure is the factor of importance when there are so many co-variates and variables? We speak with outcomes research expert and interventional cardiologist Dr. Michael O'Byrne about this important and thought-provoking recent work.DOI: 10.1016/j.jacc.2024.06.033

This week we listen in on a lecture by Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Christopher Janson, on the novel agent ivabradine. How does this agent work and in what circumstances can it be used in pediatric arrhythmia management? Is this safe to use for critical arrhythmias despite the fact that it is, at present, only available as an enteral agent? What is the proper dosing regimen with this medication? Dr. Janson answers these and many more questions about ivabradine in this lecture from the Pedirhythm XI conference in Rome, Italy on 9/20/24. 

This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fabrizio Drago and the organizers of Pedirhythm for allowing us to listen in on this wonderful lecture by a world-wide authority. 

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland. DOI: 10.1161/CIRCULATIONAHA.122.063281

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to allow for an engaging back and forth and learning experience. Has either speaker swayed you? Take a listen!

This week we speak with noted interventional cardiologist Dr. Shyam Sathanandam of LeBonheur Children's Hospital in Memphis, TN about novel, 'off-label' uses of the Amplatzer Piccolo device in children. In what sorts of lesions does Dr. Sathanandam believe this device offers distinct advantages for vascular closure? What is the feature of this device that allows it to work for small defect closure so effectively and safely? Are there any new changes coming to this device or the delivery system for PDA closure in the premature infant? These are amongst the questions and topics reviewed with our guest this week!https://doi.org/10.1080/14796678.2024.2355057

This week’s episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation in the field? We speak with third year cardiology fellow, Dr. Ogochuckwu M Ezeoke Cox, MD of C.S Mott Children’s Hospital at the University of Michigan about her recent essay on this vital topic. https://doi.org/10.1007/s00246-023-03144-7

This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He has done and seen it all and has a unique perspective. How did he achieve so much and still have a succesful 56 year marriage to his wife Carol Ann? What is Dr. Brown most proud of in a career that is as prolific as his? What advice would he have have for the next generation? Prepare to be inspired by this master surgeon and friend and colleague of many in our field. 

This week we delve into the world of the single ventricle when we speak with Dr. David Hoganson, Assistant Professor of Surgery at Harvard Medical School about a recent work he co-published with investigators from Boston Children’s Hospital on computational fluid dynamic modeling in the planning of the Fontan operation. Single ventricle heterotaxy patients with interrupted IVC are at enhanced risk for the development of pulmonary AVM’s due to flow maldistribution to the pulmonary arteries from the hepatic veins in a Fontan. Can a computational fluid dynamic model predict which operative approach would result in the most balanced hepatic venous flow distribution? Can this reduce the incidence of pulmonary AVM’s? How well did the models predict the actual pulmonary flow measured after surgery on CMR? Who beyond the heterotaxy patient might benefit from this approach? Dr. Hoganson offers us a peek into the world of personalized surgery in this week’s exciting episode.         DOI: 10.1016/j.jacadv.2024.101057