Pediheart: Pediatric Cardiology Today

This week we delve into the world of electrophysiology and also single ventricle physiology when we review a recent work from the Stanford group on outcomes after the development of ventricular arrhythmias in the single ventricle Fontan patient. Just how worried should the clinician be when these are recorded on ambulatory ECG monitors? What associations exist between these arrhythmias and the use of a Sano shunt? How should the clinician respond to a finding of non-sustained VT in the single ventricle patient? Who is a candidate for an ICD in this setting? These are amongst the questions posed to the first author of this week's work, Clinical Assistant Professor of Pediatrics and electrophysiologist at Stanford University, Dr. Heather Giacone. doi: 10.1161/CIRCEP.122.011143

In this week's episode, we delve into the world of pediatric heart transplantation and the impact that race or insurance status may have on outcomes. What are the factors that explain worse outcomes for black children waiting for a heart transplant? How is the PHTS Racial Disparity Taskforce working to reduce inequities in this field? What role does insurance status have on these outcomes? We speak with noted heart failure and transplantation expert, Dr. Neha Bansal who is Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai about this most recent PHTS multicenter study. DOI: 10.1016/j.healun.2022.12.002

In this week's first of 2 Pediheart podcast releases, we review the nursing and critical care tracks of the upcoming 8th World Congress of Pediatric Cardiology and Cardiac Surgery coming in late August, 2023. In this collaborative podcast between the Pediheart and PCICS podcasts, hosts Robert Pass, Sadie Rodriguez and Deanna Tzanetos speak with Dr. Amir Ashrafi of CHOC, Bruna Cury of Sao Jose do Rio Preto in Brazil and Dr. Sandra Staveski of UCSF about the upcoming meeting. Dr. Ashrafi, Ms. Cury and Dr. Staveski are on the planning committees and share some of the most exciting aspects of their various tracks in the upcoming meeting.For more information about the World Congress, please go to the website:https://www.wcpccs2023.org/event/1da8563e-0f65-486c-88df-70c3db431af5/summaryAnd don't forget to take a listen to Episode #257 of Pediheart also released today on the topic of fetal cardiology!

In this week's episode we speak with Assistant Professor of Pediatrics at Mount Sinai, Dr. Jennifer Cohen about a recent large scale Fetal Heart Society project she conducted on the topic of fetal ccTGA and outcomes. What observations in fetal life are associated with worse clinical outcomes? Why is it valuable to perform serial fetal echocardiograms in this patient group? How common are genetic or extracardiac abnormalities in this patient group? These are amongst the many questions reviewed with Dr. Cohen in this week's extra special 2 episode release week. DOI: 10.1161/JAHA.122.029706

This week's episode is a collaborative episode between the Pediheart and PICS Podcasts and we have 4 guests. Joining us this week are Dr. Carissa Baker-Smith of Nemours Medical Center in Delaware, Dr. Martina Bruekner of Yale University, Dr. Shelby Kutty of Johns Hopkins University and Dr. Jacqueline Sanz of Children's National Hospital. In this week's episode we learn about the general cardiology, imaging, neurodevelopmental and basic science tracks. Each guest representing the planning committee for their respective tracks will share some of the upcoming highlights of this wonderful and comprehensive conference. The list of topics of interest is positively dizzying and you will not want to miss this exciting introduction to some of the more popular tracks coming in late August, 2023!The World Congress of Cardiology and Cardiac Surgery will take place 8/27-9/1 and information can be obtained about it at this website:https://www.wcpccs2023.org/event/1da8563e-0f65-486c-88df-70c3db431af5/summary

This week we re-review a 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 work on this topic.doi: 10.1016/j.hlc.2020.05.114

In this week's episode from SCAI 2023, we speak with Professor Kritvikrom Durongpisitikul of Mahidol University, Siriraj Hospital in Bangkok, Thailand about their experience in transcatheter and surgical pulmonary valve replacement (PVR). Who is a candidate for each in the present era? Why was surgery associated with higher mortality rates in this work? Should the criteria for transcatheter PVR differ in comparison with surgery? Dr. Durongpisitikul shares his insights in this live session from SCAI which is co-moderated by Dr. Aimee Armstrong of Children's Nationwide Hospital. https://doi.org/10.1016/j.jscai.2022.100408

In this week's episode from SCAI 2023, Dr. Aimee Armstrong of Nationwide Children's Hospital joins Dr. Pass in a live session from the annual scientific sessions of SCAI. Professor of Pediatrics at UC Davis, Dr. Frank Ing, reviews his experience with recanalization of central veins in a large pediatric cohort. Who is a candidate for this intervention? When are stents preferred vs. angioplasty alone? Should all patients having central lines removed be evaluated to prevent venous occlusion? What sort of radiation dose is associated with this intervention? Dr. Ing shares his deep knowledge in a live "Pediheart" session from Phoenix, Arizona on 5/19/23 at SCAI 2023. https://doi.org/10.1016/j.jscai.2022.100547

In this week’s episode we delve into the evidence for digoxin reducing mortality in the interstage period following Norwood palliation for HLHS. We speak with Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Michael O’Byrne about a recent analysis of the PHIS database using the relatively novel “preference based instrumental variable” approach to analysis of an observational data set. How does this approach allow for possible proof of causation of effect of a variable? Why might digoxin reduce mortality in the HLHS patient following stage I palliation? Are there patients in which the impact of this agent might be greater than others? These are amongst the many questions reviewed this week with Dr. O'Byrne.https://doi.org/10.1016/j.ahj.2023.05.005

In this week's episode 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 delve into a critically important topic which is the mental health of our patients with chronic disease. How common are mental health issues amongst patients with sickle cell disease, cystic fibrosis and congenital heart disease? What accounts for differences in diagnosis or treatment of things like anxiety, depression or ADHD in these different chronic disease state patients? What is structural racism and how does this impact these findings? What is the solution to the under-recognition of mental health disorders in these chronic medcial patients? We speak with ACHD fellow at Texas Children's Hospital and the first author of this week's work, Dr. Vincent J. Gonzalez. DOI: 10.1016/j.jpeds.2023.113411Thanks to all who have been listening to the podcast the past 5 years on today's landmark, 250th episode.

This week we delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author, Dr. Anushree Agarwal, Assistant Professor of Medicine at UCSF, shares her insights into this important topic. DOI: 10.1161/JAHA.122.026732Also mentioned in today's episode is episode #222 with Dr. Dan Halpern of NYU medical center (https://www.stitcher.com/show/pediheartpediatric-cardiology-today/episode/pediheart-podcast-222-impact-of-cardiac-rehab-on-exercise-tolerance-in-the-achd-patient-206781483)

This week in a replay of a previous co-branded episode with the SADS Foundation (SADS.ORG) from 2.5 years ago, 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 nearly 250 episode series! doi: 10.1161/CIRCULATIONAHA.120.048916

In this episode we speak with Professor of Surgery at the University of Pennsylvania, Dr. Stephanie Fuller about a recent work she co-authored on the impressions of CT surgical trainees and attitudes towards the field of congenital heart surgery. What factors were important amongst those surgeons who chose to pursue the field? What are the obstacles that may make it less appealing to the CT surgical trainee? How can surgeons be effectively trained in this demanding field in an era of public reporting and USNWR rankings? What sort of innovation is happening today to improve the training of congenital heart surgeons? Dr. Fuller shares her deep insights this week. doi: 10.1053/j.semtcvs.2022.03.004

This week we sit down and speak with living legend of pediatric and congenital cardiology, Dr. Welton Gersony who is Professor Emeritus of Pediatrics at Columbia University. Dr. Gersony was the chief of cardiology for 4 decades at NY Presbyterian Hospital and is the winner of innumerable awards in our field. Today we speak with him about his life, choices and what he loved most about medicine and cardiology. What does he view as maybe his biggest impact? What was it like to work directly with/for Dr. Alexander Nadas? What is Dr. Gersony's relationship to the Kennedy family? All this and more in this fascinating discussion with someone who was there for so much of the beginning of our field and who continues to contribute even to this day.

This week we review a recent report that focuses on the question of whether the direct thrombin inhibitor, bivalirudin is superior to heparin for the small patient with a paracorporeal device both from a medical and financial perspective. Bivalirudin is 40x the cost of heparin but does that capture all of the costs and how does overall cost differ between patients treated with one versus the other agent? We speak with Assistant Professor of Pediatrics at University of Vermont, Dr. Danielle Burstein about a large PHIS database study she recently published on this topic.DOI:10.1016/j.healun.2022.10.006Also joining us this week is Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai, Dr. David Ezon to share with us the exciting news about our upcoming, in person, imaging course entitled: The Right Heart - Conversations In Care. The list of speakers is dizzying and come from the worlds of imaging but also interventions - both surgical and cardiac catheterization. Amongst a cast of many

This week we delve into the world machine learning and decision tree analysis modeling as it is applied to postoperative heart block decisions. Traditional thinking suggests that all congenital heart surgical patients with postoperative heart block should be observed for 7-10 days to allow for possible resolution of conduction block. However, is 7 days truly required in all cases? Are there patients in whom 7 days is not necessary? What could the impact be of earlier pacemaker insertion in these patients? How early can the decision to pace permanently be made and in whom? How does machine learning allow for a potentially more powerful model for this sort of analysis? We speak with Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai, Dr. Son Duong about an exciting work he co-authored at Stanford University. DOI: 10.1161/CIRCEP.122.011145

This week's episode of the podcast is supported by the SADS Foundation (SADS.ORG) and is on the topic of the overdiagnosis of LQTS. What sorts of conditions can lengthen the QT interval without true congenital LQTS syndrome? What are the most common errors of ECG interpretation that account for misdiagnosis of this condition and are there leads of the ECG that might help or hurt when attempting to accurately measure the QT interval. What is the role of the ICD in the LQTS patient? We speak with Professor of Pediatrics, Medicine and Pharmacology at the Mayo Clinic Alix School of Medicine, Dr. Michael Ackerman about a recent work he published on this important topic.doi: 10.1016/j.jacc.2022.11.036.

In this replay episode from 2021, 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 review a recent report of a new technique to implant SAPIEN valves for transcatheter pulmonary valve replacement in which 1-3 stents are implanted simultaneously with the SAPIEN valve. What are the potential benefits or disadvantages of this approach and who might be a better candidate for this method? Why is a stent needed outside of the relatively strong SAPIEN prosthesis and how does the team in San Diego choose bare metal vs. covered stents when performing this procedure? We speak with pediatric interventional cardiologist Dr. Jessica Heibel of Pediatrix in San Antonio, Texas about a recent work she co-authored with the team at Rady Children's Hospital in San Diego, California. Dr. Heibel reviews many of the finer points of transcatheter valve implantation this week. DOI: https://doi.org/10.1016/j.jscai.2022.100553