Pediheart: Pediatric Cardiology Today

This week we delve into the world of cardiovascular surgery when we review a recent paper from the team at Texas Children's Hospital about the BTT shunt. How commonly did shunts have serious complications? Does the location on the aorta matter in regards to shunt complications? What size shunt is associated with the least morbidity or mortality? Why might shunt placement via a thoracotomy be superior to sternotomy. These are amongst the many questions reviewed with the first author of this work, second year cardiology fellow at Primary Children's Hospital, Dr. Andrew Headrick. DOI: 10.1016/j.athoracsur.2021.11.003

This week we review a recent large scale administrative database study assessing racial and socioeconomic disparities in congenital heart disease outcomes in the US. How does patient neighborhood income affect outcomes? How does the presence of Down Syndrome mitigate risk? How does race or socioeconomic status affect length of stay? How can these data inform change to improve outcomes for all children with CHD? Professor Tara Karamlou of Cleveland Clinic Children's shares her deep insights into this critically important factor that may be every bit as important as the congenital heart anatomy. We also speak briefly in tribute to Dr. James Tweddell of Cincinnati Children's Hospital, who tragically passed last week. DOI: 10.1016/j.athoracsur.2021.04.008

This week we delve again into the controversy regarding optimal newborn management of the symptomatic newborn with tetralogy of Fallot. Does palliation offer a cost savings versus primary repair for the symptomatic TOF patient? What impact does the advent of transcatheter palliative approaches have upon cost? We speak with the first author of this week's work, Assistant Professor of Pediatrics at University of Pennsylvania, Dr. Michael O'Byrne. doi: 10.1016/j.jacc.2021.12.036

This week we turn back to 2020 and delve once more 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 review a recent large claims database study on WPW in children that aims to identify the true incidence of life threatening events in children with this condition. What is known about the incidence of life threatening events as well as the actual prevalence of WPW amongst children? What are the strengths and limitations of large claims database studies? How high is the risk for VF in the WPW child and how should this knowledge inform decisions regarding ablation? Noted expert in WPW, Dr. Christopher Janson of Children's Hospital of Philadelphia shares his insights this week. https://doi.org/10.1016/j.hrthm.2021.12.009

This week we speak with Associate Professor of Pediatrics at University of Washington Sujatha Buddhe of Seattle Children's Hospital about a recent survey study she conducted regarding CMR in the pediatric and congenital heart patient. How have volumes of cases changed over the past few years? Who is reading these studies? What is the advantage of a 1.5T vs. 3.0T scanner for congenital scans? What are the advantages and limitations of a survey study? Dr. Buddhe provides the answers this week. DOI: 10.1186/s12968-021-00830-4

This week we delve into the world of heart transplantation to review a recent article on the topic of outcomes of the Down syndrome patient undergoing heart transplantation. Are infections or cancers more common in this patient group following transplantation? What role does intellectual disability play in the present era in decisions regarding transplantation in this patient group? Associate Professor of Pediatrics at Vanderbilt University, Dr. Justin Godown, shares his insights into this important topic. doi: 10.1161/JAHA.121.024883

This week we play a session of the podcast from SCAI 2022 in Atlanta with Professor of Pediatrics, Columbia University - Dr. Christopher Petit reviewing a recent publication on the topic of systemic sirolimus in concert with catheter interventions for the treatment of pulmonary vein stenosis. Who is a candidate for this sort of therapy? Does systemic sirolimus confer a survival benefit over local stent delivery? Who should be caring for patients with pulmonary vein stenosis? Who is a candidate for transcatheter intervention vs. surgical intervention? Dr. Petit provides the answers in this live session from SCAI 2022. doi: 10.1016/j.jacc.2021.04.013

This week in a live session from SCAI 2022 we hear Assistant Professor of Pediatrics, Dr. Eimear McGovern shares her insights into a recent work she co-authored on changes in Fontan dimensions over time. Who needed interventions and how does the team in Kentucky choose to perform surveillance catheterizations on their Fontan patients? Is there an optimal time? What degree of stenosis or narrowing of a Fontan deserves intervention? Dr. McGovern provides the answers from Atlanta's SCAI Scientific Sessions on 5.21.22. doi: 10.1007/s00246-021-02658-2.

In this replay of episode 92 from 2019, we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if anything, can 'move the needle' to higher levels of survival in this patient population? Dr. Brink offers some interesting and important insights this week. doi: 10.1016/j.jtcvs.2019.03.126

This week we review a recent report from Lurie Children's in Chicago on the impact of fetal diagnosis of vascular rings. Does prenatal knowledge of this problem enhance postnatal outcomes? Who deserves cross sectional imaging after birth if prenatally diagnosed with a ring or sling and when and how should this be performed? We speak with Assistant Professor of Surgery at the Mayo Clinic, Dr. Elizabeth Stephens about a recent work she authored on this topic. We also briefly speak with Dr. Kenan Stern about the upcoming, free Mount Sinai Kravis Children's Hospital imaging course that is fast approaching on 5/20/22. DOI: 10.1016/j.athoracsur.2021.01.025

This week we review a recent report from the team at Boston Children's Hospital about a novel approach to avoid heart block during complex congenital heart surgery? Assistant Professor of Pediatrics at Harvard Medical School Elizabeth DeWitt shares with us her insights into a recent report she co-authored by the departments of surgery and cardiology at her institution about intraoperative mapping of conduction. How easy is it to identify the conduction system and how effective at avoiding heart block? Who is a good candidate for this approach? Dr. DeWitt offers her insights as does Dr. John Triedman, Chief of Electrophysiology and a co-author. Dr. Triedman also shares with us information regarding the upcoming PedirhythmX conference that will be held in Boston 9/22-9/24. DOI: 10.1016/j.xjtc.2021.11.017

This week we move into the world of cardiac surgery when we review a recent work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the pharmacist's perspective on some of these important questions. https://doi.org/10.1016/j.athoracsur.2022.02.047

This week we delve into two areas of interest - fellowship training and fetal cardiology when we review a multi-center work endorsed by the Fetal Heart Society on the topic of fetal heart disease counseling. How is this skill taught to cardiology fellows and what are the deficiencies that present exist? Is empathy something that can be taught? What efforts are afoot regarding formalized curricula for this topic? What is the best way to train this critical skill for the cardiologist providing fetal cardiology counseling? We speak with the first author of this week's work, Assistant Professor of Pediatrics at UT Southwestern, Dr. Jenna Keelan. DOI: 10.1007/s00246-022-02882-4

In this week's replay episode 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 we speak with living legend of cardiology, Dr. Michael Freed about his life and also his landmark paper in 1981 on PGE1. How did Dr. Freed come to conduct one of the first multi center trials of an agent in pediatrics? What was life like in the world of pediatric cardiology prior to PGE1? What is Dr. Freed up to today? What advice does he have for the younger generation? This is a rare opportunity to speak with one of the living legends of our field. DOI: 10.1161/01.cir.64.5.899

This week we review a recent work from the team at NY Presbyterian on SVT and a possible role it may rarely play in sudden cardiac arrest in children. When a patient does not have an obvious cause of arrest, is SVT a possible etiology and should invasive EP testing be considered? We speak with the senior author of this work, Dr. Leonardo Liberman about his thoughts on SVT as a possible cause of arrest and who amongst the many non-pre-excited SVT patients are perhaps 'higher risk'. doi: 10.1007/s00246-021-02720-z

This week we review the concept of stenting the pulmonary veins and we speak with Assistant Professor of Pediatrics at Baylor Medical College, Dr. Melissa Webb about a recent work she co-authored on this topic. Dr. Webb reviews a novel approach to shortening Palmaz stents and then reviews for us the rationale for stenting PV's and also discusses how these patients are longitudinally followed at Texas Children's Hospital. doi: 10.1002/ccd.29984

In this milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace. doi: 10.1007/s00134-004-2504-1

This week's replay episode is co-branded with SADS.ORG and is on the topic of pre-participation screening from 2 years back. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm.2020.04.032