Pediheart: Pediatric Cardiology Today

In this week's episode we review a recent Dutch study on 50 year follow-up of patients who had ASD repaired at an average age of 7.5 years. How do these patients compare to their middle aged counterparts who did not have congenital heart surgery? Why might the RA or RV be enlarged in these patients, decades after successful ASD closure? How common are arrhythmias seen in this cohort? How common is pulmonary hypertension seen? These are amongst the questions reviewed this week with the work's first author, Dr. Robert Martijn Kauling.DOI: 10.1016/j.ijcard.2023.131616

This week we review a recent report from the team at Boston Children's Hospital on outcomes of patients following Stage I palliation for HLHS. When patients are not doing well following this surgery, how important is it to identify surgical problems early in these patients? What are the most common problems encountered when a problem is observed? When a reintervention is performed in this setting, how do patients fare overall and is the timing of the reintervention a factor in overall outcome? Cardiac surgeon and Assistant Professor of Pediatrics at Harvard University, Dr. Meena Nathan shares her insights this week. doi: 10.1016/j.jtcvs.2022.04.033

Unplanned extubation in the PCICU patient is a serious concern with many untoward associations. Who is at highest risk for this complication? Why is this complication associated with worse outcomes in general? How does race or ethnicity impact the likelihood of this complication? We speak with Assistant Professor of Pediatrics at the University of Cincinnati and pediatric cardiac critical care expert, Dr. Tanya Perry about a recent PC4 registry study on unplanned extubation in the PCICU. doi: https://doi.org/10.1097/pcc.0000000000003235

To conclude 2023 we end with noted national authority on personal finance and investing, Mr. Paul Merriman. Mr. Merriman reviews some basic ideas about asset allocation within a retirement plan such as a 403b, 401k or IRA with the goal of achieving the highest degree of return for level of risk. He reviews the importance of diversification and also shares with us both a '2 fund' and '4 fund' approach to creating a low cost, efficient and diversified portfolio that has, historically, been associated with good long term returns. Mr. Merriman's work can be seen at: paulmerriman.comFor those interested learn more about his '2 Fund' solution: https://www.paulmerriman.com/2-funds-for-life-update-2023For those interested to learn more about his '4 Fund' solution: https://www.paulmerriman.com/4-fund-comboFor those interested in target date funds: https://www.paulmerriman.com/target-date-fundsFinally, for those who did not previously take advantage of Paul's free book, the following is a link to a free PDF of the book

To conclude 2023 we end with noted national authority on personal finance and investing, Mr. Paul Merriman. Mr. Merriman reviews some basic ideas about asset allocation within a retirement plan such as a 403b, 401k or IRA with the goal of achieving the highest degree of return for level of risk. He reviews the importance of diversification and also shares with us both a '2 fund' and '4 fund' approach to creating a low cost, efficient and diversified portfolio that has, historically, been associated with good long term returns. Mr. Merriman's work can be seen at: paulmerriman.comFor those interested learn more about his '2 Fund' solution: https://www.paulmerriman.com/2-funds-for-life-update-2023For those interested to learn more about his '4 Fund' solution: https://www.paulmerriman.com/4-fund-comboFor those interested in target date funds: https://www.paulmerriman.com/target-date-fundsFinally, for those who did not previously take advantage of Paul's free book, the following is a link to a free PDF of the book

In this replay episode from 5 years ago in 2018, we enter into the world of cardiac morphology and speak with Professor Leo Lopez of Stanford University about a recent work he wrote with the International Society for Nomenclature of Pediatric and Congenital Heart Disease regarding proper nomenclature for VSD's. Is it defect geography or borders that are most important in naming these structures? How was agreement forged between such disparate super-hero experts in cardiovascular medicine and congenital heart disease? Is Dr. Lopez using these designations at the present time? What's next for the nomenclature group? Dr. Lopez shares his insights this week.As a special treat, Dr. Lopez also sings as the musical coda to today's program. A very special treat indeed and certainly worth replaying! Hoping that all enjoy! doi: 10.1016/j.athoracsur.2018.06.020

This week we return to the world of ACHD when we review a recent German research paper on the prevalence of PTSD symptoms amongst the ACHD patient group. How common is this type of symptom observed in the ACHD patient group? What contributes to the high prevalence (17-20.5%) described in this work? What are the benefits of 'embedding' a mental health care worker in the ACHD clinic/program? What strategies can be employed in pediatric cardiology to potentially mitigate PTSD symptoms in our future ACHD patients? These are amongst the many topics reviewed this week with the Mount Sinai ACHD program clinical social worker, Ms. Meredith Kalbacker who also comments on this week's work. DOI: 10.1016/j.amjcard.2023.06.087For those interested, the book referenced by Ms. Kalbacker, Healing Hearts and Minds, can be purchased on Amazon:https://www.amazon.com/Healing-Hearts-Minds-Holistic-Congenital/dp/0197657281

In this week's episode we delve into the world of cardiac catheterization and speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel about a recent work he co-authored at Children's LA about continuation of anti-coagulation during catheterization. Does AC have to be stopped to safely perform a catheterization? Are there certain cases or patients in whom the risk may be especially high? What about NOACs or DOACs? When should closure devices be considered? These are amongst the questions posed to Dr. Patel this week.DOI: 10.1007/s00246-023-03097-x

This week we review a recent work on postoperative ectopic atrial tachycardia (EAT) following congenital heart surgery in children. Are there risk factors for this arrhythmia and are any modifiable? What is the 'go to' therapy used by the electrophysiologists at Children's LA for the acute and chronic treatment of this arrhythmia in the postoperative period? Is the presence of EAT in a postoperative congenital heart patient a marker for a worse outcome? These are amongst the questions posed to Children's of Los Angeles pediatric electrophysiologist, Dr. Jonathan Uniat. DOI: 10.1007/s00246-022-03068-8

This week we review the results of the latest update of the Single Ventricle Reconstruction trial, specifically SVR III. How are HLHS patients are faring post Norwood at age 12? What is the overall transplant-free survival rate in this group? Are there differences in survival seen at 12 years between BTTT shunt patients and RV-PA conduit shunt patients? How do they compare in exercise capabilities? What about rates of PLE or arrhythmias seen? Are there interventions that may improve outcomes going forward? These are amongst the questions reviewed this week with the first author, Dr. Caren Goldberg who is Professor of Pediatrics at the University of Michigan. DOI: https://doi.org/10.1161/circulationaha.123.065192

This week's special episode of Pediheart is a conversation with NYT author James G. Robinson. Mr. Robinson recently released his memoir More Than We Expected: Five Years With A Remarkable Child (Post Hill Press) which reviews the life and times of the Robinson family and their son Nadav who was born with complex single ventricle disease in the setting of heterotaxy syndrome. Nadav lost his life at age 5 but was a blessing to his family and those who knew him. What were some of the characteristics of the better medical communicators that the Robinson's observed? How can parents better advocate for their children during times of critical illness? How can we all bring the 'simple power of human kindness' to our care of children with congenital heart disease? Why is the opinion of the parent so important in delivering optimal care to a child with serious disease? These are amongst the many lessons we take away from Mr. Robinson's book and our conversation this week. More Than We Expected: Five Years With A Remark

This week we delve into the worlds of cardiac critical care and congenital heart surgery when we review a recent report of a randomized controlled trial assessing the impact of nasal intubation on rates of NG or G tube feeds at discharge following neonatal congenital heart surgery. Do nasally intubated patients eat by mouth faster and have shorter lengths of stay? What would be the theoretical reasons that this might be useful? What is an 'ICU Liberation bundle' and how did its application to all postop newborns improve outcomes? Can the route of tracheal intubation truly be viewed as a possible 'modifiable risk factor'? These are amongst the questions posed to cardiology fellow at the Cleveland Clinic, Dr. Melissa Yildirim who conducted this study at the University of Virginia during pediatric critical care fellowship. doi: 10.1007/s00246-023-03322-7

This week's episode is co-branded with SADS.ORG and is a review of a recent multicenter PACES study on the general outcomes of patients with congenital heart disease who have undergone MRI's. Just how worried should the practitioner be to send a pacemaker or ICD patient for an MRI of any body part? Is there a period of time after implantation when it is safer to proceed with an MRI? What is meant by an MRI conditional device or lead? Does the part of the body imaged matter in regards to risk to CIED's? These are just some of the questions posed to the senior author of this week's work, Dr. Thomas Pilcher of Primary Children's Hospital in Salt Lake City, Utah. doi: 10.1016/j.hrthm.2023.08.034For those interested to learn more about the SADS Foundation, please visit their website:SADS.ORG

In this week's episode we sit down with Professor Jane Newburger of Harvard University to learn a little bit about her life and times. Where did she grow up and who was her inspiration for becoming a doctor and cardiologist? Who were some of the mentors in her professional life? What was it like to work with Dr. Ami Rosenthal or Dr. Alexander Nadas? After such a rich and impactful career and life, what does Dr. Newburger count as her most satisfying and important accomplishments? These are amongst the many questions posed to Dr. Newburger during a live interview from the New England Congenital Cardiology Association (NECCA) in Rockport, Maine that took place on 10.21.23. Also joining the podcast to discuss the organization and its goals and accomplishments is its immediate past president, pediatric cardiac electrophysiologist, Dr. Michael Epstein. For those interested to learn more about NECCA, please go to their website: https://necca.wildapricot.org

In this replay episode of 2021, week we review a work on the use of bivalirudin on outcomes of pediatric VAD patients. We speak with Dr. Caroline Carly Heyrend of Primary Children's Hospital in Utah about a recent work she co-authored on time in therapeutic range for this agent in children with VAD's. How does bivalirudin work differently than heparin and what are the theoretical benefits or disadvantages of this agent in comparison with unfractionated heparin? Why are thrombotic complications still common amongst those with pediatric VAD's even when anticoagulation is maintained appropriately? What are the factors at work that make safe anticoagulation so difficult in this complex and fragile group of patients? Dr. Heyrend provides the pharmacist's perspective this week.DOI: 10.1097/MAT.0000000000001261

This week we delve into cardiovascular surgery when we review a recent report from the Congenital Surgeons' Society on the outcomes of the hybrid approach of pulmonary artery bands for treatment of infants with critical left heart obstructive disease. What risk factors are associated with worse outcomes? Does this approach confer an advantage in comparison to the traditional 'stage I/Norwood' approach to this problem? Does the presence of multiple risk factors worsen outcomes and if so, to what degree? How does the heterogeneity of indications for this approach to obstructive left heart lesions stymie efforts to study this intervention? DOI: 10.1016/j.jacc.2023.07.020Editorial Comment :DOI: 10.1016/j.jacc.2023.08.023

This week we discuss the role of the stress echo in the evaluation and follow-up of the patient with Kawasaki disease. What are the present recommendations on the role of this form of imaging in this patient group? What are its benefits and limitations? Can this form of testing provide actionable data beyond imaging such as CT angiography? What is the possible role of CMR in the management and follow-up of the KD patient? Dr. Kirstin Dummer of Rady Children's Hospital shares her deep insights into this endlessly fascinating topic. DOI: 10.1007/s00246-022-03037-1The AHA Scientific Statement On KD:DOI: 10.1161/CIR.0000000000000484

This week we delve into the world of fetal cardiology when review a recent report from Nationwide Children's Hospital on the utility of fetal echocardiography in the setting of a negative obstetrical ultrasound and Down syndrome. Down syndrome is associated with congenital heart disease but can the obstetrical ultrasound effectively rule out 'critical' newborn heart disease, obviating the need for a fetal echo, particularly if a postnatal transthoracic scan is planned? Associate Professor of Pediatrics, Dr. Clifford Cua shares his thoughts on this provocative question and work. doi: 10.1007/s00246-023-03183-0.Epub 2023 Jun 23.

This week we discuss an important 'general cardiology' question - namely, do all exertional chest pain patients need an echocardiogram. In this debate from the World Congress of Pediatric Cardiology and Cardiac Surgery, we hear 2 noted authorities in non-invasive imaging. First up is Dr. Carolyn Altman of Texas Children's Hospital taking the stance that it is indicated in the majority and following Dr. Altman is Dr. Kenan Stern of Mount Sinai Kravis Children's Hospital defending the role of discretion in these decisions and how 'one size may not fit all'. Both authorities provide deep insights into general cardiology and the nuances of evaluating a common cardiology complaint seen in general practice.

This week we delve into the world of interventional cardiology and specifically that of transcatheter valves when we review a recent report on the Harmony valve. How are these valves performing at one year in regards to valvular function? Is frame fracture an issue? What percentage required reintervention? How common was ventricular tachycardia seen? Should patients undergoing these implantations undergo pre-procedural EP studies? We review these questions and more with the first author of this work, noted authority on interventional cardiology, Dr. Matthew J. Gillespie, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. https://doi.org/10.1016/j.jcin.2023.03.002