Pediheart: Pediatric Cardiology Today

This week we travel back in time to 1991 to review one of the first collaborative projects between Dr. Lisa Hornberger of U. Alberta and the legendary pediatric cardiology investigator, Dr. David Sahn. In this work on tricuspid valve disorders with TR and their diagnosis in fetal life, we learn about our first understandings of this complex physiology and problem and use this as starting point to speak about Professor Sahn, who passed just a few weeks ago. Dr. Hornberger was one of his most important mentees and was inspired to become a fetal cardiologist from her work with this master of echocardiography. Here Dr. Hornberger share her thoughts on Ebstein's anomaly but also Dr. Sahn and the meaningful impact a mentor can have in shaping a person's entire life and career. Prepare to be inspired by the tale of Dr. Sahn and Dr. Hornberger this week. DOI: 10.1016/0735-1097(91)90722-l

In a replay of episode #90 from 2019, we re-review a recent report from the CTOTC-04 study group assessing the impact of novel anti-rejection approaches which generally markedly reduce or remove steroids in the prevention of rejection. How are rejection rates affected by such an approach? Did incidences of diabetes or PTLD differ when using this form of steroid reduced approach in the 'low immunological risk' subset of patients undergoing heart transplantation? We speak with the first author of this work, Professor of Pediatrics, Dr. Jacqueline Lamour of the Icahn School of Medicine at Mount Sinai. Dr. Lamour provides deep insights this week! doi: 10.1016/j.healun.2019.06.006

This week we delve into general pediatric cardiology and discuss those mild abnormalities that are sometimes seen on echo in the newborn nursery. Which of these minor findings in healthy newborns should be monitored and who can be 'discharged' from cardiology follow-up? Are there data to help inform these decisions? Dr. John Hokanson, Professor of Pediatrics, U. Wisconsin, shares his insights this week. DOI: 10.1007/s00246-021-02795-8

This week we review a recent CMR study assessing changes in myocardial fibrosis identified with CMR T1 mapping seen in TOF patients with a single nucleotide polymorphism (SNP) of hypoxia inducible factor 1 alpha. Is myocardial fibrosis in the TOF patient due to hemodynamic factors alone or are there genetic factors that predispose to differences that can be measured on CMR? Professor Lars Grosse-Wortmann of OHSU shares his deep insights into this fascinating topic in which our understanding is rapidly evolving. doi: 10.1016/j.ijcard.2021.12.047

Melody valves have been demonstrated to be associated with a small but consistent rate of endocarditis. Are there factors that might help predict who would need surgical explantation versus those who can be medically managed without surgery? Dr. Arpine Davtyan, senior cardiology fellow at Rady Children's Hospital shares insights from her recent multicenter, retrospective study on this topic. doi: 10.1007/s00246-021-02801-z

Dr. George Ofori-Amanfo, Division Chief of Pediatric Critical Care Medicine in the Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai and at the Mount Sinai Kravis Children's Hospital, died last week after a very long illness. To honor him, we go back to episode #2 in 2018 in which Professor Ofori-Amanfo shares his insights into the delivery of cardiovascular care in the developing world. Following this interview, the first in the entire Pediheart series, we hear from a large number of prominent nurses, cardiologists, critical care physicians, and surgeons who each offer their appreciations of Dr. Ofori-Amanfo. His impact will be long lasting and he will be missed.

This week's episode, the final of 2021, is on personal finance and we speak with noted personal finance expert Paul Merriman about strategies to improve investing results within a retirement account. Mr. Merriman reviews index funds, the value of these over 'actively managed' funds, and his thoughts on 'target date funds'. Finally, he shares a strategy that may improve the outcome of a target date fund strategy. Here's to a good 2022.

This week we revisit episode 135 where we discussed the topic of mortality attributable to CHD in the US and persistent racial/ethnic disparities over the past 20 years. We speak with Professor Keila Lopez of Texas Children's Hospital about a recent large scale, 'big data' study she co-authored about this topic and review the reasons for these disparities and think about possible remedies. An essential episode on a critically important topic for CHD care. doi: 10.1161/CIRCULATIONAHA.120.046822

This week we delve into the world of congenital heart disease when we review a recent work from the team at Boston Children's Hospital on the long term outcomes of truncal valves in the setting of truncus arteriosus. Who amongst truncus patients is at risk for the development of truncal regurgitation or a need for reintervention? Are there predictors that might help forecast patients who should be more closely monitored? How do the data in this work help inform the fetal counseling of the team at Boston Children's Hospital? Instructor in pediatrics, Dr. Laura Gellis, the first author of this week's work, shares her deep insights into this topic this week! doi: 10.1161/JAHA.120.019104

This week we delve into the coronavirus pandemic and specifically the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection. When there was significant initial cardiac involvement seen in the setting of MIS-C, what findings are common in the CMR of patients 6+ months later? How common is delayed enhancement seen and how does this compare with findings seen in other myocarditis patients? Who should be referred for a CMR following MIS-C? Dr. David Barris, 2nd year cardiology fellow at Mount Sinai Kravis Children's Heart Center in NYC and the first author of this week's work, provides the answers this week. DOI: 10.1016/j.jpeds.2021.10.009

This week we turn to a recent work from the group at Texas Children's Hospital about IV sotalol and the treatment of junctional ectopic tachycardia (JET). How did sotalol fair in comparison to IV amiodarone for the treatment of this potentially lethal postoperative arrhythmia? What differences were observed? How should IV sotalol be dosed and who is or is not a candidate? We speak with the first author of this work, Assistant Professor of Pediatrics at The Children's Hospital at Montefiore, Dr. Ellis Rochelson. doi: 10.1016/j.hrthm.2021.11.021

In this week's special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and third year cardiology fellow at Cincinnati Children's Hospital, speaks with Professor Roberta Williams of USC about her long and illustrious career as a pioneer in both echocardiography as well as pediatric cardiac critical care. Prepare for a lot of wisdom about career and life from this giant in the field of pediatric cardiology. An inspirational episode to end the month of November, 2021.

This week we move into the realm of public health for congenital heart care when we review a recent report on a novel approach to tackling the daunting task of enhancing access to care for congenital heart disease to all who need it in a limited resource region. We speak with Ms. Bistra Zheleva of Children's HeartLink and Professor Krishna Kumar of Amrita Institute in Cocchin, India about a recent report on how a large group of professionals have used a private/public cooperative approach based on education and novel modern methods to rapidly care for children with congenital heart disease, resulting in meaningful reductions in infant mortality as well as improvements in care throughout the congenital heart patient lifespan. Prepare to be inspired by this extraordinary tale. DOI: https://doi.org/10.5334/gh.1034

This week we delve into the world of EP when we review a recent work from the team at Rady Children's Hospital on length of treatment for infant SVT. Is there an optimal length of therapy for the infant with SVT? Are there predictors of recurrence that might suggest benefit to a longer course of medical therapy? We speak with Director of Pacing at Rady Children's Hospital, Dr. Matthew R. Williams who is the senior author of this week's work. doi: 10.1007/s00246-020-02534-5

This week we review a recent important work from Germany about the coronary perfusion in patients with HLHS and possible relations between this flow and clinical outcomes. What factors are associated with abnormalities in microvascular coronary flow in the HLHS patient? What anatomical substrate is more concerning for these sorts of problems? Are there factors that might be modifiable that could possibly improve outcomes due to coronary microvascular flow problems in the HLHS patient? How practically easy are CMR studies to assess microvascular coronary flow in the HLHS patient? These are amongst the questions posed this week to Professor Carsten Rickers of University Heart and Vascular Center at the University Hospital Hamburg-Eppendorf. DOI: 10.1161/CIRCIMAGING.121.012468

This week we replay an episode reviewing a large administrative database study from Sweden on risk for cancer amongst patients with CHD. Why are cancer rates different in the CHD patient? What are the most important factors? What actions should be taken by cardiologists caring for ACHD patients in order to properly screen for cancer? We discuss these issues with Assistant Professor of Pediatrics, Harvard Medical School, Dr. Michelle Gurvitz. doi:10.1001/jamanetworkopen.2019.6782

This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pediatric echo techs and staff physicians? Professor Jonathan N. Johnson of the Mayo Clinic shares his insights this week. DOI: 10.1016/j.echo.2020.12.009

This week we delve into the world of cardiovascular surgery to review a recent work on outcomes of arch reconstruction in the newborn and small child. We speak with Dr. Ramana Dhannapuneni, lead cardiac surgeon of Alder Hey Children's Hospital in Liverpool, UK. How often in the present era is re-operation or reintervention required? How common is the recurrent laryngeal nerve or phrenic nerve injured or affected by surgery? Dr. Dhannapuneni provides us with the surgical perspective to this complex surgery this week. doi: 10.1017/S1047951121003747

This week we enter the world of cardiac critical care to discuss delirium in the postoperative pediatric cardiac patient. We speak with nursing scientist, Professor Sandra Staveski of UCSF about a recent large multicenter study she conducted on this topic. How prevalent is this problem and why is it an important morbidity to tackle and reduce? How can nursing interventions reduce this problem and how can the ICU team working together identify and manage this problem? Dr. Staveski shares her deep nursing and critical care knowledge with us this week. DOI: 10.1097/PCC.0000000000002591

This week we review a recent report from the team at Children's Hospital of Los Angeles about prenatal and neonatal factors that might help predict the need for newborn permanent pacing in the setting of antibody-associated CCHB. We speak with Assistant Professor of Pediatrics at Mount Sinai, Dr. Justin Pick about this work. How important is third trimester fetal heart rate in predicting possible need for early pacing? Dr. Pick provides many insights this week. doi: 10.1007/s00246-021-02723