Pediheart: Pediatric Cardiology Today

This week we review a recent work from the team at Boston Children's Hospital regarding outcomes for patients with complex congenital heart disease who underwent scoliosis repair. We speak with the first author of this work, 2nd year cardiology fellow at Boston Children's, Dr. Robert Przybylski about the work. How should these patients be optimally assessed prior to and then managed during these complex and often challenging surgeries. Dr. Przybylski provides us with great insights this week. doi: 10.1007/s00246-019-02169-1.

This week we replay episode # 40 - a discussion with the inspirational figure, Professor Raman Krishna Kumar of the Amrita Institute in Cochin, India. This master of cardiology reviews how, in a limited resource environment, Professor Kumar was able to develop one of the finest pediatric heart centers in all the world. We will be back with a new episode on 3.6.20!

This week we move into the world of the CICU to review a recent work on the use of noninvasive means of ventilation following congenital heart surgery. How often does this form of ventilation prevent a child with respiratory failure avoid reintubation? What is the evidence for the benefit of this? Are we extubating patients too soon? We speak with Ms. Denise Rolim who is a highly experienced pediatric physiotherapist in the PICU of Hospital Sirio-Libanes in Sao Paulo, Brazil and who is also the first author of this week's work. A true international episode this week! doi: 10.1007/s00246-020-02290-6

This week we review a recent work on the prevalence of adverse events when starting sotalol in the pediatric patient with arrhythmias. How commonly were problems encountered? Does initiation always require hospitalization and monitoring in an inpatient setting or are there some patients who might be candidates for an outpatient approach? Is there a level of dysfunction that would preclude its use? Assistant Professor of Pediatrics at Northwestern University, Dr. Stephanie Chandler, provides insights into her work from the group at Boston Children's Hospital. Also featured is a brief discussion with Dr. Jack Rychik of Children's Hospital of Philadelphia regarding the CHOP2020 course and next year's CHOP2021. doi: 10.1016/j.hrthm.2020.01.022

The innocent heart murmur is the topic of this week's podcast. How important is the echocardiogram in allaying parental fears and anxieties when being evaluated for a murmur? Have the days of auscultation without a secondary test fallen by the wayside? We speak with a highly experienced general pediatric cardiologist, Dr. Jared LaCorte of Staten Island Pediatric Cardiology to offer his thoughts on this week's work from Melbourne, Australia. doi: 10.1111/jpc.14775

This week we delve into global pediatric cardiology and review a massive and important work from the Global Burden of Disease study group assessing the trends in congenital heart disease in the world from lower income nations to higher. How has the prevalence of congenital heart disease changed over the past 30 years? How are countries faring in their treatment of congenital heart disease? What are some strategies to address global inequities in care? We discuss these and other questions with the corresponding author of this work, Professor Craig Sable of George Washington University. doi: 10.1016/S2352-4642(19)30402-X

This week we speak with Professor of Surgery, Mark Rodefeld of Indiana University about the most recent report of his group on a sub pulmonary pump for Fontan patients. What is different about this pump versus other presently available pumps for other cardiovascular indications? What is known about the thrombogenicity of these devices? How close is the team in Indiana to animal studies? Why is a lower pressure type pump preferable for this indication? Dr. Rodefeld provides most of the answers this week. doi: 10.1016/j.jtcvs.2019.06.112.

We review a recent paper on the use of the AED for children who suffer out of hospital arrest. What factors are associated with their use and what barriers exist to their use for children? What should be the next steps to improve AED usage for children? We discuss these and other questions with Professor Peter Aziz of the Cleveland Clinic in our first co-branded episodes with the SADs Foundation in 2020! doi: 10.1542/peds.2017-1903

This week we review a recent large single center study comparing pulmonary homografts to bioprosthetic valves in the TOF patient requiring valve replacement. Is there a superior choice? Who is a better candidate for one versus the other? Which is technically easier to use and why? Who would benefit from an aortic vs. pulmonary homograft in this pulmonary position? We speak with Professor Massimo Caputo of the Bristol Heart Institute who answers these and other questions related to this important surgical paper this week. doi: 10.1161/JAHA.119.013654

Alin Gragossian, DO has an unusual perspective in medicine - she is an emergency room physician but also a cardiac transplant recipient. In this milestone 100th episode Dr. Gragossian shares her experiences of learning that she had dilated cardiomyopathy just one year ago, getting admitted to the ICU, and undergoing a heart transplant - all in < 6 months. She is 'back on the job' and she shares the details of her trials and tribulations, inspiring us all with her courage and insights into the patient experience, from the doctor's viewpoint. A different kind of inspirational, portrait in courage episode for our 100th episode! Happy New Year to all!

This week we review a recent report on the benefit of 3D imaging and printing in preparing for ductal stenting. This intervention is complex and is fraught with risk. The team at Duke review their experience with the use of 3D modeling prior to intervention and what impact this has on outcomes. We speak with the first author, Dr. Reid Chamberlain, research fellow at Duke University Pediatric Cardiology about this recent publication. doi: 10.1002/ccd.28669

This week we review the results of one of the rare placebo controlled double blind trials of an agent in pediatric cardiovascular medicine - specifically, the Fontan Undenafil trial assessing the impact of this agent on parameters of exercise in the single ventricle patient. What measures of exercise were most affected by this agent and why? What side effects were encountered? Who should receive these agents? These are amongst the many questions we tackle with the first author, Dr. David Goldberg of The Children's Hospital of Philadelphia. doi: 10.1161/CIRCULATIONAHA.119.044352

Cardiogenetics is the topic this week as we review a relatively recent report on the topic of LV non-compaction. How often do patients with this finding have positive genetic findings? Who deserves genetic testing with this finding? Should all such patients be seen by a geneticist? How frequently should phenotype positive, genotype negative patients 'check in' with a geneticist? These are amongst the questions we review with famed cardiogeneticist and senior author, Professor Stephanie Ware of Indiana University. doi: 10.1161/CIRCGENETICS.117.001735

This week we review a recent report of the PC4 group assessing the impact of inter hospital open communication and collaboration on surgical outcomes. In what manner did participation in this collaborative CICU registry improve outcomes for different hospital surgical outcomes? Why was the improvement not homogeneous between centers? How long did it take for the impact of collaboration to positively improve outcomes? We discuss these and other questions with first author Dr. Michael Gaies, Associate Professor of Pediatrics - University of Michigan. doi: 10.1016/j.jacc.2019.09.04

This week the topic is cardiovascular surgery and we speak with Dr. Ignacio Berra of Buenos Aires Argentina about a recent work he co-authored with the surgical bioengineering team at Boston Children's Hospital regarding a newly developed tool to assess the aortic valve. Can this device safely allow for visualization of the valve under the usual aortic diastolic pressures to aid in anatomical assessment and post-repair assessment? What are the technical hurdles of using this device? Is it ready for use in humans? We discuss these and other questions with Dr. Berra this week. doi: 10.1016/j.jtcvs.2018.07.113

This week we review a work that aimed to improve the thoughtfulness of echocardiography usage in the postoperative period after congenital heart surgery. Dr. Kelly Cox and colleagues report on the use of a 'checklist' type 'pause' aimed at making certain that the ordering team in the CVICU are making an informed decision regarding the need for a new echocardiogram. How often should postoperative studies be performed? How often did the 'fluid check' actually show fluid? These are amongst the many questions we post to Professor Cox who presently works at Lurie Children's Hospital - Northwestern University. doi: 10.1111/echo.1450

ECMO use in the pediatric cardiac patient can be lifesaving but the long term effects are still not well known. This week we explore the neurodevelopmental outcomes in a cohort of patients from Boston Children's Hospital who underwent ECMO support following cardiac surgery and explore factors associated with their neurodevelopmental outcomes. How do these patients fare in comparison to non-ECMO pediatric cardiac surgical patients? Are there modifiable factors that may improve outcomes? We explore these issues with Dr. Ravi Thiagarajan, Professor of Pediatrics - Harvard University and Director of Cardiac Critical Care at Boston Children's Hospital this week. doi: 10.1007/s00246-019-02115-1

This week 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's episode is co-branded with the SADS Foundation and we review a recent work by the team at U. of Washington on a comparison between the ECG and the AHA 14 point evaluation recommendation for the identification of cardiac diseases that may predispose to sudden death amongst high school athletes. We speak with Dr. Jonathan Drezner of U. of Washington about this important work and he offers many insights into the pluses and minuses of both the history and physical approach as well as the ECG. Referenced in the podcast also is https://uwsportscardiology.org/e-academy/. doi: 10.1161/JAHA.119.012235

This week we 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 Albert Einstein College of Medicine. Dr. Lamour provides deep insights this week! doi: 10.1016/j.healun.2019.06.006