Pediheart: Pediatric Cardiology Today

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

This week we delve into the world of adult congenital heart disease when we review a recent research letter from the team at the Harvard Congenital Heart Program about venous insufficiency in the Fontan patient. Why do patients with Fontan circulation develop chronic venous insufficiency and what are the implications of this problem in the Fontan patient? What sort of evaluation should be performed on the Fontan patient presenting with lower extremity venous changes? How worried should the cardiologist be when presented with a Fontan patient with these changes? These are amongst the questions reviewed on this topic with this week's guest, Assistant Professor of Clinical Pediatrics (Cardiology) at Yale University, Dr. Tony Pastor. JACC Adv 2022 Mar, 1 (1) 100002

In this week's special episode that is a combination of the Pediheart Podcast and PCICS Podcast, we speak for the entire episode with Professor of Pediatrics Dr. Gil Wernovsky of Children's National. Dr. Wernovsky is the Co-Chair of the upcoming World Congress of Pediatric Cardiology and Cardiac Surgery and shares with us all of the exciting plans for this 'meeting of meetings' that will be staged from August 27th-September 1st in Washington, DC. This is the first World Congress in the US since 1985. Co-hosts Deanna Tzanetos, Jill Zender, David Werho, Lillian Su and Sadie Rodriguez discuss with Dr. Wernovsky why this upcoming meeting will be perhaps the largest congenital heart meeting in history with 'something for everyone'. For those interested, the website for the meeting is:https://www.wcpccs2023.org

This week we delve into the world of electrophysiology when we review a recent multicenter work on the rare topic of atrial standstill. What is atrial standstill and how does it differ from SA node dysfunction? What risks are associated with this condition and how can they be mitigated? Are there factors in an atrial standstill patient that might prompt implantation of a primary prevention ICD? We speak with the first author of this week's work, Dr. Taylor Howard who is Assistant Professor of Pediatrics at Baylor College of Medicine and an attending physician in pediatric electrophysiology at Texas Children's Hospital about his most recent work. doi: 10.1016/j.jacep.2022.08.022. Epub 2022 Oct 26.

This week we delve into the world of neonatal congenital heart surgery and review a recent work on changes in the incidence of brain injury following congenital heart surgery. How common is it to see brain injury on the MRI's in this patient group? How have incidences changed over time and what is the likely reason for this? Can the types of inotropic agents used in the postoperative period potentially explain some of the improvements in outcomes that have been observed and what is the proposed mechanism for this? We speak with this week's first author, noted authority on neurodevelopmental outcomes of patients undergoing neontal heart surgery, Associate Professor of Pediatrics at UCSF, Dr. Shab Peyvandi.DOI: 10.1016/j.jacc.2022.10.029 Editorial accompanying this week's work: DOI: 10.1016/j.jacc.2022.11.027

This week we delve into the world of ACHD when we review a recent work on outcomes of non-cardiac surgery in the ACHD patient. How do ACHD patients fare in comparison to their non-ACHD cohort undergoing non-cardiac surgery? What can be done to improve outcomes in this patient group? We speak with the senior author of this work, Dr. Peyman Benharash, who is Associate Professor of Surgery at UCLA. DOI: 10.1136/heartjnl-2022-321512Also joining us this week is Dr. Alexandra Lansky of Yale University who is also the Editor-in-Chief of JSCAI which is the newest interventional cardiology journal and the official journal of SCAI. Dr. Lansky shares with us her hopes for the new journal and also the role that congenital interventions will play in this journal. Visit JSCAI.org to see what 'all the fuss' is about!

This week we replay a 2020 episode in which we reviewed a then recent PCCC study assessing outcomes of single ventricle patients who have undergone replacement of the AV or semilunar valve. We speak with Professor Geetha Raghuveer of University of Missouri-Kansas City about this work she co-authored. Outcomes are generally poor in this patient group but are there lessons that can be gleaned from the data regarding optimal timing for repair or replacement of valves in this patient group? This is a great follow-up of episode # 58 from 3.5 years ago. See you next week with a brand new episode! doi: 10.1007/s00246-019-02234-9.

This week we return to the topic of congenital heart surgery when we speak with Dr. John Iguidbashian who is a resident in surgery at U. Colorado. Dr. Iguidbashian reviews a recent paper he co-authored on the topic of the relation of duration of open chest following heart surgery to the development of surgical site infections (SSI). How long is 'too long' when it comes to an open chest and the risk for infection? Is the duration of an open chest following surgery a 'modifiable' risk factor? Are there other factors that might be associated with SSI in this setting other than duration of open chest? Dr. Iguidbashian shares his insights this week. https://doi.org/10.1007/s00246-022-03088-4.

This week we delve into the world of partial heart transplantation when we review a recent paper that discusses the rationale for its potential use in children, particularly in infants. We speak with the work's senior author, Dr. T. Konrad Rajab of the Medical University of South Carolina about the potential benefits of this approach. Who might be a candidate for this approach? What are the theoretical benefits of this approach to transplantation? How many 'partial heart' transplantations have been done to date in the US? What might be different about transplanting 'parts' of hearts rather than entire hearts? Dr. Rajab provides us with his deep insights this week. doi: 10.1111/jocs.17050

This week, to end 2022, we delve into the world of personal finance for the final episode of 2022 when we speak with Mr. Paul Merriman of paulmerriman.com. Mr. Merriman is a world-renowned expert in personal finance and investing who reviews how we might go about funding a newborn child's retirement (in 65 years!) through the magic of index investing, low costs and compounding interest. There are many lessions for all types of investing in this episode.Mr. Merriman has visited the podcast previously and I would recommend you listen to episodes #146 and 191 for his previous appearances. For those interested, his website is: https://paulmerriman.comThe articles mentioned are located at: https://paulmerriman.com/the-best-gift-of-all-a-financial-legacy-for-a-child/ and: https://paulmerriman.com/how-10000-will-help-my-newborn-granddaughter-have-a-better-retirement/For those who have not yet had the chance, you can contact me at pediheart@gmail.com for a pdf copy of his latest book We're Talking Millions: 12 Ways T

This week we enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide, sympathectomy or even ICD's for these patients? PhD candidate and physician Dr. Puck Peltenburg and CPVT world authority, Dr. Christian van der Werf (both of University of Amsterdam) share their deep insights this week. doi: 10.1161/CIRCULATIONAHA.121.056018. Epub 2021 Dec 7

This week we review a recent important work on outcomes of pregnancy in patients with bioprosthetic valves. What percentage of women entering pregnancy have a dysfunctional bioprosthetic valve? Is there a particular position of valve where the risk of dysfunction is greater for cardiac or fetal events? We speak with noted cardio-obstetrical expert, Dr. Barbara Wichert-Schmitt of Johannes Kepler University in Linz, Austria about her recent work from Canada. doi: 10.1016/j.jacc.2022.09.019

This week we review a recent report from the team at Children's National Hospital in Washington, DC on their experience with the hybrid approach to high risk infants with ductal-dependent systemic circulation. Some patients get ductal stents and others not. How is this decision made? How difficult was it to change the approach of a center that had a reputation for excellence with a more 'traditional/Norwood/Stage I palliative' approach? Are there theoretical advantages to this approach for even 'low risk' patients? We speak with the senior author of this report, Dr. Can Yerebakan who is Associate Professor of Surgery at George Washington University School of Medicine and Health Sciences. doi: 10.1016/j.jtcvs.2021.11.103

This week's episode focuses on gender disparities in salary in the field of congenital electrophysiology. To what degree are female electrophysiologists paid less than their male counterparts despite similar levels of education, work effort and seniority? What interventions could be enacted to help 'mind the gap' and level the playing field in this regard? We speak with the chief of pediatric electrophysiology at The Children's Hospital of Philadelphia, Professor Maully Shah, who is the first author of this week's research letter. doi: 10.1016/j.jacep.2022.02.011

This week we review a recent work from the Precision Medicine For Cardiomyopathy (PRIMaCY) study group on the role of stress testing in the pediatric HCM patient. Does stress testing help identify patients at risk for possible SCD or progression to heart transplantation? Should all pediatric HCM patients undergo this form of testing? What risks are associated with its use and how should these studies be performed? We speak with the first author of this novel multi center study, Associate Professor of Pediatrics Dr. Jennifer Conway of U. Alberta about this 'fresh off the presses' work. https://doi.org/10.1161/circulationaha.122.062699