Pediheart: Pediatric Cardiology Today

In this week's replay of a most special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and interventional cardiology fellow at Toronto Sick 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 fields of pediatric cardiology and pediatrics.

This week we review a recent report from China on transcatheter closure of peri-membranous VSD's with the Amplatzer ADO II device. Reported results are outstanding and this week's report is one of several from China demonstrating efficacy and safety to this approach. Despite this, this procedure is rarely performed in the west. Why might that be? Do we need 'local data' to adopt an approach or can we proceed based upon data from another location where procedural indications may be different? We speak with the director of the cardiac catheterization laboratory at Cincinnati Children's Hospital, Dr. Shabana Shahanavaz about this question based upon her editorial on this impressive Chinese work. doi: 10.1161/JAHA.121.022651 and doi: 10.1161/JAHA.122.024963

This week we delve into the world of cardiac critical care when we review a recent report on an attempt to use a multidisciplinary group of hospital professionals plus parents to design an optimal family meeting structure. How should teams prepare for these meetings? What roles should different care providers play in the team meeting? Is there evidence that a better planned meeting can be more effective in transmitting information and allaying parental fears? We speak with pediatric palliative care expert, Assistant Professor of Pediatrics Dr. Jennifer Walter of The Children's Hospital of Philadelphia about this vital topic. https://doi.org/10.1016/j.jpainsymman.2022.03.010

This week we review a recent cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of Pediatrics at U. Penn, Dr. Laura Mercer-Rosa about this important and intriguing work. https://doi.org/10.1016/j.athoracsur.2022.01.017

This week we review a recent international review on the topic of life threatening events occurring during electronic gaming. What risks do video games pose for the typical child or child with an arrhythmia condition? What precautions, if any, should be considered? Are there some sorts of games that are potentially more dangerous than others? We speak with the first and senior authors of this international survey - Dr. Claire M. Lawley of Great Ormand Street, London and Dr. Christian Turner of Sydney Children's Hospital in Sydney, Australia. doi: https://doi.org/10.1016/j.hrthm.2022.08.003.

This week we speak with noted cardiovascular surgeon Dr. John J. Lamberti who is presently Associate Professor of Surgery at Stanford University. Dr. Lamberti's career has spanned from the time of Dr. Robert Gross in the 1960's to present day with Dr. Frank Hanley and the team in Stanford. His career perfectly mirrors the transition from the 'old days' of cardiac surgery up until the present modern age and he shares his reminiscences of working with Dr. Robert Gross, Dr. Aldo Castaneda, Dr. Maurice Lev, Dr. Roberta Williams, Dr. Nadas and others. He also shares his thoughts on how to be a good mentor and what that takes from someone who has mentored many surgeons in the past 5 decades.

This week we review a recent report on the differences between pulse oximeter Sp02 and arterial Sa02. Are there patient specific factors that may result in inaccuracies of measurement? What single ventricular factors may also result in more significant inaccuracies and how should these data be used at the bedside when assessing a child who is cyanosed? We speak with Dr. Cara Pritchett, critical care fellow at Lurie Children's Hospital - Northwestern University about a recent work she co-authored on this important and practical topic. DOI: https://doi.org/10.1016/j.jscai.2022.100394

This week we review a recent work from the team at Stanford University on post-traumatic stress disorder amongst pediatric patients with ICD's as well as their parents. How common is this diagnosis seen amongst these patients and their parents and what are some of the reasons for this? How should patients receiving devices be properly screened for this and why is identification of PTSD so important? Associate Professor of Psychiatry and Behavioral Sciences at Stanford, Dr. Lauren Schneider, shares her insights into her work this week. doi: 10.1016/j.hrthm.2022.06.025

This week's episode is a replay of a co-branded 2020 episode with SADS.ORG and is on the topic of pre-participation screening. 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

This week we review a recent work from NYU-Langone on the topic of cardiac rehab for the ACHD patient. Does enrollment in a formal cardiac rehabilitation program result in meaningful improvements in exercise tolerance in the ACHD patient? Who can benefit from this? How does the impact of this form of therapy compare with more traditional medical interventions? We speak with the senior author of this week's work, Associate Professor of Medicine at NYU, Dr. Dan Halpern. DOI: 10.1161/JAHA.121.023896

This week we explore the 'basics' when we review a recent report from the team at the Amrita Institute in Cochin, India on the accuracy and precision of the physical examination in identifying heart disease. How did the stethoscope do in comparison to the 'gold standard' of echocardiography? Is it time to 'retire' the stethoscope or does it still have an honored role in the evaluation of children with possible heart disease? How can physicians and other providers get better at physical examination? Professor Krishna Kumar, chief of the cardiac program at Amrita Institute in Cocchin shares his deep insights this week! https://doi.org/10.1136/bmjpo-2022-001595

This week we review a recent work from Naples, Italy on the use of the GORE Cardioform ASD device to close large atrial septal defects in small children. Are there anatomical 'rules' to help predict who might be a candidate for transcatheter closure? What about this device makes it potentially safer for this indication? Should we be worried about wireframe fractures? We discuss this and other issues related to this topic with the first author of this week's work, interventional cardiologist, Professor Giuseppe Santoro of the University of Naples, Italy. DOI: 10.1111/jocs.16786

This week we delve into the world of bovine jugular vein grafts for the treatment of pulmonary valve dysfunction and the possible enhanced risk for infective endocarditis. How commonly are these valves affected by endocarditis and does placement at surgery in comparison to the cath lab confer a lower risk for this dreaded complication? What factor was most highly associated with the risk for endocarditis with a bovine jugular valve vein graft for PVR? A description from the team at Cincinnati Children's Hospital is on tap this week! https://doi.org/10.1177/21501351211065363

This week we delve into the world of fetal cardiology to review a recent report on fetal SVT. Are there factors in fetal life that would predict postnatal SVT? How should transesophageal pacing factor into decisions in postnatal life? How does the team at Lurie Children’s choose a 2nd agent for fetal SVT when digoxin is ineffective? Are there differences in the clinical presentation of infants prenatally diagnosed with SVT versus those diagnosed after fetal life? We speak with former EP fellow at Lurie Children's Hospital, Dr. Thomas Carberry, who is presently a pediatric electrophysiologist at DeVos Children’s Hospital. https://doi.org/10.1016/j.jacep.2022.06.003

This week we review a landmark paper reviewing the very large experience of Dr. Hanley and his team at Stanford University in managing VSD/PA with MAPCA's. What advantages are seen with the 'midline unifocalization' approach popularized by this team over the past 20+ years? Is this an approach that can be broadly applied or are the technical operative skills too challenging for most? Why are these operations so difficult? How does the Stanford team decide who is a candidate for a single operation and who is not? We explore many of these topics and others with Surgery Professor Richard Mainwaring of Stanford University who is the first author of this important paper published recently in JTCVS. You will not want to miss Dr. Mainwaring's insightful commentary on the challenges and potential benefits of this very complex and painstaking approach. doi: 10.1016/j.jtcvs.2018.03.153.

This week we review a recent work on outcomes of univentricular adult patients who have not been palliated with a Fontan. Do these patients fare better than Fontan patients? What factors are associated with worse or better outcomes? How do these factors inform decision making for the single ventricle adult patient? We speak with adult congenital expert, Dr. Danielle Massarella of University of Toronto about her thoughts on this work and some of its important lessons. DOI: https://doi.org/10.1016/j.cjca.2021.06.001

This week we review an important report on possible racial disparities amongst children on waiting lists for heart transplantation in the US. How did the 2016 changes to the Organ Procurement and Transplantation Network criteria for listing impact outcomes in listed children and unexpectedly widen racial disparities? What impact did these changes have on mortality and outcomes for white vs. non-white children? Why were differences observed? Dr. Mujeeb Zubair of Cedar-Sinai Medical Center in Los Angeles, CA and Dr. Kurt Schumacher of C.S. Mott Children's Hospital in Ann Arbor, MI share their insights this week. We also speak briefly with Dr. John Triedman of Harvard University about the upcoming Pedirhythmx conference coming in September to Boston, MA. DOI: 10.1161/CIRCULATIONAHA.122.060223

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