This week we listen in to a wonderful roundtable discussion with 3 of the pioneers in the world of pediatric electrophysiology, namely Dr. John Triedman, Dr. J. Philip Saul and Dr. Edward P. Walsh. All three were 'there at the beginning' and share their memories of how they helped to shape the field of pediatric EP. How did Drs. Walsh and Saul choose to proceed with EP training in a pre-ablation and pre-pediatric EP training era? How did all three decide to start a fellowship program to train...

This week we review a recent editorial commentary from multiple congenital heart surgical leaders in the US today. The topic of their expert opinion piece is the concept of public reporting of results and their 'amplification' through organizations such as US News and World Report, to name one. How has the use of the database from STS been sometimes misinterpreted through public reporting or ranking systems? What was the initial intent of the STS database and how does the present usage of...

In this week's podcast, we discuss a work that tries to challenge convention when we review a recent work from the team at Emory University about anticoagulation following left sided ablation of SVT in children. A short course of aspirin is commonly prescribed in this setting but what is the evidence for this? How do patients who receive aspirin fare vs. those who do not? Are there some patients in which aspirin might be more 'useful' than others? Is there adequate equipoise to consider a...

This week we review a recent large scale, multicenter study of the Pediatric Cardiac Intensive Care Society Investigators on outcomes of pulmonary atresia with intact ventricular septum (PA/IVS) in the present era. How are patients faring in the present era in comparison to the prior 1-2 decades? What are the most important factors to account for improvements observed in survival? Are there subtypes of PA/IVS that warrant early referral to heart transplantation? What is the best predictor of...

In this replay of our milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once...

This week we delve into the world of interventional cardiology and congenital heart surgery when we review a recent report from the team at Toronto Sick Children's Hospital about their experience with interventions in the pulmonary arteries following the arterial switch operation. How often are branch or main pulmonary artery narrowings serious enough to warrant intervention? What degree of RV pressure should warrant a cath or intervention? How commonly did simple balloon dilation result in a...

This week we review a report from Italy regarding the observation of RA disk thrombus formation in some patients following GORE Cardioform ASD closure. How common is this complication seen and are there some patient or device characteristics that would be considered higher risk for this complication? How does this information square with the Assured trial data? Why might there be differences between the two data sources? We speak with Associate Professor of Pediatrics at Kravis Children's...

This week we delve into the world of antibiotic prophylaxis for dental procedures. What are the data to support its use in the congenital heart patient? Why has this been such a difficult topic to study? What do we now know about this topic and what still remains unanswered? Given the low prevalence but dire consequences of this disease, how can investigators consider studying this topic in the future? Is there adequate equipoise to proceed with a randomized controlled trial? We speak with...

This week we review a recent work on the use of sodium-glucose cotransporter 2 inhibitors in the ACHD heart failure patient from Europe. Can these agents impact heart failure outcomes in this patient group? What is the mechanism by which they may improve outcomes? Are there data on their effects on the single ventricle patient? What sorts of side effects can be seen and are these more or less commonly observed in the ACHD patient? We speak with the corresponding author of this week's work,...

This week we delve into the world of fetal cardiology when we review a recent large, multicenter study on the impact of prental diagnosis of 22.q11 deletion syndrome. How did the prenatally diagnosed patients differ from those diagnosed postnatally in regards to degree of heart disease and postnatal morbidity and mortality? What is the role of cell-free DNA testing in the screening for patients with this deletion syndrome? How do outcomes differ for this syndrome between the US and other...

This week we delve into the world of cognitive bias when we review a recent review of this topic by the team at the University of Arkansas. What are some of the more important common cognitive biases that plague humans and are particularly deleterious for good decision making in 'case management/surgical' conference? What are some approaches to reducing the impact of these biases? How does the advent of ZOOM enhance or reduce bias for surgical conference decisions? We speak with noted...

This week we review a recent survey study on the topic of junctional rhythm and sinus node dysfunction in the Fontan. How important is this finding in our Fontan patients? When should a patient with a Fontan undergo pacemaker insertion? Is the loss of AV synchrony the more important hemodynamic effect of junctional rhythm or is it chronotropic incompetence? Who should be considered for a possible endocardial, transvenous atrial pacemaker in the Fontan patient? These are amongst the questions...

This week we delve into the world of interventional cardiology and the Fontan when we review a recent report from the Children's Hospital of Philadelphia on the use of the "MitraClip" for the treatment of AV valve regurgitation in the congenital heart patient. Who would be a good candidate for this novel approach? What are the steps in planning or consideration of this technique in a congenital heart patient? How durable is this form of repair? These are amongst the many questions reviewed...

This week we review an episode from 2022 in the world of cardiac surgery and pediatric pharmacology when we review a work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the...

This week we review a recent work in the artificial intelligence/deep learning space when we review a recent report from the team at Boston Children's Hospital on a novel model trained to predict LV characteristics in children from the ECG. How does such a program identify LV dilation, dysfunction or hypertrophy from a test (the ECG) not designed to provide most of this information? How well did the model perform when it was tested in a different center entirely? Why is it important to...

This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expression in the liver of Fontan patients help to explain why some patients have mild versus others...

This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expression in the liver of Fontan patients help to explain why some patients have mild versus others...

This week we review a recent report from the Boston fetal intervention group about fetal aortic valvuloplasty. What fetal/maternal factors are associated with improved outcomes or technical success of this procedure? What factors are associated with serious adverse events? Who is the 'optimal' candidate for this type of intervention? Why is larger LV size associated with improved technical success? What other types of fetal interventions are being attempted by the Boston team? Drs. Ryan...

This week we review a recent report on the development of valvular obstruction due to intimal tissue ingrowth in the Harmony valve. How common is this problem? What factors may predispose a Harmony valve patient to develop this rare complication? Does the location of the valve implant matter in regards to this complication? How should Harmony valves be surveilled? There are amongst the questions posed to this week’s guest, Assistant Professor of Medicine at U. Washington, Dr. Zachary...

This week we go back in time to 2019 to re-review an important episode in the world of ACHD and review a registry study assessing outcomes in adults with ASD and elevated PVR who underwent ASD closure. Who was a good candidate for this approach? What were the long term outcomes of this form of therapy? Did ASD closure in this setting confer a survival benefit? We review these and many other questions in a 'virtual roundtable' discussion with Drs. Elisa Bradley, presently of Penn State and Ali...

This week we delve into the world of cardiovascular surgery when we review a recent review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should the data in this work drive innovation to avoid the PAB in some settings? These are amongst the questions posed...

What is the incidence of pediatric out of hosital cardiac arrest and how does it vary depending upon age? What are the most common causes of sudden cardiac arrest in children and what factors can be potentially affected by intevention? What sorts of intervention might reduce rates of sudden cardiac arrest amongst children? Dr. Elizabeth Paratz of St. Vincent's Hospital in Melbourne, Australia, who is an expert in sudden cardiac death, will share her insights into her work and the topic this...

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...

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...