Pediheart: Pediatric Cardiology Today

This week we review a recent large scale PHIS database study on pericardial effusion following congenital heart surgery. Which operations other than ASD are most highly associated with the development of an effusion? What might be some approaches both surgically and medically to reduce the chances of these developing or requiring intervention? What are the implications of a pericardial effusion after surgery? How many require readmission for this complication? Dr. Mario O'Connor, who is a congenital heart surgical research fellow at UT Austin, shares his insights into his recent publication. 

DOI: 10.1177/21501351251322876

This week we review a recent report on LV strain following the Ross operation. Can this sort of functional analysis help predict remodeling after aortic valve replacement? How can the type of Ross potentially affect heart function after the operation? Why might some parameters of LV strain improve but others not following surgery? Can preoperative strain measurements predict perioperative course? How does the addition of a Konno to a Ross change the outcomes of function? We speak with Chief of Cardiovascular Surgery at Primary Children's Hospital in Utah, Dr. S. Adil Husain and 3rd year integrated cardiac surgical resident Michal...

This week we end 2025 with a Pediheart tradition - an episode on personal finance for medical professionals with noted authority on index investing and personal finance, Mr. Paul Merriman. Paul is a retired investment advisor who now has a popular podcast "Sound Investing" and website in which he offers advice on investing for 'do it yourself' investors. In this week's episode, the 5th of his visits to Pediheart, Mr. Merriman discusses 'factor investing' via index-like ETF's and funds. He also reviews who he believes might benefit from a financial advisor, what sort of advisor most...

This week we go back in time 2 years to review a recent paper from 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient...

This week we speak with noted congenital cardiologist Professor Krishna Kumar of the Amrita Institute in Cochin, India and discuss his recent work on inequities in congenital heart care in the world. Over 90% of patients with CHD do not have access to care in the globe today. What is the path forward to improve this sobering statistic? How can a World Health Assembly resolution practically help improve care in LMIC countries worldwide? Dr. Kumar shares his deep insights.

This week we also briefly note the passing of the wonderful and caring pediatric cardiologist Dr. Sangeetha Viswanathan of Chennai...

ECMO is the topic of this week’s episode of Pediheart. We speak with Assistant Professor of Pediatrics and cardiac critical care specialist at Northwell Health, Dr. Ivana Capin about a recent ELSO database study she conducted to assess outcomes in single ventricle patients who were treated with ECMO prior to single ventricle palliation. What factors were associated with worse overall outcomes? Can this therapy be used to stabilize the HLHS patient with an intact atrial septum? Why have outcomes for this high risk patient group not appreciably improved in the recent decade? How can these data improve pr...

This week we go back in time to 2020 to delve into the topic of fellow wellness and review a work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who was then the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as...

This week we review the topic of mitral annular disjunction ("MAD") and the possible association with ventricular arrhythmia or sudden death in the connective tissue disease patient. Is there a 'cut off' distance above which patients deserve more significant arrhythmia surveillance? What is the best way to measure the MAD distance? Can patients with low MAD distances have lower degrees or even no arrhythmic surveillance? How often should this distance be measured on CMR and can an echo measurement provide similar data? Dr. Daniel Castellanos, the first author of this work and Assistant Professor of Pediatrics at Harvard Medical School...

This week we review a recent retrospective review from Phoenix Children’s Hospital about coronary artery fistulae. How common are they and who needed intervention? How should the cardiologist think about the small fistula? Should they all be ‘followed’ or can they be discharged from cardiology follow-up? How small is ‘small enough’? We speak with Dr. Marie Chevenon who is a fetal cardiologist at Phoenix Children’s Hospital about her recent study on the Phoenix experience with coronary artery fistulae.  

https://doi.org/10.1007/s00246-024-03600-y

This week we speak with Ohio State ACHD fellow Andrew Freddo MD, PhD about a recent large single center study he conducted assessing the cardiovascular drugs that adult Fontan patients are taking and whether they might offer us insights into general well-being. Are there agents that are associated with worse outcomes? If so, is this a situation of the agent causing harm or is it a possible marker of illness? Are there agents associated with improved outcomes? These are amongst the questions reviewed with Dr. Freddo this week. 

DOI: 10.1016/j.jacadv.2025.102070

This week we review the results of the new pivotal trial of the 'Minima' stent by Renata Medical. What is special about this new device that makes it particularly desirable for use in small children? How strong is cobalt chromium and what evidence exists that it can be expanded repeatedly over 1-2 decades? Can this technology supplant surgery for certain diseases such as native coarctation? What are the limitations of this device? We speak with the first author of the pivotal trial, Dr. Patrick Sullivan of CHLA who is Associate Professor of Pediatrics at Keck Medicine at USC. 

D...

This week we review a recent survey study assessing the beliefs of fetal cardiologists and how these may influence the content and conduct of their counseling. Do most fetal cardiologists review all options including intervention, comfort care and pregnancy termination? Should there be a mandate that all do? Is it realistic or appropriate to ask a fetal cardiologist to suggest an option when they do not believe it to be a reasonable or correct choice? We speak with two of the authors of this work and they are Dr. Joanne Chiu of Harvard University and Dr. Caitlin Haxel of The...

This week we review an episode from 3 years back and delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author...

This week we review a recent work from the "Women In Pediatric Cardiology" group which is a 4 year old initiative to help lift up women pediatric cardiologists through the fostering of connections and also via mentorship programs. Why did this program develop and what are the most pressing issues affecting female pediatric cardiologists? What are the best solutions to help address gender inequities in our field? We speak with two co-authors of this week's work, Drs. Sarah Ford of Brown University and Kristin Laraja of University of Massachussetts. For those interested in participating in their work, feel free to email  P...

This week we review a recent multicenter, randomized trial pitting 2 different immunosuppressive therapeutic approaches against each other. How did a novel approach of everolimus + low dose tacrolimus compare to more standard MMF + standard, higher dose tacrolimus in avoidance of major adverse transplant events or complications? How did this first ever prospective trial in the pediatric heart transplantation world start and how difficult was it to perform in the absence of corporate or NIH support? Why can these data help inform FDA labelling for this novel approach and why is this important? Dr. Kevin Daly of Boston Children's Hospital shares his...

This week we review a recent report of the use of phenoxybenzamine for the reduction of SVR in children undergoing congenital heart surgery in India. How does this agent work and what might be the advantage versus other agents like nitroprusside or milrinone which are more commonly used? How does the cost of this agent (or phentolamine) compare with newer agents? We speak with Dr. Rohit Loomba of Lurie Children's Hospital. For those interested, in addition to working as a critical care cardiologist, Dr. Loomba is also a noted cardiac morphologist and his wonderful videos can be seen at the...

This week we replay an episode from 2 years ago on postoperative ectopic atrial tachycardia (EAT) following congenital heart surgery in children. Are there risk factors for this arrhythmia and are any modifiable? What is the 'go to' therapy used by the electrophysiologists at Children's LA for the acute and chronic treatment of this arrhythmia in the postoperative period? Is the presence of EAT in a postoperative congenital heart patient a marker for a worse outcome? These are amongst the questions posed to Children's of Los Angeles pediatric electrophysiologist, Dr. Jonathan Uniat.

·         DOI: 10.1007/s00246-022-03068-8

This week we review a recent report from the Boston Children's team on their 39 year experience managing and caring for children with myocardial infarction following Kawasaki disease (KD). What were the clinical features of KD patients that were most associated with this rare complication? What signs or symptoms should be concerning for the caregiver of patients with KD? What are the more common approaches to the management of MI in this fragile and young patient population? Dr. Sunil Ghelani of Boston Children's Hospital offers the answers this week. 

DOI: 10.1016/j.jpeds.2025.114638

This week we review a landmark paper that came out this month on the topic of ACHD. How common is neurocognitive dysfunction amongst the ACHD patient population? What factors are associated with worse or better such outcomes? What interventions should be considered to mitigate these issues? What is the relationship between mental illness and neurocognitive dysfunction? Dr. Scott Cohen of The Medical College of Wisconsin and Dr. Ali Zaidi of The Icahn School of Medicine at Mount Sinai share their insights into their recent multicenter study. 

doi: 10.1016/j.jacc.2025.06.051

Also featured after the article is a b...

This year is the 50th anniversary of the first transcatheter ASD closure in a human. To celebrate this achievement, this week we air a live interview from PICS 2025 in Chicago (conducted 8/26/25) with living interventional cardiology legend Dr. Terry King speaking about the events surrounding his landmark intervention as the first person to ever perform a transcatheter ASD closure with his partner, surgeon Dr. Noel Mills. In this one on one interview, Dr. King discusses how he came up with this idea with Dr. Mills and how he found a patient in which to proceed. He reviews what 'informed consent' was...

This week we review a recent work addressing the growing mismatch between the numbers of ACHD patients and the numbers of well trained ACHD providers. What are the most important factors influencing trainees' decisions regarding the pursuit of a career in ACHD? How can more young people be influenced to pursue this fascinating and growing field? We speak with Dr. Katia Bravo-Jaimes of The Mayo Clinic in Jacksonville, FLA about a recent survey study she conducted on the factors that influenced these important decisions. Dr. Bravo-Jaimes shares her thoughts on solutions to increase the ACHD workforce.

https://doi...

In this week's replay episode from 3 years ago, we delve into the world of pediatric heart transplantation and the impact that race or insurance status may have on outcomes. What are the factors that explain worse outcomes for black children waiting for a heart transplant? How is the PHTS Racial Disparity Taskforce working to reduce inequities in this field? What role does insurance status have on these outcomes? We speak with noted heart failure and transplantation expert, Dr. Neha Bansal who is Associate Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai about this recent PHTS multicenter...

This week we lost one of the true 'nice people' in pediatric cardiology - Dr. Richard J. Golinko who died at the age of 95. Dr. Golinko led the Mount Sinai Pediatric Cardiology Program for many years. He established many of the programs at Sinai that are now fundamental to the program and the care of children with congenital heart disease in the tri-state region. To honor Dr. Golinko's memory, we stretch back over 40 years to review a paper he co-wrote with Dr. Rubin Cooper on balloon angioplasty of aortic coarctation. We speak with Dr. Cooper, the work's first author about...

Professor Ziyad Hijazi of SIdra Medical joins Pediheart this week to celebrate Pediheart's 350th milestone and discuss his life and times from his early days in Jordan to the absolute heights of interventional cardiology. How did he meet Dr. Kurt Amplatz and become involved in the development of Amplatzer devices? Who were some of his mentors and what does he think about being a mentor? How did he come up with the idea for the PICS interventional course and how has he managed to do this consistently for over 20 years? What does he believe is important when thinking about a w...

This week we go back in time to 2022 to re-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...

This week we review a recent important longitudinal follow up study of patients who have undergone palliation for the treatment of HLHS at The Children's Hospital of Philadelphia over the past 35+ years. What are the 'transplant-free' survival numbers at 35 years follow up following newborn palliation? Are there differences between hybrid and traditional "Norwood/Stage I" palliation? What factors explain the group of HLHS patients who do are 'super-Fontan's'? What accounts for the marked variability in outcomes of these complex patients? Dr. J. William Gaynor shares his deep insights both from his large scale paper and long-term experience caring for patients...

This week we review a recent surgical paper on the 'off-label' use of the Melody valve for replacement of the AV valve in small infants and children. How effective and safe was this procedure? What factors were associated with the need for reintervention and what sorts of reinterventions were most common? Why was catheter based reintervention rarely employed? What sort of anti-coagulation protocol seems best to protect these valves? Assistant Professor of Pediatrics at the University of Nebraska, Dr. Samantha Gilg shares the insights from her work this week. 

DOI: 10.1007/s00246-024-03538-1

This week Dr. Nadine Choueiter of Mount Sinai hosts a special episode of Pediheart: Pediatric Cardiology Today in which we speak with emeritus Professor of Pediatrics at the University of Toronto, Dr. Brian McCrindle about his career and life. How did he develop a love of pediatric cardiology? Who were some of his early mentors? How did he develop the international Kawasaki Disease Registry and how has he cultivated it despite minimal funding? How did he develop an interest in preventive cardiology? How can a young person make their clinical work also their academic work? Dr. McCrindle also s...

This week we speak with congenital heart surgeon T. Konrad Rajab of Arkansas Children's Hospital about a recent report he co-authored on piglet experiments on partial heart transplantation. How did transplanted heart valves grow in comparison to standard homografts and how did the valvular function differ with time? Is there a minimum dose of immunosuppresion that can protect these valves and can this dose be lower than full heart transplantation immunosuppresion therapy? Is partial heart transplantation considered a potential life-long approach to valve replacement or mostly something used to allow for growth of valves during childhood? What do we know...

This week we speak with Professor Vladimiro Vida of U. Padua about a recent ECHSA large scale study assessing surgical outcomes of newborn cardiac surgery in Europe. What trends have become apparent in the past 10 years and why are outcomes generally better overall in this complex patient group? Why have outcomes for single ventricle surgery not improved as much as other newborn surgeries? Is there a relationship between center volume and outcomes? What interventions might result in improvements in outcomes of Norwood palliation? Dr. Vida provides his insights this week. 

https://doi.org/10.1016/j.athoracsur.2024.07.023

This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on the topic of outcomes of ablation in the early postoperative period following congenital heart surgery. Who is a candidate for this intervention and what were the outcomes? How commonly were serious complications encountered and how successful were these procedures? Dr. Dionne reviews these and other aspects of this novel review this week. 

https://doi.org/10.1016/j.hrthm.2024.08.061

This week we venture back in time to 2023 to review the results of the update of the Single Ventricle Reconstruction trial, specifically SVR III. How are HLHS patients are faring post Norwood at age 12? What is the overall transplant-free survival rate in this group? Are there differences in survival seen at 12 years between BTTT shunt patients and RV-PA conduit shunt patients? How do they compare in exercise capabilities? What about rates of PLE or arrhythmias seen? Are there interventions that may improve outcomes going forward? These are amongst the questions reviewed this week with the first author, Dr. Ca...

This week we speak with Professor Robert Hamilton of the University of Toronto about a recent case-control study in which his team identified a novel auto-antibody targeting a fetal cardiac protein that proved to have excellent sensitivity and specificity for the identification of fetuses that would develop heart block in fetal life in the offspring of women with maternal connective tissue disorders. How did the team in Toronto choose these particular target proteins? How well did this test perform in predicting heart block in pregnancies where there had been a prior pregnancy affected by block? Does this test possibly mean...

This week we move into the arena of preventive cardiology when we review a recent report from the team at Northwestern and Princeton on the impact of early childhood food insecurity on cardiovascular health of people in young adulthood. How does food insecurity in young childhood impact the cardiac health of adults? Why is most of the impact seen on BMI but not other measures of cardiovascular health. How can food programs that support improved food and nutrition security work to improve long term cardiovascular health of children and adults? Do the benefits of such programs outweight their costs? Dr...

This week we share the inspiring tale of Ms. Kayla Billington, a pediatric and neonatal critical care nurse who met a young boy with tetralogy of Fallot named Wavamuno Patrick in Uganda while working for an NGO hospital. Ms. Billington tells the story of meeting Patrick and struggling to save his life and how this simple relationship of love and caring led her to help many in Uganda with congenital heart disease. Ms. Billington speaks of partnering with Professor R. Krishna Kumar of the Amrita Institute and, in today's episode, both Ms. Billington and Dr. Kumar share the inspiring tale...

This week we take a trip back in time to reminisce about what it was like to be a fellow under famed pediatric cardiology pioneer Dr. Alexander S. Nadas. Who better to tell us about what life was like under this giant than 4 present-day giants who lived through it and got their start working for Professor Nadas. Joining the podcast in a live recording from the Boston Children's Cardiology 75th Anniversary Alumni Reunion on May 3rd are Dr. Roberta Williams, Dr. John Barry Keane, Dr. Patricia Rompf and Dr. Thomas Hougen. All have many stories to tell and they share...

This week we delve into the world of exercise physiology when we review a recent paper by Dr. Adam Powell of Cincinnati Children's Hospital on the relationship of hand grip strenth to other measures of cardiovascular and skeletal muscular health and fitness. How does hand grip strength correlate with CPET measures of exercise abilities in children? How might this inexpensive test help identify patients who might benefit from exercise therapy? Will hand grip strength one day be as ubiquitous as blood pressure in the evaluation of our CHD patients? Dr. Powell shares the answers this week.

https://doi...

This week we review a recent editorial commentary by Drs. Belinda Gray, Rachel Lampert and Michael Papadakis on the concept of the personalized emergency action plan for the patient with genetic heart disease who is 'returning to play' in vigorous sports. With newer data demonstrating that risk for SCA or SCD is perhaps not as high as was once thought in this setting of sport, can the development of a personalized emergency action plan further enhance safety beyond simple measures such as medical adherence? Who should be involved in drafting this emergency action plan and how does this feature in...

This week we review a study assessing the impact of bundle branch block (BBB) on exercise tolerance amongst the single ventricle Fontan patient cohort. Why would this be associated with worse outcomes for exercise? How should the cardiologist use this datum of BBB in a single ventricle patient to inform clinical decision making in this patient group? Why is cardiac resynchronization therapy so challenging in this patient group? Dr. Omar Meziab of The University of Arizona shares his deep insights this week. 

https://doi.org/10.1007/s00246-024-03500-1

In this replay episode from 2023, we return to the world of ACHD when we review a recent German research paper on the prevalence of PTSD symptoms amongst the ACHD patient group. How common is this type of symptom observed in the ACHD patient group? What contributes to the high prevalence (17-20.5%) described in this work? What are the benefits of 'embedding' a mental health care worker in the ACHD clinic/program? What strategies can be employed in pediatric cardiology to potentially mitigate PTSD symptoms in our future ACHD patients? These are amongst the many topics reviewed this week with the...

This week we review a recent work from the team at Seattle Children's Hospital about obstetrical sonography and referral of fetuses with 'suboptimal imaging' for fetal echocardiography. Should all 'suboptimal imaging' cases be referred? How can fetal cardiologists parse out who needs a fetal cardiac scan and when? How does the fetal team in Seattle practically serve a geographic region exceeding 2,000 miles and properly triage the referrals, particularly when 'suboptimal imaging' is the rationale for referral? Associate Professor of Pediatrics at The University of Washington, Dr. Bhawna Arya provides deep insights into her recent work on how to think about...

This week we review a recent PHTS study on long-term outcomes following heart transplantation. Why do patients develop coronary vasculopathy and how commonly is it seen at long term follow-up? What factors are associated with better or worse long term outcomes? How do 'adverse childhood experiences' result in worse outcomes for patients? Why do young transplant patients have better long-term outcomes and can this be leveraged to improve older patient outcomes? We speak with the first author of this week's work, Assistant Professor of Pediatrics at Ohio State and also from Nationwide Children's Hospital, Dr. Emily Hayes. 

DOI: 10.1111/pe...

This week we review a recent study assessing the rate of hematochezia seen in children following neonatal congenital heart surgery, predominantly for aortic obstruction such as in HLHS. How often is this sign observed in this patient group and what percentage of these patients have actual necrotizing enterocolitis (NEC)? Are there any modifiable risk factors for NEC? How can these data help clinicians separate out those with more benign forms of hematochezia from those with NEC and how might this improve care for this patient group? These are amongst the questions reviewed this week with the work's first author, University...

This week we review a recent report of 4 patients with serious complications related to either perforation or external compression from the distal tines of the Alterra prestent when used for transcatheter pulmonary valve replacement. We speak with Dr. R. Allen Ligon, interventional cardiologist at Children's Healthcare of Atlanta/Emory University about a recent multicenter report of rare complications seen with this prosthesis. How common are perforations seen with this device and how often are these clinically silent? What should be done for clinically silent prestent perforations? What sort of surveillance of all patients with this device is warranted after successful...

This week we review a report from the teams at University College, Dublin and Texas Children’s Hospital about a collaborative approach to education in which two centers across the globe participate in a shared fellow learning conference. In this conference which is aimed at fellow education, topics are chosen and discussed with facilitated learning from faculty at both sites. What can be gained for fellows on opposite sides of the Atlantic that cannot be learned from exposure to just their one site? How did this approach help fellows learn about how to deal with uncertainty in decision making? How di...

This week we review a recent review paper on newest innovations and literature on pacing in pediatric patients and learn a bit about such diverse pediatric pacing topics as:
Use of the Medtronic Micra device in an off-label manner for epicardial pacing in small infantsNovel, less invasive approaches to placing epicardial leads in small childrenThe role of leadless pacing in the pediatric or CHD patientConduction system pacing in 2025 in the congenital patient
The above are amongst the potpourri of pacing topics that we review with noted congenital electrophysiologist, Dr. Charles Berul of Children's National Hospital in Washington, DC...

This week we step back in time 3 years ago to review an important 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 work from the department of cardiology and department of cardiac surgery at Boston Children's Hospital on late hypertension in patients following coarctation repair. Late hypertension has been associated previously with late transverse aortic arch Z score but can this be predicted by the immediate postoperative transverse aortic arch Z score also? What factors account for late hypertension in the coarctation patient? Should more patients have their aorta repaired from a sternotomy? Dr. Sanam Safi-Rasmussen, who is a PhD candidate at Copenhagen University, shares her insights from a work she performed while a research fellow at...

This week we delve into the world of cardiovascular surgery and general cardiology when we review a recent report from UVA on the topic of feeding around the time of neonatal heart surgery. Does preoperative oral feeding improve the chances for 'tube-free' enteral feeds at discharge after heart surgery in small infants? Why might oral feedings improve the chances of discharge oral feedings? How should clinicians think about the known benefits of early CHD surgery for some CHD lesions with the benefits of oral feedings? Dr. Aseel Dabbagh of Children's Mercy Hospital in Kansas City shares her insights into these...

This week we review a recent ACTION NETWORK project comparing outcomes of children with CHD who undergo VAD support in comparison to those children with VAD's who do not have CHD. How do morbidity and mortality rates compare between these two cohorts? Why might there be differences in outcomes between these two groups? How are heart failure and transplant cardiologists going to improve outcomes in complex CHD VAD patients in the future? How can all cardiologists make more timely referrals to heart failure and transplant cardiologists for their congenital heart patients? Dr. Shahnawaz Amdani of the Cleveland Clinic provides many...

In this week's replay episode from 2023, we speak with Associate Professor of Pediatrics at Mount Sinai, Dr. Jennifer Cohen about a recent large scale Fetal Heart Society project she conducted on the topic of fetal ccTGA and outcomes. What observations in fetal life are associated with worse clinical outcomes? Why is it valuable to perform serial fetal echocardiograms in this patient group? How common are genetic or extracardiac abnormalities in this patient group? These are amongst the many questions reviewed with Dr. Cohen this week. 
DOI: 10.1161/JAHA.122.029706

This week we delve into the world of cardiovascular surgery when we review a recent multicenter ("Ross Collaborative") study of long term outcomes of the Ross procedure in newborns and infants. How durable of a repair is this in this young age range? How does the neo-aortic root grow with time? Why might the neo-aorta not dilate in this age group as much as is reported in older patients following the Ross procedure? Who is a candidate for this approach? How are decisions made between aortic valve repair and Ross procedure? Professor David Winlaw who is director of cardiovascular surgery...

This week we review a recent report that asks the question, 'Do all infants who present with SVT require preventive anti-arrhythmic medical therapy?' Who might be a candidate for not using an anti-arrhythmia medication in infancy? What sort of parental education is needed to potentially not use medicine and how do patients not treated compare to those who were treated with anti-arrhythmics in regards to re-admission or presentation to the emergency department or development of tachycardia induced cardiomyopathy? How should parents assess their infants for SVT at home? How long should infants be monitored prior...

This week we review a recent large scale, multicenter adult congenital heart study on outcomes of HLHS Fontan patients versus other single RV Fontan patients. How do the two groups compare in regards to thromboembolic risk, risk for arrhythmia or risk for death and heart transplantation? Why might there be differences between these single RV patient groups? How can these results inform management? We speak with Assistant Professor of Medicine and Pediatrics at The Icahn School of Medicine at  Mount Sinai, ACHD expert Dr. Kali Hopkins. 

doi: 10.1161/JAHA.124.034757. Epub 2024 Nov 27

This week to conclude 2024 we speak with noted investment expert Mr. Paul Merriman to discuss a few topics related to personal finance and investing. First we tackle the notion of having 'enough' to retire. Is there a magic value and how would one think about this? Why is an S&P 500 Index or Total US Stock Market Index a fine 'core' investment and how might one possibly improve upon its performance? What are some of the psychological hurdles we have as investors and potential retirees? Mr. Merriman reviews these and other topics on our end of year episode. 

Wi...

This week we replay episode #203 with Professor Michael Freed of Harvard University, who died this past week. In this episode from 2022 we review his seminal paper on prostaglandin for the treatment of infants with critical congenital heart disease from 1981 and then speak with Dr. Freed about his life, career, the development of PGE1 and more in this wide-ranging interview with this pediatric cardiology pioneer. Dr. Freed shares important career advice as he would to cardiology fellows during his long and illustrious career, advising and shaping the careers of pediatric cardiologists for 5 decades. 

doi: 10.1161/01.cir.64.5.899.

This week we delve into preventive cardiology with noted world authority, Associate Professor of Pediatrics, Dr. Carissa M. Baker-Smith of Nemours Health. In the present era, what roles do environment and social determinants of health play in cardiovascular disease? How should practitioners take a family history and how has the family history evolved in modern times? How can clinicians be sure that they are not 'missing' factors when they are trying to screen for cardiovascular disease risk in their patients? What are a few practical changes in how we speak with patients that we can all make to improve our...

This week we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the...

This week we celebrate the life and career of Dr. Charles Mullins who passed this past week. Dr. Mullins was Professor of Pediatrics at Baylor College of Medicine and one of the pioneers in the world of congenital heart interventional cardiology. In today's episode we will listen back to an episode from 2021 from the SCAI 2021 meeting in which we interviewed Dr. Mullins and Dr. Julie Vincent (then Professor of Pediatrics at Columbia University). Drs. Mullins and Vincent discuss their lives as interventional cardiologists and also speak about the role that mentorship played in their long careers. Dr. Aimee Armstrong of...

This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the n...

This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the...

This week we enter the world of cardiac CT for congenital heart disease reviewing a recent report of a survey of congenital cardiologists who perform congenital heart CT scans. What have been the important trends seen in the past decade beyond expansion in the field in general? Why has the use of the CT scan grown at such a rapid clip? How much radiation does a present day CT scan represent for a patient? How are cardiology fellowships responding to the growing role of this modality in the field? How can we more properly assign accurate relative value units (RVU's...

This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorization improves outcomes? What is the impact of this process on healthcare equity? These are amongst the questions reviewed this week with Dr. Brian Marcus who is a cardiologist and critical care fellow at Children's Wisconsin. 


DOI: 10.1007/s0...

Pulmonary valve replacement following the arterial switch operation is rare. However, when necessary, how do techniques of transcatheter valve replacement fare for this indication? Why would average outcomes in this setting be less good than in the typical TPVR tetralogy of Fallot patient? How does the presence of stents in the pulmonary arteries in this patient group affect candidacy for TPVR? Are there ways to predict who might be a candidate for a TPVR vs. surgical PVR before coming to the catheterization lab? These are amongst the questions reviewed and posed to Dr. Stephen Nageotte who is the director of...

This week we review a recent large scale study on catecholaminergic polymorphic ventricular tachycardia (CPVT) in children which is based on two large international registries. How do outcomes differ between those symptomatic CPVT patients treated with or without an ICD? Who amongst symptomatic CPVT pediatric patients likely warrant an ICD? What sort of ICD might be optimal - subcutaneous or transvenous? Are there ways to program ICD's in CPVT patients that may reduce inappropriate shocks? Why should the ICD be rarely employed in the CPVT pediatric patient? These are amongst the questions reviewed this week on the podcast. W...

This week we delve into the worlds of cardiac critical care and neurodevelopment when we review a recent report from the team at Children's Hospital of Philadelphia assessing an association between postoperative opioid exposure in infants following CHD surgery and neurodevelopmental outcomes. What might be the biological basis for an association between these 2 factors? How confident can we be that opioid exposure is the factor of importance when there are so many co-variates and variables? We speak with outcomes research expert and interventional cardiologist Dr. Michael O'Byrne about this important and thought-provoking recent work.


DOI: 10.1016/j.jacc.2024.06.033

This week we listen in on a lecture by Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Christopher Janson, on the novel agent ivabradine. How does this agent work and in what circumstances can it be used in pediatric arrhythmia management? Is this safe to use for critical arrhythmias despite the fact that it is, at present, only available as an enteral agent? What is the proper dosing regimen with this medication? Dr. Janson answers these and many more questions about ivabradine in this lecture from the Pedirhythm XI conference in Rome, Italy on 9/20/24.

This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fabrizio Drago and the organizers of Pedirhythm for allowing us to listen in on this wonderful lecture by a world-wide authority.

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr...

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to...

This week we speak with noted interventional cardiologist Dr. Shyam Sathanandam of LeBonheur Children's Hospital in Memphis, TN about novel, 'off-label' uses of the Amplatzer Piccolo device in children. In what sorts of lesions does Dr. Sathanandam believe this device offers distinct advantages for vascular closure? What is the feature of this device that allows it to work for small defect closure so effectively and safely? Are there any new changes coming to this device or the delivery system for PDA closure in the premature infant? These are amongst the questions and topics reviewed with our guest this week!
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This week’s episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation in the field? We speak with third year cardiology fellow, Dr. Ogochuckwu M Ezeoke Cox, MD of C.S Mott Children’s Hospital at the University of Michigan about her recent essay on this vital topic. 

https://doi.org/10.1007/s00246-023...

This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He...

This week we delve into the world of the single ventricle when we speak with Dr. David Hoganson, Assistant Professor of Surgery at Harvard Medical School about a recent work he co-published with investigators from Boston Children’s Hospital on computational fluid dynamic modeling in the planning of the Fontan operation. Single ventricle heterotaxy patients with interrupted IVC are at enhanced risk for the development of pulmonary AVM’s due to flow maldistribution to the pulmonary arteries from the hepatic veins in a Fontan. Can a computational fluid dynamic model predict which operative approach would result in the most balanced hepa...

This week we turn back the clocks to re-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, Associate Professor at Baylor...

This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated with graft failure in the present era in comparison to the past? What might be the impact of newer heart perfusion devices used to transport organs for transplant? These are amongst the...

This week we review a recent report assessing LV function and properties in the Ebstein's anomaly patient using CMR. How often is LV dysfunction observed in the Ebstein's patient who is about to undergo surgical Cone repair? How often did the echo underestimate LV dysfunction in comparison to the 'gold standard' CMR? How often is LV non-compaction observed when using strict criteria in this disease? Can CMR assessment of LV function preoperatively predict postoperative ICU course? These are amongst the questions posed to the first author of this week's work, advanced imaging fellow at U. Pittsburgh, Dr. Aditi Gupta. 
Duration: 00:25:48

This week we delve into the world of electrophysiology and review a recent report from the team at Primary Children’s hospital on the use of intravascular ultrasound for EP ablation procedures in children. How is this technology useful for ‘routine’ ablations in kids? Are there some forms of tachycardia where its use is more important than others? How does it lower procedural time or improve efficacy? We speak with Dr. Thomas Pilcher, chief of pediatric electrophysiology at Primary Children’s about his center's recent report in the use of this technology for ablation in children and those with congenital heart di...

This past week marked the passing of the great pediatric cardiology pioneer, Dr. Sylvia Griffiths. Dr. Griffiths was a trainee of Dr. Ruth Wittemore of Yale University and was one of the founders of the pediatric cardiology program at NY Presbyterian Hospital in the mid 1950's with Dr. Sidney Blumenthal. Her career spanned 7 decades, all at NY Presbyterian, Columbia University. She is remembered as a pioneering woman in medicine as well as a pioneer as a pediatric cardiologist. She is also remembered as a kind and warm colleague and friend. In today's 304th episode of Pediheart we review a 55 year...

This week we review a recent paper from last 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient group and how might the...

This week we go back in time to 20222 to re-review an episode focusing 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's topic is ductal stenting in a low resource environment. We review a recent report from the team at Amrita Institute in Kerala, India about their large, over 10 year experience in ductal stenting. Why has this approach superceded BTTS in this environment? How does the team determine if a patient is a candidate and what morphologies of duct would be inappropriate for intervention? How does the team manage PGE prior to ductal stenting to allow that perfect balance between pulmonary blood flow and ductal constriction to improve procedural success? What can operators in the west learn from the experience...

This week we review a novel multivariable model used to predict mortality in the repaired tetralogy of Fallot patient. Can this model identify who amongst the repaired TOF patients is at risk for death in the coming years? What are the most important inputs to this model? Why does the use of a validation cohort provide greater strength to this model and is there still room for improvement in the model? Can the data in this work help inform decisions regarding pulmonary valve replacement timing? These are amongst the questions posed to the senior author of this work, Cardiologist-in-Chief at...

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 the next generation of EP doctors? What sort of 'technology' existed to perform...

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 these data differ from the initial intent? Do STS risk adjustment models capture all...

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 multicenter trial? Is that even necessary? Joining us to discuss this and more about this...

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 a better outcome and what percentage of PA/IVS patients ultimately have a 2 ventricle repair? Where are the areas for...

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 again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach t...

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 meaningful degree of reduction in pulmonary artery obstruction and/or RV pressure? How commonly were complications observed? These are amongst the questions reviewed this...

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 Hospital at Mount Sinai, Dr. Barry Love who is also Director of the Congenital Cardiac Catheterization Laboratory at Mount Sinai Hospital. 

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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 Advanced Imaging Fellow at Boston Children's Hospital, Dr. Francesca Sperotto of Harvard University about her recent multicenter...

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, Dr. Anastasia Egorova of Leiden University in the Netherlands. 

https://doi.org/10.1016/j.jacc.2024.02.017

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 countries and why might this be? These are amongst the many questions reviewed with the first author of this week's...

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 authority on this topic, Dr. Joshua Daily who is Associate Professor of Pediatrics at The University of Arkansas...

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 posed to this week's guest, noted pediatric electrophysiologist and Professor of Pediatrics at OHSU, Dr. Seshadri Balaji. 

https://doi.o...

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 with this week's senior author, Professor of Pediatrics at the Children's Hospital of...

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 pharmacist's perspective on some of these important questions.

https://doi.org/10.1016/j.athoracsur.2022.02.047

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 understand how a model of this sort is making its determinations? How might such a...

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 severe fibrosis or even frank cirrhosis? Can these insights provide hope for improved surveillance or therapy for this problem? Dr...

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 severe fibrosis or even frank cirrhosis? Can these insights provide hope for improved surveillance or therapy for this problem? Dr...