Pediheart: Pediatric Cardiology Today

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

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

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

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

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

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

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

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

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

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

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

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

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

This week we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if anything, can 'move the needle' to higher levels of survival in this patient population? Dr. Brink offers some interesting and important insights this week. doi: 10.1016/j.jtcvs.2019.03.126.

This week we speak with cardiovascular surgeon Dr. Johann Brink about a recent work he co-authored from the Royal Children's Hospital in Melbourne, Australia about the team's experience with shunt malfunctions. Are there factors that are associated with shunt failure in this sometimes fragile patient group? Survival to Fontan in most series is roughly 70% - what, if anything, can 'move the needle' to higher levels of survival in this patient population? Dr. Brink offers some interesting and important insights this week. doi: 10.1016/j.jtcvs.2019.03.126.