Pediheart: Pediatric Cardiology Today

This week we review the impact of conduit size on exercise capacity in the single ventricle Fontan patient. Is there an optimal sized conduit for the Fontan patient? What is the role of formal exercise stress testing in the evaluation and monitoring of the Fontan patient? We review these questions and more with Associate Professor of Medicine at UT Southwestern - Dr. Ari Cedars. doi: 10.1007/s00246-019-02190-4

This week's episode is co-branded with SADS.ORG and we review a paper on the clinical presentation of those who have conditions associated with sudden cardiac death. Are there questions about the patient and family history and physical examination signs that can improve the identification of those at risk before an event of cardiac arrest? We review this important question and others with Assistant Professor of Pediatrics at Washington University in St. Louis, Dr. Aarti Dalal. Referenced also in this discussion is the following webpage: https://www.sads.org/Library/School-Materials/Risk-Assessment#.XW25gy2ZOu4.DOI:10.1016/j.jpeds.2016.06.088

This week's episode is co-branded with SADS.ORG and we review a paper on the clinical presentation of those who have conditions associated with sudden cardiac death. Are there questions about the patient and family history and physical examination signs that can improve the identification of those at risk before an event of cardiac arrest? We review this important question and others with Assistant Professor of Pediatrics at Washington University in St. Louis, Dr. Aarti Dalal. Referenced also in this discussion is the following webpage: https://www.sads.org/Library/School-Materials/Risk-Assessment#.XW25gy2ZOu4.DOI:10.1016/j.jpeds.2016.06.088

This week we discuss the results of a phase 2 trial of autologous stem cell therapy for the treatment of patients with HLHS. How challenging was it to obtain autologous stem cells from a large number of patients in multiple locations throughout North America? What are the theoretical benefits for this form of therapy? What evidence presently exists for its potential efficacy? How is this therapy best delivered to the myocardium. We discuss these and other questions with the senior author of a recent work on this topic, Professor Timothy Nelson of the Mayo Clinic. doi: 10.1016/j.jtcvs.2019.06.001

This week we discuss the results of a phase 2 trial of autologous stem cell therapy for the treatment of patients with HLHS. How challenging was it to obtain autologous stem cells from a large number of patients in multiple locations throughout North America? What are the theoretical benefits for this form of therapy? What evidence presently exists for its potential efficacy? How is this therapy best delivered to the myocardium. We discuss these and other questions with the senior author of a recent work on this topic, Professor Timothy Nelson of the Mayo Clinic. doi: 10.1016/j.jtcvs.2019.06.001

This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What areas were particularly well served by this approach? Dr. Brian White, senior cardiology fellow at CHOP provides important insights into this project that he co-authored. doi: 10.1111/echo.14441

This week we enter the worlds of fellow education and echocardiography to review a recent report of a QI project performed at Children's Hospital of Philadelphia regarding the performance of echocardiograms by first year fellows in cardiology. Can the implementation of a checklist protocol improve the consistency of echocardiograms performed by fellows? What was the impact of this protocol? What areas were particularly well served by this approach? Dr. Brian White, senior cardiology fellow at CHOP provides important insights into this project that he co-authored. doi: 10.1111/echo.14441

This week we review a recent study from The University of Toronto on the impact of timing of the arterial switch operation for DTGA on brain growth and neurodevelopmental outcomes. Can the timing of this surgery impact these outcomes? What is the reason for this? Is it rational to perform this surgery early to improve neurological outcomes? How important is the conduct in the OR versus the ICU? These are amongst the questions we address with Professor Jane Newburger of Harvard University - Boston Children's Hospital this week! doi: 10.1161/CIRCULATIONAHA.118.037495

This week we review a recent study from The University of Toronto on the impact of timing of the arterial switch operation for DTGA on brain growth and neurodevelopmental outcomes. Can the timing of this surgery impact these outcomes? What is the reason for this? Is it rational to perform this surgery early to improve neurological outcomes? How important is the conduct in the OR versus the ICU? These are amongst the questions we address with Professor Jane Newburger of Harvard University - Boston Children's Hospital this week! doi: 10.1161/CIRCULATIONAHA.118.037495

This week we review a recent paper on the topic of durable VAD's in congenital heart patients. Who is a candidate for such a device and what are the outcomes with these in this selected patient group? What are the impediments to their use? What role might public reporting have on the use of these devices and transplantation in general on the congenital heart population? We touch on all of these questions and more with Dr. Lauren Glass, Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai - NYC where she is Associate Director of Heart Failure and Cardiac Transplantation. doi: 10.1097/MAT.0000000000001041

This week we review a recent paper on the topic of durable VAD's in congenital heart patients. Who is a candidate for such a device and what are the outcomes with these in this selected patient group? What are the impediments to their use? What role might public reporting have on the use of these devices and transplantation in general on the congenital heart population? We touch on all of these questions and more with Dr. Lauren Glass, Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai - NYC where she is Associate Director of Heart Failure and Cardiac Transplantation. doi: 10.1097/MAT.0000000000001041

This week's episode is our second 'co-branded' episode with the SADS Foundation (SADS.ORG) and we speak with the founder and director of Crediblemeds.org, Professor of Medicine Ray Woosley of the University of Arizona. Dr. Woosley speaks with us about how he started the first website dedicated to assessing the evidence for drugs' impact on the QT interval establishing a reliable and trusted website for clinicians and patients to visit to learn about possible drug interactions and their impact on LQTS and the QT interval in general. How was the site first conceived? What are the latest changes on the site? What are the plans for this work going forward? Is grapefruit juice really dangerous? Why does the site request that all have to sign up to access the site? Professor Woosley provides all the answers and more this week!

This week's episode is our second 'co-branded' episode with the SADS Foundation (SADS.ORG) and we speak with the founder and director of Crediblemeds.org, Professor of Medicine Ray Woosley of the University of Arizona. Dr. Woosley speaks with us about how he started the first website dedicated to assessing the evidence for drugs' impact on the QT interval establishing a reliable and trusted website for clinicians and patients to visit to learn about possible drug interactions and their impact on LQTS and the QT interval in general. How was the site first conceived? What are the latest changes on the site? What are the plans for this work going forward? Is grapefruit juice really dangerous? Why does the site request that all have to sign up to access the site? Professor Woosley provides all the answers and more this week!

This week we review a recent Swedish paper that assessed the risk for cancer in patients with congenital heart disease and compared this to normal controls in a large administrative database. Why are cancer rates different in the congenital heart patient? What are the most important factors? What actions should be taken by those cardiologists caring for ACHD patients to properly screen for cancer? We discuss all of the above and more with Assistant Professor of Pediatrics - Harvard University - Dr. Michelle Gurvitz. doi: 10.1001/jamanetworkopen.2019.6762

This week we review a recent Swedish paper that assessed the risk for cancer in patients with congenital heart disease and compared this to normal controls in a large administrative database. Why are cancer rates different in the congenital heart patient? What are the most important factors? What actions should be taken by those cardiologists caring for ACHD patients to properly screen for cancer? We discuss all of the above and more with Assistant Professor of Pediatrics - Harvard University - Dr. Michelle Gurvitz. doi: 10.1001/jamanetworkopen.2019.6762