Pediheart: Pediatric Cardiology Today

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

This week we turn back to 2020 and delve once more into the world of mental health and review a new large study from the group at Texas Children's on prevalence of anxiety, depression and ADHD amongst the pediatric CHD patient group. How common are these disorders in the young CHD patient and how does this compare to the general pediatric population? What role does minority or insurance status have on diagnosis or treatment of these disorders? Third year cardiology fellow Dr. Vincent J. Gonzalez shares insights from his important work this week. doi: 10.1542/peds.2020-1693

This week we review a recent large claims database study on WPW in children that aims to identify the true incidence of life threatening events in children with this condition. What is known about the incidence of life threatening events as well as the actual prevalence of WPW amongst children? What are the strengths and limitations of large claims database studies? How high is the risk for VF in the WPW child and how should this knowledge inform decisions regarding ablation? Noted expert in WPW, Dr. Christopher Janson of Children's Hospital of Philadelphia shares his insights this week. https://doi.org/10.1016/j.hrthm.2021.12.009

This week we speak with Associate Professor of Pediatrics at University of Washington Sujatha Buddhe of Seattle Children's Hospital about a recent survey study she conducted regarding CMR in the pediatric and congenital heart patient. How have volumes of cases changed over the past few years? Who is reading these studies? What is the advantage of a 1.5T vs. 3.0T scanner for congenital scans? What are the advantages and limitations of a survey study? Dr. Buddhe provides the answers this week. DOI: 10.1186/s12968-021-00830-4

This week we delve into the world of heart transplantation to review a recent article on the topic of outcomes of the Down syndrome patient undergoing heart transplantation. Are infections or cancers more common in this patient group following transplantation? What role does intellectual disability play in the present era in decisions regarding transplantation in this patient group? Associate Professor of Pediatrics at Vanderbilt University, Dr. Justin Godown, shares his insights into this important topic. doi: 10.1161/JAHA.121.024883

This week we play a session of the podcast from SCAI 2022 in Atlanta with Professor of Pediatrics, Columbia University - Dr. Christopher Petit reviewing a recent publication on the topic of systemic sirolimus in concert with catheter interventions for the treatment of pulmonary vein stenosis. Who is a candidate for this sort of therapy? Does systemic sirolimus confer a survival benefit over local stent delivery? Who should be caring for patients with pulmonary vein stenosis? Who is a candidate for transcatheter intervention vs. surgical intervention? Dr. Petit provides the answers in this live session from SCAI 2022. doi: 10.1016/j.jacc.2021.04.013

This week in a live session from SCAI 2022 we hear Assistant Professor of Pediatrics, Dr. Eimear McGovern shares her insights into a recent work she co-authored on changes in Fontan dimensions over time. Who needed interventions and how does the team in Kentucky choose to perform surveillance catheterizations on their Fontan patients? Is there an optimal time? What degree of stenosis or narrowing of a Fontan deserves intervention? Dr. McGovern provides the answers from Atlanta's SCAI Scientific Sessions on 5.21.22. doi: 10.1007/s00246-021-02658-2.

In this replay of episode 92 from 2019, 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 review a recent report from Lurie Children's in Chicago on the impact of fetal diagnosis of vascular rings. Does prenatal knowledge of this problem enhance postnatal outcomes? Who deserves cross sectional imaging after birth if prenatally diagnosed with a ring or sling and when and how should this be performed? We speak with Assistant Professor of Surgery at the Mayo Clinic, Dr. Elizabeth Stephens about a recent work she authored on this topic. We also briefly speak with Dr. Kenan Stern about the upcoming, free Mount Sinai Kravis Children's Hospital imaging course that is fast approaching on 5/20/22. DOI: 10.1016/j.athoracsur.2021.01.025

This week we review a recent report from the team at Boston Children's Hospital about a novel approach to avoid heart block during complex congenital heart surgery? Assistant Professor of Pediatrics at Harvard Medical School Elizabeth DeWitt shares with us her insights into a recent report she co-authored by the departments of surgery and cardiology at her institution about intraoperative mapping of conduction. How easy is it to identify the conduction system and how effective at avoiding heart block? Who is a good candidate for this approach? Dr. DeWitt offers her insights as does Dr. John Triedman, Chief of Electrophysiology and a co-author. Dr. Triedman also shares with us information regarding the upcoming PedirhythmX conference that will be held in Boston 9/22-9/24. DOI: 10.1016/j.xjtc.2021.11.017

This week we move into the world of cardiac surgery when we review a recent 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 delve into two areas of interest - fellowship training and fetal cardiology when we review a multi-center work endorsed by the Fetal Heart Society on the topic of fetal heart disease counseling. How is this skill taught to cardiology fellows and what are the deficiencies that present exist? Is empathy something that can be taught? What efforts are afoot regarding formalized curricula for this topic? What is the best way to train this critical skill for the cardiologist providing fetal cardiology counseling? We speak with the first author of this week's work, Assistant Professor of Pediatrics at UT Southwestern, Dr. Jenna Keelan. DOI: 10.1007/s00246-022-02882-4