Pediheart: Pediatric Cardiology Today

This week we speak with Dr. Douglas Mah, Assistant Professor of Pediatrics - Harvard Medical School and Director of the Pacemaker and ICD Service at Children's Hospital Boston about a recent paper he published with his colleagues on coronary artery compression from epicardial pacemaker leads. Who is at risk for this rare complication? How can patients be screened? Once identified, what is the treatment? We review all this and more with Dr. Mah. doi: 10.1016/j.hrthm.2018.06.038

This week we explore the world of 'fast tracking' patients following cardiac surgery and focus on how to best provide analgesia and sedation to such patients. Are there advantages to intermittent boluses of such agents rather than a low dose basal infusion? What are the implications of such a strategy for nursing and medical care? Does 'waiting' for discomfort prior to administration of medication work better than 'preventing' such? Are there patients who would not be good candidates for such an approach? We explore these issues with Assistant Professor of Pediatrics at Mount Sinai Medical Center - NYC, Dr. Scott Aydin who is also associate director of the pediatric critical care unit at that same institution.

This week we explore the world of 'fast tracking' patients following cardiac surgery and focus on how to best provide analgesia and sedation to such patients. Are there advantages to intermittent boluses of such agents rather than a low dose basal infusion? What are the implications of such a strategy for nursing and medical care? Does 'waiting' for discomfort prior to administration of medication work better than 'preventing' such? Are there patients who would not be good candidates for such an approach? We explore these issues with Assistant Professor of Pediatrics at Mount Sinai Medical Center - NYC, Dr. Scott Aydin who is also associate director of the pediatric critical care unit at that same institution.

This week we explore the question of optimal timing of the Fontan operation. What factors are associated with good or bad outcome after Fontan in regards to age at surgery? Can Fontan palliation have a positive impact on cardiac function? Is there a 'sweet spot' regarding timing of this single ventricle palliation? Who deserves a fenestration? These are amongst the many questions we review this week in our review of a recent large German experience in Fontan in patients with advanced age at Fontan. We discuss the paper and aspects of it with noted surgeon Dr. Ram Kumar Subramanyan, Assistant Professor of Surgery and Pediatrics of USC - Children's LA. DOI: 10.1016/j.jtcvs.2018.03.155

This week we explore the question of optimal timing of the Fontan operation. What factors are associated with good or bad outcome after Fontan in regards to age at surgery? Can Fontan palliation have a positive impact on cardiac function? Is there a 'sweet spot' regarding timing of this single ventricle palliation? Who deserves a fenestration? These are amongst the many questions we review this week in our review of a recent large German experience in Fontan in patients with advanced age at Fontan. We discuss the paper and aspects of it with noted surgeon Dr. Ram Kumar Subramanyan, Assistant Professor of Surgery and Pediatrics of USC - Children's LA. DOI: 10.1016/j.jtcvs.2018.03.155

Interventional cardiology is on tap this week as we explore the world of transcatheter management of the dysfunctional RVOT with 2 papers on this topic. In the first, Dr. Mary Hunt Martin, Assistant Professor of Pediatrics - University of Utah is the first author on a recent PHN paper on outcomes of Melody implantation in the native RVOT. Dr. Martin joins us to answer a number of questions about this important work. The second work is a recent multi center French study on use of the Sapien valve in the RVOT/conduit. How do the acute results with this valve compare with the Melody? What are the indications for Melody vs. Sapien? These are amongst the questions we tackle this week on the podcast. DOI: 10.1016/j.jcin.2018.05.051 and DOI: 10.1016/j.jcin.2018.05.050

Interventional cardiology is on tap this week as we explore the world of transcatheter management of the dysfunctional RVOT with 2 papers on this topic. In the first, Dr. Mary Hunt Martin, Assistant Professor of Pediatrics - University of Utah is the first author on a recent PHN paper on outcomes of Melody implantation in the native RVOT. Dr. Martin joins us to answer a number of questions about this important work. The second work is a recent multi center French study on use of the Sapien valve in the RVOT/conduit. How do the acute results with this valve compare with the Melody? What are the indications for Melody vs. Sapien? These are amongst the questions we tackle this week on the podcast. DOI: 10.1016/j.jcin.2018.05.051 and DOI: 10.1016/j.jcin.2018.05.050

This week we explore the interpretation of T wave inversions in the athlete with Professor Sanjay Sharma, Professor of Cardiology University of London. Which T wave inversions are "normal variants" and which are worrisome for disease? What is the role of genetic testing in determining who has disease? We review Prof. Sharma's group's recent paper on this topic and discuss different aspects of this work with this world-renowned figure in this field. DOI: 10.1161/CIRCULATIONAHA.118.034208

This week we explore the interpretation of T wave inversions in the athlete with Professor Sanjay Sharma, Professor of Cardiology University of London. Which T wave inversions are "normal variants" and which are worrisome for disease? What is the role of genetic testing in determining who has disease? We review Prof. Sharma's group's recent paper on this topic and discuss different aspects of this work with this world-renowned figure in this field. DOI: 10.1161/CIRCULATIONAHA.118.034208

This week we delve into the world of Marfan Syndrome and review a recent report from the Pediatric Heart Network with the first author of this work, Dr. Seda Selamet Tierney - Associate Professor of Pediatrics, Stanford University. Why does stiffness of the aortic wall predict dilation and need for surgery? Does the use of atenolol or losartan affect aortic growth or dilation? Which agent is preferable? Dr. Selamet Tierney shares her insights this week on the podcast. DOI: 10.1016/j.amjcard.2018.01.016

This week we delve into the world of Marfan Syndrome and review a recent report from the Pediatric Heart Network with the first author of this work, Dr. Seda Selamet Tierney - Associate Professor of Pediatrics, Stanford University. Why does stiffness of the aortic wall predict dilation and need for surgery? Does the use of atenolol or losartan affect aortic growth or dilation? Which agent is preferable? Dr. Selamet Tierney shares her insights this week on the podcast. DOI: 10.1016/j.amjcard.2018.01.016

This week we review a novel paper on MRI changes observed in TOF adults. Are these signs for advanced brain 'aging' in tetralogy adults? We also review a prospective trial of different mechanical ventilation strategies during SVT ablations in children. Can tidal volume or PEEP affect catheter stability while mapping or ablating SVT? We discuss this question with the first author of this work, Dr. Christopher Janson, Assistant Professor of Pediatrics at The Children's Hospital of Philadelphia. Articles: DOI: 10.1371/journal.pone.0202496; DOI: 10.1007/s00246-018-1968-7

This week we review a novel paper on MRI changes observed in TOF adults. Are these signs for advanced brain 'aging' in tetralogy adults? We also review a prospective trial of different mechanical ventilation strategies during SVT ablations in children. Can tidal volume or PEEP affect catheter stability while mapping or ablating SVT? We discuss this question with the first author of this work, Dr. Christopher Janson, Assistant Professor of Pediatrics at The Children's Hospital of Philadelphia. Articles: DOI: 10.1371/journal.pone.0202496; DOI: 10.1007/s00246-018-1968-7

This week we explore the world of cardiac transplantation with particular emphasis on the Fontan patient and transplantation. Outcomes are improving rapidly. Why is this? What about the liver and how are decisions made regarding cardiac versus cardiac+hepatic transplantation in this patient population? We review all of these questions with world authority on cardiac transplantation Dr. Daphne Hsu, Professor of Pediatrics, Chief of Pediatric Cardiology and Interim Chair of Pediatrics at Montefiore - Albert Einstein College of Medicine. Her insights into this complex patient group are valuable and novel. Article reviewed: DOI: 10.1016/j.athoracsur.2016.08.110

This week we explore the world of cardiac transplantation with particular emphasis on the Fontan patient and transplantation. Outcomes are improving rapidly. Why is this? What about the liver and how are decisions made regarding cardiac versus cardiac+hepatic transplantation in this patient population? We review all of these questions with world authority on cardiac transplantation Dr. Daphne Hsu, Professor of Pediatrics, Chief of Pediatric Cardiology and Interim Chair of Pediatrics at Montefiore - Albert Einstein College of Medicine. Her insights into this complex patient group are valuable and novel. Article reviewed: DOI: 10.1016/j.athoracsur.2016.08.110