Pediheart: Pediatric Cardiology Today

In this week's replay episode we review the important topic of anticoagulation of the Fontan patient. We speak with hematology researcher, Dr. Chantal Attard of The Murdoch Children's Research Institute of The University of Melbourne about a recent cross-sectional study comparing multiple factors in patients with Fontan circulation on aspirin vs. warfarin. What were the demonstrable differences in outcome? Are there ways to make the use of warfarin more safe? What about novel anticoagulants - what is their possible role and what evidence exists for their use in this setting? Dr. Attard provides many key 'takeaways' this week! doi: 10.1016/j.jtcvs.2020.12.102

This week we speak with living legend of cardiology, Dr. Michael Freed about his life and also his landmark paper in 1981 on PGE1. How did Dr. Freed come to conduct one of the first multi center trials of an agent in pediatrics? What was life like in the world of pediatric cardiology prior to PGE1? What is Dr. Freed up to today? What advice does he have for the younger generation? This is a rare opportunity to speak with one of the living legends of our field. DOI: 10.1161/01.cir.64.5.899

This week we review a recent work from the team at NY Presbyterian on SVT and a possible role it may rarely play in sudden cardiac arrest in children. When a patient does not have an obvious cause of arrest, is SVT a possible etiology and should invasive EP testing be considered? We speak with the senior author of this work, Dr. Leonardo Liberman about his thoughts on SVT as a possible cause of arrest and who amongst the many non-pre-excited SVT patients are perhaps 'higher risk'. doi: 10.1007/s00246-021-02720-z

This week we review the concept of stenting the pulmonary veins and we speak with Assistant Professor of Pediatrics at Baylor Medical College, Dr. Melissa Webb about a recent work she co-authored on this topic. Dr. Webb reviews a novel approach to shortening Palmaz stents and then reviews for us the rationale for stenting PV's and also discusses how these patients are longitudinally followed at Texas Children's Hospital. doi: 10.1002/ccd.29984

In this 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 to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace. doi: 10.1007/s00134-004-2504-1

This week's replay episode is co-branded with SADS.ORG and is on the topic of pre-participation screening from 2 years back. Can the ECG offer important benefits vs. the standard 14 point AHA H&P approach? Which approach was more effective in 'real life'? We speak with Professor Robert Campbell of Emory University this week to delve into this contentious and important topic. DOI: 10.1016/j.hrthm.2020.04.032

This week we delve into cardiac surgery and review a recent paper from Rady Children's Hospital about patch material and outcomes in the CHD surgical patient. What are the reasons that glutaraldehyde is used to treat patches used for surgery and what are the potential benefits and disadvantages? What sorts of patches are best for what indications? Are there data to suggest superiority of one patch material versus another? We speak with the senior author of this week's work, Assistant Professor of Surgery at Mount Sinai, Dr. Raghav Murthy about this interesting topic. DOI: 10.1016/j.athoracsur.2020.11.014

This week we review a recent work from Utrecht University in The Netherlands on the topic of postoperative pericardial effusion following congenital heart surgery. Some use steroids, some NSAIDs and some colchicine. Are there any data supporting one agent versus the other? We speak with the first author of this work, Poznan University of Medical Sciences student, Nirmiti Somani about this practical and important issue in congenital heart surgery. DOI: 10.1007/s00246-022-02820-4

This week we delve into the world of the single ventricle patient when we speak with Dr. Adam Lubert of Cincinnati Children's Hospital Center about a recent work he co-authored on MRI imaging of the liver in the Fontan patient. Can simple liver metrics help predict hemodynamics or even outcomes in the single ventricle patient with a Fontan? What is the optimal way to image the liver in this patient group? Are there congenital patients other than Fontan patients who might merit liver imaging? Professor Lubert shares his deep insights this week. doi: 10.1016/j.amjcard.2021.10.045.

This week we travel back in time to 1991 to review one of the first collaborative projects between Dr. Lisa Hornberger of U. Alberta and the legendary pediatric cardiology investigator, Dr. David Sahn. In this work on tricuspid valve disorders with TR and their diagnosis in fetal life, we learn about our first understandings of this complex physiology and problem and use this as starting point to speak about Professor Sahn, who passed just a few weeks ago. Dr. Hornberger was one of his most important mentees and was inspired to become a fetal cardiologist from her work with this master of echocardiography. Here Dr. Hornberger share her thoughts on Ebstein's anomaly but also Dr. Sahn and the meaningful impact a mentor can have in shaping a person's entire life and career. Prepare to be inspired by the tale of Dr. Sahn and Dr. Hornberger this week. DOI: 10.1016/0735-1097(91)90722-l

In a replay of episode #90 from 2019, we re-review a recent report from the CTOTC-04 study group assessing the impact of novel anti-rejection approaches which generally markedly reduce or remove steroids in the prevention of rejection. How are rejection rates affected by such an approach? Did incidences of diabetes or PTLD differ when using this form of steroid reduced approach in the 'low immunological risk' subset of patients undergoing heart transplantation? We speak with the first author of this work, Professor of Pediatrics, Dr. Jacqueline Lamour of the Icahn School of Medicine at Mount Sinai. Dr. Lamour provides deep insights this week! doi: 10.1016/j.healun.2019.06.006

This week we delve into general pediatric cardiology and discuss those mild abnormalities that are sometimes seen on echo in the newborn nursery. Which of these minor findings in healthy newborns should be monitored and who can be 'discharged' from cardiology follow-up? Are there data to help inform these decisions? Dr. John Hokanson, Professor of Pediatrics, U. Wisconsin, shares his insights this week. DOI: 10.1007/s00246-021-02795-8

This week we review a recent CMR study assessing changes in myocardial fibrosis identified with CMR T1 mapping seen in TOF patients with a single nucleotide polymorphism (SNP) of hypoxia inducible factor 1 alpha. Is myocardial fibrosis in the TOF patient due to hemodynamic factors alone or are there genetic factors that predispose to differences that can be measured on CMR? Professor Lars Grosse-Wortmann of OHSU shares his deep insights into this fascinating topic in which our understanding is rapidly evolving. doi: 10.1016/j.ijcard.2021.12.047

Melody valves have been demonstrated to be associated with a small but consistent rate of endocarditis. Are there factors that might help predict who would need surgical explantation versus those who can be medically managed without surgery? Dr. Arpine Davtyan, senior cardiology fellow at Rady Children's Hospital shares insights from her recent multicenter, retrospective study on this topic. doi: 10.1007/s00246-021-02801-z

Dr. George Ofori-Amanfo, Division Chief of Pediatric Critical Care Medicine in the Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai and at the Mount Sinai Kravis Children's Hospital, died last week after a very long illness. To honor him, we go back to episode #2 in 2018 in which Professor Ofori-Amanfo shares his insights into the delivery of cardiovascular care in the developing world. Following this interview, the first in the entire Pediheart series, we hear from a large number of prominent nurses, cardiologists, critical care physicians, and surgeons who each offer their appreciations of Dr. Ofori-Amanfo. His impact will be long lasting and he will be missed.