Pediheart: Pediatric Cardiology Today

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 delve into the world of ACHD when we review a recent large data evaluation from the team at Erasmus University in the Netherlands regarding outcomes of DTGA/Arterial Switch patients who have gone through pregnancy. How do these patients fare in general? What sort of pre-pregnancy evaluation should these patients have? Where should their offspring be delivered? Is a maternal fetal medicine expert required for all? Do all DTGA/Switch patients require tertiary care centers? Dr. Karishma Ramlakhan, PhD candidate at Erasmus University shares her deep insights this week. doi: 10.1161/JAHA.120.018176

This week we review a recent work from the team at University of Alabama in Birmingham about clinical outcome disparities amongst Black children with Kawasaki disease. What differences exist in outcomes between these groups and are these differences social or biological in origin? We speak with one of the authors of this work, Assistant Professor of Pediatrics Leslie Collins about this important work. doi: 10.1016/j.jpeds.2020.09.052

From August 2020 - This week we delve into the topic of fellow wellness and review a recent work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who is the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness. An important topic for our milestone 130th episode. doi: 10.1007/s00246-019-02276-z. Back next week with a new episode!

This week we spend the entire episode speaking with Professor Peter Lang of Harvard University about his rich and long career in pediatric cardiology during one of the most exciting times of the field. Dr. Lang's story includes a virtual who's who of important cardiologists and cardiac surgeons for the past 50 years including Dr. Connie Hayes, Dr. Roberta Williams, Dr. Alexander Nadas, Dr. Richard Van Praagh, Dr. Aldo Castaneda, Dr. Bill Norwood and many, many more. This is a rare opportunity to hear about the development of the Norwood procedure from someone who was at the bedside of the first 30-50 ever performed as well as someone who helped develop the entire field of cardiac critical care. Prepare to be inspired by this towering figure this week.

This week we review a recent work assessing changes in Fontan conduit cross sectional area over time. What accounts for these changes and how do these affect exercise capacity? What does the future hold for the Fontan procedure? Is there an optimal conduit size for patients? We speak with Assistant Professor of Pediatrics at USC, Dr. Neil Patel this week! doi: 10.1016/j.jtcvs.2020.09.140

This week we enter the world of pulmonary hypertension (PH) and review a large multicenter registry study assessing outcomes of the Potts shunt for the management of severe PH. Who is a good or bad candidate for this therapy? Is there an advantage to placement of a valve in the shunt? Does this form of palliation affect lung transplant eligibility? We speak with the first author of this week's paper, Dr. R. Mark Grady, Professor of Pediatrics at Washington University. doi: 10.1016/j.jacc.2021.05.039. For this interested, the organization mentioned this week is ljshealinghearts.com.

This week we enter the world of CT surgery to review a recent STS database study on outcomes of diaphragm paralysis following congenital heart surgery. How common is a diaphragm paralyzed following surgery and what are the main risk factors for this complication? How commonly are these plicated and how do those who are plicated fare in comparison to those managed more conservatively? Professor Narutoshi Hibino of U. Chicago shares his insights this week. doi: 10.1016/j.athoracsur.2020.05.175.

This week we replay an episode that reviews a critically important neurodevelopmental issue affecting infants who have single ventricle palliation - namely hearing loss. How common is hearing loss seen and what role does IV furosemide play in this finding amongst single ventricle patients? Are there techniques to avoid this complication and yet still use this commonly used diuretic agent? We discuss this important issue and study with Dr. Ari Joffe, Professor of Pediatrics University of Alberta - Stollery Children's Hospital who is the senior author of this week's work. doi: 10.1097/PCC.0000000000001807

This week we delve into the world of myocarditis and cardiogenetics when we review a recent work on deleterious cardiomyopathic genes and a possible role for these in patients who have unfavorable myocarditis outcomes. Are cardiomyopathy genes seen more commonly in pediatric patients with myocarditis who die? Is there a role for genetic testing in the myocarditis patient? How might deleterious genetic defects influence outcomes in myocarditis? We speak with Assistant Professor of Medicine at The Icahn School of Medicine at Mount Sinai, Amy Kontorovich who is the first author of this week's work. DOI: 10.1161/CIRCGEN.121.003426

This week we delve into the heart failure and transplantation realm when we review a recent large scale PHIS database study assessing the associations of tracheostomy and outcomes of pediatric heart transplantation. Are tracheostomies associated with worse outcomes or mediastinitis? Who is a good candidate for this therapy? How difficult is it to discuss this option with families and why? These are amongst the questions reviewed with the senior author of this work, Professor Antonio Cabrera of the University of Utah. DOI: 10.1111/petr.13904

This week in our 2nd 'fellow takeover' episode we speak with the inspiring figure, Dr. Elisabeth Martin, who is Assistant Professor of Surgery at Stanford University and one of the cardiovascular surgeons at Lucile Packard Children's Hospital. How did this young surgeon choose to become a cardiac surgeon and what trials and tribulations have accompanied her journey to the highest levels of congenital cardiovascular surgery in the world today? Dr. Sarah Pradhan, 3rd year cardiology fellow at Cincinnati Children's Hospital interviews this up and coming superstar, Dr. Martin. Prepare to be inspired and energized by her story.

This week we review a recent very large scale project from Denmark on the impact of CHD on preterm labor and birth. We speak with Assistant Professor of Pediatrics at Indiana University, Neonatologist Paulomi Chaudhry about the work and her thoughts on what factors may be modifiable in the care of the preterm infant with CHD. What sorts of studies are needed going forward to improve the outcomes of these infants who had CHD but are premature? Dr. Chaudhry provides a number of answers this week! doi: 10.1016/j.jpeds.2020.09.059

This week, in a co-branded episode with SADS.ORG, we speak with Professor Michael Ackerman of The Mayo Clinic about a recent work he published with his team on a novel AI model to assess the ECG for the diagnosis of LQTS. How accurately can this technology identify a patient with LQTS? Can it identify the genetic diagnosis from the ECG alone? What are the implications of this sort of technology in regards to screening patients for LQTS? These are amongst the many topics reviewed with Dr. Ackerman this week on the podcast. doi: 10.1001/jamacardio.2020.7422

This week we delve into the world of noninvasive imaging and review a very novel approach from the team at Stanford University about tele-visits and the use of remote parentally acquired, focused echocardiograms for monitoring of Marfan's patients. Can any parent be trained to perform a focused echocardiogram in their homes? What is the cost associated with this approach? Can this technique be applied to other cardiovascular problems? We speak with Associate Professor of Pediatrics, Seda Selamet Tierney about her recent work on this interesting topic. doi: 10.1016/j.jpeds.2021.01.004