Pediheart: Pediatric Cardiology Today

This week we speak with Professor Vladimiro Vida of U. Padua about a recent ECHSA large scale study assessing surgical outcomes of newborn cardiac surgery in Europe. What trends have become apparent in the past 10 years and why are outcomes generally better overall in this complex patient group? Why have outcomes for single ventricle surgery not improved as much as other newborn surgeries? Is there a relationship between center volume and outcomes? What interventions might result in improvements in outcomes of Norwood palliation? Dr. Vida provides his insights this week. https://doi.org/10.1016/j.athoracsur.2024.07.023

This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on the topic of outcomes of ablation in the early postoperative period following congenital heart surgery. Who is a candidate for this intervention and what were the outcomes? How commonly were serious complications encountered and how successful were these procedures? Dr. Dionne reviews these and other aspects of this novel review this week. https://doi.org/10.1016/j.hrthm.2024.08.061

This week we venture back in time to 2023 to review the results of the update of the Single Ventricle Reconstruction trial, specifically SVR III. How are HLHS patients are faring post Norwood at age 12? What is the overall transplant-free survival rate in this group? Are there differences in survival seen at 12 years between BTTT shunt patients and RV-PA conduit shunt patients? How do they compare in exercise capabilities? What about rates of PLE or arrhythmias seen? Are there interventions that may improve outcomes going forward? These are amongst the questions reviewed this week with the first author, Dr. Caren Goldberg who is Professor of Pediatrics at the University of Michigan. DOI: https://doi.org/10.1161/circulationaha.123.065192

This week we speak with Professor Robert Hamilton of the University of Toronto about a recent case-control study in which his team identified a novel auto-antibody targeting a fetal cardiac protein that proved to have excellent sensitivity and specificity for the identification of fetuses that would develop heart block in fetal life in the offspring of women with maternal connective tissue disorders. How did the team in Toronto choose these particular target proteins? How well did this test perform in predicting heart block in pregnancies where there had been a prior pregnancy affected by block? Does this test possibly mean that fewer fetuses of mothers with connective tissue will need surveillance? Dr. Hamilton shares the details of this fascinating study this week. https://doi.org/10.1016/s2665-9913(25)00092-xWe also speak with Drs. David Ezon and Kenan Stern about the upcoming 16th Annual Mount Sinai Imaging Symposium - Conversations in Care: Cardiac Conundrums & 3D Echo Workshop which will be taking place at Mount Sinai on 5/31/25. Details are available at the following website:https://mssm.cloud-cme.com/course/courseoverview?P=5&EID=46043

This week we move into the arena of preventive cardiology when we review a recent report from the team at Northwestern and Princeton on the impact of early childhood food insecurity on cardiovascular health of people in young adulthood. How does food insecurity in young childhood impact the cardiac health of adults? Why is most of the impact seen on BMI but not other measures of cardiovascular health. How can food programs that support improved food and nutrition security work to improve long term cardiovascular health of children and adults? Do the benefits of such programs outweight their costs? Dr. Nilay Shah of Northwestern University shares his deep insights into his work and these questions this week.DOI: 10.1001/jamacardio.2025.1062

This week we share the inspiring tale of Ms. Kayla Billington, a pediatric and neonatal critical care nurse who met a young boy with tetralogy of Fallot named Wavamuno Patrick in Uganda while working for an NGO hospital. Ms. Billington tells the story of meeting Patrick and struggling to save his life and how this simple relationship of love and caring led her to help many in Uganda with congenital heart disease. Ms. Billington speaks of partnering with Professor R. Krishna Kumar of the Amrita Institute and, in today's episode, both Ms. Billington and Dr. Kumar share the inspiring tale of how they have worked together to help save the lives of children from Uganda at Amrita. Prepare to be amazed by their tale. Ms. Billington's efforts highlight the critical need for congenital heart care in Uganda and many other nations in Africa. For those interested, you can learn more about Patys Project and how you can help at:https://patysproject.org

This week we take a trip back in time to reminisce about what it was like to be a fellow under famed pediatric cardiology pioneer Dr. Alexander S. Nadas. Who better to tell us about what life was like under this giant than 4 present-day giants who lived through it and got their start working for Professor Nadas. Joining the podcast in a live recording from the Boston Children's Cardiology 75th Anniversary Alumni Reunion on May 3rd are Dr. Roberta Williams, Dr. John Barry Keane, Dr. Patricia Rompf and Dr. Thomas Hougen. All have many stories to tell and they share their remembrances and insights in this special episode honoring the memory of the founder of the cardiac program at Boston Children's Hospital - Dr. Nadas. 

This week we delve into the world of exercise physiology when we review a recent paper by Dr. Adam Powell of Cincinnati Children's Hospital on the relationship of hand grip strenth to other measures of cardiovascular and skeletal muscular health and fitness. How does hand grip strength correlate with CPET measures of exercise abilities in children? How might this inexpensive test help identify patients who might benefit from exercise therapy? Will hand grip strength one day be as ubiquitous as blood pressure in the evaluation of our CHD patients? Dr. Powell shares the answers this week.https://doi.org/10.1016/j.jpedcp.2025.200144

This week we review a recent editorial commentary by Drs. Belinda Gray, Rachel Lampert and Michael Papadakis on the concept of the personalized emergency action plan for the patient with genetic heart disease who is 'returning to play' in vigorous sports. With newer data demonstrating that risk for SCA or SCD is perhaps not as high as was once thought in this setting of sport, can the development of a personalized emergency action plan further enhance safety beyond simple measures such as medical adherence? Who should be involved in drafting this emergency action plan and how does this feature in the concept of 'shared decision-making'? DOI: 10.1161/CIRCULATIONAHA.124.072830

This week we review a study assessing the impact of bundle branch block (BBB) on exercise tolerance amongst the single ventricle Fontan patient cohort. Why would this be associated with worse outcomes for exercise? How should the cardiologist use this datum of BBB in a single ventricle patient to inform clinical decision making in this patient group? Why is cardiac resynchronization therapy so challenging in this patient group? Dr. Omar Meziab of The University of Arizona shares his deep insights this week. https://doi.org/10.1007/s00246-024-03500-1

In this replay episode from 2023, we return to the world of ACHD when we review a recent German research paper on the prevalence of PTSD symptoms amongst the ACHD patient group. How common is this type of symptom observed in the ACHD patient group? What contributes to the high prevalence (17-20.5%) described in this work? What are the benefits of 'embedding' a mental health care worker in the ACHD clinic/program? What strategies can be employed in pediatric cardiology to potentially mitigate PTSD symptoms in our future ACHD patients? These are amongst the many topics reviewed this week with the former Mount Sinai ACHD program clinical social worker, Ms. Meredith Kalbacker who also comments on this week's work. DOI: 10.1016/j.amjcard.2023.06.087For those interested, the book referenced by Ms. Kalbacker, Healing Hearts and Minds, can be purchased on Amazon:https://www.amazon.com/Healing-Hearts-Minds-Holistic-Congenital/dp/0197657281

This week we review a recent work from the team at Seattle Children's Hospital about obstetrical sonography and referral of fetuses with 'suboptimal imaging' for fetal echocardiography. Should all 'suboptimal imaging' cases be referred? How can fetal cardiologists parse out who needs a fetal cardiac scan and when? How does the fetal team in Seattle practically serve a geographic region exceeding 2,000 miles and properly triage the referrals, particularly when 'suboptimal imaging' is the rationale for referral? Associate Professor of Pediatrics at The University of Washington, Dr. Bhawna Arya provides deep insights into her recent work on how to think about fetuses referred for 'suboptimal imaging' as a rationale for fetal consultation. https://doi.org/10.1007/s00246-024-03495-9

This week we review a recent PHTS study on long-term outcomes following heart transplantation. Why do patients develop coronary vasculopathy and how commonly is it seen at long term follow-up? What factors are associated with better or worse long term outcomes? How do 'adverse childhood experiences' result in worse outcomes for patients? Why do young transplant patients have better long-term outcomes and can this be leveraged to improve older patient outcomes? We speak with the first author of this week's work, Assistant Professor of Pediatrics at Ohio State and also from Nationwide Children's Hospital, Dr. Emily Hayes. DOI: 10.1111/petr.70042

This week we review a recent study assessing the rate of hematochezia seen in children following neonatal congenital heart surgery, predominantly for aortic obstruction such as in HLHS. How often is this sign observed in this patient group and what percentage of these patients have actual necrotizing enterocolitis (NEC)? Are there any modifiable risk factors for NEC? How can these data help clinicians separate out those with more benign forms of hematochezia from those with NEC and how might this improve care for this patient group? These are amongst the questions reviewed this week with the work's first author, University of Michigan Assistant Professor of Pediatrics, Dr. Courtney Strohacker. DOI: 10.1007/s00246-024-03485-xFor those interested in pediatric podcasts, please take a look at this list of the 'top 15' pediatric topic podcasts - we are #4 in pediatrics for 2025!https://podcast.feedspot.com/pediatric_podcasts/

This week we review a recent report of 4 patients with serious complications related to either perforation or external compression from the distal tines of the Alterra prestent when used for transcatheter pulmonary valve replacement. We speak with Dr. R. Allen Ligon, interventional cardiologist at Children's Healthcare of Atlanta/Emory University about a recent multicenter report of rare complications seen with this prosthesis. How common are perforations seen with this device and how often are these clinically silent? What should be done for clinically silent prestent perforations? What sort of surveillance of all patients with this device is warranted after successful placement? These are amongst the questions posed to Dr. Ligon and discussed this week. DOI: 10.1016/j.jaccas.2024.102836

This week we review a report from the teams at University College, Dublin and Texas Children's Hospital about a collaborative approach to education in which two centers across the globe participate in a shared fellow learning conference. In this conference which is aimed at fellow education, topics are chosen and discussed with facilitated learning from faculty at both sites. What can be gained for fellows on opposite sides of the Atlantic that cannot be learned from exposure to just their one site? How did this approach help fellows learn about how to deal with uncertainty in decision making? How did this trans-continental learning approach enhance patient and team communication? These are amongst the many questions posed to senior cardiologist and senior author of this week's work, Professor Colin McMahon of University College, Dublin, Ireland.   ·         DOI: 10.1007/s00246-024-03469-x

This week we review a recent review paper on newest innovations and literature on pacing in pediatric patients and learn a bit about such diverse pediatric pacing topics as:Use of the Medtronic Micra device in an off-label manner for epicardial pacing in small infantsNovel, less invasive approaches to placing epicardial leads in small childrenThe role of leadless pacing in the pediatric or CHD patientConduction system pacing in 2025 in the congenital patientThe above are amongst the potpourri of pacing topics that we review with noted congenital electrophysiologist, Dr. Charles Berul of Children's National Hospital in Washington, DC in a co-branded episode with the SADS Foundation. For more information on SADS, please go to their website: SADS.ORG.DOI: 10.1016/j.hrthm.2024.02.011

This week we step back in time 3 years ago to review an important cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of Pediatrics at U. Penn, Dr. Laura Mercer-Rosa about this important and intriguing work. https://doi.org/10.1016/j.athoracsur.2022.01.017

This week we review a work from the department of cardiology and department of cardiac surgery at Boston Children's Hospital on late hypertension in patients following coarctation repair. Late hypertension has been associated previously with late transverse aortic arch Z score but can this be predicted by the immediate postoperative transverse aortic arch Z score also? What factors account for late hypertension in the coarctation patient? Should more patients have their aorta repaired from a sternotomy? Dr. Sanam Safi-Rasmussen, who is a PhD candidate at Copenhagen University, shares her insights from a work she performed while a research fellow at Boston Children's Hospital. DOI: 10.1016/j.jtcvs.2024.08.049

This week we delve into the world of cardiovascular surgery and general cardiology when we review a recent report from UVA on the topic of feeding around the time of neonatal heart surgery. Does preoperative oral feeding improve the chances for 'tube-free' enteral feeds at discharge after heart surgery in small infants? Why might oral feedings improve the chances of discharge oral feedings? How should clinicians think about the known benefits of early CHD surgery for some CHD lesions with the benefits of oral feedings? Dr. Aseel Dabbagh of Children's Mercy Hospital in Kansas City shares her insights into these and other questions. DOI: 10.1007/s00246-024-03750-z

This week we review a recent ACTION NETWORK project comparing outcomes of children with CHD who undergo VAD support in comparison to those children with VAD's who do not have CHD. How do morbidity and mortality rates compare between these two cohorts? Why might there be differences in outcomes between these two groups? How are heart failure and transplant cardiologists going to improve outcomes in complex CHD VAD patients in the future? How can all cardiologists make more timely referrals to heart failure and transplant cardiologists for their congenital heart patients? Dr. Shahnawaz Amdani of the Cleveland Clinic provides many insights this week. DOI: 10.1016/j.jacc.2024.10.083

In this week's replay episode from 2023, we speak with Associate Professor of Pediatrics at Mount Sinai, Dr. Jennifer Cohen about a recent large scale Fetal Heart Society project she conducted on the topic of fetal ccTGA and outcomes. What observations in fetal life are associated with worse clinical outcomes? Why is it valuable to perform serial fetal echocardiograms in this patient group? How common are genetic or extracardiac abnormalities in this patient group? These are amongst the many questions reviewed with Dr. Cohen this week. DOI: 10.1161/JAHA.122.029706

This week we delve into the world of cardiovascular surgery when we review a recent multicenter ("Ross Collaborative") study of long term outcomes of the Ross procedure in newborns and infants. How durable of a repair is this in this young age range? How does the neo-aortic root grow with time? Why might the neo-aorta not dilate in this age group as much as is reported in older patients following the Ross procedure? Who is a candidate for this approach? How are decisions made between aortic valve repair and Ross procedure? Professor David Winlaw who is director of cardiovascular surgery at Lurie Children's Hospital/Northwestern University joins the podcast this week to discuss the results of this multicenter work on this topic of which he is the senior author.DOI: 10.1016/j.jtcvs.2024.06.030

This week we review a recent report that asks the question, 'Do all infants who present with SVT require preventive anti-arrhythmic medical therapy?' Who might be a candidate for not using an anti-arrhythmia medication in infancy? What sort of parental education is needed to potentially not use medicine and how do patients not treated compare to those who were treated with anti-arrhythmics in regards to re-admission or presentation to the emergency department or development of tachycardia induced cardiomyopathy? How should parents assess their infants for SVT at home? How long should infants be monitored prior to discharge to home after a single uncomplicated episode of SVT? We speak with Assistant Professor of Pediatrics at Washington University and the first author of this week's work, Dr. Anthony Pompa. DOI: 10.1007/s00246-023-03263-1

This week we review a recent large scale, multicenter adult congenital heart study on outcomes of HLHS Fontan patients versus other single RV Fontan patients. How do the two groups compare in regards to thromboembolic risk, risk for arrhythmia or risk for death and heart transplantation? Why might there be differences between these single RV patient groups? How can these results inform management? We speak with Assistant Professor of Medicine and Pediatrics at The Icahn School of Medicine at  Mount Sinai, ACHD expert Dr. Kali Hopkins. doi: 10.1161/JAHA.124.034757. Epub 2024 Nov 27

This week to conclude 2024 we speak with noted investment expert Mr. Paul Merriman to discuss a few topics related to personal finance and investing. First we tackle the notion of having 'enough' to retire. Is there a magic value and how would one think about this? Why is an S&P 500 Index or Total US Stock Market Index a fine 'core' investment and how might one possibly improve upon its performance? What are some of the psychological hurdles we have as investors and potential retirees? Mr. Merriman reviews these and other topics on our end of year episode. Wishing all a happy and healthy new year to you and your families and loved ones. Paul Merriman's Website: https://www.paulmerriman.comPaul's "Quilt" Chart: https://www.paulmerriman.com/12-hidden-lessons-from-investment-history#gsc.tab=0Paul's "Bootcamp" page: https://www.paulmerriman.com/bootcampLast Year's episode of Pediheart was replayed on Mr. Merriman's site: https://www.paulmerriman.com/pediheart-podcast-279-asset-allocation-in-your-retirement-accounts#gsc.tab=0Paul's book "We're Talking Millions": https://www.paulmerriman.com/free-books#gsc.tab=0

This week we replay episode #203 with Professor Michael Freed of Harvard University, who died this past week. In this episode from 2022 we review his seminal paper on prostaglandin for the treatment of infants with critical congenital heart disease from 1981 and then speak with Dr. Freed about his life, career, the development of PGE1 and more in this wide-ranging interview with this pediatric cardiology pioneer. Dr. Freed shares important career advice as he would to cardiology fellows during his long and illustrious career, advising and shaping the careers of pediatric cardiologists for 5 decades. doi: 10.1161/01.cir.64.5.899.

This week we delve into preventive cardiology with noted world authority, Associate Professor of Pediatrics, Dr. Carissa M. Baker-Smith of Nemours Health. In the present era, what roles do environment and social determinants of health play in cardiovascular disease? How should practitioners take a family history and how has the family history evolved in modern times? How can clinicians be sure that they are not 'missing' factors when they are trying to screen for cardiovascular disease risk in their patients? What are a few practical changes in how we speak with patients that we can all make to improve our understanding of our patients and their families? An important conversation this week with Dr. Baker-Smith.https://doi.org/10.1007/s11883-024-01232-4

This week we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the liver in the Fontan patient? Dr. Yuli Kim, Director of the ACHD program at The University of Pennsylvania shares her deep insights this week into this important topic. DOI: 10.1093/eurheartj/ehad788

This week we celebrate the life and career of Dr. Charles Mullins who passed this past week. Dr. Mullins was Professor of Pediatrics at Baylor College of Medicine and one of the pioneers in the world of congenital heart interventional cardiology. In today's episode we will listen back to an episode from 2021 from the SCAI 2021 meeting in which we interviewed Dr. Mullins and Dr. Julie Vincent (then Professor of Pediatrics at Columbia University). Drs. Mullins and Vincent discuss their lives as interventional cardiologists and also speak about the role that mentorship played in their long careers. Dr. Aimee Armstrong of Nationwide Children's Hospital also participates in this conversation. Following this interview replay with Drs. Mullins and Vincent, we speak with Dr. Frank Ing who is the Director of Pediatric Cardiology at UC Davis and the former director of the catheterization lab at Texas Children's and a former trainee and close friend of Dr. Mullins and his family. Dr. Ing shares his memories of training under Dr. Mullins, his thoughts on what was possibly Dr. Mullins' greatest professional contribution and finally speaks about what he learned about being a good mentor from his years with Dr. Mullins. 

This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the notion of social determinants of health? Ms. Meisol reviews this and more in our wide ranging conversation about the extraordinary Professor Helen Taussig. We also share a brief conversation of Dr. Taussig from 1977, speaking about her role in the development of the BTT shunt. For those interested, Ms. Meisel's book is available: https://bookshop.org/p/books/a-heart-afire-helen-brooke-taussigs-battle-against-heart-defects-unsafe-drugs-and-injustice-in-medicine-patricia-meisol/19955020?ean=9780262048521or wherever you get your books!

This week we speak for the entire episode with award winning author Patricia Meisol about her recent book entitled: A Heart Afire: Helen Brooke Taussig's Battle Against Heart Defects, Unsafe Drugs, and Injustice in Medicine. We review Dr. Taussig's early life and the impact it had on her life. Why was there friction between Drs. Taussig and Blalock? What was Dr. Taussig's role in the establishment of the most stringent drug testing rules in the world today? What would Dr. Taussig consider to be her greatest achievement? Was Dr. Taussig the first in our field to understand the notion of social determinants of health? Ms. Meisol reviews this and more in our wide ranging conversation about the extraordinary Professor Helen Taussig. We also share a brief conversation of Dr. Taussig from 1977, speaking about her role in the development of the BTT shunt. For those interested, Ms. Meisel's book is available: https://bookshop.org/p/books/a-heart-afire-helen-brooke-taussigs-battle-against-heart-defects-unsafe-drugs-and-injustice-in-medicine-patricia-meisol/19955020?ean=9780262048521or wherever you get your books!

This week we enter the world of cardiac CT for congenital heart disease reviewing a recent report of a survey of congenital cardiologists who perform congenital heart CT scans. What have been the important trends seen in the past decade beyond expansion in the field in general? Why has the use of the CT scan grown at such a rapid clip? How much radiation does a present day CT scan represent for a patient? How are cardiology fellowships responding to the growing role of this modality in the field? How can we more properly assign accurate relative value units (RVU's) to the significant work effort involved in the performance and reporting of this novel modality. We speak with the first author of this week's work, Assistant Professor of Pediatrics at Weill Cornell, Dr. Rebecca Epstein.  doi: 10.1016/j.jcct.2024.02.002. Epub 2024 Feb 15.

This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorization improves outcomes? What is the impact of this process on healthcare equity? These are amongst the questions reviewed this week with Dr. Brian Marcus who is a cardiologist and critical care fellow at U. Wisconsin. DOI: 10.1007/s00246-023-03255-1

Pulmonary valve replacement following the arterial switch operation is rare. However, when necessary, how do techniques of transcatheter valve replacement fare for this indication? Why would average outcomes in this setting be less good than in the typical TPVR tetralogy of Fallot patient? How does the presence of stents in the pulmonary arteries in this patient group affect candidacy for TPVR? Are there ways to predict who might be a candidate for a TPVR vs. surgical PVR before coming to the catheterization lab? These are amongst the questions reviewed and posed to Dr. Stephen Nageotte who is the director of the cardiac catheterization laboratory at Loma Linda Children's Hospital in Loma Linda, California.  DOI: 10.1002/ccd.31152

This week we review a recent large scale study on catecholaminergic polymorphic ventricular tachycardia (CPVT) in children which is based on two large international registries. How do outcomes differ between those symptomatic CPVT patients treated with or without an ICD? Who amongst symptomatic CPVT pediatric patients likely warrant an ICD? What sort of ICD might be optimal - subcutaneous or transvenous? Are there ways to program ICD's in CPVT patients that may reduce inappropriate shocks? Why should the ICD be rarely employed in the CPVT pediatric patient? These are amongst the questions reviewed this week on the podcast. We speak with the work's senior author, Dr. Shubhayan Sanatani who is the chief of pediatric cardiology at BC Children's Hospital in Vancouver, British Columbia, Canada. doi: 10.1016/j.hrthm.2024.04.006. Epub 2024 Apr 7.

This week we delve into the worlds of cardiac critical care and neurodevelopment when we review a recent report from the team at Children's Hospital of Philadelphia assessing an association between postoperative opioid exposure in infants following CHD surgery and neurodevelopmental outcomes. What might be the biological basis for an association between these 2 factors? How confident can we be that opioid exposure is the factor of importance when there are so many co-variates and variables? We speak with outcomes research expert and interventional cardiologist Dr. Michael O'Byrne about this important and thought-provoking recent work.DOI: 10.1016/j.jacc.2024.06.033

This week we listen in on a lecture by Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Christopher Janson, on the novel agent ivabradine. How does this agent work and in what circumstances can it be used in pediatric arrhythmia management? Is this safe to use for critical arrhythmias despite the fact that it is, at present, only available as an enteral agent? What is the proper dosing regimen with this medication? Dr. Janson answers these and many more questions about ivabradine in this lecture from the Pedirhythm XI conference in Rome, Italy on 9/20/24. 

This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fabrizio Drago and the organizers of Pedirhythm for allowing us to listen in on this wonderful lecture by a world-wide authority. 

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland. DOI: 10.1161/CIRCULATIONAHA.122.063281

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to allow for an engaging back and forth and learning experience. Has either speaker swayed you? Take a listen!

This week we speak with noted interventional cardiologist Dr. Shyam Sathanandam of LeBonheur Children's Hospital in Memphis, TN about novel, 'off-label' uses of the Amplatzer Piccolo device in children. In what sorts of lesions does Dr. Sathanandam believe this device offers distinct advantages for vascular closure? What is the feature of this device that allows it to work for small defect closure so effectively and safely? Are there any new changes coming to this device or the delivery system for PDA closure in the premature infant? These are amongst the questions and topics reviewed with our guest this week!https://doi.org/10.1080/14796678.2024.2355057

This week's episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation in the field? We speak with third year cardiology fellow, Dr. Ogochuckwu M Ezeoke Cox, MD of C.S Mott Children's Hospital at the University of Michigan about her recent essay on this vital topic. https://doi.org/10.1007/s00246-023-03144-7

This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He has done and seen it all and has a unique perspective. How did he achieve so much and still have a succesful 56 year marriage to his wife Carol Ann? What is Dr. Brown most proud of in a career that is as prolific as his? What advice would he have have for the next generation? Prepare to be inspired by this master surgeon and friend and colleague of many in our field. 

This week we delve into the world of the single ventricle when we speak with Dr. David Hoganson, Assistant Professor of Surgery at Harvard Medical School about a recent work he co-published with investigators from Boston Children's Hospital on computational fluid dynamic modeling in the planning of the Fontan operation. Single ventricle heterotaxy patients with interrupted IVC are at enhanced risk for the development of pulmonary AVM's due to flow maldistribution to the pulmonary arteries from the hepatic veins in a Fontan. Can a computational fluid dynamic model predict which operative approach would result in the most balanced hepatic venous flow distribution? Can this reduce the incidence of pulmonary AVM's? How well did the models predict the actual pulmonary flow measured after surgery on CMR? Who beyond the heterotaxy patient might benefit from this approach? Dr. Hoganson offers us a peek into the world of personalized surgery in this week's exciting episode.         DOI: 10.1016/j.jacadv.2024.101057

This week we turn back the clocks to re-review a recent research letter from the team at the Harvard Congenital Heart Program about venous insufficiency in the Fontan patient. Why do patients with Fontan circulation develop chronic venous insufficiency and what are the implications of this problem in the Fontan patient? What sort of evaluation should be performed on the Fontan patient presenting with lower extremity venous changes? How worried should the cardiologist be when presented with a Fontan patient with these changes? These are amongst the questions reviewed on this topic with this week's guest, Associate Professor at Baylor University, Dr. Tony Pastor.JACC Adv 2022 Mar, 1 (1) 100002

This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated with graft failure in the present era in comparison to the past? What might be the impact of newer heart perfusion devices used to transport organs for transplant? These are amongst the questions reviewed with Professor of Pediatrics at U. Colorado, Dr. Scott R. Auerbach. DOI: 10.1016/j.healun.2024.03.002

This week we review a recent report assessing LV function and properties in the Ebstein's anomaly patient using CMR. How often is LV dysfunction observed in the Ebstein's patient who is about to undergo surgical Cone repair? How often did the echo underestimate LV dysfunction in comparison to the 'gold standard' CMR? How often is LV non-compaction observed when using strict criteria in this disease? Can CMR assessment of LV function preoperatively predict postoperative ICU course? These are amongst the questions posed to the first author of this week's work, advanced imaging fellow at U. Pittsburgh, Dr. Aditi Gupta. https://doi.org/10.1007/s00246-024-03585-8

This week we delve into the world of electrophysiology and review a recent report from the team at Primary Children's hospital on the use of intravascular ultrasound for EP ablation procedures in children. How is this technology useful for ‘routine' ablations in kids? Are there some forms of tachycardia where its use is more important than others? How does it lower procedural time or improve efficacy? We speak with Dr. Thomas Pilcher, chief of pediatric electrophysiology at Primary Children's about his center's recent report in the use of this technology for ablation in children and those with congenital heart disease. https://doi.org/10.1093/europace/euae047

This past week marked the passing of the great pediatric cardiology pioneer, Dr. Sylvia Griffiths. Dr. Griffiths was a trainee of Dr. Ruth Wittemore of Yale University and was one of the founders of the pediatric cardiology program at NY Presbyterian Hospital in the mid 1950's with Dr. Sidney Blumenthal. Her career spanned 7 decades, all at NY Presbyterian, Columbia University. She is remembered as a pioneering woman in medicine as well as a pioneer as a pediatric cardiologist. She is also remembered as a kind and warm colleague and friend. In today's 304th episode of Pediheart we review a 55 year old paper by Dr. Griffiths on outcomes of partial AV canal repair and speak with the present chief of pediatric cardiology at NY Presbyterian, Dr. Christopher Petit about the important role she played at Columbia. We then speak with Professor of Pediatrics at the Albert Einstein College of Medicine, Dr. Christine Walsh about the role she played in Dr. Walsh's life as well as the lives of so many patients, colleagues and friends. Her imprint will remain and she will always be missed and remembered fondly by all. DOI: 10.1161/01.cir.40.1.21

This week we review a recent paper from last 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient group and how might the data in this work inform risk stratification and management of failing Fontan patients in whom transplantation is being considered? These are amongst the questions posed this week to the week's expert, Dr Daphne Hsu who is Professor of Pediatrics at the Albert Einstein College of Medicine at The Children's Hospital at Montefiore. https://doi.org/10.1016/j.jacc.2023.06.037For those interested in learning more about Dr. Hsu, take a listen to episode #166 from June, 2021:https://www.spreaker.com/episode/pediheart-podcast-166-a-conversation-with-professor-daphne-hsu--45144274