Podcasts about achd

CardioNerds (Drs. Rawan Amir, Tripti Gupta, and Alysha Joseph) discuss the fundamentals of adult congenital heart disease (ACHD) surgery with Dr. Elizabeth Stephens.  Audio editing by CardioNerds academy intern, Grace Qiu.  Using a case of a young adult undergoing a Ross procedure, the episode walks through what happens in the operating room—from induction and intraoperative transesophageal echocardiography (TEE) to cardiopulmonary bypass (CPB), myocardial protection, and surgical repair. The discussion highlights key concepts including cardioplegia, cross-clamp and bypass times, hypothermic circulatory arrest, and the complexity of redo sternotomy. This episode provides learners with a practical framework to interpret operative reports, anticipate postoperative physiology, and better collaborate with surgical teams. This episode was produced by the CardioNerds ACHD Council and planned by Dr. Rawan Amir.  CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode Page Pearls “LV distension kills patients.”Preventing left ventricular distension with appropriate venting and awareness of aortic insufficiency is critical to intraoperative safety.  TEE can change the surgical plan in real time.Findings such as underestimated aortic regurgitation, mitral pathology, or a PFO may directly alter cannulation and cardioplegia strategy.  Cross-clamp time = myocardial ischemic time; bypass time = systemic stress.Both are key predictors of postoperative complications including renal injury, bleeding, and ventricular dysfunction.  Redo sternotomy risk is driven by anatomy, not just number.Aorta adherent to the sternum, conduit position, and chamber pressurization define risk more than the number of prior surgeries.  Think longitudinally—ACHD surgery is lifetime planning.Surgical materials and strategies must account for future interventions, especially in younger patients. Notes: Notes drafted by Dr. Alysha Joseph, aided by generative artificial intelligence. What are the key steps in congenital cardiac surgery from incision to closure? Preoperative planning is multidisciplinary, involving surgeon, anesthesia, cardiology, and ICU teams; high-risk inductions (e.g., critical AS, Williams syndrome) are identified early TEE is performed immediately after induction to reassess anatomy and may reveal new findings (e.g., underestimated AI, mitral disease, PFO) Median sternotomy is performed, followed by creation of a pericardial well to optimize exposure Heparin is administered prior to cannulation; arterial and venous cannulas are placed for initiation of CPB Cross-clamp is applied and cardioplegia delivered to arrest the heart, allowing a still and protected operative field Surgical repair (e.g., Ross procedure) is performed, followed by de-airing, cross-clamp removal, and reperfusion Patient is weaned from bypass with TEE reassessment, hemostasis achieved, and chest closed What is cardioplegia and how is it delivered? Cardioplegia is a potassium-rich solution that arrests myocardial activity and reduces metabolic demand Most commonly used solution in the U.S. is Del Nido cardioplegia, originally developed for pediatric myocardium Delivery strategies include: Antegrade (via aortic root) – standard approach  Ostial (direct coronary delivery) – used when aortic root cannot be relied upon  Retrograde (via coronary sinus) – useful in severe AI or coronary disease NOTE: Severe aortic regurgitation can impair antegrade delivery and requires alternative strategies and LV venting  What do cross-clamp time and bypass time represent clinically? Cross-clamp time = duration of myocardial ischemia while the heart is arrested Bypass time = total duration on CPB, reflecting systemic exposure to non-physiologic circulation Prolonged cross-clamp time (>2–3 hours) increases risk of myocardial dysfunction, especially with poor baseline function Longer bypass time is associated with increased risk of renal injury, coagulopathy, and bleeding These metrics often reflect both case complexity and intraoperative challenges What is hypothermic circulatory arrest (HCA) and when is it used? HCA involves complete cessation of blood flow to allow a bloodless surgical field Typically used in complex aortic arch repairs Patients are cooled to ~18°C to reduce metabolic demand and protect organs Duration is ideally limited to

In this episode, CardioNerds Dr. Colin Blumenthal, Dr. Kelly Arps, and Dr. Yong Hao Yeo are joined by electrophysiology expert Dr. Bradley Knight to discuss atrial fibrillation (AF) management in challenging clinical scenarios. We explore arrhythmias in patients with pre-excitation syndromes, particularly Wolff-Parkinson-White (WPW) syndrome, and strategies for rhythm control. We also discuss AF management in pregnancy, adult congenital heart disease, and patients with tachycardia-bradycardia (tach-brady) syndrome. This episode provides essential insights into nuanced decision-making for the care of patients with complex arrhythmia profiles. Audio editing by CardioNerds academy intern, Grace Qiu. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! PEARLS AF in WPW is a true emergency—AV nodal blocking agents can be deadly. In patients with WPW syndrome, AF can rapidly conduct through the accessory pathway, risking ventricular fibrillation and sudden death. Avoid AV nodal blockers like beta-blockers and calcium channel blockers. Catheter ablation is the first-line rhythm control strategy in WPW. Catheter ablation carries a Class I recommendation and offers >90% success. If antiarrhythmic drugs are needed, sodium channel blockers like flecainide or propafenone are preferred in patients without structural heart disease. In pregnancy, protecting the mother is protecting the fetus. An unstable mother means an unstable fetus. Rate control is the first step in AF with rapid ventricular responses and electrical cardioversion is safe when needed. Multidisciplinary care is essential. AF in congenital heart disease is often outside the pulmonary veins. Surgical scars and chamber remodeling in ACHD patients often lead to AF from non-pulmonary vein foci. Electrogram-based mapping and targeted ablation strategies are essential to increase success rate of durable rhythm control. Tachy-brady syndrome may require pacing to unlock therapy. AF may cause atrial myopathy and sinus node dysfunction. These patients often require permanent pacing to allow safe use of rate-controlling medications like beta-blockers and to prevent syncope or chronotropic incompetence. Notes: Notes drafted by Dr. Yong Hao Yeo Why is atrial tachycardia in patients with WPW syndrome dangerous? Patients with WPW commonly present with supraventricular tachycardia (SVT) due to atrioventricular reentrant circuits, either orthodromic or antidromic. This SVT can degenerate into AF. In the absence of AV nodal as the governor between the atrium and ventricles, the accessory pathway may conduct impulses rapidly and frequently. This can lead to dangerously high ventricular rates, predisposing patients to ventricular fibrillation and sudden cardiac arrest. What are some strategies for rhythm control in patients with WPW and atrial tachycardia? Catheter ablation is the first-line therapy (Class I recommendation), with a success rate of over 90%. Ablation reduces the risk of sudden cardiac arrest, though some patients may remain prone to AF. If ablation is not feasible/ contraindicated, sodium channel blockers such as flecainide and propafenone are good options in patients without ischemia or structural heart disease (Class IIa recommendation). Amiodarone should be avoided because it has a long half-life, can accumulate in the system, and may delay definitive treatment with catheter ablation. AV nodal blocking agents like beta blockers and calcium channel blockers should be avoided, as they are less effective at controlling ventricular rate in WPW and can increase conduction over the accessory pathway. These agents can also exacerbate the risk of rapid ventricular rates during AF and worsen left ventricular function. What are some special considerations in managing AF in pregnant patients? The primary goal in managing cardiovascular disease during pregnancy is to protect the mother, as fetal outcomes depend on maternal well-being. Therefore, while caution is necessary, we should avoid undertreating pregnant patients with AF. In cases of AF with rapid ventricular response (RVR), rate control is usually the first-line strategy, with beta blockers preferred over digoxin or non-dihydropyridine calcium channel blockers. It is then reasonable to initially observe for spontaneous conversion in stable patients. Antiarrhythmic drugs (AADs) are generally avoided during the first trimester, but clinical judgment on a case-by-case basis is essential. Evidence for the safety of AADs in pregnancy is limited, often derived from their use in other conditions such as fetal SVT. Flecainide and sotalol are reasonable options for rhythm control (Class IIa recommendation). Electrical cardioversion is considered safe in pregnancy and should be utilized when indicated (Do not forget!). There is no pregnancy-specific thromboembolic risk stratification tool. CHA₂DS₂-VASc scoring and the presence of risk factors like mitral stenosis can help guide anticoagulation decisions, though the magnitude of thromboembolic risk during pregnancy remains unclear. Rate control agents are typically continued during delivery due to the increased physiologic stress of labor and delivery. Multidisciplinary care is crucial and should involve obstetrics, maternal-fetal medicine, cardiology, and electrophysiology specialists. What are some key considerations for AF management in patients with adult congenital heart disease (ACHD)? Patients with repaired congenital heart disease are at increased risk for arrhythmias due to two main factors: surgical scars that create arrhythmogenic foci and mechanical remodeling of the atria or ventricles resulting from the underlying disease. In these patients with structural heart disease, sodium channel blockers may not be ideal antiarrhythmic options. When selecting an antiarrhythmic drug, clinicians must consider the nature of structural or surgical impairments, such as right bundle branch block or prolonged QT interval. It is also essential to assess renal and hepatic function (often impaired in patients with ACHD) to ensure appropriate metabolism and clearance of antiarrhythmic medications. Electrogram-based ablation strategies (those leveraging artificial intelligence are developing!) may help identify effective ablation targets, which are often outside the pulmonary veins in patients with ACHD. These individualized approaches can improve ablation success rates in this complex patient population. What makes tachycardia-bradycardia (tach-brady) syndrome a unique challenge in arrhythmia management? Patients who present with both AF and bradycardia, especially with syncope, require a thoughtful diagnostic approach to identify the underlying rhythm disturbance. Extended cardiac monitoring, including event monitors or implantable loop recorders, can help capture intermittent arrhythmias and correlate them with symptoms. AF may lead to atrial myopathy, and since the sinus node resides within the atrium, this can result in sinus node dysfunction—a hallmark of tachy-brady syndrome. Following spontaneous conversion from AF to sinus rhythm, sinus node dysfunction may persist, leading to prolonged pauses or chronotropic incompetence. Management becomes more complex when beta-blockers are needed for AF with RVR, as they can exacerbate bradycardia. Permanent pacemaker implantation is often the next step to consider. Permanent pacemaker implantation is often considered to facilitate safe rate control in these cases. In younger patients, aggressive AF burden reduction may prevent atrial remodeling and the development of true atrial myopathy, potentially avoiding pacemaker implantation. References Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;149(1). doi:https://doi.org/10.1161/CIR.0000000000001193 ‌ Van IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024;45(36). doi:https://doi.org/10.1093/eurheartj/ehae176 ‌ Joglar JA, Kapa S, Saarel EV, et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. Published online May 1, 2023. doi:https://doi.org/10.1016/j.hrthm.2023.05.017 ‌ Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary. Journal of the American College of Cardiology. 2019;73(12):1494-1563. doi:https://doi.org/10.1016/j.jacc.2018.08.1028 ‌

In this replay episode from 2 years ago, 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

Common Scenarios in ACHD   Guest: Maan Jokhadar, M.D. Host: Malcolm Bell, M.D.   In this third and final episode discussing ACHD, Drs. Bell and Jokhadar review practical management considerations for adults with congenital heart disease, focusing on common conditions encountered in general cardiology and primary care. The discussion highlights bicuspid aortic valve disease and associated aortopathy, repaired tetralogy of Fallot and coarctation of the aorta, prosthetic valve management, anticoagulation and bridging decisions, and current recommendations for endocarditis prophylaxis. Emphasis is placed on surveillance, complication prevention, and thoughtful risk–benefit assessment in routine and procedural care. Be sure to listen to the previous two episodes, “The Hospitalized ACHD Patient” and “ACHD for the Primary Care Provider.”   Topics Discussed: Bicuspid Aortic Valve (BAV) Coarctation of the Aorta (COA) Tetralogy of Fallot (TOF) Mechanical and Bioprosthetic Valves Anticoagulation Management Subacute Bacterial Endocarditis (SBE) Prophylaxis   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.   Recorded on: 04-November-2025

ACHD for the Primary Care Provider   Guest: Maan Jokhadar, M.D. Host: Malcolm Bell, M.D.    This is the second of three episodes on adult congenital heart disease. Be sure to go back and listen to episode one, “The Hospitalized ACHD Patient.” In this episode, listeners will hear a primer on caring for adults with congenital heart disease (ACHD) in the primary care setting. Dr. Malcolm Bell and Dr. Maan Jokhadar discuss when ACHD patients should be referred for specialized evaluation, how to locate clinics, and which symptoms should raise concern. Key practical tips are shared to help avoid common pitfalls and ensure safe, effective care for this unique patient population.   Topics Discussed: Do all patients with CHD need to be seen in an ACHD clinic? How to locate ACHD clinic? What are some alarm symptoms for ACHD? Common pitfalls to avoid   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.   Recorded on: 04-November-2025

This week we sit down and speak with noted non-invasive imaging expert Dr. Kelly Han of U. Utah about a recent work she co-authored on recommendations for the development of a congenital heart CCT program. What are the absolute essentials when considering offering these services in a center? How do different scanners differ from one another and how important is it to have single vs. dual source CT? Can good work be performed on 'older' machines? Who are the most important team members for a congenital CT team? Dr. Han shares her thoughts as well as the ideas of many of the thought leaders who co-authored this important statement paper. DOI: 10.1016/j.jcct.2025.01.003

This week we listen in to a recent presentation by congenital heart nursing pioneer Ms. Gwen Fosse BSN MSA RN FAHA. Ms. Fosse is a pediatric cardiovascular nursing specialist at Mott Children's Hospital at U. Michigan and has literally done and seen it all over the past 50 years in congenital heart nursing. In this presentation from the CHOP Cardiology 2026 meeting Ms. Fosse shares with us her impressions from a career that spans multiple decades and advances in the field. This presentation was the 26th Annual Thomas Garrett Rauch Memorial Lecture in Nursing at this esteemed conference. 

The Hospitalized ACHD Patient   Guest: Maan Jokhadar, M.D. Host: Malcolm Bell, M.D.   This is the first of three episodes on adult congenital heart disease. Adults with congenital heart disease are often admitted for a wide range of cardiac and non-cardiac issues, many of which carry unique management considerations. This episode emphasizes the importance of early ACHD consultation, especially in patients with cyanosis or prior complex repairs, and why even “simple” lesions deserve careful attention. We also touch on key bedside considerations that can significantly impact outcomes if overlooked. The goal is to build awareness and confidence when caring for this growing and complex patient population.   Topics Discussed: Why are ACHD patients admitted?  When should a practitioner consult ACHD for their patient?  What are some of the common pitfalls to avoid?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.   Recorded on: 04-November-2025

In this episode of JACC This Week, Dr. Carolyn Lam and Dr. Harlan Krumholz spotlight the 2025 Adult Congenital Heart Disease (ACHD) Guidelines and explore what they signal for the future of cardiovascular care. Framed by Dr. Krumholz's Editor's Page, "From Survival to Stewardship," this discussion highlights a broader transformation in cardiology: advances that once turned fatal conditions into survivable ones now demand lifelong, structured, and hyper-specialized care. The conversation examines how ACHD exemplifies the shift from episodic survival to coordinated stewardship—where surveillance, systems design, and scalable expertise are essential. The episode also reviews key updates from the guidelines, including risk-based classification, lifelong monitoring, ACHD center collaboration, and global and early-career perspectives. Additional highlights from the issue include cardiac screening in the young, cardio-renal trial insights from CONFIDENCE, wildfire-related cardiovascular risk, and emerging cardiometabolic intersections. This mini-spotlight issue challenges clinicians to rethink how specialized cardiovascular care can be delivered effectively at scale.

This week we review a fascinating very long-term surgical follow-up study from the team at Royal Children's Hospital in Melbourne reviewing over 30 year follow-up following the arterial switch operation for the treatment of transposition of the great vessels. What percentage of patients need reintervention by 30 years post neonatal repair? What anatomical sub-types are more likely to be associated with a need for reintervention and why? When intervention is required for neo-aortic or aortic root problems, can these usually be repaired or do they require replacement? Professor Igor Konstantinov from Melbourne shares his deep insights into this complex patient group. DOI: 10.1016/j.jtcvs.2025.09.008

This week we go back in time 2 years to review a recent paper from 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

Ridenbaugh Canal Headworks Modernization Project.

This week we speak with Ohio State ACHD fellow Andrew Freddo MD, PhD about a recent large single center study he conducted assessing the cardiovascular drugs that adult Fontan patients are taking and whether they might offer us insights into general well-being. Are there agents that are associated with worse outcomes? If so, is this a situation of the agent causing harm or is it a possible marker of illness? Are there agents associated with improved outcomes? These are amongst the questions reviewed with Dr. Freddo this week. DOI: 10.1016/j.jacadv.2025.102070

This week we review an episode from 3 years back and delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author, Dr. Anushree Agarwal, Assistant Professor of Medicine at UCSF, shares her insights into this important topic. DOI: 10.1161/JAHA.122.026732Also mentioned in today's episode is episode #222 with Dr. Dan Halpern of NYU medical center (https://www.stitcher.com/show/pediheartpediatric-cardiology-today/episode/pediheart-podcast-222-impact-of-cardiac-rehab-on-exercise-tolerance-in-the-achd-patient-206781483)

This week we review a landmark paper that came out this month on the topic of ACHD. How common is neurocognitive dysfunction amongst the ACHD patient population? What factors are associated with worse or better such outcomes? What interventions should be considered to mitigate these issues? What is the relationship between mental illness and neurocognitive dysfunction? Dr. Scott Cohen of The Medical College of Wisconsin and Dr. Ali Zaidi of The Icahn School of Medicine at Mount Sinai share their insights into their recent multicenter study. doi: 10.1016/j.jacc.2025.06.051Also featured after the article is a brief description of the upcoming Mount Sinai ACHD Conference called: Kawasaki Disease Across The Ages: From Childhood Onset To Adult Outcomes - The 4th Mount SInai ACHD Symposium. We speak with Dr. Nadine Choueiter who is the Course Director of this conference about the goals and objectives of the conference. Dr. Zaidi is the course co-director. For those interested in signing up, please go to this webpage:https://physicians.mountsinai.org/news/register-today-for-the-fourth-annual-mount-sinai-adult-congenital-heart-disease-symposium

This week we review a recent work addressing the growing mismatch between the numbers of ACHD patients and the numbers of well trained ACHD providers. What are the most important factors influencing trainees' decisions regarding the pursuit of a career in ACHD? How can more young people be influenced to pursue this fascinating and growing field? We speak with Dr. Katia Bravo-Jaimes of The Mayo Clinic in Jacksonville, FLA about a recent survey study she conducted on the factors that influenced these important decisions. Dr. Bravo-Jaimes shares her thoughts on solutions to increase the ACHD workforce.https://doi.org/10.1161/jaha.125.041276

In this episode of Better Edge, C. Charles Jain, MD, the new associate medical director for Adult Congenital Heart Disease at Northwestern Medicine Bluhm Cardiovascular Institute, shares his clinical expertise and strategic vision for advancing adult congenital heart disease (ACHD) care. Dr. Jain discusses his new role and outlines a comprehensive approach to improving outcomes for ACHD. He emphasizes the importance of multidisciplinary collaboration and seamless transitions from pediatric to adult care, key parts of Northwestern Medicine's approach. Dr. Jain also highlights his research interests, commitment to providing whole-person care and upcoming initiatives to expand access and enhance continuity of care at Bluhm Cardiovascular Institute.

As medical and surgical treatment of congenital heart lesions improve, the vast majority of babies born with heart problems are living long and productive lives. While it is remarkable, it also brings new challenges for their care, especially during the critical transition to adulthood. A new medical specialty has developed to address this specific need, driven by the growing demand for expertise in the lifelong care of patients with congenital heart lesions. To unpack this topic, we are joined by Roni Jacobsen, MD. She is the Medical Director of our Adult Congenital Heart Disease Program at Children's Hospital Colorado. We have one of the largest programs in the country with exceptional outcomes, treating patients with congenital heart problems that continue into adulthood. Dr. Jacobsen specializes in internal medicine as well as pediatrics and is trained in pediatric cardiology and adult congenital heart disease. She is an Associate Professor of Pediatrics at the University of Colorado School of Medicine. Some highlights from this episode include:  Defining adult congenital heart disease and understanding its differences from other heart diseases  Why so many patients don't understand their disease  Understanding the advancements in treatments  The role that pediatricians play in steering families towards continued care and proper transition once that child hits adulthood  For more information on Children's Colorado, visit: childrenscolorado.org. 

CardioNerds ACHD Council members Dr. Rawan Amir and Dr. Claire Cambron lead a profound conversation with ACHD faculty Dr. Allison Tsao, Dr. Jill Steiner, and Dr. Katherine Salciccioli. Together, they explore the emotional and professional challenges that ACHD providers face across the lifespan of congenital heart disease. Topics discussed include navigating challenging case scenarios, empowering patients through tough decisions, leveraging multi-subspecialty expertise, celebrating the successes, preparing for and grieving loss, and more. This episode was planned by the CardioNerds ACHD Council. CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

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

Happy Treefort! We're checking in on the local music festival's big ambitions this year, starting with a successful bid to pour liquor at the Main Stage. And, Hey Boise newsletter editor Blake Hunter is explaining to producer Frankie Barnhill why state lawmakers seem hellbent on controlling Boise roads. Plus, a record-breaking 81 degrees and the inside scoop on the new Oldspeak Bar in Garden City.  Here's ACHD Commissioner Kent Goldthorpe's Facebook post criticizing the Idaho Legislature.  Want some more Boise news? Head over to our Hey Boise newsletter where you'll get a cheatsheet to the city every weekday morning. Learn more about the sponsor of this March 28th episode:  Inn at 500 Clover Care Consulting Interested in advertising with City Cast Boise? Find more info HERE. Reach us at boise@citycast.fm. Learn more about your ad choices. Visit megaphone.fm/adchoices

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 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

C'est l'un des albums les plus attendus de cette fin d'année : le dernier "Lucky Luke", le 11e depuis la disparition de Morris, sort vendredi 15 novembre en librairie. Son titre : "Un cow-boy sous pression". Présentation avec le dessinateur Achdé et le scénariste Jul. Ecoutez L'invité de RTL Midi avec Eric Brunet et Céline Landreau du 14 novembre 2024.

C'est l'un des albums les plus attendus de cette fin d'année : le dernier "Lucky Luke", le 11e depuis la disparition de Morris, sort vendredi 15 novembre en librairie. Son titre : "Un cow-boy sous pression". Présentation avec le dessinateur Achdé et le scénariste Jul. Ecoutez L'invité de RTL Midi avec Eric Brunet et Céline Landreau du 14 novembre 2024.

With all the recent growth in the Treasure Valley, our roads are busier than ever. So what's the Ada County Highway District doing to help with the congestion? Today, executive producer Frankie Barnhill and Idaho Statesman reporter Nick Rosenberger dig into ACHD's new 5-year plan to find out what it could mean for your daily commute. Want some more Boise news? Head over to our Hey Boise newsletter where you'll get a cheat sheet to the city every weekday morning. Interested in advertising with City Cast Boise? Find more info HERE. Reach us at boise@citycast.fm. Learn more about your ad choices. Visit megaphone.fm/adchoices

With the Nov. 5 election coming up, we're digging into another hyper-local race you need to know about. Today, we're talking transportation — specifically, a rematch between Alexis Pickering and Rebecca Arnold for a seat on the Ada County Highway District Commission. This District 2 campaign touches on safety, bike lanes, growing traffic concerns, and what the role of ACHD should be. Idaho Statesman reporter Nick Rosenberger is breaking down what candidates have said and what this election could mean for the future of getting around Boise. Want some more Boise election info? Head over to our Hey Boise newsletter where we cover local races that affect you.  Learn more about the sponsor of this October 24th episode: Inn at 500 Interested in advertising with City Cast Boise? Find more info HERE. Reach us at boise@citycast.fm. Learn more about your ad choices. Visit megaphone.fm/adchoices

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

durée : 00:03:31 - Les P'tits Bateaux - par : Camille Crosnier - C'est la question de Georges, 12 ans au dessinateur Jul qui a repris avec Achdé le personnage du cow-boy. Et en a écrit 4 volumes. - Jul : Dessinateur de presse et auteur de bandes dessinées - réalisé par : Stéphanie TEXIER

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

Every day thousands of people use the Five Mile Overpass to commute. It's the only freeway overpass in Boise that has not been rebuilt to make it safer and more bike- and pedestrian-friendly. However, that is about to change.

ACC.24: SGLT2i in ACHD

This week we review a recent work on the use of sodium-glucose cotransporter 2 inhibitors in the ACHD heart failure patient from Europe. Can these agents impact heart failure outcomes in this patient group? What is the mechanism by which they may improve outcomes? Are there data on their effects on the single ventricle patient? What sorts of side effects can be seen and are these more or less commonly observed in the ACHD patient? We speak with the corresponding author of this week's work, Dr. Anastasia Egorova of Leiden University in the Netherlands. https://doi.org/10.1016/j.jacc.2024.02.017

In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Tomio Tran from Seattle. They discuss his paper about how well smartwatches measure peak oxygen consumption compared to CPET in ACHD subjects. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful. Link to published paper: https://heart.bmj.com/content/110/5/353 

This week we delve into the world of interventional cardiology and the Fontan when we review a recent report from the Children's Hospital of Philadelphia on the use of the "MitraClip" for the treatment of AV valve regurgitation in the congenital heart patient. Who would be a good candidate for this novel approach? What are the steps in planning or consideration of this technique in a congenital heart patient? How durable is this form of repair? These are amongst the many questions reviewed this week with this week's senior author, Professor of Pediatrics at the Children's Hospital of Philadelphia, Dr. Matthew J. Gillespie. DOI: 10.1002/ccd.30935

This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expression in the liver of Fontan patients help to explain why some patients have mild versus others severe fibrosis or even frank cirrhosis? Can these insights provide hope for improved surveillance or therapy for this problem? Dr. Bravo-Jaimes provides the answers this week. https://doi.org/10.1016/j.jacc.2023.12.005

This week we enter the world of the adult congenital heart patient when we discuss Fontan associated liver disease with an ACHD expert, Dr. Katia Bravo-Jaimes of the Mayo Clinic. In this episode we discuss the role of intrahepatic transcriptomics and how genetic analysis of liver biopsy tissue may provide new insights into the pathophysiology of this disease process. How can differential gene expression in the liver of Fontan patients help to explain why some patients have mild versus others severe fibrosis or even frank cirrhosis? Can these insights provide hope for improved surveillance or therapy for this problem? Dr. Bravo-Jaimes provides the answers this week. https://doi.org/10.1016/j.jacc.2023.12.005

This week we review a recent report on the development of valvular obstruction due to intimal tissue ingrowth in the Harmony valve. How common is this problem? What factors may predispose a Harmony valve patient to develop this rare complication? Does the location of the valve implant matter in regards to this complication? How should Harmony valves be surveilled? There are amongst the questions posed to this week's guest, Assistant Professor of Medicine at U. Washington, Dr. Zachary Steinberg. doi: 10.1002/ccd.30901.Epub 2023 Nov 5.

This week we go back in time to 2019 to re-review an important episode in the world of ACHD and review a registry study assessing outcomes in adults with ASD and elevated PVR who underwent ASD closure. Who was a good candidate for this approach? What were the long term outcomes of this form of therapy? Did ASD closure in this setting confer a survival benefit? We review these and many other questions in a 'virtual roundtable' discussion with Drs. Elisa Bradley, presently of Penn State and Ali Zaidi of Mount Sinai - NYC. Both are world authorities on ACHD and it is a great treat to have such 2 experts both on the show to discuss the subtleties of this complex topic.doi: 10.1016/j.ijcard.2019.03.056

durée : 00:03:31 - Les P'tits Bateaux - par : Noëlle Bréham - C'est la question de Georges, 12 ans au dessinateur Jul qui a repris avec Achdé le personnage du cow-boy. Et en a écrit 4 volumes.

In this week's episode we review a recent Dutch study on 50 year follow-up of patients who had ASD repaired at an average age of 7.5 years. How do these patients compare to their middle aged counterparts who did not have congenital heart surgery? Why might the RA or RV be enlarged in these patients, decades after successful ASD closure? How common are arrhythmias seen in this cohort? How common is pulmonary hypertension seen? These are amongst the questions reviewed this week with the work's first author, Dr. Robert Martijn Kauling.DOI: 10.1016/j.ijcard.2023.131616

The Ada County Highway District has had their hands full lately, especially with all the snow. Idaho Matters sits down with ACHD to talk about the work they are doing to keep roadways safe.

Découvrez le livre du jour des Grosses Têtes. Retrouvez tous les jours le meilleur des Grosses Têtes en podcast sur RTL.fr et l'application RTL.

This week 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 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

CardioNerds (Dr. Josh Saef and Dr. Sumeet Vaikunth) join Dr. Sheng Fu, Dr. Payton Kendsersky, and Dr. Aniqa Shahrier from the Medical University of South Carolina for some off-shore fishing. They discuss the following featuring a patient with D-TGA and Eisenmenger's syndrome treated with a Heartmate 3. Expert commentary was provided by Dr. Brian Houston. The episode audio was edited by student Dr. Adriana Mares. A 39-year-old woman with a history of D-transposition of the great arteries (D-TGA) with prior atrial switch repair (Mustard) was admitted from the clinic with cardiogenic shock. She underwent right heart catheterization which demonstrated elevated biventricular filling pressures and low cardiac index. An intra-aortic balloon pump was placed, and the patient was evaluated for advanced therapies. A liver biopsy showed grade 3 fibrosis, which, in combination with her shock state, made her a high-risk candidate for isolated heart or combined heart-liver transplantation. After a multi-disciplinary discussion, the patient underwent a Heartmate III left ventricular assist device (LVAD) implant in her systemic right ventricle. Although she did well post-operatively, she was admitted after a month with recurrent cardiogenic shock, with imaging showing her inflow cannula had become perpendicular to the septum.  The patient and family eventually decided to pursue comfort measures, and the patient passed. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 Pearls - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 Early diagnosis of cyanotic congenital heart disease is paramount for treatment and prevention of future complications. Adult congenital heart disease requires a multi-disciplinary team for management in consultation with an adult congenital cardiology specialist. Eisenmenger syndrome is related to multiple systemic complications and has a high rate of mortality. Advancement in PAH medical management can offer noninvasive treatment options for some patients. Transthoracic echocardiography is the cornerstone for diagnosis. Other modalities (e.g. cardiac CT, cardiac MRI, invasive catheterization) can aid in diagnosis and management. Pearls - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 While advances in pediatric surgery have allowed many patients born with congenital heart disease to survive into adulthood, adult congenital heart disease (ACHD) patients are complex and prone to numerous adverse sequalae including arrhythmias, heart failure, valvular disease, and non-cardiac organ dysfunction. Heart failure can be a challenging presentation in ACHD patients due to a longstanding history of clinical compensation. Their unique and complex anatomy, as well as highly variable clinical presentation, present unique challenges when it comes to advanced heart failure options such as durable left ventricular assist devices (LVAD) or transplantation. While durable LVAD implantation is possible in patients with systemic right ventricles, anatomic compatibility is paramount and poses ongoing challenges in their management. Goals of care discussions should be had early, as options for treatment may be limited. Show Notes - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 What are some common sequelae in ACHD patients? ACHD patients are a heterogeneous population, but atrial tachycardias are extremely frequent in this patient population, often due to re-entrant pathways around surgical suture lines. These can often be treated with radiofrequency ablation while paying clos...

This week's episode is co-branded with SADS.ORG and is a review of a recent multicenter PACES study on the general outcomes of patients with congenital heart disease who have undergone MRI's. Just how worried should the practitioner be to send a pacemaker or ICD patient for an MRI of any body part? Is there a period of time after implantation when it is safer to proceed with an MRI? What is meant by an MRI conditional device or lead? Does the part of the body imaged matter in regards to risk to CIED's? These are just some of the questions posed to the senior author of this week's work, Dr. Thomas Pilcher of Primary Children's Hospital in Salt Lake City, Utah. doi: 10.1016/j.hrthm.2023.08.034For those interested to learn more about the SADS Foundation, please visit their website:SADS.ORG

CardioNerds (Amit Goyal and Daniel Ambider) ACHD series co-chair Dr. Daniel Clark (Vanderbilt University), cardiology FIT lead Dr. Stephanie Fuentes (Houston Methodist Hospital), and Dr. Frank Fish, a Pediatric Electrophysiologist and the Director of the Pediatric Electrophysiology (EP) Lab at Monroe Carrell Jr Children's Hospital at Vanderbilt University. He is a board certified Adult Congenital Heart Disease (ACHD) physician and has a wealth of experience performing EP procedures in adults living with congenital heart disease. Audio editing was performed by student Dr. Shivani Reddy. In this episode, we discuss key concepts and management of electrophysiologic issues that we can encounter when caring for adults with congenital heart disease.  Arrythmias in adults with congenital heart disease can be intrinsic due to the defect itself or as a consequence of the interventions that they have undergone to palliate and/or repair these defects. The complex anatomy of these patients and the years of pressure and volume load make them not only exquisitely hemodynamically sensitive to arrhythmias (that may otherwise not be of much consequence to the general population) but they also make interventions (catheter ablation or device implant) complex. We therefore embark in a case-based discussion of patients with ACHD (Fontan circulation, Ebstein's anomaly and Tetralogy of Fallot) in an effort to highlight the presentation of arrythmias and the management strategy in this very important group of patients. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Electrophysiology in ACHD Patients with Fontan circulation have a high risk of developing atrial (and ventricular) arrhythmias and they are highly sensitive to the hemodynamic consequences that these arrythmias ensue.  The goal of therapy then should be to achieve sinus or atrial paced rhythm. Rate control should NOT the goal. Patients with Ebstein's anomaly have high arrhythmic potential. They can have multiple accessory pathways (especially right sided) which can in turn be associated with sudden cardiac death. We should have low threshold for EPS +/- catheter ablation in patients with WPW pattern. Patients with Tetralogy of Fallot have a unique risk for SCD that warrant ICD implant apart from the standard criteria (LVEF 180 ms) and surgical repair approach. Patient's anatomy is the major consideration when implanting devices (PPM/ICD). We ought to assess for residual intracardiac shunt at the atrial level and consider closing if feasible prior to placing a device. CRT has merit in systemic LV but less so in systemic RV. Notes- Electrophysiology in ACHD What should we know about atrial arrhythmias in a Fontan patient? Intraatrial re-entrant tachycardia (IART) is slower than typical atrial flutter with atrial rates generally

This week we review a recent large scale assessment of survival amongst patients with CHD who were born between 1980 and 1997 in the US. What percentage of those born with CHD actually survived to age 35? What were the factors associated with improved or worse outcomes? How did those with HLHS fair in this time period? What was the impact of genetic syndromes or non-cardiac abnormalities on outcomes of children with congenital heart disease? We speak with this week's work's first author, CDC epidemiologist, Ms. Karri F. Downing. https://doi.org/10.1161/circulationaha.123.064400

Eisenmenger syndrome is an end-stage complication of congenital heart disease that occurs when a left to right shunt causes pulmonary over-circulation, leading to vascular remodeling, increased vascular resistance, and ultimately even shunt reversal. Aside from cardiac complications, this pathology has unique complications secondary to chronic cyanosis. In this episode of CardioNerds co-founder Dr. Amit Goyal, ACHD series co-chair Dr. Josh Saef, and Dr. Khaled Tuwairqi (ACHD cardiologist at King Faisal / Elite Hospitals) join Dr. Alexander (Sasha) Optowsky (Director of the Adult Congenital Heart Disease Program at Cincinnati Childrens) to discuss diagnosis and management of Eisenmenger syndrome. Show notes were drafted by Dr. Anna Scandinaro and episode audio was edited by CardioNerds Academy Intern Dr. Akiva Rosenzveig. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Eisenmenger Syndrome First described in 1897 by Victor Eisenmenger, Eisenmenger syndrome is a long-term complication of unrepaired left to right shunts, resulting from pulmonary vascular remodeling and pulmonary hypertension. This eventually leads to reversal of the shunt, with right to left flow causing cyanosis. Evaluation for Eisenmenger syndrome should include a comprehensive history, physical exam, ECG, echocardiogram, cardiac catheterization, and laboratory work to identify multi-system complications of cyanosis and secondary erythrocytosis. The most definitive means to diagnose Eisenmenger syndrome in a patient with a prior left-to-right shunt lesion is with a right heart cardiac catheterization showing right to left shunting (Qp:Qs < 1). Eisenmenger syndrome is a multi-organ disease and many manifestations occur due to secondary erythrocytosis. Prevention and treatment of these complications are the major goals of care in this population. Complications of Eisenmenger syndrome include gout, bilirubin gallstones, stroke, paraganglioma/pheochromocytoma, thrombophilia, retinal changes, hypertrophic osteoarthropathy, and kyphoscoliosis. Emergency non-cardiac complications of Eisenmenger syndrome include cerebral abscess and hemoptysis. Pregnancy is contraindicated in Eisenmenger syndrome due to high maternal and fetal mortality. Notes- Eisenmenger Syndrome 1. How does Eisenmenger syndrome develop? Does everyone with a left-to-right shunt develop it? Can it develop as an iatrogenic complication? The pulmonary vasculature is not used to seeing the increased flow it receives in the context of a left to right shunt. Over time this leads to an increase in pulmonary vascular resistance and pulmonary hypertension. When pulmonary pressures exceed systemic pressures, this causes shunt reversal with right to left shunting causing deoxygenated blood to cross from right side of the heart to the left side bypassing the lungs and causing cyanosis. The process of developing Eisenmenger syndrome is chronically progressive and so adaptive changes have time to occur. Not all persons with unrepaired shunts will develop Eisenmenger syndrome ...

This week we delve into the world of ACHD when we review a recent important work from the multicenter INDICATOR study group assessing the impact on overall outcomes in TOF patients who have their pulmonary valve replaced. Are survival rates improved by replacement of the pulmonary valve in the TOF patient? What about the effect on ventricular tachycardia? What are the proposed mechanisms by which PVR can positively affect this critical outcomes? Are there differences between transcatheter PVR and surgical in this regard? Is there an RV volume that is the 'sweet spot' for PVR? These are amongst the many questions posed to Professor of Pediatrics and Medicine at Harvard University, Dr. Anne Marie Valente. https://doi.org/10.1016/j.jacc.2023.02.052