Podcasts about fallot

We'd like to extend our sincere thanks to our episode sponsor, reStickity®. Their innovative, mess-free reusable sticker sets allow families to personalize hospital spaces with familiar photos and comforting images, helping bring a sense of home to the hospital. To learn more, visit their website and use code CLOC10 for an exclusive discount available to our listeners. In this inspiring episode, we meet Sarah Michelle Boes—nurse practitioner, entrepreneur, and mom to Meadow, who was diagnosed in utero with Tetralogy of Fallot and multiple congenital heart defects. Sarah brings a powerful trifecta of perspectives: as a medical provider, mental health advocate, and dedicated heart mom. We cover: ✅ Meadow's life-saving heart surgeries and long ICU stays ✅ How Sarah navigated new motherhood with OCD and anxiety ✅ The emotional toll of being both a medical provider and a parent ✅ Creating a connection through medical play to ease doctor visits ✅ How Sarah turned survival into purpose through national advocacy Whether you're a fellow medical parent, healthcare provider, or mental health professional, this episode will leave you with real insight into the raw challenges and unexpected joys of raising a child with complex medical needs. Key Topics & Highlights [00:00] – Meet Sarah Michelle Boes Nurse practitioner, entrepreneur, and heart mom Her daughter Meadow's surprise diagnosis of Tetralogy of Fallot at 36 weeks ⏱️ [03:00] – From Business Success to Medical Crisis Selling her business weeks before Meadow's diagnosis The shock of learning Meadow had four heart defects ⏱️ [05:00] – Learning to Navigate as a Medical Parent How Sarah's medical background helped (and complicated) her parenting Teaching her husband how to advocate medically alongside her ⏱️ [07:00] – Mother's Intuition & Switching OBs Sarah felt something was wrong during pregnancy but was dismissed A new ultrasound revealed her daughter's heart looked “weird” ⏱️ [10:00] – NICU Rollercoaster Begins Meadow intubated within hours of birth due to medication side effect Sarah and her husband find strength in teamwork ⏱️ [14:00] – Advice for New Heart Parents The overwhelm of tracking vitals and data post-discharge Feeling more like Meadow's nurse than her mom ⏱️ [17:00] – The Unexpected Second Surgery & Major Setbacks Meadow's patch failed, requiring emergency open-heart surgery Her chest remained open for a week due to complications ⏱️ [21:00] – A Brain Bleed Diagnosis & Mental Health Spiral Sarah shares how uncertainty triggered her OCD Emotional trauma of seeing Meadow cold, still, and open-chested ⏱️ [25:00] – Living in the ICU Full-Time How Sarah and her husband made the hospital their home The benefits of being physically present 24/7 ⏱️ [28:00] – Discharge Shock & OCD Diagnosis Meadow is stable—but Sarah's anxiety peaks post-discharge Diagnosed with OCD just 10 days after coming home ⏱️ [32:00] – Healing Through Gratitude & Giving Back Family vacation sparks the idea for a donation The heart institute is named in Meadow's honor with a mural ⏱️ [36:00] – Sarah's Ongoing CHD Advocacy Work Advocating for the Congenital Heart Futures Act Raising awareness for adult congenital cardiology and research needs ⏱️ [40:00] – The Power of Medical Play Meadow's echos improved after doing medical play at home Sarah incorporates play to help her daughter cope with appointments ⏱️ [43:00] – Reflections & Advice for Other Parents Learning how strong her partnership with her husband is Why having the right support person changes everything ⏱️ [45:00] – Where to Follow Sarah & Continue the Journey Website, LinkedIn, Instagram, and more Connect with Sarah Michelle Boes

In this episode of Navigating Mental Illness: Parents Stories, the hosts interview Sarah Bose, who shares her compelling journey from rural Kentucky to becoming a nurse practitioner and a mother. Sarah details her daughter's diagnosis with Tetralogy of Fallot, a congenital heart defect, and discusses the emotional highs and lows from selling her business to managing her daughter's multiple surgeries.  She opens up about her personal mental health challenges, ultimately leading to her diagnosis of obsessive-compulsive disorder (OCD). Sarah stresses the importance of being a strong advocate for one's child and highlights the crucial role of collaboration with medical teams. Additionally, she talks about her advocacy work for congenital heart disease, aiming to improve future care and outcomes for affected children. The episode offers invaluable insights into coping with uncertainty, managing mental health, and the resilience needed in the face of life's unpredictable challenges. 00:00 Introduction and Welcome 02:27 Meet Sarah Bose: A Journey from Kentucky to Nursing 04:08 Navigating Pregnancy and Unexpected Diagnoses 06:07 Understanding Tetralogy of Fallot and Early Surgeries 08:25 Mental Health Challenges and OCD Diagnosis 15:19 Coping Mechanisms and Family Dynamics 22:18 Advocacy and Future Goals 33:12 Concluding Thoughts and Reflections

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Yoshitaka Kimura, MD, PhD, of Leiden University Medical Center, to discuss proactive ablation strategies in patients with repaired Tetralogy of Fallot (rTOF). Dr. Kimura presents data from a long-term, single-center study evaluating electroanatomical mapping and preventive ablation of slow-conducting anatomical isthmuses (SCAI) in rTOF patients without prior ventricular tachycardia (VT). The findings show that identifying and successfully ablating SCAI significantly reduced VT incidence, with all VT events occurring in patients where ablation failed. Moreover, this approach reduced the proportion of patients qualifying for ICD implantation from 25–51% under current guidelines to just 11%. Dr. Kimura underscores a paradigm shift in congenital heart disease management—from treating VT reactively to preventing it proactively—highlighting the value of data-driven, tailored care strategies that avoid unnecessary device implantation and better target high-risk individuals.

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 special electrophysiology-themed issue of JACC, summarized by Dr. Valentin Fuster, dives into cutting-edge research on atrial fibrillation, pulsed field ablation, sudden cardiac arrest in athletes, and preventive strategies in congenital heart disease. From new therapies like finerenone to breakthrough mapping techniques, this episode captures the evolving sophistication and promise of arrhythmia management in modern cardiology.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Professor Robert Sneyd, Vice Chair of Aortic Dissection Awareness UK & Ireland, about the charity's dedication to promoting awareness of aortic dissection. Chapters 00:00 Intro 03:52 RLAAO Isolated MR Study 09:07 Early Outcomes Reop Aortic Root 11:39 Fallot and Its Variants 16:55 Low-Dose Warfarin, Mech AV 22:02 AVR w LIMA-LAD & AAR 23:40 Pulm Thromboendarterectomy 25:28 Modified Birmingham Technique 27:32 Dr. Sneyd, Aortic Dissection Awareness 31:16 Upcoming Events 32:33 Closing They discuss Professor Sneyd's experience with an acute Type A aortic dissection and the lifesaving operation he underwent. Additionally, they explore his involvement with Aortic Dissection Awareness UK & Ireland and the charity's new programs. They also cover the organization's outreach efforts and the important patient guide available on their website.   Joel also reviews recent JANS articles on mortality and stroke after routine left atrial appendage occlusion in patients undergoing isolated mitral repair without atrial fibrillation in the United States, if early outcomes of reoperative aortic root surgery is impacted by previous root procedures and indicate reintervention, Fallot and its variants from diagnosis to pulmonary valve replacement, and low-dose warfarin with a novel mechanical aortic valve.   In addition, Joel explores aortic valve replacement with LIMA to LAD artery and an ascending aortic replacement, step-by-step pulmonary thromboendarterectomy for chronic thromboembolic disease, and Norwood-Sano Stage I palliation for hypoplastic left heart syndrome. Before closing, he highlights upcoming events in CT surgery.   JANS Items Mentioned  1.) Mortality and Stroke After Routine Left Atrial Appendage Occlusion in Patients Undergoing Isolated Mitral Repair Without Atrial Fibrillation in the United States  2.) Are Early Outcomes of Reoperative Aortic Root Surgery Impacted by Previous Root Procedure and Indication for Reintervention?  3.) Fallot and Its Variants: From Diagnosis to Pulmonary Valve Replacement  4.) Low-Dose Warfarin With a Novel Mechanical Aortic Valve: Interim Registry Results at 5-Year Follow-Up  CTSNET Content Mentioned  1.) Aortic Valve Replacement With LIMA to LAD Artery and an Ascending Aortic Replacement  2.) Step-by-Step Pulmonary Thromboendarterectomy for Chronic Thromboembolic Disease  3.) Norwood-Sano Stage I Palliation for Hypoplastic Left Heart Syndrome: The Modified Birmingham Technique  Other Items Mentioned  1.) Aortic Dissection Awareness UK & Ireland Website   2.) Webinar Series: Women in Cardiothoracic Surgery—Advancement Through Collaboration   3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Dans cet épisode de Parents d'abord, Natasha St-Pier se confie sur un moment clé de sa maternité : le jour où elle a appris que son fils, Bixente, souffrait de malformations cardiaques. Elle raconte avec émotion cette annonce bouleversante, le combat qui a suivi et comment cette épreuve a transformé sa vision de la maternité. Hébergé par Audion. Visitez https://www.audion.fm/fr/privacy-policy pour plus d'informations.

This episode covers Tetralogy of Fallot.Written notes can be found at https://zerotofinals.com/paediatrics/cardiology/tetralogyoffallot/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

Send us a textCan an unexpected adventure in Kraków teach you about resilience and support? Join me, Anna Jaworski, as I recount a thrilling axe-throwing escapade with my husband, Frank, which became an unexpected metaphor for our family's journey with our courageous daughter, Hope, who battles a congenital heart defect. In this episode of Heart to Heart with Anna, we spotlight the power of belief and community support, drawing parallels between personal adventures and the challenges of raising a child with CHD. Dive into the exciting plans for Heart Month, where Mended Little Hearts takes center stage with the "Rock your Scar" photo contest and the "Share your HeArt" art competition, igniting awareness and solidarity within the CHD community.Our journey doesn't stop there. Reflecting on the Top Ten Episodes of 2024, discover the inspiring stories of resilience and advocacy from amazing individuals. Hear about Hope's passion for writing and the unwavering strength of heart moms like Rita Scoggins. Be inspired by advocates such as Deanna Altomara and Meagan Houpt, who continue to break barriers. Celebrate fitness and perseverance with Ben Johnson's triumph over tetralogy of Fallot, and witness Marina Lohri's transformation from survivor to heart community supporter. This episode serves as both a heartfelt reflection and an exciting preview of what's to come on Heart to Heart with Anna in 2025.Top Ten Episodes:#10 https://tinyurl.com/H2HAnna446 #9 https://tinyurl.com/H2HandChapter1 #8 https://tinyurl.com/H2HwAnna431#7 https://tinyurl.com/H2HwAnna442#6 https://tinyurl.com/H2HMeaganHouptCh3and4 #5 https://tinyurl.com/H2HwAnna444 #4 https://tinyurl.com/H2HwAnnaE434#3 https://tinyurl.com/H2HwAnna466#2 https://tinyurl.com/H2HwAnna443#1 https://tinyurl.com/MarinaLohriLink to Mended Little Hearts Heart Month Activities: https://tinyurl.com/MLHFeb2024Support the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on technique and outcomes of intracardiac echocardiography to assist anatomical isthmus ablation in repaired Tetralogy of Fallot patients with ventricular tachycardia.

In this episode of Your Kids Don't Suck, Cara and Rythea sit down with researcher and parent Ash Lowenthal to discuss their PhD work on trauma-informed care and non-coercive, collaborative parenting. Ash shares their passion for challenging systems that perpetuate trauma and explores how these principles can inform parenting journeys.Key Topics:Parallels between non-coercive parenting and trauma-informed care in professional settings.Why traditional "authoritative" parenting often falls short compared to collaborative methods.Evidence supporting non-coercive approaches in fostering resilience and emotional safety in children.Practical strategies for integrating trauma-informed principles into everyday parenting.Research gaps in "gentle parenting" and why it may not always meet its promises.References:Harris & Fallot (2001): Dynamics between service providers and users can mirror abusive relationships. Envisioning a trauma-informed service system: A vital paradigm shift.Lowenthal (2020): Implementation of trauma-informed care in child- and youth-serving sectors. International Journal of Child and Adolescent Resilience.Durrant & Stewart-Tufescu (2017): Defining discipline in the era of children's rights. The International Journal of Children's Rights.Curran & Hill (2022): Impact of parental expectations and criticism on perfectionism. Psychological Bulletin.Fuentes et al. (2022): Parental warmth without strictness fosters adolescent empathy and self-concept. Frontiers in Psychology.Garcia et al. (2020): Parenting warmth and psychosocial adjustment across generations. International Journal of Environmental Research and Public Health.For access to these articles (often behind paywalls), email Ash, and they'll provide a PDF version.Connect with Ash:Email: ash.lowenthal@gmail.comInstagram: @ash.lowenthal

Send us a textEver thought you could lead an exhilarating life despite a congenital heart defect? Meet Ben Johnson, a formidable heart warrior born with tetralogy of Fallot. Tune in as Ben, now 45, recounts his spirited childhood and how his heart condition didn't stop him from being a vibrant, active child. From hospital memories to a loving family and supportive teachers, Ben's story is a testament to resilience and the power of a strong support system. He takes us through his childhood escapades, proving that with the right mindset and community, a heart defect doesn't have to define your limits.Our conversation with Ben reveals the intricate journey of living with congenital heart defects, focusing on the visible reminders, including his scars and tattoos, and their role in shaping his life narrative. Delve into Ben's fitness journey where he embraces an active lifestyle with weightlifting, debunking common myths about limitations for heart patients. With the guidance of a personal trainer and self-monitoring, Ben exemplifies how managing health proactively can lead to a robust and fulfilling life, inspiring others with heart conditions to pursue their ambitions confidently.The episode doesn't just stop at physical well-being. We explore the significant link between exercise and mental health, sharing personal triumphs over post-surgical discomfort and the incredible benefits of targeted workouts. From stretching and strengthening exercises to the profound impact of endorphins, discover how maintaining an active routine can elevate mood and reduce anxiety. Encouraging inclusivity in physical activities, we stress that everyone, irrespective of physical limitations, can find joy and freedom in movement. Join us in fostering a community of heart warriors, advocating for empowerment, and cherishing each milestone along our shared journeys.Ben Johnson's contact information: https://tinyurl.com/y9yw53njThanks to our newest HUG Patron, Ayrton Beatty and long-standing Patrons: Laura Redfern, Pam Davis, Michael Liben, Nancy Jensen, Alicia Lynch, Deena Barber, Carlee McGuire, Carter & Faye Mayberry, and Frank Jaworski. We appreciate you!Support the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

On this week's Dads with Daughters podcast, we spoke with Kevin Baker, a certified life coach and father of three. Known affectionately as "Coach Kevin," he offers unique insights into parenting through his personal and professional experiences. This episode delved into various aspects of fatherhood, particularly focusing on raising resilient daughters amidst challenges. Whether you're a new dad or a seasoned parent, the lessons and strategies discussed provide valuable takeaways for all. The Initial Joy and Unexpected Challenges The Joy of Fatherhood Kevin Baker's journey into fatherhood was initially marked by joy and excitement—emotions that many of us can relate to. Upon learning that he would be having a daughter, his initial thoughts mirrored those of countless new dads: excitement quickly followed by planning. From due dates to potential weather conditions, Kevin and his wife wanted to be prepared for every scenario. Navigating Health Challenges However, their plans changed dramatically when their daughter was diagnosed with Tetralogy of Fallot, a congenital heart condition. This unexpected news threw Kevin and his wife into a whirlwind of medical appointments and surgeries. Through three open-heart surgeries, they learned an invaluable lesson about the unpredictability of life: planning is essential, but flexibility and emotional resilience are paramount. Facing Parenthood Fears Head-On Common Fears Like many fathers, Kevin faced immense fears, particularly concerning his daughter's future independence given her medical challenges. His fear extended into other areas, such as her social and emotional well-being. These fears initially overshadowed his joy but evolved over time. Kevin's story is a testament to the fact that all parents, regardless of their child's health, share common anxieties about their child's future. Overcoming Fear Kevin emphasized the importance of addressing these fears constructively. He learned to channel his anxiety into positive, actionable steps. "Letting go of expectations," he said, allowed him to focus on being present, loving, and patient. This mindset not only alleviated his fears but also enabled his daughter to thrive despite her challenges. Reprogramming the Parental and Child Scripts Resetting as Parents Resetting parental expectations begins with a broad perspective on life. Kevin and his wife realized that life's journey is long and unpredictable. They practiced zooming out to see the bigger picture, understanding that daily worries shouldn't overshadow long-term happiness and success. This perspective shift provided them with emotional stability and resilience, enabling them to navigate their daughter's health issues with greater ease. Empowering Their Daughter For their daughter, reprogramming her mindset involved instilling tools for self-empowerment. Kevin shared how they focused on open communication, consistent encouragement, and helping her develop critical life skills. A significant part of this was educating her about the reality of social media, debunking the myths of perfection that it often portrays. They reinforced her self-worth and capabilities, allowing her to combat negative thoughts effectively. Coaching Tweens and Teens: A Broader Perspective Understanding Teen Angst Working with teens and tweens, both professionally and as a father, has given Kevin unique insights into the adolescent mind. He emphasizes the importance of understanding the thoughts and feelings that teens experience daily. Many teens struggle with feelings of inadequacy, anxiety, and a lack of direction, often exacerbated by societal pressures. Strategies for Parents Kevin's primary advice for parents is to focus on connection and communication. Instead of pressing for immediate answers, he advises listening attentively—considering both words and body language—before responding thoughtfully. He acknowledges that parents might not always be the best confidants for their teens, suggesting the involvement of other trusted adults, like extended family members or professional coaches. Resources and Final Thoughts Kevin's experiences and advice emphasize the importance of patience, understanding, and clear communication in parenting. One resource he recommends is Tara Brach's book, "Radical Acceptance," which advises parents to pause and breathe before reacting. This practice empowers both parent and child to make better decisions. Closing Insights To summarize, Kevin Baker's journey offers invaluable lessons for all parents. His emphasis on patience, flexibility, and emotional resilience can guide us all in raising strong, independent children. Resources like "Radical Acceptance" and coaching can also provide valuable support as we navigate the challenges of parenthood. For those looking to explore more about Kevin's perspectives or seek personalized guidance, he is available through his website, lifecoachkevin.com, and various social media channels. Fatherhood is an ever-evolving role, and by embracing lessons from leaders like Kevin Baker, we can strive to be the best dads we can be.   TRANSCRIPT (Unedited transcript created with CASTMAGIC) Dr. Christopher Lewis [00:00:05]: Welcome to dads with daughters. In this show, we spotlight dads, resources, and more to help you be the best dad you can be. Dr. Christopher Lewis [00:00:16]: Welcome back to the Dads with Daughters podcast where we bring you guests to be active participants in your daughters' lives, raising them to be strong, independent women. Really excited to have you back again this week. I love being able to sit down, talk to you, work with you as we are working to be the best dads that we can be and to be able to raise those strong independent women that we all want our daughters to become. And that being said, as I've said in the past, and I'll say it again, I know it is so important that you're here today because that means that you're willing to learn, you're willing to listen, and you're willing to do what it takes to be able to get to that endpoint that you want for yourself and for your family. And to do that, you have to be willing to be open to listening, to learning, and to take it all in, and to figure out what works, and to figure out what works best for you and your family. Everything that you're gonna be hearing today may not work exactly for your family. And that's okay. Because each of us is going to father in different ways. Dr. Christopher Lewis [00:01:15]: There's not one right way to father, and there's no one playbook to follow to be able to know how best to be a father to your kids. There are so many different ways that you can do that. And what's most important though, is that you're willing to know and you're willing to learn and find some of those other tools that you can add to your own toolbox to put into place and to be able to try some of those out. Because you know what? You might learn something new about yourself and something new that you can put into place to help you be that dad that you wanna be. And that's why in every episode, I love being able to bring you different guests, different people with different experiences, different dads coming from different walks of life, and as well as other experts, other people that can help you to be that father that you wanna be. And this week, we have another great guest with us. This week, we have Kevin Baker joining us or otherwise known as coach Kevin. And coach Kevin's gonna be talking with us about his own experience as a father of 3, as well as Kevin is a certified life coach who works with families and teams and helps individuals to be able to build the best version of themselves. Dr. Christopher Lewis [00:02:26]: We're gonna be talking about that as well. So I'm really excited to have him here. Kevin, thanks so much for joining us today. Kevin Baker [00:02:32]: Oh, thanks for having me, Chris. It's a pleasure to be here. And I look forward to getting some insights from you too. This is great. Dr. Christopher Lewis [00:02:37]: I really appreciate you being here today. And one of the things that I love to do, 1st and foremost, is turn the clock back in time. And I know you've got 3 kids, 1 daughter, and 2 sons. And I wanna turn the clock all the way back. I know you've got a 14 year old daughter, so let's go back. Maybe it's 13 years, maybe it's 14 years, you never know. But talk to me about that first moment, that first reaction that you had when you found out that you were going to be a father to a daughter? Kevin Baker [00:03:02]: Oh, pure excitement and just so much joy. Overwhelming amount actually of excitement. And it quickly turned into, okay, what do I have to do next? What's the next step? What do we do? So a little bit of anxiety being a plan. We started to make arrangements, figure out this is the due date. Kevin Baker [00:03:18]: What's it going to be like? What's the weather going to be like? Where are we going to go? What are we going to do? How are we going to do it? And so we had this great plan. And then fast forward 8 months, final checkup at the doc, they said, We're seeing something with a heart and we want to get you guys over to the hospital to check it out. And 4 days later, our daughter was born and she was diagnosed in utero with a heart condition called Tetralogy of Fallot that would require intervention at some point, which was like a total shock to us. We did not expect this. We had these plans, but what about our plans? And so we very quickly learned that it's great to have plans, but you could pretty much throw those out the window. And that has been the MO for my daughter ever since for the last 14 years. And it's been great. What a great learning experience. Kevin Baker [00:04:01]: What a great way to what a great introduction into parenting is that it's great to have expectations and it's great to have plans, but really it's all out of your control. So don't stress too much about it when things deviate from what your perfect plan was. But fast forward 14 years, she's had 3 open heart surgeries. She had 2, her 1st year of life where they corrected the ASD and the VSD in the heart and fixed one of her valves and also fixed the bundle of tissue that was sort of in the way of things. But she just recently on May 2nd, had her 3rd open heart surgery and is fully recovered from that. And she's been swimming in the lake all summer. So it's been fantastic. And we live right outside of Boston, which is probably one of the best places in the world to have that sort of thing happen. Kevin Baker [00:04:38]: So we're grateful and we're blessed that we've been through it. And it's been a rollercoaster of feelings, ups and downs and but we know life is a long journey and we are giving her all the tools we possibly can for her toolbox to be strong and happy and successful whatever that means to her moving forward in life. So that is the short version of becoming a parent for me. Dr. Christopher Lewis [00:04:59]: Now, every father that I've talked to talks about fear, and your fears may be very different than some other dads, especially with some of these surgeries that your daughter has had to have in her first 14 years of life. But I'm gonna ask you the question anyways. As you entered into fatherhood, and as you've gone through these 14 years, what's been the biggest fear that you've had in raising a daughter? Kevin Baker [00:05:23]: You know, that's a great question. The biggest fear that I've had, just because my daughter has had so many challenges I would say that she's had to overcome and she still does. She's got some communication issues, you know, some social emotional stuff happening, you know, which a lot of kiddos do. But I think my biggest fear is that she wouldn't be prepared for life outside of the house when it's time for her to be independent. And that was a fear of mine. However, it's not a fear of mine anymore. And I have been able to take all those thoughts and all those fears that I've had and let them go and sort of let go of all my expectations about what she's going to do when she gets older, who she's going to be when she grows up and just know in my heart and in my soul that we're are doing the best job that we possibly can to help this kiddo figure out who she wants to be on her own. And she's learning and she's doing great. Kevin Baker [00:06:12]: And that all gets reinforced to us through parent teacher conferences or speaking with other adults that help out along the way to raise our family and when I'm able to let go of the fears and let go of the expectations and just know that everything's going to be okay because we have the tools to deal with it, then we're all a lot happier for it. And so, I try to not be afraid of anything because that doesn't serve anyone. Dr. Christopher Lewis [00:06:39]: You're not the only father that has had to have those fears and has not had a child that has had to have all of those challenges within her life and that they've had to deal with in their life. But not every father has had to also deal with those. And sometimes things can change. Things can get thrown through a loop, and you've definitely had to deal with that. I guess as I think about that and what you just said, I've got 2 questions. 1st, tell me about what you and your significant other had to do to be able to reset that mindset. I'm gonna say maybe programming. Reset the script that you had in your brain about how things were going to be versus how they were? And then, 2, how have you had to work to help your own daughter to reset her script about the way in which she had to see this for herself? Kevin Baker [00:07:34]: The first an the answer to the first question is that, you know, we really in order to reset the script as parents, we had to zoom way out on life and realize that, you know, life is a long journey. And, you know, everybody goes through stuff day to day that gets you emotional. It gives you different thoughts that you have to work through and overcome. There's a lot of worry. The world is a busy, hectic and anxiety inducing place when you think about all the things that could happen in life. But being able to zoom out and know that, yeah, some days are really, really hard. But if you think about it the right way and you know that tomorrow's another day and it's all going to be fine and we have the tools and we have the for instance, the greatest medical professionals, some of the greatest medical professionals in the world here to help us deal with some of this stuff and know that we are smart and capable adults that can work through any problem that presents itself to us. All we have to do is breathe and reason and have the resources that we were taught to use growing up, that we're going to get through it and it's going to be okay. Kevin Baker [00:08:33]: And yeah, there are a lot of nights where there's anxiety about what's going to happen. Is she going to be okay? Is she going to be able to play on the playground? Is she going to have restrictions? Is she going to be able to get a job one day? Is she going to be able to drive? All these things that us as parents we worry about. But really, if we just focus on being present and showing love and having patience, then we have everything we need to be the best parents we can be and taking the anxiety and the worry about the future out of it and just focus on the present and do the best we can. That's how we get by day to day. And yes, some days are hard, but we get through it. We keep our positive mindset and we get through it and you know it gets better. And once you know it the next day when you tell yourself it's all going to be fine, it actually is. And how has my daughter been able to reset? We've given her a lot of tools and she's developed a lot of tools to be able to keep up with her classmates and her peers and to be able to communicate as effectively as possible with her teachers and her other trusted adults. Kevin Baker [00:09:32]: And we tell her that she's doing a great job and we congratulate her and we're her cheerleader and we keep an open and transparent relationship so we can communicate and try and figure out what thoughts are you having and how can we help you with whatever you're dealing with? And just to keep that open dialogue and communication and let her know that everything's going to be okay. And now that she's 14, a lot of the reset is trying to impress upon her that what some of the stuff she might see online or on social media isn't really the whole truth. And some of these folks may be just showing you the top 1%, all the good stuff that's happening in their life. And maybe you don't have the fear of missing out on that because that might not be a 100% real. So bringing that all back down to reality, is a really important aspect of keeping that reset in play. Dr. Christopher Lewis [00:10:15]: It is such an important thing. I've seen it in my own daughters, and I know that so many parents do, especially in those tween and teen years. And I mentioned the fact that you had a lot of opportunity over your career to be able to work with teens and tweens, to be able to really look at who they want to be, but also how they want to get there, and helping people and helping teens in that way. Kevin Baker [00:10:42]: You know, the number one thing that I hear from kiddos all the time, and one of the things that we work through, because I think it's the most important thing to work through with them, is what is going on in their mind, and what thoughts are they having when they're put in certain situations that are causing the feelings and emotions that they're having that are causing the actions or non action that they're taking, which is leading to results that are either what they're looking for or not what they're looking for. So digging into what issue are they having? Is it an issue about friends? Is it academic performance? Is it something happened to do with anxiety? Or is it a lack of motivation? All these things that the parents see as red flags for instance, when they are, you know, spending too much time on the computer or not getting good grades or not socializing with too many friends or not finding interest in things that are happening in and around their life. And so, what we talk about right off the bat is what are the thoughts that you're having? And a lot of them are having thoughts that they're not good enough or they're never going to make it or, you know, they'll never be, you know, rich and famous or they don't know what they want to do with their life or they're wasting time or, you know, all these negative, deconstructive, limiting beliefs that they've had through inputs from parents, teachers and you know, there's a saying, it's parents, teachers, and preachers that really influence the belief systems that we have and parents influence their kiddos with beliefs without even knowing that they're actually programming the mind of their child. So digging into really what are those beliefs? What are those thoughts you're having? And why are you having that thought that you're not good enough? And how did that come to be? And then dissecting it. And then giving them an opposite, more empowering, constructive thought like actually, you know, with practice, I will be good enough and I could actually be one of the best or I am going to make it. You know, with hard work and persistence, I am going to make it and I'm going to be one of the best. And give them that mindset that when they have one of those negative thoughts and they have a thought that they know is not a fact to analyze that, and they come up with a new thought that empowers them. And when they have the ability to change that, to recognize that they are not their thoughts and the thoughts are just an internal narrative that's happening, everybody has it. Kevin Baker [00:12:53]: It's a voice in their head and everybody has it, but when you can control it so that it tells you so that it doesn't hold you back and it actually pushes you forward so you can get through whatever's holding you back without talking yourself out of it, that's where we want to be with the kiddos. You know, we want to give them the ability to empower themselves when a situation arises so that when they start to feel negative or they have an experience and, you know, they think they're not good enough, that they tell themselves like, hold up, you are good enough, you got this, Just do it. Dr. Christopher Lewis [00:13:22]: And one of the things that can get really challenging in those teen and tween years is that your your children are going to are going through this transition, are going through this transition that all of us went through as kids, where they begin to test the waters even more and test the values and the family mores that have been put into place and that they've been growing up with to try to identify who do they, who are they, who do they wanna be, who are they, to try to identify who they are and who they want to be. And that can be really challenging for parents in many different ways. So I guess I'd love to have you talk to me a little bit about the work that you've done with tweens and teens. And as you're working with them as individuals from their perspective, what are you hearing from them? What are some of the things that they're saying to you? And I know you're trying to work with the parents as well because sometimes parents just don't understand as they're trying to parent these kids through what they're going through. So are there things that they can do to be able to reconnect and be able to understand their kids in a different way? Kevin Baker [00:14:28]: Well, that's a great question, and and it's it's almost a trick question because when you're a parent asking those questions and trying to understand your kiddo, they don't always respond, and it doesn't work. Parents, it doesn't work when you're trying to do that with your kiddo. That's why it takes a village, and you need to have other trusted people in your circle that can work with you and your kiddo to get to the bottom of it because they're not gonna be as open with you no matter what. You could be the you could have the closest relationship. Like this kind of stuff doesn't work with my kids. It works great with everybody else's but, you know, there's a thing. We have a limit on what we can do. So and it's just because they see us 20 hours a day or whatever it is. Kevin Baker [00:15:07]: You know, it's because we're there. We have all these other roles and responsibilities that sometimes prevents us from cracking the code with our own kiddos. But I would say that letting your kiddo know that, Hey, I'm here for you if you need anything, like if you want to talk. And really the first thing to do is connect. Like find the one thing that you can do to really connect with your child because it might be sitting down and watching them play a video game and asking them questions about it and then see what conversation comes from that. But showing them that you're there and you care, and then making that judgment as a parent, it's like, Is there something going on? And what can we do to help you get through some of this stuff? And they might have an aunt or uncle that they respect that's not the parent that can come in and open them up a little bit and get into that conversation. Or before you go to therapy, I always say triage with coaching because, you know, a lot of the stuff can be talked through. And when we focus on the positive with coaching, sometimes people don't need to go to therapy. Kevin Baker [00:16:08]: Sometimes they do need to go to therapy. But parents start with connection and communicating and letting them know that you're there and you care is the number one thing. Dr. Christopher Lewis [00:16:15]: So listening to what you just said, one question that still comes to my mind is if your child is having those thoughts, if you're noticing it, where's the best place to start in having these conversations with them, to engage with them, and to try to help them understanding that we may not understand completely what's going on as well? Doctor. Robert Whitfield Kevin Baker [00:16:33]: (zero forty five:fifty four): And people change along the way. Parents change along the way. I've had 3 kids, and I think that they each have sort of had a different version of me as their father, as I've become a better dad or not, depending on which kid you ask. But we learn, and we get new tools, And I have become a better father. Over the 14 years, you know, you learn as you go, and the kiddos change drastically. Dr. Christopher Lewis [00:16:53]: I love that concept because I think that sometimes parents get themselves into a situation where they're racking their brains, and they're trying to figure out how can I connect with them better? How can I do something to be able to reconnect? And it doesn't always happen. Now, I am making a generalization because every child is different. And as you inevitably probably either have heard or will hear, older people are always saying to newer parents, oh, you know, just wait until those teenage years. Well, the teenage years are not always going to be challenging. They may be, but they're not always going to be. So you have to realize that every child is different. And when you have multiple kids, each of your children may be different when it comes to how they go through their tween and teenage year experiences for themselves. So as you're going through this with your kids and you're realizing that each of your children are going to be different, sometimes you have kids that are going through this at the same time, and you have to have a different approach. Dr. Christopher Lewis [00:17:53]: And you have to have a different approach to working with your children. It's not always a rinse, wash, and repeat. What do you say to parents when it comes to parenting multiple tween or teens during the same period? Because we know that each of them are not going to be able to go through the same process together. Kevin Baker [00:18:12]: Yeah. I think it's important to know that all kids are different. And, yes, they all come from you, but they are all very, very much different. And they all have their own vision. They all have their own vision, their own subconscious, and, and they all need to be treated similarly, but they're all gonna have different needs. And so trying to identify, I guess, what each kiddo needs that's different from one another is something you have to really be aware of. And that comes from listening. And when your child's talking to you, not racking your brain, thinking about what you're gonna say back to them, but to actually just listen, like to all the words and how they're saying it and what their body language is telling you while they say it. Kevin Baker [00:18:52]: And then take all that information in and determine what your response is going to be. And to not react right away, but to give it time and pause and let everything they're saying go through the emotional part of processing and give it a minute and then reply with a reasoned response is the best way to try and figure out who each one of your kiddos is individually. And then let them know that they have such special characteristics and, you know, they have this unique identifier that is them and their personality and what you love about it to help foster that sense of individuality and to build up their self confidence and their self esteem and their self-concept because they all need to have, they all need to know their important qualities and their characteristics and their values. Like you might have a kiddo who's very sensitive and empathetic and caring and loving and really cherishes family and friendships. And you might have another kiddo who is a little bit, I don't know, more outgoing. Maybe they're a jokester. You know, maybe they are the life of the party. You know, maybe they were always the ones doing magic tricks growing up, trying to be the center of attention. Kevin Baker [00:20:00]: You know, so all kids are different, and they all have their different qualities in trying to foster that so that your kiddos grow up with their own sense of self-concept which will carry them through life. And that's the thing that on the hard days when they get faced with an issue with friends or something academically that they can say like, You know what? I'm really smart and I can do this. Or, I am super friendly and no matter what that person says, like, I know I'm me and I am a great person and I can do this and I can make these friends or whatever the case may be, but giving them that sense of self. Dr. Christopher Lewis [00:20:30]: Now, I know that you've worked with a lot of not only tweens and teens but also parents. And as you work with these individuals, are there any resources that you encourage parents or fathers to refer to as they're going through this period of time with their teen and tweens? Kevin Baker [00:20:45]: I mean, there are some great podcasts out there, this being one of them. There's so many different resources for parents to dig in and to really spend time paying attention to. I think one of the authors that I think is really hitting the nail on the head is her name is Tara Brach. Tara Brach wrote and really the essence of it is to when you are faced with a situation with your kiddo and you don't know what to do, and maybe you're having an argument, maybe you want them to do some chores that they are procrastinating on. Maybe there's something you need them to do that they're not doing it and you're about to get really with them, but to pause and breathe. The book is called Radical Acceptance. And in essence, it is, you know, accept that your kiddo is their own person and they know the right answers in their subconscious. They know what to do and they want to please their parents. Kevin Baker [00:21:36]: And if we pause and we breathe and we give them a chance to do that without intervening, kids will make the right decisions. And to be able to practice that and then actually see it happen, like right before you knock on your kiddo's door, after you've asked them to come down for dinner half a dozen times and they're still up there playing Fortnite or whatever it is, just walk away and don't nag them anymore and let them make the decision and let them make the choice and have the consequence because it's all a learning experience. And reading that book, Radical Acceptance, was a game changer for me in parenting and I'm happy to share that resource with whoever's interested. Dr. Christopher Lewis [00:22:10]: Now, we always finish our interviews with what I like to call our fatherhood 5, where I ask you 5 more questions to delve deeper into you as a dad. Are you ready? Kevin Baker [00:22:18]: Yep. Ready. Dr. Christopher Lewis [00:22:18]: In one word, what is fatherhood? Kevin Baker [00:22:20]: Patience. Dr. Christopher Lewis [00:22:21]: When was the time that you finally felt that you succeeded at being a father to a daughter? Kevin Baker [00:22:25]: When she made the honor roll. Dr. Christopher Lewis [00:22:26]: Now, if I was to talk to your 3 kids, how would they describe you as a dad? Kevin Baker [00:22:30]: Maybe cringey. A little bit cringe. It's a new term that when I tell my dad jokes, they don't sometimes they don't find them funny, they find them cringey. But I'd say fun, most of the time. Dr. Christopher Lewis [00:22:38]: Who inspires you to be a better dad? Kevin Baker [00:22:40]: Let's say my father. Dr. Christopher Lewis [00:22:41]: Now, you've given a lot of piece of advice today, things that every dad can think about. What's one piece of advice you'd wanna give to every dad? Kevin Baker [00:22:47]: I would say breathe. Breathe. When it gets tough, just breathe and let the emotion pass because emotions change. You might have an emotion of anger or being overwhelmed or being anxious about a certain situation your kid may or may not be faced with. But I think breathing is the most important thing we can do. Dr. Christopher Lewis [00:23:03]: Well, Kevin, I just wanna say thank you for helping teens and tweens, and thank you for being here today for sharing your wisdom on working with those teens and tweens, and for telling us more about your experience as a father. If people wanna find out more about you, where should they go? Kevin Baker [00:23:17]: Sure. They can go to life coach Kevin.com. So on Instagram at life coach Kevin and on Facebook at teen life coach. Happy to have consultation calls with anyone that's seen some red flags. If you're frustrated or confused with what's going on with your kiddo, feel free to sign up for a call, and we can chat through it and see if working together might be the right fit. Dr. Christopher Lewis [00:23:33]: I really appreciate you being here today, and I wish you all the best. Kevin Baker [00:23:37]: Same here, Chris. Thanks a lot. Dr. Christopher Lewis [00:23:38]: If you've enjoyed today's episode of the Dads with Daughters podcast, we invite you to check out the fatherhood insider. The fatherhood insider is the essential resource for any dad that wants to be the best dad that he can be. We know that no child comes with an instruction manual and most dads are figuring it out as they go along, and the fatherhood insider is full of resources and information that will up your game on fatherhood. Through our extensive course library, interactive forum, step by step road maps, and more, you will engage and learn with experts, but more importantly, dads like you. So check it out at fathering together dot org. If you are a father of a daughter and have not yet joined the dads with daughters Facebook community, there's a link in the notes today. Dads with Daughters is a program of fathering together. We look forward to having you back for another great guest next week, all geared to helping you raise strong empowered daughters and be the best dad that you can be. We're all in the same boat, and it's full of tiny screaming passengers. We spend the time, We give the lessons. We make the meals. We buy them presents and bring your a game. Because those kids are growing fast. The time goes by just like a dynamite blast. Calling astronauts and firemen, carpenters, and muscle men, get out and be the world to them. Be the best dad you can be.

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

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on cumulative radiation exposure and lifetime cancer risk in patients with Tetralogy of Fallot requiring early intervention.

In questa puntata sentirete la storia di Maria Cantarutti e della sua cardiopatia, la Tetralogia di Fallot.

Lori Myers, shares her experience living with VSD and Tetralogy of Fallot, which caused her to be born as a "blue baby" and have various health issues throughout her life. After multiple surgeries and diagnoses, she was eventually told she had pulmonary arterial hypertension (PAH). Despite the prognosis, Lori is now in her tenth year since the diagnosis. She emphasizes the importance of listening to one's own body and following medical advice. Lori finds strength in her family, particularly her grandchildren. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on social @phaware  Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com

This podcast discusses anesthetic considerations for patients with unrepaired tetralogy of Fallot who are undergoing non-cardiac surgeries. LEARNING OBJECTIVES Upon listening to this podcast, learners will be able to: - Explain preoperative considerations - Provide an anesthetic management plan - Describe specific non-cardiac surgical procedures and the considerations that need to be addressed when performing them - Anticipate the postoperative considerations AUTHORS Annette Schure, MD Senior Associate in Cardiac Anesthesia Boston Children's Hospital Assistant Professor of Anesthesia Harvard Medical School Christian Refakis, MD Clinical Fellow Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital Robert Soohey Medical Student Tufts University School Of Medicine DATES Initial publication: September 4, 2024. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Refakis C, Marcley S, Soohey R, Marques B, Wolbrink TA, Schure AY. Anesthesia for Non-Cardiac Surgeries: Unrepaired TOF. 09/2024. OPENPediatrics. Podcast: https://soundcloud.com/openpediatrics/anesthesia-for-non-cardiac-surgeries-unrepaired-tof-openpediatrics.

Riata shares her story of her baby Riana and the diagnosis of Tetralogy of Fallot and Atrioventricular septal defect (AVSD, a heart defect) and T21. Riata was 29 at the time of this first pregnancy. She had to travel for care, due to living in a very rural part of Wyoming. Riata wishes to share her story to remind those opposed to abortion that abortion bans affect more than their propaganda "poster child" of abortion. It doesn't discriminate by demographics, religious affiliation, political party, or social status - because it is healthcare! Riata has also shared her story in an advocacy manner in other publications: https://www.nytimes.com/.../27/us/abortion-women-tfmr.html https://www.cbsnews.com/amp/news/roe-v-wade-reversal-brings-uncertainty-in-states-with-trigger-laws/ Resources mentioned:1.“Releasing a Wanted Pregnancy” TFMR support & resources pamphlet. Free download here: https://www.thetfmrdoula.com/pamphlet 2.The TFMR Support Circle, our free Facebook group for termination for medical reasons (TFMR) parents. Apply to join here: https://www.thetfmrdoula.com/facebookgroup And if you would like to share your TFMR Story on "Our TFMR Stories," email me here to find out more: sabrina at theTFMRdoula dot com Music clip:Pamgaea by Kevin MacLeodLink: https://incompetech.filmmusic.io/song/4193-pamgaeaLicense: https://creativecommons.org/licenses/by/4.0/

This week on The Beat, Editor in Chief Joel Dunning discusses the implementation of the Versius robotic surgical system for thoracic surgery and summarizes the ability of the Versius surgical system to successfully and safely complete a range of thoracic procedures aligned with phase 2a of the (Development) of the Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework for surgical innovation.   He also discusses the perioperative tools to predict neurocognitive outcomes in congenital heart surgery, the differences in right heart function after pulmonary valve replacement in patients with pulmonary valve stenosis versus tetralogy of Fallot, and the left atrial appendage closure for stroke prevention in atrial fibrillation.  In addition, Joel discusses neoarotic valve repair with a subannular ring for complex trileaflet prolapse after an arterial switch operation, the use of the autologous innominate vein as a substitute for the pulmonary arteries, and another installment in Dr. Tristan Yan's aortic repair series focused on the technical details of the mini-access David procedure. Before saying goodbye, Joel discusses upcoming events in CT surgery.  JANS Items Mentioned Implementation of the Versius Robotic Surgical System for Thoracic Surgery: First Clinical Evaluation of Feasibility and Performance  Perioperative Tools to Predict Neurocognitive Outcome in Congenital Heart Surgery  Differences in Right Heart Function After Pulmonary Valve Replacement in Patients With Pulmonary Valve Stenosis Versus Tetralogy of Fallot  Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation: Current Status and Perspectives  CTSNet Content  Neoaortic Valve Repair With a Subannular Ring for Complex Trileaflet Prolapse After an Arterial Switch Operation  Deep Dive Into Aortic Surgery: Mini-Access David Procedure—Endoscopic Assessment of Valve Competency   The Use of the Autologous Innominate Vein as a Substitute for the Pulmonary Arteries in Pulmonary Atresia and Absent PAs  Other Items Mentioned CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week we review a novel multivariable model used to predict mortality in the repaired tetralogy of Fallot patient. Can this model identify who amongst the repaired TOF patients is at risk for death in the coming years? What are the most important inputs to this model? Why does the use of a validation cohort provide greater strength to this model and is there still room for improvement in the model? Can the data in this work help inform decisions regarding pulmonary valve replacement timing? These are amongst the questions posed to the senior author of this work, Cardiologist-in-Chief at Boston Children's Hospital and Professor of Pediatrics at Harvard University, Dr. Tal Geva. Novel risk calculator: https://github.com/rTOF-INDICATOR/MORTALITY-RISK-Scoredoi: 10.1161/JAHA.123.034871. Epub 2024 Jun 11.

CardioNerds Dr. Josh Saef and Dr. Tommy Das join Dr. Omkar Betageri, Dr. Andrew Geissler, Dr. Philip Lacombe, and Dr. Cashel O'Brien from the Maine Medical Center in Portland, Maine to enjoy an afternoon by the famous Portland headlight. They discuss a case of a patient who presents with obstructive cardiogenic shock. Dr. Bram Geller and Dr. Jon Donnelly provide the Expert CardioNerd Perspectives & Review segment for this episode. Dr. Maxwell Afari, the Maine Medical Center cardiology fellowship program director highlights the fellowship program. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. This is the case of a 42 year-old woman born with complicated Tetralogy of Fallot repair culminating in a 29mm Edwards Sapiens (ES) S3 valve placement within a pulmonary homograft for graft failure who was admitted to the cardiac ICU for progressive cardiogenic shock requiring vasopressors and inotropic support. Initial workup showed lactic acidosis, acute kidney injury, elevated NT-proBNP, and negative blood cultures. TTE showed at least moderate biventricular systolic dysfunction. She was placed on furosemide infusion, blood cultures were drawn and empiric antibiotics initiated. Right heart catheterization demonstrated elevated right sided filling pressures, blunted PA pressures with low PCWP, low cardiac index, and low pulmonary artery pulsatility index. Intracardiac echocardiography (ICE) showed a large mass within the ES valve apparatus causing restrictive valve motion with a low gradient across the pulmonic valve in the setting of poor RV function. Angiography revealed a large filling defect and balloon valvuloplasty was performed with immediate hemodynamic improvement. Blood cultures remained negative, she was gradually weaned off of inotropic and vasopressor support, and discharged. Despite empiric treatment for culture negative endocarditis and ongoing anticoagulation, she was readmitted for recurrent shock one month later at which time the pulmonic mass was revisualized on ICE. A valve-in-valve transcatheter pulmonary valve (29mm ES S3) was placed to compress what was likely pannus, with an excellent hemodynamic result and no visible mass on ICE. 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 Pearls - Obstructive Cardiogenic ShocK Tetralogy of Fallot is the most common cyanotic defect and can lead to long term complications after surgical repair including chronic pulmonary insufficiency, RV dysfunction, residual RVOT obstruction and branch pulmonary artery stenoses. Chronic RV failure may be more indicative of a structural defect and therefore require interventional or surgical management. Valve thrombosis, infective endocarditis and obstructive pannus formation should be considered in the differential of a patient with obstructive shock with a prosthetic valve. Bioprosthetic pulmonic valve obstruction may be effectively managed with balloon valvuloplasty in patients who present in acute extremis but TCPV will likely provide a more lasting result. While valvular gradients are typically assessed via echocardiography, invasive hemodynamics can serve as a critical adjunctive tool in its characterization. Show Notes - Obstructive Cardiogenic ShocK Notes were drafted by Drs. Omkar Betageri, Philip Lacombe, Cashel O'Brien, and Andrew Geissler. What are the common therapies and management for Tetralogy of Fallot? Tetralogy of Fallot is the most common cyanotic defect in children beyond the age of one year Anatomic Abnormalities: Anterior and Superior deviation of the conal septum creating a SubAo VSD and encroachment on the RVOT.

This week on The Beat, Editor in Chief Joel Dunning focuses on all the latest news and clinical content in cardiothoracic surgery. In addition, Joel discusses outcomes after hybrid chemotherapy and surgery lung cancer treatment, mechanical circulatory support during revascularization, and research opportunities for early career investigators in cardiac surgery. He also talks about videos demonstrating tetralogy of Fallot repair, repair of post-intubation tracheal stenosis, and a recorded webinar on the Ross procedure. Before saying goodbye, he discusses upcoming events in CT surgery. JANS Items Mentioned Surgical Outcomes After Chemotherapy Plus Nivolumab and Chemotherapy Plus Nivolumab and Ipilimumab in Patients With Non-Small Cell Lung Cancer  Mechanical Circulatory Support During Surgical Revascularization for Ischemic Cardiomyopathy  Research Concepts and Opportunities for Early Career Investigators in Cardiac Surgery  CTSNet Content Mentioned Tetralogy of Fallot With Absent Pulmonary Valve: Repair by Anterior Translocation of Branch Pulmonary Arteries and Reduction Plasty  Post-Intubation Tracheal Stenosis: Tracheal Resection With Dorsal Mucosectomy and Primary Anastomosis  The Ross Procedure: Clinical Evidence, Surgical Technique, and Q&A  Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Welcome twin sister Regina and her husband Shane In this episode of "Pushing Forward with Alycia | A Disability Podcast," Alycia Anderson invites her twin sister, Regina Weinstein, and brother-in-law, Shane, to share their poignant journey with their daughter Ella, who was born with Congenital Heart Defect (CHD). As we observe American Heart Month and Congenital Heart Defect Awareness Week (CHD), their story serves as an offering of hope, boundless strength, and the unbreakable love of family in the face of life's challenges. Through Ella's journey, Alycia and Regina reflect on their twin connection, as if the shared strength flows through her. Key Highlights:

Download for FREE today -  special Mnemonics Cheatsheet - so you can be SURE that you have that Must Know information down:  bit.ly/nursing-memory   Outline The 4 T's T-Tetralogy of Fallot T-Truncus Arteriosus T-Transposition of the Great Vessels T-Tricuspid Atresia Description Cyanotic heart defects are a group of congenital heart defects that result from deoxygenated blood by-passing the lungs and going into systemic circulation. Tetralogy of Fallot includes 4 anatomical abnormalities that are pictured below. Truncus Arteriosus is a condition where the pulmonary trunk and aorta don't properly divide in development. This results in one large vessel carrying mixed blood to the heart, lungs, and systemic circulation. Transportation of the Great Vessels is a condition where vessels are swapped or may be in abnormal positions. Tricuspid Atresia is a condition where there is no tricuspid valve, which leads to an undersized or absent right ventricle.

We have a great show for you this Saturday which will provide all of the answers you have come to expect from The Word on Medicine. This week's program discusses Congenital Heart Disease. Congenital heart surgeons, Dr. Michael Mitchell and Dr. Tracy Geoffrion, along with a patient and her mother, discuss an overview of congenital heart disease, reasons for surgery, and Tetralogy of Fallot. Tetralogy of Fallot is a group of four congenital heart defects that babies can be born with that make it difficult for them to get oxygen, and requires surgery to repair. Listen to this inspiring story of a thriving 8-year-old girl born with Tetralogy of Fallot and the amazing lifesaving work being done at Children's Wisconsin.

A look at the main forms of congenital heart disease including Left to Right Shunts (VSD,ASD, Patent Ductus Arteriosus, Anomalous Pulmonary Vein Connections) and Right to Left Shunts (Tetralogy of Fallot, Transposition of the Great Arteries, Ebsteins Anomaly). Heart Sounds by:Easy Auscultation https://www.easyauscultation.com/heart-soundsLicense https://drive.google.com/file/d/1alTtvcl4sXTwPLhTYIxRps-deCVbGQRz/view?usp=drive_linkVolumes altered - no other changes made. Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Congenital Heart Disease?0:20 Types of Congenital Heart Disease Overview1:07 Normal Anatomy & Physiology 1:43 Left to Right Shunting Pathophysiology (Eisenmenger's Syndrome)3:04 Ventricular Septal Defect (VSD)5:25 Atrial Septal Defect (ASD)7:35 Patent Ductus Arteriosus (PDA)11:16 Anomalous Pulmonary Venous Connections (APVC)13:53 Tetralogy of Fallot (TOF)14:49 Transposition of the Great Arteries (TGA) 16:02 Ebstein's Anomaly17:45 Aortic Coarctation References:BMJ Best Practice (2023) Congenital Heart Disease. Available at https://bestpractice.bmj.com/topics/en-gb/1308/detailsArvanitaki, A (2020) Eisenmenger syndrome: diagnosis, prognosis and clinical management. Available at **https://heart.bmj.com/content/106/21/1638Remien, K & Majmunda, S.H (2023) Physiology, Fetal Circulation. Available at https://www.ncbi.nlm.nih.gov/books/NBK539710/MSD Manuals Pro. Congenital Cardiovascular Anomalies. Available at https://www.msdmanuals.com/en-gb/professional/pediatrics/congenital-cardiovascular-anomaliesPlease remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

Ashley showed up for her 20 week anatomy scan ultrasound just like any other mom - excited to see her sweet baby on the screen and to walk away with some photos to show off to family and friends. But her excitement was quickly disrupted with an in utero diagnosis. Ashley's daughter presented with a heart defect formally known as Tetraology of Fallot with Pulmonary Atresia. This led to many moments of panic, anxiety, and worry, referral to follow-up visits with specialists, big decisions, and a completely different pregnancy and delivery experience than Ashley ever imagined for herself. In this podcast, we dive into the importance of advocating for yourself or your child any time a diagnosis is received, strategies for handling unexpected diagnosis, and navigating parenthood when your child has a diagnosis. You won't want to miss hearing Ashley's story and I know, as moms, we need the reminder to relinquish control sometimes...to let go of expectations...and to live without letting our challenges define us. Support the showLet's connect on social media! Send me your thoughts to https://www.instagram.com/alanna.hellman/. I'd love to get to know you better! Join the MWO Community: https://www.facebook.com/groups/momsworkingovertimeYou can always find more information at www.momsworkingovertime.com.Thank you so much for listening! Love what you hear? Please share the podcast and leave a review! It means the world to me and helps me reach more moms so I can remind them how amazing they're doing.

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

Do you want to become a confident advocate for your child's medical needs? Are you searching for a solution to navigate the complex world of medical care for children with conditions? Join us as we welcome Kayleigh Koehler, a Child Life Specialist who has transformed into a medical parent. She will be sharing valuable insights and strategies on how you can achieve the ultimate goal of becoming a knowledgeable and effective advocate for your child's medical journey. Get ready to embark on a transformative journey towards becoming the empowered advocate your child needs. Kayleigh Koehler is a remarkable and multifaceted individual who navigates through life wearing various hats. As a wife to her high school sweetheart Mitch and a mother to their charming four-year-old son, Hudson, Kayleigh's world is filled with love and profound resilience. Professionally, she is a dedicated child life specialist working tirelessly in a cardiac ICU. Her firsthand expertise and personal connection to her job started to take a unique and powerful perspective when her unborn son was diagnosed with a heart condition. Kayleigh's courage, wisdom, and gutsy perseverance inscribed an unforgettable chapter in her life story where her professional and personal world astoundingly intertwined. Because of this experience, I am a better child life specialist. Because I understand the world in a different way that I simply could not understand when I wasn't a mom. - Kayleigh Koehler    The key moments in this episode are: 00:00:00 - Introduction, 00:01:42 - Reflections on Trauma and Mental Health, 00:09:47 - Advocacy and Empathy in Child Life, 00:13:21 - Permission to Coexist with Messiness, 00:13:56 - Conclusion, 00:16:17 - Introducing a New Course for Parents, 00:17:25 - The Importance of Advocacy, 00:21:05 - Speaking Up for Change, 00:24:35 - The Pressure of Being a Parent Advocate, 00:27:08 - Differentiating Between Healthy and Unhealthy Advocacy, 00:30:45 - The Importance of Support and Self-Care, 00:31:38 - Utilizing Social Media for Connection, 00:32:03 - Prioritizing Mental Health, 00:33:08 - Dreams and Future Aspirations, 00:33:28 - Resources and Support Whether you are a parent or professional, we want you to join our community. Sign up for our newsletter here. Parents, download our free parent starter kit. When you download our starter kit, you'll learn how to: Give medicine to your child without it becoming a wrestling match Prepare your child (and yourself) for a shot so they can feel less anxious Create and use a coping plan for any medical appointment or procedure The first sign of sniffles, or worse, shouldn't send you into a tailspin. Feel confident in your role as a parent and advocate, no matter what medical situation you're facing. Child life specialists, get affordable PDUs on-demand here. Shop for your CLOC gear here. Feel empowered with Child Life On Call's Mastering Immunizations: Expert Tips to Prepare, support and respond like a Child Life Specialist  Course for Parents, Child Life Specialists and Clinicians!

In today´s episode we speak to British pro wheelchair tennis player Alfie Hewett.Alfie is 25 and already a 25-time Grand Slam Champion, winning 7 singles and 18 doubles titles with fellow Brit Gordon Reid. Born with the congenital heart defect Tetralogy of Fallot, Alfie was diagnosed with Perthes Disease at the age of six. He chats to CTC Host Dan Kiernan about his journey from being told he was wheelchair-bound at just 7-years-old , to becoming the youngest men´s singles world number 1, aged 20.Alfie´s story is one of perseverance, resilience and the power of family. Enjoy listening to this inspirational chat with an inspirational young man.Read full show-notes here.

Welcome to the ChildLife On Call podcast, where I, Katie Taylor, sit down with Kayleigh Koehler, a certified child life specialist, to discuss her journey as a medical mom and a child life specialist in a cardiac ICU. Join us as we dive into Kayleigh's personal story, from her gut intuition during pregnancy to her son's diagnosis, and the emotional challenges she faced along the way. We explore the importance of trusting gut intuition, the complexities of navigating the healthcare system as a parent, and the impact of personal experiences on professional practice. Whether you're a child life specialist, nurse, doctor, or any healthcare professional working with pediatric patients, this episode will provide you with valuable insights and a deeper understanding of the emotional journey of becoming a medical mom. Get ready to be inspired and gain a new perspective on supporting families through challenging medical experiences. In this episode, you will be able to: Delve into the empathetic journey of a child life specialist turned medical mom and the untold lessons it brings. Learn the underrated power of trusting gut instincts during pregnancy for improved health decisions. Acknowledge the challenges and rewards of juggling roles as a child life specialist and a parent to a child with a cardiac defect. Dissect the fight for children's rights in healthcare and the persistence it requires to make a change. Unpack the emotional turmoil in parenting and its impact on one's personal identity in exigent situations. My special guest is Kayleigh Koehler Our guest today, Kayleigh Koehler, paints a picture of resilience and determination in her unique personal and professional journey. From her early days being a carefree high school lover with her husband, Mitch, to becoming a mother to their vibrant son, Hudson - she personifies strength. Alongside the joys and challenges of parenting, Kayleigh also stars as a certified child life specialist working passionately in a cardiac ICU. When they discovered Hudson's heart condition, her professional and personal life merged in an unprecedented way. This transformative experience endowed Kayleigh with a profound understanding of patient care, advocacy, and resilience. Her story is a testament to her unbreakable spirit. The key moments in this episode are: 00:00:00 - Introduction, 00:03:59 - Colliding Worlds, 00:06:20 - Identity Shift, 00:08:55 - Gut Intuition, 00:12:11 - Anatomy Scan, 00:14:57 - The Moment of Knowing, 00:18:08 - Feeling Angry and Resentful, 00:19:36 - Coming to Terms with the Diagnosis, 00:21:42 - Living in the Messiness, 00:28:22 - Giving Permission for Imperfection, Whether you are a parent or professional, we want you to join our community. Sign up for our newsletter here. Parents, download our free parent starter kit. When you download our starter kit, you'll learn how to: Give medicine to your child without it becoming a wrestling match Prepare your child (and yourself) for a shot so they can feel less anxious Create and use a coping plan for any medical appointment or procedure The first sign of sniffles, or worse, shouldn't send you into a tailspin. Feel confident in your role as a parent and advocate, no matter what medical situation you're facing. Child life specialists, get affordable PDUs on-demand here. Shop for your CLOC gear here. Feel empowered with Child Life On Call's Mastering Immunizations: Expert Tips to Prepare, support and respond like a Child Life Specialist  Course for Parents, Child Life Specialists and Clinicians!

In this episode, we review the high-yield topic of Tetralogy of Fallot⁠ ⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Commentary by Dr. Valentin Fuster

On today's episode of the podcast, Katie interviews Rylee Neal who decided to become a Child Life Specialist from her past experiences being hospitalized with a heart condition called tetralogy of fallot.  An experience with a Child Life Specialist during one of her hospital stays lead her to pursue the field of Child Life. Katie and Rylee have some great conversation about scars, our feelings and how as Child Life Specialists or parents we constantly are looking to better ourselves. You will leave this episode with a heartfelt perspective from Rylee as she shares pieces of her journey as patient and clinician. [3:23] Rylee introduces herself [4:41] First memory of her diagnosis [5:45] Realizing her diagnosis was serious at age 13 [6:45] Aversion to medical care [8:01] Reading consent forms at a young age [10:00] How preparing ahead would have helped Rylee [12:07] Wanting to know more the Child Life Specialist who helped her [14:30] How she fell in love with the Child Life field [16:50] How her parents get sappy hearing about her work [19:00] Rylee shares about her scars [21:18] Kids say what they feel [22:26] Being able to relate with the children [24:07] Not letting worse case scenarios creep into personal thoughts [26:33] Feeling your feelings and decompressing [28:42] Continual betterment [30:35] Creating a virtual diversion wall [33:01] Getting patients out of bed Connect with Rylee by sending her a message here! Whether you are a parent or professional, we want you to join our community. Sign up for our newsletter here. Parents, download our free parent starter kit. When you download our starter kit, you'll learn how to: Give medicine to your child without it becoming a wrestling match Prepare your child (and yourself) for a shot so they can feel less anxious Create and use a coping plan for any medical appointment or procedure The first sign of sniffles, or worse, shouldn't send you into a tailspin. Feel confident in your role as a parent and advocate, no matter what medical situation you're facing. Child life specialists, get affordable PDUs on-demand here. Shop for your CLOC gear here.

Dr. Andy Wicks is a physical therapist, educator, podcaster, and connoisseur of fine nugae paternae. He is currently on faculty at Grand Valley State University and the host of the APTA Michigan's Waves podcast.My goal is three-fold: to banish polos and khakis from the PT clinic; to have something, anything, named after me before I retire; and to get people to stop using the tired adage of "PT means Pain and Torture." Episode TakeawaysWhat is Trauma?Who has trauma?What is trauma-informed care?How to change your mindset to provide appropriate care to your patients and to become a better human“If nothing else, just be kind to them.”Connect with AndyTwitterInstagramWebsiteResourceshttps://www.apta.org/article/2021/05/11/mind-body-traumaHarris,  M.,  &  Fallot,  R.  (Eds).  (2001).  Using  Trauma  Theory  to  Design  Service  Systems: New  Directions  for  Mental  Health  Services.   Jennings,  A.  (2004).  Models  for  Developing  Trauma-Informed  Behavioral  Health  Systems and  Trauma-Specific  Services.   van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.V. Felitti, et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adult: The Adverse Childhood Experience (ACE) Study.” American Journal of Preventive Medicine 14, no. 4 (1998); 245-58.Committee on the Assessment of Ongoing Effects in the Treatment of Posttraumatic Stress Disorder; Institute of Medicine. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment. Washington (DC): National Academies Press (US); 2012 Jul 13. 2, History, Diagnostic Criteria, and Epidemiology. Available from: https://www.ncbi.nlm.nih.gov/books/NBK201095/“SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach.” SAMHSA's Trauma and Justice Strategic Initiative, US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Policy, Planning, and Innovation. July 2014.https://drjacobham.com/videos/2017/5/24/understanding-trauma-learning-brain-vs-survival-brain

Commentary by Dr. Valentin Fuster

Micky Foos has been beating the odds her entire life. At age 25, she has already endured ten different heart surgeries. We hear what it's like living with a chronic illness — especially one you can't see. 

Commentary by Dr. Valentin Fuster

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This week, please join author Mikael Dellborg and Associate Editor Gerald Greil as they discuss the article "Adults With Congenital Heart Disease: Trends in Event-Free Survival Past Middle Age." Dr. Greg Hundley: Welcome listeners to this March 21st issue. And I am one of your co-hosts, Dr. Greg Hundley, Associate Editor Director of the Pauley Heart Center at VSU Health in Richmond, Virginia. Dr. Peder Myhre: And I am the other co-host, Dr. Peder Myhre, from Akershus University Hospital and University of Oslo in Norway. Dr. Greg Hundley: Well, Peder, we have a very interesting feature discussion this week. It focuses on adults with congenital heart disease. And as you are aware, over the last 25 to 30 years the survival rate of individuals with congenital heart disease has really improved. And this group, led by Professor Dellborg, will discuss with us more on results from a Swedish registry examining patients after the age of 18 with adult congenital heart disease. But before we get to that, how about we grab a cup of coffee and jump into some of the other articles in the issue? Would you like to go first? Dr. Peder Myhre: I would love it to, Greg, thank you. So Greg, the first paper is about aortic stenosis and the genome-wide association study looking at aortic stenosis in patients from the Million Veteran Program. And as you know, Greg, calcific aortic stenosis is the most common valve of heart disease in older adults and has no effective preventive therapies. Genome-wide Association studies, GWAS, can identify genes influencing disease and may help prioritize therapeutic targets for aortic stenosis. And in this study, which comes to us from co-corresponding authors, O'Donnell from VA Boston Health System and Dr. Natarajan from Massachusetts General Hospital, both in Boston Massachusetts, performed genetic analysis in 14,451 cases with aortic stenosis and almost 400,000 controls in the Multiancestry Million Veteran Program. And replication for these results was performed in five other cohorts. Dr. Greg Hundley: Wow, Peder, so a very large gene-wide association study. So what did they find? Dr. Peder Myhre: So Greg, the authors found 23 lead variants representing 17 unique genomic regions. And of the 23 lead variants, 14 were significant in replication, representing 11 unique genomic regions. And five replicated genomic regions were previously known risk loci for aortic stenosis, while six were novel. And of the 14 replicated lead variants, only two of these were also significant in atherosclerotic cardiovascular disease GWAS. And in Mendelian randomization, lipoprotein a and LDL cholesterol were both associated with aortic stenosis, but the association between LDL cholesterol and aortic stenosis was attenuated when adjusting for LP a. So Greg, in conclusion this study identified six novel genomic regions for aortic stenosis, and secondary analysis highlighted roles of lipid metabolism, inflammation, cellular senescence and adiposity in the pathobiology of or stenosis, and also clarified the shared and differential genetic architectures of aortic stenosis with atherosclerotic cardiovascular disease. Dr. Greg Hundley: Wow, Peder, what a beautiful description. Very comprehensive study. Well, my study comes to us from the world of preclinical science and, Peder, it involves embryonic heart development. So Peder, placental and embryonic heart development occur in parallel, and these organs have been proposed to exert reciprocal regulation during gestation. Poor presentation has been associated with congenital heart disease, an important cause of infant mortality. However, the mechanisms by which altered placental development can lead to congenital heart disease remain really unresolved. So in this study, led by Dr. Suchita Nadkarni from Queen Mary University of London and colleagues, the team used an in vivo neutrophil-driven placental inflammation model via antibody depletion of maternal circulating neutrophils at key stages during time-mated murine pregnancy, embryonic day 4.5, 7.5, and then the animals were culled at embryonic day 14.5 to assess placental and embryonic heart development. Dr. Peder Myhre: Oh, wow. Very interesting design. And, Greg, I'm curious to know what did they find? Dr. Greg Hundley: Right, Peder. So they found that neutrophil-driven placental inflammation leads to inadequate placental development and loss of barrier function. And consequently, placental inflammatory monocytes of maternal origin become capable of then migrating to the embryonic heart and alter the normal composition of resonant cardiac macrophages and cardiac tissue structure. This cardiac impairment continues into postnatal life, hindering normal tissue architecture and function. Also, they found that tempering placental inflammation can prevent this fetal cardiac defect and is sufficient to promote normal cardiac function in postnatal life. So in conclusion, Peder, these observations provide a mechanistic paradigm whereby neutrophil-driven inflammation in pregnancy can preclude normal embryonic heart development as a direct consequence of poor placental development. And this in turn certainly has major implications on cardiac function into the adult life of these animals. And this really warrants further study in larger animal models and perhaps human subjects. Dr. Peder Myhre: Very interesting, Greg. Thank you for summarizing that. And we also have some other articles in the mail bag today. Do you mind going first? Dr. Greg Hundley: Sure, Peder. So what I've got is a very nice exchange of letters from Doctors Deng, Schmidt, and Tabák regarding a prior paper entitled, "Risk of Macrovascular and Microvascular Disease in Diabetes Diagnosed Using Oral Glucose Tolerance Test With and Without Confirmation by Hemoglobin A1c: The Whitehall II Cohort Study." Dr. Peder Myhre: And Greg, we also have a Research Letter from Dr. Niklas Bergh entitled, "Risk of Heart Failure in Congenital Heart Disease: A Nationwide Register-based Cohort Study." And then there is an article summarizing Highlights from the Circulation Family written by Molly Robbins [and Dr. Parag Joshi] where she summarizes, first the characteristics of pleomorphic ventricular tachycardia described in Circulation: A and E, then racial inequities in assessing advanced heart failure therapies reported in Circulation: Heart Failure. Outpatient clinic-based vascular procedure outcomes are compared with those done in a hospital setting in Circulation: Cardiovascular Quality and Outcomes. Then there's a paper about immune cell imaging using nuclear methods from Circulation: Cardiovascular Imaging. And finally, temporal trends in left main PCI from the UK described in Circulation: Cardiovascular Interventions. And then Greg, we have one final very interesting paper, which is a joint opinion from the European Society of Cardiology, American Heart Association, and American College of Cardiology, in addition to the World Heart Federation and it's entitled, "Randomized Trials Fit for the 21st Century." And I'm going to read you a quote from the beginning of this article, Greg. It is, "Randomized controlled trials are the cornerstones for reliably validating therapeutic strategies. However, during the past 25 years, the rules and regulations governing randomized trials and their interpretation have become increasingly burdensome, and the cost and complexity of trials has become prohibitive. The present model is unsustainable, and the development of potentially effective treatments is often stopped prematurely on financial grounds, while existing drug treatments or non-drug interventions, such as screening strategies or management tools, may not be assessed reliably." What do you think about that? Dr. Greg Hundley: Oh, wow, Peder. Very provocative. So it'd be interesting for our listeners to take a gander at that particular paper. Well, what a great issue and how about we get on to that feature discussion? Dr. Peder Myhre: Let's go. Dr. Mercedes Carnethon: Thank you for joining us on this episode of Circulation on the Run Podcast. My name is Mercedes Carnethon. I'm an Associate Editor at the journal Circulation and Professor and Vice Chair of Preventive Medicine at the Northwestern University, Feinberg School of Medicine. I'm thrilled today to be able to host this podcast alongside my colleague at Circulation, Gerald Greil, and with our special guest today, Dr. Mikael Dellborg from the Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital. Welcome this morning, Mikael, to our podcast. We're really excited that you shared this important work to us about adults with congenital heart disease, particularly given the burden of the condition and how many more individuals are living to adulthood with congenital heart disease. So I'd love to really just open with asking you to tell us a little bit about your study and what you found. Professor Mikael Dellborg: Well, first thank you for inviting me to talk about these issues. I very much appreciate the opportunity and I appreciate having the paper published by Circulation, which of course is a great honor. Our study included 37,278 patients with congenital heart disease born between 1950 and 1999, and alive at 18 years of age. Follow-up was started in 1968 and at 18 years of age, and went on until the end of 2017 or death. So the mean follow-up was 19.2 years. And for every patient with CHD, we had 10 randomly chosen controls from the general population registry, matched for year of birth and sex and, of course, without CHD, so 37,000 patients and 412,000 controls. During the follow-up, 1,937 patients with CHD died or 5.2%, as compared to 1.6% of controls, a mortality three to four times higher among patients with CHD. Still, at 50 years of follow-up, i.e. at age 68, more than 75% of all patients with CHD were still alive, and I think that is the positive news of this paper. Mortality wise, this could be expected highest among those with the most severe defects, the conotruncal defects, i.e., the transposition of the great arteries, the tetrology patients, double out ventricles and so on. And there the hazard ratio for death was 10.1 times that of controls. But also, for non-com complex conditions such as that we consider very malignant such as atrial septal defect, the ASD, there was a slight but significant increase in risk with the hazard ratio 1.4 times that of controls. We also looked at how the increased risk of mortality changed over time. And when comparing birth year by birth year, we could see that things started to really change in the mid 1970s, where the hazard ratio began to decline. So if you were born around 1950, '60 or '70, once you reached 18 years of age, your risk of dying had not really changed over the years. But once you were born '75, '80, '85 and on, your risk past 18 years of age declined and was lower as compared to those born before that, although still higher than the risk for controls. This decline was dramatic and significant for all patients with complex CHD. For patients with less complex conditions, it was smaller and not statistically significant. Although it trended in the same direction. The excess risk also declined with age. Typically, it declined from 20 to 100 times the risk of controls in the first years after turning 18, to seven to eight times after 30 years of follow-up. In other words, when you were in your fifties the difference between CHD and controls was much smaller, although still existed. Dr. Mercedes Carnethon: Oh, wow. So that really seems to shift over time and that gap got a little smaller with aging. What about these findings surprised you? Professor Mikael Dellborg: What surprised us was to see that there is a... For the CHD population as a group, we can see that the changes in operative techniques, the possibility to operate on much earlier time that became used in the '70s, mid-late '70s, early '80s, that has really changed life for so many patients. When we started the Adult Congenital Heart Unit at our hospital in 1996, there was a belief that either you were cured or you are a sad person to follow. You will only have trouble and you will die in your thirties or you'll get a transplant. That was the three conditions that we could see coming, but that's not true. I mean, again, once you turn 18, once you come to the adult cardiologist, you will most likely be 68, 70 years, 75 years of age. Dr. Mercedes Carnethon: Now, that is fantastic. I want to turn to you, Gerald, because you were obviously the handling editor of this piece and saw a lot of strengths. Can you tell us a little bit about why you wanted this piece for Circulation? Dr. Gerald Greil: Mikael, thank you so much for submitting to Circulation. The numbers of the patients you had for this study, including the controls, is impressive and we all think that it's one of the largest patients areas we looked at. Mikael, obviously this is all exceptional, but can you line out to us what are the strengths and limitations of your study? And how you think the results of your investigations are going to impact patient care in the future? Professor Mikael Dellborg: Thank you, Gerald. I think that the strengths are obviously, like you pointed out, there's 37,000 patients. There is 50 years of patients, there's 20 years of follow-up on average and that's clearly a strength. Also, that we have virtually no patients lost to follow-up. We have many controls and the registers we used are public, mandatory and have been fully operational for CHD care and CHD hospitals and including the death registry since 1968, which is when we really started the follow-up. So it's a broad and complete spectrum of patients with congenital heart disease, excluding none, and I think it's fair to say that our data reflect what you can expect from a population of eight to 10 million people, which is the Swedish population during these years. The weaknesses are clearly, as with any data of this sort, i.e. Large public registers, you will always lack the granularity. The clinical data, the blood pressure, weight, ECG, the echocardiogram, the cath data, et cetera. And also the lifestyle information, smoking, exercise, diet. It's also important to realize that Sweden was, particularly at this time before 2000, it was a fairly homogenous society in terms of ethnicity. One feature, which I'm not sure if it's a strength or a limitation, is that we group patients with CHD into one or sometimes two complex non-complex or at the most six groups. And since CHD consists of about 400 different diagnosis and entities, we paint a broader general picture. But if you want to know more about specific conditions such as say, hypoplastic left heart syndrome, you need to look for other and more specific papers. We're currently working on several more analysis based on this material for more narrow patient groups where we can take into consideration also things such as type of surgery or intervention, timing of intervention, medication and so on. We have a lot of data on this, but it was simply not possible to put everything into one paper. Dr. Gerald Greil: Yeah, I mean speaking about getting more specific, we were fortunate enough having one of your colleagues publishing about patients with congenital heart disease. They looked at the time period from 1930 to 2017 using the same database. And they focused specifically on heart failure in this group of patient describing it in a research letter, actually in the same volume your paper's published. How does this study relate to your work? And how do you think are their results impacting the care of these patients? Professor Mikael Dellborg: I think they relate to our paper in a nice way, because one of the things we also could show was that the morbidities of patients with adult congenital heart disease are significant. The risk of heart failure, atrial fibrillation, stroke, nonfatal MI, diabetes, and so on, is much larger in that group. And the cumulative risk of having any such adverse event is about 75% at age 68 after 50 years of follow-up. The letter by Bergh et al. focuses on, as you say, heart failure. And during a follow-up or 25 years, there was an overall, like you said, 8.7 times higher risk for patients with CHD to develop heart failure. The most, I think, important factor from this is not only that the risk is increased, it has been described before and it's obvious and quite intuitive, but there was a dramatic difference in the age of onset of heart failure, which was about 40 years in patients with CHD compared to 66 years of age for the controls who developed heart failure. And again, it was obvious that it was highest among the most complex CHD. The risk was 20 to 40 times higher. But also among non-complex CHD, the atrial receptor defects, the ventricular receptor defects, the risk was significantly higher, five to 10 times. One thing we saw there was that... That could be seen there was that the risk was particularly high in the youngest age group, the youngest patients, as compared to controls. And not so much, although still significant, it increased also in the higher age groups. We could also see that the risk of heart failure seemed to increase. It was higher among those born after 1970 as compared to those before 1930 to '69. And I have two explanations for that. One is that a lot of patients born in 1930 and so on were not captured by our registers, because they have died before that. But it also reflects that the most complex patients, the most likely to develop heart failure, they survive these days. They did not survive in their thirties, forties, fifties, sixties and early seventies and so on, so that's why. So things haven't been worse, but we do have a much sicker group of patients with congenital heart disease that are alive today. Dr. Mercedes Carnethon: That's very hopeful. When I hear that and I think about the impact that treatment and therapy has had on these improvements in survival, it's really exciting to hear. We were really enthusiastic because our colleagues, Dr. Rosenthal and Qureshi from London, submitted an editorial to discuss your piece as well as Dr. Bergh's piece. And they're discussing in it some of the complexity in providing this care and what it has taken to get us to this point where survival is better. Can you tell us a little bit based on the findings from your study and what you know of the field, how do you envision the future care of adults with congenital heart disease? Professor Mikael Dellborg: Yes, Mercedes, thank you. I think this is a very nice editorial. It summarizes very well where we are today, and I think they see the future very much along the same lines as I do and as we do. But the large number of patients with CHD living into their sixties, seventies, and eighties, they will not only live longer, they will also have more comorbidities. And I think that's what our data shown and what the editorial is discussing. This will require some changes to be made to the care of adults with congenital heart disease. We will clearly, as pointed out, need large, highly specialized, very competent ACHD centers located close to, or at least in close corporation with pediatric centers. There's no doubt about that building such centers need to continue and you need roughly one large complete such center with outpatient clinic, surgical interventions, structured transfer, specialized physicians, physiotherapists, nurses, education research, et cetera. You need about one such center per 5 million people. But over time the need of ACHD patients will also change and this will have impact also on the large specialized centers. For instance, if you have an adult patient with say, tetrology of Fallot, fairly common disease in this setting, well operated on a early childhood, well-functioning, modest right ventricular dysfunction, modest pulmonary valve insufficiency, and it's followed by a large centralized ACHD unit. You will keep track of the right ventricle size waiting for the proper time to intervene and replace the right ventricular outflow tract by surgery or catheter. This waiting is probably 10, 15, maybe 20 years before anything needs to be done. But during that time the patient develops hypertension, type 2 diabetes, AFib, and the chances of this happening at some time are fairly substantial. So either the ACHD unit needs to take care of also these comorbidities and that's not always the case today. And I think it's unrealistic to expect primary care GPs to do this. I mean, would you as primary... As a GP start the SGLT2 treatment? Is that okay for a patient with Fallot? Or the indications for anticoagulation the same as... And that's not easy patients to handle. So on the other hand, if the ACHD unit will take care also of all these comorbidities, they will, I think, have too much to do and I think they will find it difficult to completely cope with this. So as in increasing role for cardiologists who are knowledgeable on ACHD care, but who perhaps spend most of the time caring for the usual patients with heart failure and AFib, post-MI, type 2 diabetes and who are confident in using novel anti-diabetic medications, but at the same time they know about Fallot. They know enough to understand the do's and don'ts, and they can interact on a regular basis with the local ACHD units. So patients will see their general cardiologist twice a year perhaps, and the ACHD center every two years, something like that. I think there's a great need for that. Dr. Mercedes Carnethon: I really appreciate having your insights on that. Do you have anything, Gerald, that you'd like to follow up with? I think the feedback that you've shared with us, Mikael, about where you see the treatment field going for adults has been very comprehensive and it's fantastic to be able to have these conversations with you, because obviously these discussions go beyond what you can share in the original research article, which is why we really enjoy this opportunity with the podcast. So Gerald, I'd really like to turn it to you for a final wrap up, given your expertise in this area. Dr. Gerald Greil: Yeah, I mean, Mikael, thank you so much to you and your colleagues just giving us this great overview, and even more importantly giving us the perspective how this field is going. I think we are getting more and more aware that there are more patients with and adults with congenital heart disease we need to take care of. We need to find new strategies, as you correctly pointed out, to cope with the enormous burden of disease and providing these patients good quality of life and excellent outcome after sometimes a very difficult start in their lives. And we need to be aware of the pediatricians and adult cardiologists and other subspecialties are forming a team and working together and not working as separate entities. So thank you so much for giving us this perspective. And I would hand over to Mercedes to wrap up the whole discussion please. Dr. Mercedes Carnethon: Well, yes, I just really want to thank our listeners for tuning in with us today. It was such a delight to have you here with us, Dr. Dellborg, and thank you as well for sharing your insights. Thank you for joining us again for this episode of Circulation on the Run Podcast. It's meant to whet your appetite and turn you towards the journal so that you can read more. So thank you very much. Dr. Greg Hundley: This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own, and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

#9 In this episode, Kathryn and Boots share stories of how they manage other people's reactions to their heart journeys. Kathryn also shares her journey with Ehlers-danlos syndrome, POTS, Tetralogy of Fallot and Fibryomyalgia. If you have been wondering how to talk to someone dealing with a life changing illness or if you are afraid to share your story, this episode is for you.Website: The Heart Chamber (theheartchamberpodcast.com)Transcript: Joyful Beat | The Heart Chamber (theheartchamberpodcast.com)The Heart Chamber (@theheartchamberpodcast)Thanks to Michael Moeri for being my right hand man. Michael Moeri - Audio Editor, Podcast Producer and Marketing Director0:00 intro 2:00 Welcome Kathryn! How Boots found Kathryn via social media 3:00 About Kathryn and her Tetralogy of Fallot and craniosynotosis journey 4:20 She thought her medical journey would be over early in life but she continued to struggle with touch and cyclic vomiting syndrome 5:00 Diagnosed with fibromyalgia and arthritis 5:40 and then a friend mentioned Ehlers-Danlos syndrome to Kathryn which she took to her doctor. The doctor immediately agreed and diagnosed her on the spot at age 22. It all made sense. She was struggling with POTS as well as hypermobility. Covid 6:40 Kathryn contracted Covid which negatively affected her medication, Midodrine, from treating her POTS 8:50 Ehlers-Danlos syndrome diagnosis 10:30 Fibromyalgia diagnosis 12:00 Kathryn's biggest shift with the medical community happened this past year after having both hips reconstructed due to collagen malfunction. 14:15 A heart MRI is ordered at UCLA and her life takes a turn 15:50 She learns she has pectus excavatum at age 25 which impacted her right ventricle 20:00 surgery is not possible to correct the pectus excavatum 22:00 Her struggle with endometriosis 24:00 The opportunity to practice radical acceptance over and over again 26:00 finding her specialist at UCLA 28:00 “but you look so young and healthy” 30:00 advocating for mental health therapy 31:00 confronting our mortality 32:00 What do you need to hear instead? 35:00 “I don't know what to say but I am here with you.” 37:00 Boots shares her experience with meeting others where they are in their own journeys 39:00 Kathryn shares her struggle with working with others older than her. 42:00 “I'm no longer threatening. Now I am an inspiration.” 43:00 “I can't control other people's perceptions of me.” 44:00 Why Kathryn “came out” about her medical journey 46:30 Her life as a horse rider and how her condition affects her riding. 48:00 The power of sharing our stories 49:00 Boots talks about the power of grace

February is the month we celebrate and bring awareness to all the beautiful babies out there with congenital heart defects. My baby, Meadow, was born with a congenital heart defect called Tetralogy of Fallot, and I felt called to talk about not only Meadow's story, but what it's been like as a heart mom and a Nurse Practitioner. In this episode, I'm sharing how I've navigated these two roles, where I've found synergy in both, and where I've had to separate being Meadow's mom and a Nurse Practitioner.   Get full show notes and more information here: http://www.stressfreenp.com/81

TSRA Podcast: Congenital - Tetralogy of Fallot (Michael Cain & Matthew Stone) by TSRA

1.12 Tetralogy of Fallot   Cardiovascular system review for the USMLE Step 1 exam.

The title is not the give away you think it is! The guys follow a BLS crew that responds to the call no one ever wants to respond to. (WARNING: This episode contains sensitive subject matter.)

"It's not a time to say I'm sorry, It's a time to acknowledge that, yes in fact you had something you did not plan for, a traumatic event. But also you did have a baby and to step into that joy and gratitude and not lose sight of those things.-Jamie Cline Jamie shares how her daughter Callie has persevered with tetralogy of fallot and later on a limb loss.She learned about her daughter's tetralogy of fallot just hours after having her 7 weeks premature. When Callie turned one, she shares how they came to the decision to do a lower leg amputation. Jamie shares Callie's journey of learning to walk with a prosthetic as well as the emotional journey she embarked on as a mother. [3:00] Jamie shares about their family and hobbies [4:50] Close monitoring during Jamie's pregnancy due to her pre-existing type 1 diabetes [5:37] Callie was born 7 weeks early via c-section [6:43] Learning of Callie's heart condition, Tetralogy of fallot [8:30] The grief and anger to follow the initial diagnosis [10:35] Feeling cheated of hopes and dreams she had [11:40] Sharing the emotional challenges of others saying they are sorry rather than celebration [13:12] Callie had to be transferred to a different hospital for the surgery [15:00] How their community rallied around supported their family [17:18] Callie went between the NICU and PICU for close to 3 months [20:40] The best Christmas gift- Callie got to come home for Christmas [21:40] Noticing Callie's limb difference shortly after birth [26:05] At 19 months old, Callie had her amputation surgery [27:30] Decision making process [30:08] How grief was a big part of Jamie's journey to healing [32:00] Jamie shares how she took care of her self during this difficult time [36:00] How Callie has changed their lives and the positive things she has gleaned from being her mother Connect with Jaime:  Instagram Website Whether you are a parent or professional, we want you to join our community. Sign up for our newsletter here. Parents, download our free parent starter kit. When you download our starter kit, you'll learn how to: Give medicine to your child without it becoming a wrestling match Prepare your child (and yourself) for a shot so they can feel less anxious Create and use a coping plan for any medical appointment or procedure The first sign of sniffles, or worse, shouldn't send you into a tailspin. Feel confident in your role as a parent and advocate, no matter what medical situation you're facing. Child life specialists, get affordable PDUs on-demand here. Shop for your CLOC gear here. Catch up with CLOC on Instagram, Facebook and meet Katie for a Q+A every Monday at 10 AM CST.

This week we delve again into the controversy regarding optimal newborn management of the symptomatic newborn with tetralogy of Fallot. Does palliation offer a cost savings versus primary repair for the symptomatic TOF patient? What impact does the advent of transcatheter palliative approaches have upon cost? We speak with the first author of this week's work, Assistant Professor of Pediatrics at University of Pennsylvania, Dr. Michael O'Byrne. doi: 10.1016/j.jacc.2021.12.036

CardioNerds (Daniel Ambinder), ACHD series co-chairs,  Dr. Josh Saef (ACHD fellow, University of Pennsylvania) Dr. Daniel Clark (ACHD fellow, Vanderbilt University), and ACHD FIT lead Dr. Jon Kochav (Columbia University) join Dr. Eric Krieger (Director of the Seattle Adult Congenital Heart Service and the ACHD Fellowship, University of Washington) to discuss multimodality imaging in congenital heart disease. Audio editing by CardioNerds Academy Intern, Dr. Maryam Barkhordarian. In this episode we discuss the strengths and weaknesses of the imaging modalities most commonly utilized in the diagnosis and surveillance of patients with ACHD.  Specifically, we discuss transthoracic and transesophageal echocardiography, cardiac MRI and cardiac CT. The principles learned are then applied to the evaluation of two patient cases – a patient status post tetralogy of Fallot repair with a transannular patch, and a patient presenting with right ventricular enlargement of undetermined etiology. 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 Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team 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 - Cardiovascular Multimodality Imaging in Congenital Heart Disease Transthoracic echocardiography (TTE) is the first line diagnostic test for the diagnosis and surveillance of congenital heart disease due to widespread availability, near absent contraindications, and ability to perform near comprehensive structural, functional, and hemodynamic assessments in patients for whom imaging windows allow visualization of anatomic areas of interest.Transesophageal echocardiography (TEE) use in ACHD patients is primarily focused on similar indications as in acquired cardiovascular disease patients: the assessment of endocarditis, valvular regurgitation/stenosis severity and mechanism, assessment of interatrial communications in the context of stroke, evaluation for left atrial appendage thrombus, and for intraprocedural guidance. When CT or MRI are unavailable or contraindicated, TEE can also be used when transthoracic imaging windows are poor, or when posterior structures (e.g. sinus venosus, atrial baffle) need to be better evaluated.Cardiac MRI (CMR) with MR angiography imaging is unencumbered by imaging planes or body habitus and can provide comprehensive high resolution structural and functional imaging of most cardiac and extracardiac structures. Additional key advantages over echocardiography are ability to reproducibly quantify chamber volumes, flow through a region of interest (helpful for quantifying regurgitation or shunt fraction), assess for focal fibrosis via late gadolinium enhancement imaging, and assess the right heart.Cardiac CT has superior spatial resolution in a 3D field of view which makes it useful for clarifying anatomic relationships between structures, visualizing small vessels such as coronary arteries or collateral vessels, and assessing patency of larger vessels (e.g branch pulmonary arteries) through metallic stents which may obscure MR imaging.

Tetralogy of Fallot (ToF) is a cyanotic congenital heart disease characterized by four key defects - pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect and overriding aorta. In this episode we'll talk through the physiological consequences of these defects, the complications of this condition, and then we'll go through it from top to bottom using the Straight A Nursing LATTE Method.   Are you starting nursing school soon? I'd love to see you in my free class. Register here.   Want to maximize your learning by reading this information, too? Check out the article and references here.       RATE, REVIEW AND FOLLOW! If this episode helped you, please take a moment to rate and review the show! This helps others find the podcast, which helps me help even more people :-) Click here, scroll to the bottom, then simply tap to rate with 5 stars and select, "write a review." I'd love to hear how the podcast has helped you! If you're not following yet, what are you waiting for? It takes just a quick moment and the episodes show up like magic every Thursday. And, when I release a bonus episode, those show up, too! You'll never miss a thing! In Apple Podcasts, just click on the three little dots in the upper right corner here. Know someone who would also love to study with me? Share the show or share specific episodes with your classmates...when we all work together, we all succeed! On Apple Podcasts, the SHARE link is in the same drop-down as the follow link. Spread the love! Thanks for studying with me! Nurse Mo