Pediheart: Pediatric Cardiology Today

Latest Episodes:

Pediheart Podcast #292: Impact Of Prenatal Diagnosis On 22q11 Deletion Syndrome Outcomes Apr 12, 2024

Show notes

This week we delve into the world of fetal cardiology when we review a recent large, multicenter study on the impact of prental diagnosis of 22.q11 deletion syndrome. How did the prenatally diagnosed patients differ from those diagnosed postnatally in regards to degree of heart disease and postnatal morbidity and mortality? What is the role of cell-free DNA testing in the screening for patients with this deletion syndrome? How do outcomes differ for this syndrome between the US and other countries and why might this be? These are amongst the many questions reviewed with the first author of this week's work, Dr. Lindsay Freud who is the director of fetal cardiology at Toronto Sick Kid's Hospital and also Associate Professor of Pediatrics at the University of Toronto.
Also joining the podcast this week are the co-directors of this year's Mount Sinai Imaging Symposium entitled: Conversations in Care - The Single Ventricle. Dr. David Ezon, Dr. Jennifer Cohen, Dr. Kenan Stern and Mount Sinai Technical Director and Echo Lab Manager, Ms. Jen Lie Yau share their thoughts about the upcoming conference. This year's symposium will be taking place on May 4th, 2024 and the faculty are a who's who of important pediatric cardiac specialists from the worlds of imaging, interventional cardiology, sonography, surgery and more.
For those interested, you can get more information about this wonderful conference at the following web address:
https://mssm.cloud-cme.com/assets/MSSM/data/Single%20Ventricle%20Symposium24G.pdf
Today's article link:

DOI: 10.1016/j.ajog.2023.09.005

Pediheart Podcast #291: Reducing Cognitive Biases In Congenital Heart Decision Making Apr 05, 2024

Show notes

This week we delve into the world of cognitive bias when we review a recent review of this topic by the team at the University of Arkansas. What are some of the more important common cognitive biases that plague humans and are particularly deleterious for good decision making in 'case management/surgical' conference? What are some approaches to reducing the impact of these biases? How does the advent of ZOOM enhance or reduce bias for surgical conference decisions? We speak with noted authority on this topic, Dr. Joshua Daily who is Associate Professor of Pediatrics at The University of Arkansas in Little Rock for his deep insights into this topic.
https://doi.org/10.1007/s00246-024-03462-4
Other resources mentioned by Dr. Daily include:
- Thinking Fast and Slow by Daniel Kahneman
- Thinking In Bets by Annie Duke
- Predictably Irrational by Dan Ariely
- How To Decide by Annie Duke

Pediheart Podcast #290: Junctional Rhythm And The Fontan Patient Mar 29, 2024

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This week we review a recent survey study on the topic of junctional rhythm and sinus node dysfunction in the Fontan. How important is this finding in our Fontan patients? When should a patient with a Fontan undergo pacemaker insertion? Is the loss of AV synchrony the more important hemodynamic effect of junctional rhythm or is it chronotropic incompetence? Who should be considered for a possible endocardial, transvenous atrial pacemaker in the Fontan patient? These are amongst the questions posed to this week's guest, noted pediatric electrophysiologist and Professor of Pediatrics at OHSU, Dr. Seshadri Balaji.
https://doi.org/10.1007/s00246-023-03296-6

Pediheart Podcast #289: Transcatheter Edge-To-Edge AV Valve Repair In Congenital Heart Disease Mar 22, 2024

Show notes

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

DOI: 10.1002/ccd.30935

Pediheart Podcast Replay of #205: Cefazolin Dosing For Pediatric Cardiovascular Surgery Mar 15, 2024

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This week we review an episode from 2022 in the world of cardiac surgery and pediatric pharmacology when we review a work from Australia on levels of cefazolin during and after surgery. Is there an optimal dose regimen that will achieve proper MIC levels of drug? What should the goal of therapy be in regards to MIC levels? Are there novel means of dosing cefazolin? We speak with pediatric critical care pharmacy coordinator at Mount Sinai Kravis Children's Hospital, Dr. Jessica Frye for the pharmacist's perspective on some of these important questions.
https://doi.org/10.1016/j.athoracsur.2022.02.047

Pediheart Podcast #288: Can An AI ECG Model Predict LV Dysfunction And Remodeling In Children? Mar 08, 2024

Show notes

This week we review a recent work in the artificial intelligence/deep learning space when we review a recent report from the team at Boston Children's Hospital on a novel model trained to predict LV characteristics in children from the ECG. How does such a program identify LV dilation, dysfunction or hypertrophy from a test (the ECG) not designed to provide most of this information? How well did the model perform when it was tested in a different center entirely? Why is it important to understand how a model of this sort is making its determinations? How might such a model be used clinically? These are amongst the many questions reviewed with the work's first author, Dr. Joshua Mayourian MD, PhD who is a first year cardiology fellow at Boston Children's Hospital.
https://doi.org/10.1161/circulationaha.123.067750

Pediheart Podcast #287: Fontan Associated Liver Disease And Intrahepatic Transcriptomics Mar 01, 2024

Show notes

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

Pediheart Podcast #287: Fontan Associated Liver Disease And Intrahepatic Transcriptomics Mar 01, 2024

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Pediheart Podcast #286: All About Fetal Aortic Valvuloplasty Feb 23, 2024

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This week we review a recent report from the Boston fetal intervention group about fetal aortic valvuloplasty. What fetal/maternal factors are associated with improved outcomes or technical success of this procedure? What factors are associated with serious adverse events? Who is the 'optimal' candidate for this type of intervention? Why is larger LV size associated with improved technical success? What other types of fetal interventions are being attempted by the Boston team? Drs. Ryan Callahan and Wayne Tworetzky of The Children's Hospital of Philadelphia and Boston Children's Hospital, respectively, share their deep knowledge of fetal intervention this week.
https://doi.org/10.1016/j.jacadv.2024.100835

Pediheart Podcast #285: Rare RV Outflow Neointimal Obstruction With The Harmony TPV25 Feb 16, 2024

Show notes

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

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