Pediheart: Pediatric Cardiology Today

This week we review a recent report from the team at UTSW comparing early outcomes following biventricular repair vs. Fontan palliation for complex congenital heart disease with borderline ventricles or complex cardiac anatomy that may, in the past, have been immediate triggers for single ventricle palliation. Who is a good candidate for this sort of two ventricle approach and what anatomical types could be viewed as 'low lying fruit' for two ventricle palliation? How do early outcomes compare between these two very different approaches? Are we choosing Fontan approaches more commonly because of a perception of greater predictability? Is this true or accurate? Dr. Nicholas Andersen and Dr. Abhay Divekar of UTSW share their deep insights into this fascinating study and approach. 

https://doi.org/10.1016/j.athoracsur.2026.07.021

This week we delve into the world of fetal cardiology to review a recent work on mild aortic stenosis in fetal life. This is a rare finding and the outcomes of this varied. How commonly does this finding result in severe or critical aortic stenosis? Is there a risk for hypoplastic left heart syndrome? Are there findings that would auger and better or worse outcome for this observation? How should patient families be counseled when encountering this finding on a fetal scan? Associate Professor of Pediatrics at Stanford University, Dr. Michelle Kaplinski shares her deep insights this week. 

• DOI: 10.1016/j.echo.2025.08.031

This week we explore a recent PHIS database study assessing clinical outcomes for transcatheter balloon dilation of the aortic valve in the setting of aortic valve stenosis in early life. Why do critical AS patients fare less well than those with severe AS? Is this an issue of procedural failure or patient characteristics? Is there adequate equipoise for a study comparing surgery to balloon dilation? Is such a study even feasible given the present day levels of surgical experience with neonatal aortic valve surgery? These are amongst the questions posed to Associate Professor of Pediatrics at Vandarbilt University, Dr. George Nicholson who is the senior author of this week's work. 

• DOI: 10.1007/s00246-026-04196-1

This week we replay an episode from 2022 i which we reviewed a then recent report on the differences between pulse oximeter Sp02 and arterial Sa02. Are there patient specific factors that may result in inaccuracies of measurement? What single ventricular factors may also result in more significant inaccuracies and how should these data be used at the bedside when assessing a child who is cyanosed? We speak with Dr. Cara Pritchett, critical care fellow at Lurie Children's Hospital - Northwestern University about a recent work she co-authored on this important and practical topic.

DOI: https://doi.org/10.1016/j.jscai.2022.100394

This week we note and mourn the passing of pediatric cardiologist and thought leader Dr. Steven Lipshultz who passed on September 4, 2026. Dr. Lipshultz was one of the most significant cardiologists of the past half century and his contributions to the fields of pediatric cardiomyopathy, HIV cardiomyopathy and cardio-oncology were gigantic and meaningful. This week we turn back the clock and review a landmark work of Dr. Lipshultz from the Pediatric Cardiomyopathy Registry that was published in 2003 in the NEJM and we speak with 3 pediatric cardiomyopathy experts as well as friends and colleagues of Dr. Lipshultz - namely Dr. Neha Bansal of NYU, Dr. Daphne Hsu of the Albert Einstein College of Medicine and Dr. Joseph Rossano of the Children's Hospital of Philadelphia. Each shares their remembrances of this work and provide insights into the legacy of Dr. Lipshultz. 

doi: 10.1056/NEJMoa021715.

This week we review a recent work assessing the impact of birth day of the week on neurological outcomes amongst newborns undergoing CHD surgery. Why might certain days of the week be associated with higher degrees of white matter injury in the brain of newborns who have had congenital heart surgery? What are the potential mechanisms for this? What might be the unintended consequences of ‘controlling’ birth day of the week? We speak with the Associate Division Chief for Research within the Division of Cardiac Anesthesiology at Children's Hospital of Philadelphia and author of this week’s work, Dr. Jennifer Lynch.  

• DOI: 10.1016/j.xjon.2026.101700

This week we take a step back in time 4 years ago to recall when we spoke with noted cardiovascular surgeon Dr. John J. Lamberti who is Associate Professor of Surgery at Stanford University. Dr. Lamberti's career has spanned from the time of Dr. Robert Gross in the 1960's to present day with Dr. Frank Hanley and the team in Stanford. His career perfectly mirrors the transition from the 'old days' of cardiac surgery up until the present modern age and he shares his reminiscences of working with Dr. Robert Gross, Dr. Aldo Castaneda, Dr. Maurice Lev, Dr. Roberta Williams, Dr. Nadas and others. He also shares his thoughts on how to be a good mentor and what that takes from someone who has mentored many surgeons in the past 5 decades.

This week we review the use of right axillary artery access for aortic valvuloplasty in infants. Why would this approach potentially offer advantages versus the more traditional femoral or even carotid approach? What are the particular dangers of this approach? How should the interventionist pick the approach when planning an aortic valvuloplasty in an infant with valvar aortic stenosis? We speak with Dr. Jameel Al-Ata of King Faisal Specialist Hospital in Jeddah, Saudi Arabia this week. 

• DOI: 10.1007/s00246-025-03991-6

This week we speak with Ms. Sharon Welsh BSN, RN about a novel project she has embarked upon called CLEAR CHD PHYSIOLOGY (on Instagram chdphysiology.icu) which is a physiology-based site intended to teach bedside critical care nurses about CHD physiology. What signs or symptoms are important and what is their meaning? Why is nursing at the bedside of a sick postoperative newborn so much more difficult than it was at the start of Ms. Welsh's career? How does Ms. Welsh use AI to create a flexible learning tool for RN's and all interested in congenital heart physiology? Ms. Welsh provides the answers this week.

This week we speak with Dr. Ted O'Leary, Co-Director of Adult Congenital Heart Disease Electrophysiology at Boston Children's Hospital about a recent publication he authored on the use of pulsed field ablation (PFA) for the transcatheter ablation management of complex atrial arrhythmias in ACHD patients. How does PFA work and what are some of the potential advantages and disadvantages of this novel ablation energy technology? What are the advantages of a variable loop catheter in this setting? Is PFA going to supplant radiofrequency current for standard "SVT" ablations one day? These are amongst the questions reviewed with Dr. O'Leary this week. 

• DOI: 10.1161/CIRCEP.125.014619