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

doi: 10.1016/j.hrthm.2023.08.034

For those interested to learn more about the SADS Foundation, please visit their website:

SADS.ORG

In this week's episode we sit down with Professor Jane Newburger of Harvard University to learn a little bit about her life and times. Where did she grow up and who was her inspiration for becoming a doctor and cardiologist? Who were some of the mentors in her professional life? What was it like to work with Dr. Ami Rosenthal or Dr. Alexander Nadas? After such a rich and impactful career and life, what does Dr. Newburger count as her most satisfying and important accomplishments? These are amongst the many questions posed to Dr. Newburger during a live interview from the New England Congenital Cardiology Association (NECCA) in Rockport, Maine that took place on 10.21.23. Also joining the podcast to discuss the organization and its goals and accomplishments is its immediate past president, pediatric cardiac electrophysiologist, Dr. Michael Epstein.

For those interested to learn more about NECCA, please go to their website:

https://necca.wildapricot.org

In this replay episode of 2021, week we review a work on the use of bivalirudin on outcomes of pediatric VAD patients. We speak with Dr. Caroline Carly Heyrend of Primary Children's Hospital in Utah about a recent work she co-authored on time in therapeutic range for this agent in children with VAD's. How does bivalirudin work differently than heparin and what are the theoretical benefits or disadvantages of this agent in comparison with unfractionated heparin? Why are thrombotic complications still common amongst those with pediatric VAD's even when anticoagulation is maintained appropriately? What are the factors at work that make safe anticoagulation so difficult in this complex and fragile group of patients? Dr. Heyrend provides the pharmacist's perspective this week.

DOI: 10.1097/MAT.0000000000001261

This week we delve into cardiovascular surgery when we review a recent report from the Congenital Surgeons' Society on the outcomes of the hybrid approach of pulmonary artery bands for treatment of infants with critical left heart obstructive disease. What risk factors are associated with worse outcomes? Does this approach confer an advantage in comparison to the traditional 'stage I/Norwood' approach to this problem? Does the presence of multiple risk factors worsen outcomes and if so, to what degree? How does the heterogeneity of indications for this approach to obstructive left heart lesions stymie efforts to study this intervention?

• DOI: 10.1016/j.jacc.2023.07.020

Editorial Comment :

• DOI: 10.1016/j.jacc.2023.08.023

This week we discuss the role of the stress echo in the evaluation and follow-up of the patient with Kawasaki disease. What are the present recommendations on the role of this form of imaging in this patient group? What are its benefits and limitations? Can this form of testing provide actionable data beyond imaging such as CT angiography? What is the possible role of CMR in the management and follow-up of the KD patient? Dr. Kirstin Dummer of Rady Children's Hospital shares her deep insights into this endlessly fascinating topic.

• DOI: 10.1007/s00246-022-03037-1

The AHA Scientific Statement On KD:

• DOI: 10.1161/CIR.0000000000000484

This week we delve into the world of fetal cardiology when review a recent report from Nationwide Children's Hospital on the utility of fetal echocardiography in the setting of a negative obstetrical ultrasound and Down syndrome. Down syndrome is associated with congenital heart disease but can the obstetrical ultrasound effectively rule out 'critical' newborn heart disease, obviating the need for a fetal echo, particularly if a postnatal transthoracic scan is planned? Associate Professor of Pediatrics, Dr. Clifford Cua shares his thoughts on this provocative question and work.

doi: 10.1007/s00246-023-03183-0.Epub 2023 Jun 23.

This week we discuss an important 'general cardiology' question - namely, do all exertional chest pain patients need an echocardiogram. In this debate from the World Congress of Pediatric Cardiology and Cardiac Surgery, we hear 2 noted authorities in non-invasive imaging. First up is Dr. Carolyn Altman of Texas Children's Hospital taking the stance that it is indicated in the majority and following Dr. Altman is Dr. Kenan Stern of Mount Sinai Kravis Children's Hospital defending the role of discretion in these decisions and how 'one size may not fit all'. Both authorities provide deep insights into general cardiology and the nuances of evaluating a common cardiology complaint seen in general practice.

This week we delve into the world of interventional cardiology and specifically that of transcatheter valves when we review a recent report on the Harmony valve. How are these valves performing at one year in regards to valvular function? Is frame fracture an issue? What percentage required reintervention? How common was ventricular tachycardia seen? Should patients undergoing these implantations undergo pre-procedural EP studies? We review these questions and more with the first author of this work, noted authority on interventional cardiology, Dr. Matthew J. Gillespie, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

https://doi.org/10.1016/j.jcin.2023.03.002

This week we will hear 2 lectures from the World Congress on ablation in children from two world authorities. In the first, Professor Jeff Kim of Texas Children's Hospital speaks about unusual accessory pathway connections and offers some insights into how to ablate them. Following Dr. Kim, Professor John Papagiannis, chief of cardiology at the Onassis Center in Greece offers us some insights into why some AVNRT is challenging to ablate and how to approach these rare but difficult cases. Why is ablation not 100% effective in children for 'simple' things like accessory pathways or AVNRT? Drs. Kim and Papagiannis provide a few insights into why there is no such thing as 'just AVNRT' or 'just a pathway'.

This week we go back in time 2 years ago and we spend the entire episode speaking with Professor Peter Lang of Harvard University about his rich and long career in pediatric cardiology during one of the most exciting times of the field. Dr. Lang's story includes a virtual who's who of important cardiologists and cardiac surgeons for the past 50 years including Dr. Connie Hayes, Dr. Roberta Williams, Dr. Alexander Nadas, Dr. Richard Van Praagh, Dr. Aldo Castaneda, Dr. Bill Norwood and many, many more. This is a rare opportunity to hear about the development of the Norwood procedure from someone who was at the bedside of the first 30-50 ever performed as well as someone who helped develop the entire field of cardiac critical care. Prepare to be inspired by this towering figure this week.