In this replay episode from 2023, we return to the world of ACHD when we review a recent German research paper on the prevalence of PTSD symptoms amongst the ACHD patient group. How common is this type of symptom observed in the ACHD patient group? What contributes to the high prevalence (17-20.5%) described in this work? What are the benefits of 'embedding' a mental health care worker in the ACHD clinic/program? What strategies can be employed in pediatric cardiology to potentially mitigate PTSD symptoms in our future ACHD patients? These are amongst the many topics reviewed this week with the former Mount Sinai ACHD program clinical social worker, Ms. Meredith Kalbacker who also comments on this week's work. 

• DOI: 10.1016/j.amjcard.2023.06.087

For those interested, the book referenced by Ms. Kalbacker, Healing Hearts and Minds, can be purchased on Amazon:

https://www.amazon.com/Healing-Hearts-Minds-Holistic-Congenital/dp/0197657281

This week we review a recent work from the team at Seattle Children's Hospital about obstetrical sonography and referral of fetuses with 'suboptimal imaging' for fetal echocardiography. Should all 'suboptimal imaging' cases be referred? How can fetal cardiologists parse out who needs a fetal cardiac scan and when? How does the fetal team in Seattle practically serve a geographic region exceeding 2,000 miles and properly triage the referrals, particularly when 'suboptimal imaging' is the rationale for referral? Associate Professor of Pediatrics at The University of Washington, Dr. Bhawna Arya provides deep insights into her recent work on how to think about fetuses referred for 'suboptimal imaging' as a rationale for fetal consultation. 

https://doi.org/10.1007/s00246-024-03495-9

This week we review a recent PHTS study on long-term outcomes following heart transplantation. Why do patients develop coronary vasculopathy and how commonly is it seen at long term follow-up? What factors are associated with better or worse long term outcomes? How do 'adverse childhood experiences' result in worse outcomes for patients? Why do young transplant patients have better long-term outcomes and can this be leveraged to improve older patient outcomes? We speak with the first author of this week's work, Assistant Professor of Pediatrics at Ohio State and also from Nationwide Children's Hospital, Dr. Emily Hayes. 

• DOI: 10.1111/petr.70042

This week we review a recent study assessing the rate of hematochezia seen in children following neonatal congenital heart surgery, predominantly for aortic obstruction such as in HLHS. How often is this sign observed in this patient group and what percentage of these patients have actual necrotizing enterocolitis (NEC)? Are there any modifiable risk factors for NEC? How can these data help clinicians separate out those with more benign forms of hematochezia from those with NEC and how might this improve care for this patient group? These are amongst the questions reviewed this week with the work's first author, University of Michigan Assistant Professor of Pediatrics, Dr. Courtney Strohacker. 

• DOI: 10.1007/s00246-024-03485-x

For those interested in pediatric podcasts, please take a look at this list of the 'top 15' pediatric topic podcasts - we are #4 in pediatrics for 2025!

https://podcast.feedspot.com/pediatric_podcasts/

This week we review a recent report of 4 patients with serious complications related to either perforation or external compression from the distal tines of the Alterra prestent when used for transcatheter pulmonary valve replacement. We speak with Dr. R. Allen Ligon, interventional cardiologist at Children's Healthcare of Atlanta/Emory University about a recent multicenter report of rare complications seen with this prosthesis. How common are perforations seen with this device and how often are these clinically silent? What should be done for clinically silent prestent perforations? What sort of surveillance of all patients with this device is warranted after successful placement? These are amongst the questions posed to Dr. Ligon and discussed this week. 

DOI: 10.1016/j.jaccas.2024.102836

This week we review a report from the teams at University College, Dublin and Texas Children’s Hospital about a collaborative approach to education in which two centers across the globe participate in a shared fellow learning conference. In this conference which is aimed at fellow education, topics are chosen and discussed with facilitated learning from faculty at both sites. What can be gained for fellows on opposite sides of the Atlantic that cannot be learned from exposure to just their one site? How did this approach help fellows learn about how to deal with uncertainty in decision making? How did this trans-continental learning approach enhance patient and team communication? These are amongst the many questions posed to senior cardiologist and senior author of this week’s work, Professor Colin McMahon of University College, Dublin, Ireland.  

 ·         DOI: 10.1007/s00246-024-03469-x

This week we review a recent review paper on newest innovations and literature on pacing in pediatric patients and learn a bit about such diverse pediatric pacing topics as:

• Use of the Medtronic Micra device in an off-label manner for epicardial pacing in small infants
• Novel, less invasive approaches to placing epicardial leads in small children
• The role of leadless pacing in the pediatric or CHD patient
• Conduction system pacing in 2025 in the congenital patient

The above are amongst the potpourri of pacing topics that we review with noted congenital electrophysiologist, Dr. Charles Berul of Children's National Hospital in Washington, DC in a co-branded episode with the SADS Foundation. For more information on SADS, please go to their website: SADS.ORG.

• DOI: 10.1016/j.hrthm.2024.02.011

This week we step back in time 3 years ago to review an important cardiac MRI report on Fontan geometry and hemodynamics as measured by computational fluid dynamic analysis. How do factors like Fontan geometry or 'power loss' relate to quality of life for the Fontan young adult patient? How do these data inform imaging in the operating room during these palliations? We speak with the first author of this work, Associate Professor of Pediatrics at U. Penn, Dr. Laura Mercer-Rosa about this important and intriguing work. https://doi.org/10.1016/j.athoracsur.2022.01.017

This week we review a work from the department of cardiology and department of cardiac surgery at Boston Children's Hospital on late hypertension in patients following coarctation repair. Late hypertension has been associated previously with late transverse aortic arch Z score but can this be predicted by the immediate postoperative transverse aortic arch Z score also? What factors account for late hypertension in the coarctation patient? Should more patients have their aorta repaired from a sternotomy? Dr. Sanam Safi-Rasmussen, who is a PhD candidate at Copenhagen University, shares her insights from a work she performed while a research fellow at Boston Children's Hospital. 

• DOI: 10.1016/j.jtcvs.2024.08.049

This week we delve into the world of cardiovascular surgery and general cardiology when we review a recent report from UVA on the topic of feeding around the time of neonatal heart surgery. Does preoperative oral feeding improve the chances for 'tube-free' enteral feeds at discharge after heart surgery in small infants? Why might oral feedings improve the chances of discharge oral feedings? How should clinicians think about the known benefits of early CHD surgery for some CHD lesions with the benefits of oral feedings? Dr. Aseel Dabbagh of Children's Mercy Hospital in Kansas City shares her insights into these and other questions. 

• DOI: 10.1007/s00246-024-03750-z