This week we enter the world of cardiac CT for congenital heart disease reviewing a recent report of a survey of congenital cardiologists who perform congenital heart CT scans. What have been the important trends seen in the past decade beyond expansion in the field in general? Why has the use of the CT scan grown at such a rapid clip? How much radiation does a present day CT scan represent for a patient? How are cardiology fellowships responding to the growing role of this modality in the field? How can we more properly assign accurate relative value units (RVU's) to the significant work effort involved in the performance and reporting of this novel modality. We speak with the first author of this week's work, Assistant Professor of Pediatrics at Weill Cornell, Dr. Rebecca Epstein.  

doi: 10.1016/j.jcct.2024.02.002. Epub 2024 Feb 15.

This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorization improves outcomes? What is the impact of this process on healthcare equity? These are amongst the questions reviewed this week with Dr. Brian Marcus who is a cardiologist and critical care fellow at Children's Wisconsin. 

• DOI: 10.1007/s00246-023-03255-1

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. 

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• DOI: 10.1002/ccd.31152

This week we review a recent large scale study on catecholaminergic polymorphic ventricular tachycardia (CPVT) in children which is based on two large international registries. How do outcomes differ between those symptomatic CPVT patients treated with or without an ICD? Who amongst symptomatic CPVT pediatric patients likely warrant an ICD? What sort of ICD might be optimal - subcutaneous or transvenous? Are there ways to program ICD's in CPVT patients that may reduce inappropriate shocks? Why should the ICD be rarely employed in the CPVT pediatric patient? These are amongst the questions reviewed this week on the podcast. We speak with the work's senior author, Dr. Shubhayan Sanatani who is the chief of pediatric cardiology at BC Children's Hospital in Vancouver, British Columbia, Canada. 

doi: 10.1016/j.hrthm.2024.04.006. Epub 2024 Apr 7.

This week we delve into the worlds of cardiac critical care and neurodevelopment when we review a recent report from the team at Children's Hospital of Philadelphia assessing an association between postoperative opioid exposure in infants following CHD surgery and neurodevelopmental outcomes. What might be the biological basis for an association between these 2 factors? How confident can we be that opioid exposure is the factor of importance when there are so many co-variates and variables? We speak with outcomes research expert and interventional cardiologist Dr. Michael O'Byrne about this important and thought-provoking recent work.

• DOI: 10.1016/j.jacc.2024.06.033

This week we listen in on a lecture by Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Christopher Janson, on the novel agent ivabradine. How does this agent work and in what circumstances can it be used in pediatric arrhythmia management? Is this safe to use for critical arrhythmias despite the fact that it is, at present, only available as an enteral agent? What is the proper dosing regimen with this medication? Dr. Janson answers these and many more questions about ivabradine in this lecture from the Pedirhythm XI conference in Rome, Italy on 9/20/24. 

This week we listen in on a wonderful review lecture on fetal arrhythmias by noted fetal cardiologist Professor Bettina Cuneo. In this lecture Dr. Cuneo reviews the basics of fetal tachycardias and bradycardias and how these arrhythmias are diagnosed and sometimes treated. This is a lecture that was delivered on 9/20/24 by Dr. Cuneo at the Pedirhythm XI meeting in Rome, Italy. Thanks go to Dr. Fabrizio Drago and the organizers of Pedirhythm for allowing us to listen in on this wonderful lecture by a world-wide authority. 

In this week's replay episode from 2 years ago, we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland. 
DOI: 10.1161/CIRCULATIONAHA.122.063281

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to allow for an engaging back and forth and learning experience. Has either speaker swayed you? Take a listen!

This week we speak with noted interventional cardiologist Dr. Shyam Sathanandam of LeBonheur Children's Hospital in Memphis, TN about novel, 'off-label' uses of the Amplatzer Piccolo device in children. In what sorts of lesions does Dr. Sathanandam believe this device offers distinct advantages for vascular closure? What is the feature of this device that allows it to work for small defect closure so effectively and safely? Are there any new changes coming to this device or the delivery system for PDA closure in the premature infant? These are amongst the questions and topics reviewed with our guest this week!

https://doi.org/10.1080/14796678.2024.2355057

This week’s episode reviews the notion of the underrepresented in medicine physician and the decision to pursue pediatric cardiology. How would improved representation amongst the congenital heart work force result in better outcomes for patients? How does a diverse workforce foster improved communication with patients? What are some practical steps that can be employed to improve representation in the field? We speak with third year cardiology fellow, Dr. Ogochuckwu M Ezeoke Cox, MD of C.S Mott Children’s Hospital at the University of Michigan about her recent essay on this vital topic. 

https://doi.org/10.1007/s00246-023-03144-7