Pediheart: Pediatric Cardiology Today

This week we review a recent work on fetal atrial septal interventions in the patient with hypoplastic left ventricle or double outlet right ventricle with mitral valve atresia/dysplasia and a restrictive or intact atrial septum. How often was this procedure technically feasible and successful? What are the criteria to be considered for such an intervention? Why does use of a laser improve the crossing of the atrial septum in this procedure? Should prenatal intervention be used instead of postnatal intervention in this setting? Associate Professor of Pediatrics at Baylor College of Medicine, Dr. Betul Yilmaz shares her insights into this fascinating topic.

https://doi.org/10.1161/CIRCINTERVENTIONS.125.015209

This week we replay an important episode from 2 years ago in which we delved into the world of antibiotic prophylaxis for dental procedures. What are the data to support its use in the congenital heart patient? Why has this been such a difficult topic to study? What do we now know about this topic and what still remains unanswered? Given the low prevalence but dire consequences of this disease, how can investigators consider studying this topic in the future? Is there adequate equipoise to proceed with a randomized controlled trial? We speak with Advanced Imaging Fellow at Boston Children's Hospital, Dr. Francesca Sperotto of Harvard University about her recent multicenter meta-analysis of 30 studies including over one million cases of endocarditis. DOI: 10.1001/jamacardio.2024.0873

This week we review a follow-up work from the team at USC and Children's LA led by Dr. Yaniv Bar-Cohen on a novel micropacemaker. How has the device changed and improved over the past 3-5 years since his last visit to Pediheart? What are some of the difficulties of designing a device that is both stable on the epicardium but not inclined to develop inflammation? Why did the team move from a screw in eletrode model to a different design? What applications could this device have both for infants but also adults? Dr. Bar-Cohen shares his deep knowledge of both electrophysiology and device design this week.

DOI: 10.1016/j.hrthm.2025.01.036

For those interested in stepping back in time to hear Dr. Bar-Cohen's first description of an earlier version of this novel pacemaker, here is the link from 2018:

https://podcasts.apple.com/us/podcast/pediheart-podcast-26-novel-means-of-epicardial/id1341472214?i=1000498801107

This week we review a recent large scale PHIS database study on pericardial effusion following congenital heart surgery. Which operations other than ASD are most highly associated with the development of an effusion? What might be some approaches both surgically and medically to reduce the chances of these developing or requiring intervention? What are the implications of a pericardial effusion after surgery? How many require readmission for this complication? Dr. Mario O'Connor, who is a congenital heart surgical research fellow at UT Austin, shares his insights into his recent publication. 

DOI: 10.1177/21501351251322876

This week we review a recent report on LV strain following the Ross operation. Can this sort of functional analysis help predict remodeling after aortic valve replacement? How can the type of Ross potentially affect heart function after the operation? Why might some parameters of LV strain improve but others not following surgery? Can preoperative strain measurements predict perioperative course? How does the addition of a Konno to a Ross change the outcomes of function? We speak with Chief of Cardiovascular Surgery at Primary Children's Hospital in Utah, Dr. S. Adil Husain and 3rd year integrated cardiac surgical resident Michal Schaffer of the University of Utah about these and other topics related to LV function following the Ross operation in children. 

·         DOI: 10.1007/s00246-025-04124-9