In this week's replay episode from 3 years ago, we delve into the world of pediatric heart transplantation and the impact that race or insurance status may have on outcomes. What are the factors that explain worse outcomes for black children waiting for a heart transplant? How is the PHTS Racial Disparity Taskforce working to reduce inequities in this field? What role does insurance status have on these outcomes? We speak with noted heart failure and transplantation expert, Dr. Neha Bansal who is Associate Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai about this recent PHTS multicenter study.

• DOI: 10.1016/j.healun.2022.12.002

This week we lost one of the true 'nice people' in pediatric cardiology - Dr. Richard J. Golinko who died at the age of 95. Dr. Golinko led the Mount Sinai Pediatric Cardiology Program for many years. He established many of the programs at Sinai that are now fundamental to the program and the care of children with congenital heart disease in the tri-state region. To honor Dr. Golinko's memory, we stretch back over 40 years to review a paper he co-wrote with Dr. Rubin Cooper on balloon angioplasty of aortic coarctation. We speak with Dr. Cooper, the work's first author about the work as well as his remembrances of the man, Dr. Golinko. Also joining us this week is Dr. Anthony Rossi of Nicklaus Children's Hospital and Dr. Rica Arnon of Mount Sinai to share their individual remembrances of this wonderful and warm leader. 

doi: 10.1161/01.cir.70.5.903

Professor Ziyad Hijazi of SIdra Medical joins Pediheart this week to celebrate Pediheart's 350th milestone and discuss his life and times from his early days in Jordan to the absolute heights of interventional cardiology. How did he meet Dr. Kurt Amplatz and become involved in the development of Amplatzer devices? Who were some of his mentors and what does he think about being a mentor? How did he come up with the idea for the PICS interventional course and how has he managed to do this consistently for over 20 years? What does he believe is important when thinking about a work/life balance? This is a rare opportunity to learn from someone who has seen and done it all in every corner of the world in pediatric cardiology. 

For those interested, this is the link to the PICS course in late August, 2025 in Chicago:

https://www.picsymposium.com/home.html

This week we go back in time to 2022 to re-enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide, sympathectomy or even ICD's for these patients? PhD candidate and physician Dr. Puck Peltenburg and CPVT world authority, Dr. Christian van der Werf (both of University of Amsterdam) share their deep insights this week. doi: 10.1161/CIRCULATIONAHA.121.056018. Epub 2021 Dec 7

This week we review a recent important longitudinal follow up study of patients who have undergone palliation for the treatment of HLHS at The Children's Hospital of Philadelphia over the past 35+ years. What are the 'transplant-free' survival numbers at 35 years follow up following newborn palliation? Are there differences between hybrid and traditional "Norwood/Stage I" palliation? What factors explain the group of HLHS patients who do are 'super-Fontan's'? What accounts for the marked variability in outcomes of these complex patients? Dr. J. William Gaynor shares his deep insights both from his large scale paper and long-term experience caring for patients with HLHS.

doi: 10.1016/j.jacc.2025.04.028

This week we review a recent surgical paper on the 'off-label' use of the Melody valve for replacement of the AV valve in small infants and children. How effective and safe was this procedure? What factors were associated with the need for reintervention and what sorts of reinterventions were most common? Why was catheter based reintervention rarely employed? What sort of anti-coagulation protocol seems best to protect these valves? Assistant Professor of Pediatrics at the University of Nebraska, Dr. Samantha Gilg shares the insights from her work this week. 

• DOI: 10.1007/s00246-024-03538-1

This week Dr. Nadine Choueiter of Mount Sinai hosts a special episode of Pediheart: Pediatric Cardiology Today in which we speak with emeritus Professor of Pediatrics at the University of Toronto, Dr. Brian McCrindle about his career and life. How did he develop a love of pediatric cardiology? Who were some of his early mentors? How did he develop the international Kawasaki Disease Registry and how has he cultivated it despite minimal funding? How did he develop an interest in preventive cardiology? How can a young person make their clinical work also their academic work? Dr. McCrindle also shares some insights into navigating a successful life as well as retirement. This is a rare opportunity to be inspired by one of the great pediatric cardovascular researchers of the past 3 decades. 

This week we speak with congenital heart surgeon T. Konrad Rajab of Arkansas Children's Hospital about a recent report he co-authored on piglet experiments on partial heart transplantation. How did transplanted heart valves grow in comparison to standard homografts and how did the valvular function differ with time? Is there a minimum dose of immunosuppresion that can protect these valves and can this dose be lower than full heart transplantation immunosuppresion therapy? Is partial heart transplantation considered a potential life-long approach to valve replacement or mostly something used to allow for growth of valves during childhood? What do we know about the world's limited experience in humans of this approach? Dr. Rajab shares the answers this week in an exciting 'sci-fi' episode. The future is now.

https://doi.org/10.1016/j.jacbts.2024.10.015

This week we speak with Professor Vladimiro Vida of U. Padua about a recent ECHSA large scale study assessing surgical outcomes of newborn cardiac surgery in Europe. What trends have become apparent in the past 10 years and why are outcomes generally better overall in this complex patient group? Why have outcomes for single ventricle surgery not improved as much as other newborn surgeries? Is there a relationship between center volume and outcomes? What interventions might result in improvements in outcomes of Norwood palliation? Dr. Vida provides his insights this week. 

https://doi.org/10.1016/j.athoracsur.2024.07.023

This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on the topic of outcomes of ablation in the early postoperative period following congenital heart surgery. Who is a candidate for this intervention and what were the outcomes? How commonly were serious complications encountered and how successful were these procedures? Dr. Dionne reviews these and other aspects of this novel review this week. 

https://doi.org/10.1016/j.hrthm.2024.08.061

This week we venture back in time to 2023 to review the results of the update of the Single Ventricle Reconstruction trial, specifically SVR III. How are HLHS patients are faring post Norwood at age 12? What is the overall transplant-free survival rate in this group? Are there differences in survival seen at 12 years between BTTT shunt patients and RV-PA conduit shunt patients? How do they compare in exercise capabilities? What about rates of PLE or arrhythmias seen? Are there interventions that may improve outcomes going forward? These are amongst the questions reviewed this week with the first author, Dr. Caren Goldberg who is Professor of Pediatrics at the University of Michigan. 

DOI: https://doi.org/10.1161/circulationaha.123.065192

This week we speak with Professor Robert Hamilton of the University of Toronto about a recent case-control study in which his team identified a novel auto-antibody targeting a fetal cardiac protein that proved to have excellent sensitivity and specificity for the identification of fetuses that would develop heart block in fetal life in the offspring of women with maternal connective tissue disorders. How did the team in Toronto choose these particular target proteins? How well did this test perform in predicting heart block in pregnancies where there had been a prior pregnancy affected by block? Does this test possibly mean that fewer fetuses of mothers with connective tissue will need surveillance? Dr. Hamilton shares the details of this fascinating study this week. 


https://doi.org/10.1016/s2665-9913(25)00092-x


We also speak with Drs. David Ezon and Kenan Stern about the upcoming 16th Annual Mount Sinai Imaging Symposium - Conversations in Care: Cardiac Conundrums & 3D Echo Workshop which will be taking place at Mount Sinai on 5/31/25. Details are available at the following website:

https://mssm.cloud-cme.com/course/courseoverview?P=5&EID=46043

This week we move into the arena of preventive cardiology when we review a recent report from the team at Northwestern and Princeton on the impact of early childhood food insecurity on cardiovascular health of people in young adulthood. How does food insecurity in young childhood impact the cardiac health of adults? Why is most of the impact seen on BMI but not other measures of cardiovascular health. How can food programs that support improved food and nutrition security work to improve long term cardiovascular health of children and adults? Do the benefits of such programs outweight their costs? Dr. Nilay Shah of Northwestern University shares his deep insights into his work and these questions this week.

• DOI: 10.1001/jamacardio.2025.1062

This week we share the inspiring tale of Ms. Kayla Billington, a pediatric and neonatal critical care nurse who met a young boy with tetralogy of Fallot named Wavamuno Patrick in Uganda while working for an NGO hospital. Ms. Billington tells the story of meeting Patrick and struggling to save his life and how this simple relationship of love and caring led her to help many in Uganda with congenital heart disease. Ms. Billington speaks of partnering with Professor R. Krishna Kumar of the Amrita Institute and, in today's episode, both Ms. Billington and Dr. Kumar share the inspiring tale of how they have worked together to help save the lives of children from Uganda at Amrita. Prepare to be amazed by their tale. Ms. Billington's efforts highlight the critical need for congenital heart care in Uganda and many other nations in Africa. 

For those interested, you can learn more about Patys Project and how you can help at:

https://patysproject.org

This week we take a trip back in time to reminisce about what it was like to be a fellow under famed pediatric cardiology pioneer Dr. Alexander S. Nadas. Who better to tell us about what life was like under this giant than 4 present-day giants who lived through it and got their start working for Professor Nadas. Joining the podcast in a live recording from the Boston Children's Cardiology 75th Anniversary Alumni Reunion on May 3rd are Dr. Roberta Williams, Dr. John Barry Keane, Dr. Patricia Rompf and Dr. Thomas Hougen. All have many stories to tell and they share their remembrances and insights in this special episode honoring the memory of the founder of the cardiac program at Boston Children's Hospital - Dr. Nadas. 

This week we delve into the world of exercise physiology when we review a recent paper by Dr. Adam Powell of Cincinnati Children's Hospital on the relationship of hand grip strenth to other measures of cardiovascular and skeletal muscular health and fitness. How does hand grip strength correlate with CPET measures of exercise abilities in children? How might this inexpensive test help identify patients who might benefit from exercise therapy? Will hand grip strength one day be as ubiquitous as blood pressure in the evaluation of our CHD patients? Dr. Powell shares the answers this week.

https://doi.org/10.1016/j.jpedcp.2025.200144

This week we review a recent editorial commentary by Drs. Belinda Gray, Rachel Lampert and Michael Papadakis on the concept of the personalized emergency action plan for the patient with genetic heart disease who is 'returning to play' in vigorous sports. With newer data demonstrating that risk for SCA or SCD is perhaps not as high as was once thought in this setting of sport, can the development of a personalized emergency action plan further enhance safety beyond simple measures such as medical adherence? Who should be involved in drafting this emergency action plan and how does this feature in the concept of 'shared decision-making'? 

DOI: 10.1161/CIRCULATIONAHA.124.072830

This week we review a study assessing the impact of bundle branch block (BBB) on exercise tolerance amongst the single ventricle Fontan patient cohort. Why would this be associated with worse outcomes for exercise? How should the cardiologist use this datum of BBB in a single ventricle patient to inform clinical decision making in this patient group? Why is cardiac resynchronization therapy so challenging in this patient group? Dr. Omar Meziab of The University of Arizona shares his deep insights this week. 

https://doi.org/10.1007/s00246-024-03500-1

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