Pediheart: Pediatric Cardiology Today

This week we discuss a recent report from the team at SickKids in Toronto on minimally invasive cardiac surgery. What sorts of operations are most common for this approach? Why are length of ICU and length of hospitalization periods lower in this surgical cohort than more traditional midline sternotomy approaches? How does one train a surgeon to perform these operations if the surgical exposure is so small, allowing only the priimary surgeon to see the majority of the surgery? What are the limits of this sort of surgical approach? These are amongst the questions posed to the first author of this work, Associate Professor of Surgery at University of Toronto, Dr. Christoph Haller. DOI: 10.1016/j.jtcvs.2025.12.009

This week we review a recent report using data from the IMPACT registry assessing the rates of major adverse events during cath of the pediatric cardiomyopathy patient. How commonly are complications encountered and who is at greatest risk? How much additional risk is incurred by performance of an endomyocardial biopsy at the time of catheterization? Pediatric critical care expert, Dr. Alejandro Martinez Herrada of Nicklaus Children's Hospital provides his insights this week. doi: 10.1161/JAHA.125.047780.

This week we delve again into the world of adult congenital heart disease and specifically the realm of biomarkers when we review a recent report of the proteomics of the adult Fontan patient. What is proteomics and how can this inform our understanding of the pathophysiology and adaptive pathways of the Fontan circulation? Are there meaningful differences in the patterns of protein expression between the adult Fontan patient and control 2 ventricle subjects? What might account for differences and how can we understand these differences to explain outcomes in the Fontan adult patient? We speak with the first and senior authors of this week's work, Professor Alexander Opotowsky of the University of Cincinnati and Mr. Ismael Assi who is a Sarnoff Fellow and soon to be 4th year medical student at the University of Cincinnati. DOI: 10.1016/j.jacadv.2026.102810 

This week we speak with a true pioneer in pediatric cardiology, Professor Rica Arnon of Mount Sinai in NYC. Dr. Arnon's career has spanned from the mid 1970's right up to the present time where she is still working as a cardiology consultant and educator at Mount Sinai in Pediatrics after more than 50 years. In this episode we learn the travails of a pioneering women in medicine/cardiology as Dr. Arnon shares with us the challenges and triumphs of a career that balanced outstanding clinical excellence with a rich family life. Why did she travel from Israel to the US to train? How did she choose to become a pediatric cardiologist and who were her mentors? What makes a good teacher of cardiology for young learners? What advice can this master of cardiology provide regarding 'balance' in a clinically active life when one is also devoted to their family? What is better in our field today and what does Dr. Arnon believe may have been lost along the way? Dr. Arnon tells it to us 'straight' in a delightful conversation with a master clinician and teacher. A conversation with Dr. Michael Freed:https://podcasts.apple.com/us/podcast/pediheart-podcast-replay-of-203-a-conversation/id1341472214?i=1000681074493A conversation with Dr. Welton Gersony:https://podcasts.apple.com/us/podcast/pediheart-podcast-247-a-conversation-with-living/id1341472214?i=1000607813461

This week we review a recent meta-analysis of studies assessing efficacy of adenosine in children to terminate SVT. Does the PALS recommendation of 100 mcg/kg as a starting dose for SVT management make scientific sense given what we know about the efficacy rates of this dose? Why might inadequate doses be potentially dangerous for children with acute SVT? Is there adequate data to consider changes to the recommended starting dose in this situation? Dose adenosine work well for all forms of tachycardia involving the AV node? Pediatric emergency physician and family medicine physician, Dr. Lais dos Santos of Mossoro', Brazil shares the results of a large scale meta-analysis that she performed and offers some answers to these and other questions. DOI: 10.1007/s00246-026-04281-5

This week we review a recent report of a novel form of CPVT (catecholaminergic polymorphic ventricular tachycardia) with associated neurodevelopmental delays. What is the genetic basis for these patients? What is different about the arrhyhthmias seen and how they are triggered in this variant? Should all patients with CPVT be screened for neurodevelopmental delays? Should those with neurodevelopmental delays and RYR2 variants be screened for CPVT? Associate Professor of Peditrics at Baylor College of Medicine/Texas Children's Hospital, Dr. Christina Miyake, shares her deep insights this week. doi: 10.1161/CIRCEP.124.013437

This week we go back 2.5 years and delve into the world of cardiovascular surgery when we review a review of STS data on the pulmonary artery band (PAB). The STS assigns a STAT category of 4 to this operation, denoting higher risk for mortality. Is this warranted? Are all PAB candidates equal? What features are associated with higher or lower mortality rates in patients undergoing banding? Should the data in this work drive innovation to avoid the PAB in some settings? These are amongst the questions posed to the senior author of this week's work, cardiovascular surgeon Dr. Tara Karamlou who is Professor of Surgery at the Cleveland Clinic in Cleveland, Ohio. DOI: 10.1016/j.athoracsur.2023.09.020

This week we speak with 2 pioneers in the field of pediatric cardiac critical care, Dr. Anthony Rossi and Dr. Gil Wernovsky. Both were present at the very start of the field of cardiac critical care for children. What was it like in an era before transesophageal echocardiography or even postoperative echo? Why was the advent of the bidirectional cavo-pulmonary anastomosis such a game changer in the care of children with heart disease? What do Drs. Rossi and Wernovsky think were the most important improvements to care for children with heart disease in their 35+ year careers? What about care today troubles these intensive care gurus? This is a rare opportunity to speak with two who have seen and done it all in cardiac critical care for children.For those interested to hear Dr. Rossi speak about goal directed therapy, take a listen to episode 21 and episode 200 of this podcast!

This week we review a recent report from the team at Amrita Institute in Cocchin, India about their use of extended reality and virtual reality as well as heart model printing to aid in planning for complex intracardiac baffles for the treatment of complex congenital heart defects. What was the process used to provide actionable advice in the operating room during surgery? How has the team in southern India created a workflow that can accurately predict this complex anatomy and the patches needed to successfully septate complex hearts? We speak with the director of the 3D imaging group at Amrita, Professor Mahesh Kappanayil about this remarkable achievement of imaging in collaboration with surgery. DOI: 10.1016/j.jtcvs.2026.03.616

This week we review a landmark paper from the NEJM by the SCOUT-HCM study group assessing the impact of mavacamten on HCM in the adolescent patient. How does this agent work and what impact did it have on the LVOT gradients in obstructed HCM teens? Does this agent affect other biomarkers associated with more obstruction in this setting? Who is a good potential candidate for the use of this agent? Why must the EF be carefully monitored while using this agent? Dr. Joseph Rossano, Professor of Pediatrics at The University of Pennsylvania and the chief of pediatric cardiology at The Children's Hospital of Philadelphia joins the podcast to discuss this groundbreaking work.doi: 10.1056/NEJMoa2601103

This week we feature a collaboration episode between the Pediheart Podcast and the PedsCrit Podcast in which pediatric critical care experts Drs. Alice Shanklin of Northwell Medical Center and Dr. Zac Hodges of UT Southwestern discuss the evaluation and management of heart block in children. What should the clinician be thinking when encountering a previously healthy child with heart block? When is pacing indicated and how should it be performed? Who is a candidate for transvenous or transcutaneous pacing, who is not and why? Drs. Pass, Shanklin and Hodges review many aspects of this in an episode from the PedsCrit Podcast. https://www.pedscrit.com/

This week we review a recent work from the CT group at NY Presbyterian assessing the impact of phenylephrine during pediatric congenital CT scans to lower heart rate. Why is a lower heart rate better for CCT's? Should this agent be routinely employed for this indication during CT scans in children? Dr. Yosef Cohen, pediatrics resident at the Children's Hospital at Montefiore shares his insights from a recent work he co-authored. doi: 10.1093/ehjimp/qyag023. eCollection 2025 Aug.

In this replay episode from 2 years ago, we delve into the world of adult congenital heart disease to review the topic of liver disease in the Fontan patient and specifically, hepatocellular carcinoma (HCC). What is the prevalence of this disease in the Fontan single ventricle adult patient? How effective are scores like the MELD-XI or Fibrosis-4 Index at identification of HCC in the Fontan patient? How should the Fontan adult patient be surveilled for this form of cancer? What evidence is there that earlier identification of HCC is associated with better outcomes? What may prove to be the most important factor in protection of the liver in the Fontan patient? Dr. Yuli Kim, Director of the ACHD program at The University of Pennsylvania shares her deep insights this week into this important topic.DOI: 10.1093/eurheartj/ehad788

This week we review a recent Australian prospective assessment of aspirin resistance in children undergoing heart surgery. How common is this seen in this patient group and what are the reasons? What is the best test to perform to assess this and what tests may not be worthwile? Who deserves 'routine' testing for this possible problem? Cardiovascular surgeon Dr. Supreet Marathe of Queensland Children's Hospital in Brisbane, Australia shares the results of this recent publication. DOI: 10.1016/j.jtcvs.2025.09.013

This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on sinus node dysfunction following congenital heart surgery. How common was this encountered and how often were either temporary or permanent pacing needed? Are there certain surgeries that are more associated with the need for pacing after surgery? Why is this so common following heart surgery? Dr. Dionne shares her deep knowledge this week on this surprisingly common problem.  DOI: 10.1016/j.hrthm.2026.01.049

In this compelling lecture by Dr. David Winlaw of Northwestern University, we hear his thoughts on the state of the CICU/Surgeon relationship and he offers his thoughts on how to improve care for children with congenital heart disease undergoing surgery. Why does he believe that the more old fashioned approach of having cardiac programs run by academic departments is no longer optimal? What do critical care doctors not understand about surgery and vice versa? Are we asking too much of our CICU practitioners? How can the 'shift work' mentality be abolished and how can we avoid burnout for our critical care front line staff while also improving outcomes for patients? How can we bring joy back into the care of children with critical heart disease? Dr. Winlaw shares his insights from a long career in multiple centers worldwide in the Thomas J. Spray Lecture at the Cardiology 2026 CHOP conference from late February, 2026 in Arizona. 

This week we sit down and speak with noted non-invasive imaging expert Dr. Kelly Han of U. Utah about a recent work she co-authored on recommendations for the development of a congenital heart CCT program. What are the absolute essentials when considering offering these services in a center? How do different scanners differ from one another and how important is it to have single vs. dual source CT? Can good work be performed on 'older' machines? Who are the most important team members for a congenital CT team? Dr. Han shares her thoughts as well as the ideas of many of the thought leaders who co-authored this important statement paper. DOI: 10.1016/j.jcct.2025.01.003

This week we listen in to a recent presentation by congenital heart nursing pioneer Ms. Gwen Fosse BSN MSA RN FAHA. Ms. Fosse is a pediatric cardiovascular nursing specialist at Mott Children's Hospital at U. Michigan and has literally done and seen it all over the past 50 years in congenital heart nursing. In this presentation from the CHOP Cardiology 2026 meeting Ms. Fosse shares with us her impressions from a career that spans multiple decades and advances in the field. This presentation was the 26th Annual Thomas Garrett Rauch Memorial Lecture in Nursing at this esteemed conference. 

This week we speak with Professor James Cnota of Cincinnati Children's Hospital about a recent report he co-authored from the SVR trial regarding the impact of tricuspid regurgitation (TR) on outcomes in hypoplastic left heart syndrome (HLHS). How common is TR seen in the HLHS patient and how does this change over time after surgical palliations? Is there an optimal time to intervene on the tricuspid valve in this patient group? What does the future hold for tricuspid surgical interventions? Dr. Cnota has the answers this week. doi: 10.1007/s00246-025-04122-x

This week we listen in to a wonderful presentation that was delivered at the CHOP 2026 annual conference which was held in Phoenix, AZ. In this week's lecture we hear Dr. Gail Pearson of the NHLBI and NIH deliver her thoughts about the future of congenital heart research. Where does this master of research believe the next discoveries are going to arise from? What are the lessons we have learned from the PHN research endeavors over the past 25 years? Dr. Pearson offers her thoughts in this wonderful presentation which was the 24th Annual William J. Rashking Memorial Lecture at this conference. This presentation was delivered on 2.28.26.

This week we speak with Dr. John Brown who is the Harris B. Schumacker Professor Emeritus of Surgery at the University of Indiana. A congenital heart surgeon for over 45 years, Dr. Brown has performed more than 15,000 pediatric heart operations at Riley Hospital for Children and another 5000 heart operations in adults at IU and Methodist Hospitals. He performed the first pediatric heart transplant in Indiana and developed the first clinical use of the bovine jugular vein and valve for a pulmonary valve replacment in children. He also performed the only known twin to twin newborn heart transplant in the world. He has done and seen it all and has a unique perspective. How did he achieve so much and still have a succesful 56 year marriage to his wife Carol Ann? What is Dr. Brown most proud of in a career that is as prolific as his? What advice would he have have for the next generation? Prepare to be inspired by this master surgeon and friend and colleague of many in our field.

This week we review a fascinating very long-term surgical follow-up study from the team at Royal Children's Hospital in Melbourne reviewing over 30 year follow-up following the arterial switch operation for the treatment of transposition of the great vessels. What percentage of patients need reintervention by 30 years post neonatal repair? What anatomical sub-types are more likely to be associated with a need for reintervention and why? When intervention is required for neo-aortic or aortic root problems, can these usually be repaired or do they require replacement? Professor Igor Konstantinov from Melbourne shares his deep insights into this complex patient group. DOI: 10.1016/j.jtcvs.2025.09.008

Why are compassion, kindness and humility critical to the care of patients in 2026? How can practitioners be taught these approaches and how does this 'triple gift' not only improve patient care but also professional interactions? Can this be taught? If so, what are the best ways? Professor Colin McMahon of Children's Health Ireland at Crumlin shares his deep insights into this important and oft-neglected aspect of being a caregiver. DOI: 10.1007/s00246-026-04161-yFollowing today's interview we also briefly speak with Professor Jack Rychik of Children's Hospital of Philadelphia about the upcoming CHOP 2026 meeting entitled "Cardiology 2026 - Together!". For those interested in possibly attending this meeting which begins on 2.28.26, take a look at the website below for more information:https://www.chop.edu/events/cardiology-2026

This week we replay an episode from nearly 2 years ago about an editorial commentary from multiple congenital heart surgical leaders in the US. The topic of their expert opinion piece is the concept of public reporting of results and their 'amplification' through organizations such as US News and World Report, to name one. How has the use of the database from STS been sometimes misinterpreted through public reporting or ranking systems? What was the initial intent of the STS database and how does the present usage of these data differ from the initial intent? Do STS risk adjustment models capture all aspects of risk for patients undergoing surgery and how do deficiencies in this result in unfair 'rankings' of programs? Can we 'take control' of our data and interpret it more clearly and accurately for the public and reduce misusage or misinterpretation of the data? How can public reporting result in improved outcomes? How can 'gaming' of the system be reduced? Dr. Emile Bacha, Professor of Surgery at Columbia University shares his deep insights into a complex and challenging topic.DOI: 10.1016/j.jtcvs.2023.03.022

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.2025.01.036For 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

This week we end 2025 with a Pediheart tradition - an episode on personal finance for medical professionals with noted authority on index investing and personal finance, Mr. Paul Merriman. Paul is a retired investment advisor who now has a popular podcast "Sound Investing" and website in which he offers advice on investing for 'do it yourself' investors. In this week's episode, the 5th of his visits to Pediheart, Mr. Merriman discusses 'factor investing' via index-like ETF's and funds. He also reviews who he believes might benefit from a financial advisor, what sort of advisor most should seek out and why he believes that many do not need one if they can 'stay the course'. Resources mentioned in today's podcast are below. Wishing all a happy and healthy new year in 2026. Paul's website:https://www.paulmerriman.com/#gsc.tab=0'Best In Class' ETF's:https://www.paulmerriman.com/Best-in-Class-ETF-Recommendations2025#gsc.tab=0Sound Investing 'Quilt Charts':https://irp.cdn-website.com/6b78c197/files/uploaded/(K)_Quilt_Charts_(1928-2024)_-_2024_Returns_(1).pdfDFA 'Turn Out The Noise':https://www.dimensional.com/filmAs a reminder, all of the information provided in this week's episode should be considered entertainment and all financial decisions should be vetted with professionals or knowledgeable and trusted friends/family. 

This week we go back in time 2 years to review a recent paper from 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient group and how might the data in this work inform risk stratification and management of failing Fontan patients in whom transplantation is being considered? These are amongst the questions posed this week to the week's expert, Dr Daphne Hsu who is Professor of Pediatrics at the Albert Einstein College of Medicine at The Children's Hospital at Montefiore.https://doi.org/10.1016/j.jacc.2023.06.037For those interested in learning more about Dr. Hsu, take a listen to episode #166 from June, 2021:https://www.spreaker.com/episode/pediheart-podcast-166-a-conversation-with-professor-daphne-hsu--45144274

This week we speak with noted congenital cardiologist Professor Krishna Kumar of the Amrita Institute in Cochin, India and discuss his recent work on inequities in congenital heart care in the world. Over 90% of patients with CHD do not have access to care in the globe today. What is the path forward to improve this sobering statistic? How can a World Health Assembly resolution practically help improve care in LMIC countries worldwide? Dr. Kumar shares his deep insights.This week we also briefly note the passing of the wonderful and caring pediatric cardiologist Dr. Sangeetha Viswanathan of Chennai, India who tragically died suddenly this week while attending the World Congress events in Hong Kong. Dr. Kumar's words regarding his friend, former fellow and colleague are read in remembrance of this wonderful and giving cardiologist whose loss will be deeply felt by her patients, family and friends. DOI: 10.1016/j.jacc.2025.07.070

ECMO is the topic of this week’s episode of Pediheart. We speak with Assistant Professor of Pediatrics and cardiac critical care specialist at Northwell Health, Dr. Ivana Capin about a recent ELSO database study she conducted to assess outcomes in single ventricle patients who were treated with ECMO prior to single ventricle palliation. What factors were associated with worse overall outcomes? Can this therapy be used to stabilize the HLHS patient with an intact atrial septum? Why have outcomes for this high risk patient group not appreciably improved in the recent decade? How can these data improve prognostic clarity when speaking with families in this difficult situation.Also joining us briefly is Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, Dr. Scott Aydin to discuss his co-author and mentor, Dr. George Ofori-Amanfo as we approach the 4th anniversary of his untimely and tragic passing. DOI: 10.1017/S1047951125001386

This week we go back in time to 2020 to delve into the topic of fellow wellness and review a work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who was then the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness. doi: 10.1007/s00246-019-02276-z.

This week we review the topic of mitral annular disjunction ("MAD") and the possible association with ventricular arrhythmia or sudden death in the connective tissue disease patient. Is there a 'cut off' distance above which patients deserve more significant arrhythmia surveillance? What is the best way to measure the MAD distance? Can patients with low MAD distances have lower degrees or even no arrhythmic surveillance? How often should this distance be measured on CMR and can an echo measurement provide similar data? Dr. Daniel Castellanos, the first author of this work and Assistant Professor of Pediatrics at Harvard Medical School shares his deep insights this week.DOI: 10.1016/j.jocmr.2025.101954

This week we review a recent retrospective review from Phoenix Children’s Hospital about coronary artery fistulae. How common are they and who needed intervention? How should the cardiologist think about the small fistula? Should they all be ‘followed’ or can they be discharged from cardiology follow-up? How small is ‘small enough’? We speak with Dr. Marie Chevenon who is a fetal cardiologist at Phoenix Children’s Hospital about her recent study on the Phoenix experience with coronary artery fistulae.  https://doi.org/10.1007/s00246-024-03600-y

This week we speak with Ohio State ACHD fellow Andrew Freddo MD, PhD about a recent large single center study he conducted assessing the cardiovascular drugs that adult Fontan patients are taking and whether they might offer us insights into general well-being. Are there agents that are associated with worse outcomes? If so, is this a situation of the agent causing harm or is it a possible marker of illness? Are there agents associated with improved outcomes? These are amongst the questions reviewed with Dr. Freddo this week. DOI: 10.1016/j.jacadv.2025.102070

This week we review the results of the new pivotal trial of the 'Minima' stent by Renata Medical. What is special about this new device that makes it particularly desirable for use in small children? How strong is cobalt chromium and what evidence exists that it can be expanded repeatedly over 1-2 decades? Can this technology supplant surgery for certain diseases such as native coarctation? What are the limitations of this device? We speak with the first author of the pivotal trial, Dr. Patrick Sullivan of CHLA who is Associate Professor of Pediatrics at Keck Medicine at USC. DOI: 10.1161/CIRCINTERVENTIONS.125.015618

This week we review a recent survey study assessing the beliefs of fetal cardiologists and how these may influence the content and conduct of their counseling. Do most fetal cardiologists review all options including intervention, comfort care and pregnancy termination? Should there be a mandate that all do? Is it realistic or appropriate to ask a fetal cardiologist to suggest an option when they do not believe it to be a reasonable or correct choice? We speak with two of the authors of this work and they are Dr. Joanne Chiu of Harvard University and Dr. Caitlin Haxel of The University of Vermont. DOI: 10.1002/pd.6706

This week we review an episode from 3 years back and delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author, Dr. Anushree Agarwal, Assistant Professor of Medicine at UCSF, shares her insights into this important topic. DOI: 10.1161/JAHA.122.026732Also mentioned in today's episode is episode #222 with Dr. Dan Halpern of NYU medical center (https://www.stitcher.com/show/pediheartpediatric-cardiology-today/episode/pediheart-podcast-222-impact-of-cardiac-rehab-on-exercise-tolerance-in-the-achd-patient-206781483)

This week we review a recent work from the "Women In Pediatric Cardiology" group which is a 4 year old initiative to help lift up women pediatric cardiologists through the fostering of connections and also via mentorship programs. Why did this program develop and what are the most pressing issues affecting female pediatric cardiologists? What are the best solutions to help address gender inequities in our field? We speak with two co-authors of this week's work, Drs. Sarah Ford of Brown University and Kristin Laraja of University of Massachussetts. For those interested in participating in their work, feel free to email  [email protected] and your information will be passed along to the authors. DOI: 10.1007/s00246-024-03576-9

This week we review a recent multicenter, randomized trial pitting 2 different immunosuppressive therapeutic approaches against each other. How did a novel approach of everolimus + low dose tacrolimus compare to more standard MMF + standard, higher dose tacrolimus in avoidance of major adverse transplant events or complications? How did this first ever prospective trial in the pediatric heart transplantation world start and how difficult was it to perform in the absence of corporate or NIH support? Why can these data help inform FDA labelling for this novel approach and why is this important? Dr. Kevin Daly of Boston Children's Hospital shares his deep insights into this work this week!DOI: 10.1001/jama.2025.14338

This week we review a recent report of the use of phenoxybenzamine for the reduction of SVR in children undergoing congenital heart surgery in India. How does this agent work and what might be the advantage versus other agents like nitroprusside or milrinone which are more commonly used? How does the cost of this agent (or phentolamine) compare with newer agents? We speak with Dr. Rohit Loomba of Lurie Children's Hospital. For those interested, in addition to working as a critical care cardiologist, Dr. Loomba is also a noted cardiac morphologist and his wonderful videos can be seen at the following web address:https://www.youtube.com/@Talking_HeartsToday's paper:DOI: 10.4103/jpbs.jpbs_868_25

This week we replay an episode from 2 years ago on postoperative ectopic atrial tachycardia (EAT) following congenital heart surgery in children. Are there risk factors for this arrhythmia and are any modifiable? What is the 'go to' therapy used by the electrophysiologists at Children's LA for the acute and chronic treatment of this arrhythmia in the postoperative period? Is the presence of EAT in a postoperative congenital heart patient a marker for a worse outcome? These are amongst the questions posed to Children's of Los Angeles pediatric electrophysiologist, Dr. Jonathan Uniat. ·         DOI: 10.1007/s00246-022-03068-8

This week we review a recent report from the Boston Children's team on their 39 year experience managing and caring for children with myocardial infarction following Kawasaki disease (KD). What were the clinical features of KD patients that were most associated with this rare complication? What signs or symptoms should be concerning for the caregiver of patients with KD? What are the more common approaches to the management of MI in this fragile and young patient population? Dr. Sunil Ghelani of Boston Children's Hospital offers the answers this week. DOI: 10.1016/j.jpeds.2025.114638

This week we review a landmark paper that came out this month on the topic of ACHD. How common is neurocognitive dysfunction amongst the ACHD patient population? What factors are associated with worse or better such outcomes? What interventions should be considered to mitigate these issues? What is the relationship between mental illness and neurocognitive dysfunction? Dr. Scott Cohen of The Medical College of Wisconsin and Dr. Ali Zaidi of The Icahn School of Medicine at Mount Sinai share their insights into their recent multicenter study. doi: 10.1016/j.jacc.2025.06.051Also featured after the article is a brief description of the upcoming Mount Sinai ACHD Conference called: Kawasaki Disease Across The Ages: From Childhood Onset To Adult Outcomes - The 4th Mount SInai ACHD Symposium. We speak with Dr. Nadine Choueiter who is the Course Director of this conference about the goals and objectives of the conference. Dr. Zaidi is the course co-director. For those interested in signing up, please go to this webpage:https://physicians.mountsinai.org/news/register-today-for-the-fourth-annual-mount-sinai-adult-congenital-heart-disease-symposium

This year is the 50th anniversary of the first transcatheter ASD closure in a human. To celebrate this achievement, this week we air a live interview from PICS 2025 in Chicago (conducted 8/26/25) with living interventional cardiology legend Dr. Terry King speaking about the events surrounding his landmark intervention as the first person to ever perform a transcatheter ASD closure with his partner, surgeon Dr. Noel Mills. In this one on one interview, Dr. King discusses how he came up with this idea with Dr. Mills and how he found a patient in which to proceed. He reviews what 'informed consent' was in 1975 and also how he and Dr. Mills accurately estimated ASD size in an era that preceded 2D echocardiography. Dr. King speaks about the role of family in his life and offers advice to the next generation. Finally, he shares with us what he is up to today and why he does not believe in retirement. Prepare to be excited and inspired by this wonderful figure in our field. 

This week we review a recent work addressing the growing mismatch between the numbers of ACHD patients and the numbers of well trained ACHD providers. What are the most important factors influencing trainees' decisions regarding the pursuit of a career in ACHD? How can more young people be influenced to pursue this fascinating and growing field? We speak with Dr. Katia Bravo-Jaimes of The Mayo Clinic in Jacksonville, FLA about a recent survey study she conducted on the factors that influenced these important decisions. Dr. Bravo-Jaimes shares her thoughts on solutions to increase the ACHD workforce.https://doi.org/10.1161/jaha.125.041276

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