Pediatric Resident Education in Pediatric Cardiology – A Needs Assessment

Background: Although congenital heart disease is the most common human birth defect, the scope and breadth of pediatric cardiology is far more diverse. Additionally, there continues to be rapid advancements in the field with educators becoming increasingly sub-specialized. As such, determining the topics general pediatric residents are taught must be selected based on numerous factors including resident career goals, core topics for board exams, and educator preferences. This study aimed to determine if the educational needs of general pediatric residents are met while on a pediatric cardiology rotation. Methods: All PL-2 and PL-3 residents in the Children’s National Hospital pediatrics residency program who had completed a required cardiology rotation as well as all pediatric cardiology fellows and pediatric cardiology attendings were asked to complete a survey. Participation in the study was voluntary. Respondents were asked to answer questions related to the perceived effectiveness and applicability of the currently administered cardiology curriculum, specifically inquiring about methods of teaching, the level taught, and the utility of topics selected. Results: Twenty-four (31%) of the 77 eligible residents completed the survey. Fourteen (82%) of the eligible attendings and nine (75%) of the cardiology fellows completed the survey. Seventeen unique topics in pediatric cardiology were ranked. The highest rated topics based on both perceived needs and wants included congenital heart disease, murmurs, cardiac physiology, ECG interpretation, and syncope/dizziness. Participants reported the highest satisfaction for whiteboard and bedside teaching. Conclusions: Overall, general pediatrics residents were satisfied with the current educational design of the inpatient cardiology rotation. These data provide a framework, both in teaching modalities and core concepts, for continued development and reassessment of inpatient pediatric cardiology rotations to optimally prepare pediatric residents with a strong foundation in pediatric cardiology.

Challenges in device closure of PDA in adults.

Objective: To describe the challenges and outcomes of per cutaneous closure of PDA in adolescents and adults. Study Design: Cross Sectional, Retrospective Analysis. Setting: Department of Pediatric Cardiology, CPE Institute of Cardiology, Multan. Period: 2017 to 2019. Material & Methods: A total of 111 adolescent and adult patients were included in the study. Patients with irreversible severe pulmonary hypertension were not included. Sampling with consecutive nonprobability was done. Procedure was done according to standard protocols. Different devices were used in different patients according to morphology of defect. Devices included SHSMA and Lifetech duct occluders. In two patients VSD muscular devices were also used. Results: Mean age was 22 + 7.88 years. Out of these 111 subjects, 72 (63%) were female and 39 (37%) were male with a ratio of 1.84:1. Two patients were of moderate size (3-5mm) PDA, 26 (27%) were of moderately large (5-7mm) size and majority of patients had large size (>7mm) PDA (55%). Majority of PDAs were type A (100, 90%), one was type B, 4 were type C and 6 were of type E according to Krichenko classification. No complications occurred except in one patient in which device was embolized. Foaming through the device was noted in 65 patients after 24 hours post procedure echocardiography. Conclusion: It was concluded that PDA device closure has its own challenges in adults but it is safe and effective as well.

Pediatric arrhythmology is an important direction of pediatric cardiology

Проблема сердечно-сосудистых заболеваний на протяжении последних трех десятилетий в мире остается одной из наиболее актуальных для здравоохранения.

Abstract 12134: Risk of In-Hospital Deterioration for Children With Single Ventricle Physiology

Introduction: Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality, with much of that increased risk coming in the first year of life. Understanding which children are at the highest risk for clinical deterioration may allow for increased monitoring and earlier escalation of care, with associated decreased mortality. Methods: We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU inpatient service from 2014 - 2018 for children < 18 years old. Clinical deterioration was defined as an unplanned transfer to the ICU or inpatient mortality. Children with SV were selected by diagnosis codes. Results: From the entire cohort of 1612 pediatric cardiology admissions (56 % male, 25% SV), 288 admissions had a deterioration event including 26 deaths. Infants less than one year with SV (n = 197 admissions) were significantly more likely to have a deterioration event (107 events over 62 admissions with an event) than the overall pediatric cardiology cohort (OR 2.11, 95% CI 1.52-2.93). Among infants with SV, those with a deterioration event were significantly younger (median 1.7 v 4.3 months, p < 0.001). Further, at baseline they had significantly lower oxygen saturation (84% v 87%, p < 0.01), lower systolic blood pressure (85mmHg v 90mmHg, p< 0.02), higher respiration rate (48 v 44, p < 0.01), and higher hematocrit (44.0 v 40.2, p < 0.005) compared to those who remained stable. Mean Pediatric Early Warning Scores (PEWS) were significantly higher for infants with SV who had a deterioration event (1.4 v 0.9, p < 0.001) and PEWS scores significantly increased in the 48 hours prior to an event (p < 0.001). Of the 104 non-death events, 61 required an increase in oxygen support and 51 required a fluid bolus prior to the event (p < 0.001). Conclusions: Infants with SV are at high risk for clinical deterioration. There are baseline differences in vital signs and lab work between those that remain stable and those that have a deterioration event. PEWS scores and oxygen and fluid treatment significantly increase prior to deterioration events. Leveraging data from the Electronic Medical Record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

Adaptations of Pediatric Cardiology Practice During the COVID-19 Pandemic

During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, pediatric heart centers were forced to rapidly alter the way patient care was provided to minimize interruption to patient care as well as exposure to the virus. In this survey based descriptive study we characterize changes that occurred within pediatric cardiology practices across the United States and describe provider experience and attitudes towards these changes during the pandemic. Common changes that were implemented included decreased numbers of procedures, limiting visitors, and shifting towards telemedicine encounters. The information obtained from this survey may be useful in guiding and standardizing responses to future public health crises.