Pediatric Heart Failure & Transplant Physician-Scientist at Inova LJ Murphy Children’s Hospital and @ihvinews. Researching to save kids from heart failure.
@josephspinner Intrigued @josephspinner …do you consider positive troponin still peri? Or is that myo? ie would you treat a positive troponin patient with colchicine? These days it seems every trop+ pt gets mri which is inevitably positive thus no longer peri and no longer colchicine.
#Tweetorial (6 of 6) There remains significant disparity in heart transplant outcomes, specifically higher rates of DSA and AMR in black patients. Access to molecular diagnostics may improve outcomes for all heart transplant recipients.
#Tweetorial (5 of 6) From early work at Stanford, dd-cfDNA research has expanded rapidly in the past 10 years, transforming rejection diagnosis in adults, where biopsy is able to be avoided in many cases. Newer assays may improve precision in diagnosing rejection.
#Tweetorial (4 of 6) Molecular diagnostics are needed in pediatric transplantation, where endomyocardial biopsy has more morbidity, and transplants are complicated by prior congenital heart disease and abnormal immunity.
#Tweetorial (3 of 6) HLA Sensitization starts pre-transplant from pregnancy, transfusion, VAD, and congenital heart disease repair. It can increase significantly peri- and post-transplant as donor-specific antibodies, contributing to rejection.
#Tweetorial (2 of 6) Molecular biomarkers for diagnosing rejection are comercially available with significant cost. While proteins (BNP, Tn, CRP) are low-cost, they are not specific in diagnosing rejection. HLA and non-HLA antibody work will continue to impact posttransplant care
Ventricular assist devices are challenging for infants, especially with single ventricle defects. Le Bonheur Cardiology Fellow Cihangir Buyukgoz, MD, found that better anti-coagulation strategies and device engineering led to better outcomes & fewer adverse effects. #WCPCCS2023
"...given the well-known issues of bringing pediatric-specific devices to market and the reliance on innovations for adults, it is essential that future decisions about devices designed for adults take into consideration the impact on pediatric patients." https://t.co/DVRoZxp534
#HCM at #WCPCCS2023. Great overview by Joe Rossano @HeartCare4Kids of emerging HCM therapies including VANISH results where valsartan is disease-modifying in sarcomeric HCM.
A brave group of congenital heart disease experts discussing FONTAN Heart Failure, Heart or Heart+Liver Transplantation. Fantastic review of the literature, though we have lots to learn! #ISHLT2023#rovingreporter@EstelaAzeka @AmyKiskaddon @KSimpsonMD @nehban @DavePengMD
Out With the Old, In With the New in Heart Transplant Rejection: Great Discussions from the LEADERS in cell-free DNA, microRNA, Gene Expression Profiling, Digital Microscope and more #ISHLT2023#rovingreporter@JigPatelMDPhD@PalakShahMD
@lucianopotena
@KiranKhush1
Kicking off #ISHLT2023 with an excellent account by Dr. Sebastien Hascoet of Reverse Potts Shunt and heart/lung transplantation for pediatric patients, proposing criteria for treatment of children with severe Pulmonary Arterial Hypertension. Bon Travail! #rovingreporter
Already learning at #ISHLT2023 pre-meetings. Lori West challenging AMR experts to examine ABO Abs as is done with HLA Abs, groundwork for transplanting across ABO barrier to overcome significant HLA barrier.