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CORONARY ARTERY DISEASE - ACS & AMI

CONGENITAL

CRITICAL CARE

PEDIATRIC

CANCARE

CPCA

CAIC

EARLY CAREER INVOLVEMENT

335 - CHALLENGING CASES IN CONGENITAL HEART DISEASE AND PEDIATRIC CARDIAC INTENSIVE CARE

Saturday, October 26, 2024

11:00 AM – 12:00 PM PT

Room: 212-213

Workshop Description: Three real but anonymized challenging cases of pediatric congenital heart disease in the critical care unit requiring high level multi-specialty collaborative care will be reviewed including information on the clinical case and ultimate management as well decision-making process and rationale.

1) A fetus with severe Ebstein’s anomaly and circular shunt complicated by hydrops and requiring urgent delivery with intubation and ECMO “exit procedure” prior to emergent surgery. Optimal patient care required complex multi-specialty decision-making, planning, and coordination.

2) A 6 year old patient with failing systemic circulation after double switch procedure for ccTGA. Optimal care required diligent clinical surveillance and responsive, flexible, and collaborative decision-making.

3) A 16 month old patient with Trisomy 21 and unbalanced AVSD initially palliated with a BPCP and ultimately converted to biventricular repair. Post-operatively the patient required VA-ECMO which was converted to VV-ECMO. Care required collaborative decision-making with patient's quantity but also quality of life at the centre.

This will be the first time at CCC that pediatric cardiac critical care experts will be presenting and sharing their clinical and professional experience related to the coordination and collaboration of care for these challenging patients in the pediatric cardiac critical care unit. Our planning committee, presenters, and discussion panel is multidisciplinary and carries a broad perspective including experts in fetal cardiology, pediatric cardiac echo imaging, interventional cardiology, cardiovascular surgery, bioethics, adult cardiac critical care, and ECMO. In addition to staff physicians, we have included a trainee and nurse practitioner perspective. With this diverse group of contributors we hope to both demonstrate through delivered content as well as participant discussion the value of collaborative care for challenging and complex patients and invite all interested specialties and subspecialties.

Interactive and Engagement Activities Description: Each clinical case will be presented in five minutes followed by a five minute description of the relevant background literature and approach to decision-making. Nine minutes per case for 27min total (45%) of the workshop time will be devoted to audience member discussion with panelists and presenters.

Learning Objectives:

At the end of this session participants will be able to:

examine the importance of preparatory planning and interdisciplinary collaboration in the context of complex decision-making towards, and implementation of, high-stakes management for patients with a significant risk of poor outcomes;
describe diagnostic and clinical tools to evaluate effectiveness of the systemic circulation in a post-operative double switch;
recognize the value of a responsive and flexible approach to decision making when a planned approach fails;
discuss the implications on relative quality of life over the long and short term after a failed or struggling double switch and related decision-making with patients and families; and
describe the important principles applied to decisions regarding univentricular palliation versus biventricular repair and related post-operative management considerations.

Disclosure(s):

Haley Christian, MD, MEd, FRCPC: No financial relationships to disclose

Cheryl Peters, MD: No financial relationships to disclose

Luc Mertens, MD: No financial relationships to disclose

Kaitlin M. Best, PhD, MN NP-Paediatrics, CCRN, CPNP-PC: No financial relationships to disclose

Lindsay R. Freud, MD, FASE, FAHA: No financial relationships to disclose

Seth Gray, MD: No financial relationships to disclose

Iain C. Johnstone: No financial relationships to disclose

Kaitlyn Lopushinsky, MD: No financial relationships to disclose

Vijay Anand: No financial relationships to disclose

Osami Honjo, MD, PhD: No financial relationships to disclose

Ashok Kakadekar, n/a: No financial relationships to disclose

Roxanne Kirsch, MD: No financial relationships to disclose

Muhieldin Muhiedinahamad, MD: No financial relationships to disclose

Gurmeet Singh, MD: Abbott Medical: Honoraria (Ongoing)

Steven L. Rathgeber, MD: No financial relationships to disclose

Co-Chair(s)

Haley Christian, MD, MEd, FRCPC

PEDIATRIC CARDIAC INTENSIVIST
CCS/CANCARE/CPCA
University of Toronto
Cheryl Peters, MD

PEDIATRIC CARDIAC ANESTHESIOLOGIST AND INTENSIVIST
CCS, CANCARE, CPCA
BC Children's Hospital

Presenter(s)

Kaitlin M. Best, PhD, MN NP-Paediatrics, CCRN, CPNP-PC (she/her/hers)

Nurse Practitioner
The Hospital for Sick Children
Lawrence Bloomberg Faculty of Nursing, University of Toronto
Haley Christian, MD, MEd, FRCPC

PEDIATRIC CARDIAC INTENSIVIST
CCS/CANCARE/CPCA
University of Toronto
Lindsay R. Freud, MD, FASE, FAHA

Head, Fetal Cardiology
CPCA
University of Toronto
Seth Gray, MD

PEDIATRIC CARDIAC INTENSIVIST
Hospital for Sick Children
University of Toronto
Iain C. Johnstone (he/him/his)

Pediatric Intensivist
BC Children's Hospital
UBC
Kaitlyn Lopushinsky, MD (she/her/hers)

Pediatric Critical Care Fellow
University of British Columbia
University of British Columbia
Cheryl Peters, MD

PEDIATRIC CARDIAC ANESTHESIOLOGIST AND INTENSIVIST
CCS, CANCARE, CPCA
BC Children's Hospital

Panelist(s)

VA

Vijay Anand (he/him/his)

Attending Physician
Stollery Children's Hospital
OH

Osami Honjo, MD, PhD

Surgical Director, Heart Transplantation and Mechanical Circulatory Support
CCS/CSCS
University of Toronto
Ashok Kakadekar, n/a (he/him/his)

Pediatric Cardiologist
University of British Columbia
Uinversity of British Columbia
Roxanne Kirsch, MD (she/her/hers)

PEDIATRIC CARDIAC INTENSIVIST
CCS
University of Toronto
Muhieldin Muhiedinahamad, MD

CARDIAC SURGEON
CCS, CSCS
GS

Gurmeet Singh, MD

CARDIAC SURGEON
CCS, CANCARE, CSCS
CANCARE, CSCS

Planning Committee Member(s)

Lindsay R. Freud, MD, FASE, FAHA

Head, Fetal Cardiology
CPCA
University of Toronto
KH

Karen Harrington, MD

PEDIATRIC INTENSIVIST
CCS
OH

Osami Honjo, MD, PhD

Surgical Director, Heart Transplantation and Mechanical Circulatory Support
CCS/CSCS
University of Toronto
Ashok Kakadekar, n/a (he/him/his)

Pediatric Cardiologist
University of British Columbia
Uinversity of British Columbia
Roxanne Kirsch, MD (she/her/hers)

PEDIATRIC CARDIAC INTENSIVIST
CCS
University of Toronto
Kaitlyn Lopushinsky, MD (she/her/hers)

Pediatric Critical Care Fellow
University of British Columbia
University of British Columbia
Luc Mertens, MD

Section Head, Echocardiography
CCS,CPCA
University of Toronto
Muhieldin Muhiedinahamad, MD

CARDIAC SURGEON
CCS, CSCS
Steven L. Rathgeber, MD

PEDIATRIC CARDIOLOGIST
CCS, CAIC, CPCA
University of British Columbia
GS

Gurmeet Singh, MD

CARDIAC SURGEON
CCS, CANCARE, CSCS
CANCARE, CSCS