Caitlin Whyte (Host): Welcome to Weekly Dose of Wellness. I'm your host, Caitlin Whyte. And with me today is Dr. Demetrios Mallios, a cardiothoracic surgeon at the Children's Heart Institute at Miller Children's and Women's Hospital from MemorialCare. We will be talking about congenital heart defects in older children.

Doctor, what are some signs of a heart condition that parents might not even realize are heart-related?

Dr. Demetrios Mallios: So, heart conditions can present in a lot of different ways, but some of the ones that people are sometimes surprised by is things like difficulty feeding, poor weight gain, recurrent or frequent viral infections. So, these are three in particular that come to mind that can be signs of underlying heart disease that maybe aren't typically things that people think of when it comes to heart disease.

Host: And I know things like fatigue and fainting are all symptoms that can be easy to dismiss. So, how do you help families connect those dots?

Dr. Demetrios Mallios: Yeah, that's true. There can be a lot of symptoms like fatigue and like some of these other things that we described that can be easy to miss or can be what we call generalized symptoms. That could be signs of many different potential things going on. So, the most important thing that I always tell parents is that parents know their kids better than anybody else.

So if they continue to believe that something is going on or something is not right, just be advocates for your children and get them into the primary care doctor. Share your concerns with the primary care doctor and the primary care doctors are oftentimes very, very skilled at picking up these potential congenital heart issues.

Host: Of course. Now, have you ever seen any cases where a child's symptoms were brushed off as normal, like being tired after playtime, only to discover something more serious?

Dr. Demetrios Mallios: It has happened, but it's relatively a rare occurrence. I would say the vast majority of congenital heart disease, particularly the serious conditions, are diagnosed either before the baby's even born or when the baby is very, very young. And so, it's not often that you see a child make it through into, you know, age two, three, four, five years old with an undiagnosed heart condition, it can happen. But it's not a frequent occurrence.

Host: Now, I want to bring up Bronny James' story, which really shook people, an elite athlete collapsing during practice. What can we learn from cases like his and how can that help us change or improve in the future?

Dr. Demetrios Mallios: Yeah. So, that's a great question and cases like his are a little bit scary. We do see things like this come across the news every so often where somebody who's an elite athlete performing at an elite level, who presumably has been through many different medical examinations and tests, just kind of falls over from some cardiac condition or another. And we're working always trying to get better at identifying some of these conditions and knowing that they're present before they actually present.

But unfortunately, sometimes the first presenting symptoms are these types of events. And so, what we also have to focus on aside from just the identification is how we'll deal with these kinds of cases when they do present and that's something that has been the focus of a lot of pediatric and adult cardiac care is really focusing on having people trained in things like CPR, having people trained in how to use AEDs. And just the awareness of these types of events, I think, has led to a lot better outcomes when we do see them occur.

Host: Of course. And I know we touched on it a bit already, but do you see many kids whose heart conditions weren't caught until they were older? And how common is that?

Dr. Demetrios Mallios: I would say that it tends to be less common than the case where children are born with a defect that is known, or the defect is diagnosed soon after birth. There are some conditions that are starting to get diagnosed more frequently, namely anomalous coronary arteries. These are lesions that are starting to be seen and diagnosed, like I said, more frequently because of the higher frequency of CT scans being done.

It's an evolving area of treatment and medicine within pediatric cardiac surgery and adult cardiac surgery as well, because some of these are being diagnosed in adulthood. But the short story is we're still trying to figure out which of these patients need intervened on, and what type of intervention to do for them. So, it's an area of active research, but that would be the area where I would say that we're starting to see more and more of these things being diagnosed. Not that they're occurring more frequently, but that we're identifying them more frequently.

Host: Okay. So if a parent is listening to us right now and thinking, you know, my child gets winded pretty easily or fatigued pretty easily, what should they do next?

Dr. Demetrios Mallios: I would say that in a case of a child that's having symptoms like these, the best thing to do is take them to the primary care physician, share your concerns with a primary care physician and try to get the appropriate workup for this child. Oftentimes, this could be something as simple as asthma, or other very basic conditions that may have nothing to do with the heart.

But once you have gone down the road and exhausted a lot of other potential causes, and you're still having a child with symptoms, it's fair, if there's concern, to ask for a referral to a cardiologist, or even an echocardiogram, which allows for diagnosis of the vast majority of cardiac conditions.

Host: So, how does that process then go? What kind of tests or screenings are available if a pediatrician suspects something's off and refers a child over to you?

Dr. Demetrios Mallios: Yeah. So if a pediatrician is suspicious that something may be wrong, there's a lot of different tests we can do that are minimally invasive or not invasive at all. And some of the most basic ones are EKG, chest x-rays in some cases can be revealing. An echocardiogram really gives us great anatomic assessment of the heart itself and a lot of the large blood vessels that are connected to it. It can tell us about the flow through the valves and whether or not the valves are leaky or narrow. It can show us any defects in the heart muscle and holes in walls where there shouldn't be holes. And so, an echocardiogram, like I said, will show the vast majority of these defects. And if anything further needs to be delineated beyond echocardiogram, we have other imaging that we call cross-sectional imaging. So, a CT scan or an MRI can be used as well to gather further information.

Host: And how does your team respond when a child comes in after a cardiac event or an emergency? What does that care look like?

Dr. Demetrios Mallios: We have a lot of different protocols in place to help us care for children or adults who come in with urgent or emergent cardiac events. There are many different teams that are activated. The cardiologists are involved, the cardiac surgeons are involved. The ICU physicians are involved. And we obviously start off by assessing the patients, making sure that we stabilize them first and foremost. And once we have them stabilized, then we do further assessment to better identify what the underlying problem is and how and when we need to fix it.

Host: Now, I imagine that this can be terrifying for families. So, how do you also help parents navigate that fear and uncertainty?

Dr. Demetrios Mallios: Yeah, it's something that can be very scary for parents. I mean in the medical field, oftentimes, this becomes a bit of a routine because we're so used to seeing it. And in a lot of ways, that's good because we're able to maintain focus, and maintain calm in these situations that can be very stressful. But we always have to remember in the background that for the families, this is really, really a stressful event. And so, we have a lot of help from nursing teams, from social work, from child life therapy, from our palliative care teams that really help us get families through some of these really difficult situations with some sick patients.

Host: Absolutely. And, Doctor, what do you wish more parents knew about congenital heart defects, especially those ones that aren't caught early?

Dr. Demetrios Mallios: I would like the messaging around congenital heart disease really to be that the majority of it is something that we can deal with in today's modern era of medicine. There remains some very serious conditions that require multiple surgeries that can be life-limiting. They can ultimately require transplant. But I would say that the vast majority of these heart conditions, whether they're the ones that are diagnosed early or late, they can be intervened upon either with surgery or with transcatheter methods. And really, these children can live pretty long, productive and fruitful lives. And so, that's what I would want the messaging to be, is that, yeah, this is really scary, yeah, unfortunately it is very common. But because of that, actually, we've gotten quite good at dealing with it and treating these patients so that they can have productive long lives.

Host: Well, thank you so much for this really important information, doctor. that was Dr. Demetrios Mallios. For more information, go to millerchildrens.org/heart. And if you enjoyed this podcast, please share it on your social channels and check out our entire podcast library for more episodes. I'm your host, Caitlin Whyte. And this is Weekly Dose of Wellness. Thanks for listening.