Nineteen staff pediatric cardiologists provide a range of expertise in the care of children with congenital and acquired cardiac disease. Fellows rotate through each subspecialty area during the course of fellowship with flexibility to focus based on interest. Areas of subspecialty expertise include:
- Heart failure/myopathy, mechanical assist device support, and cardiac transplantation
- Interventional cardiac catheterization
- Cardiac intensive care
- Electrophysiology (including RF and cryoablation)
- Echocardiography (including transesophageal and intracardiac)
- Perinatal cardiology (including fetal and maternal cardiology)
- Preventative cardiology and lipid clinic
- Exercise physiology
Inpatient Service
Evonne Morell, DO
Each year the fellow is assigned to two months on the in-patient service. This includes management of all care for admitted patients. The patients range in age from neonate to adult. In addition, the fellow is the Cardiology consultant for pre-operative and post-operative patients on the Cardiothoracic Surgery service as well as consultant to other services in the hospital. During the in-patient rotation, the fellow participates in teaching house staff and fourth year medical students. The attending cardiologist provides one-on-one supervision during these rotations. Fellow responsibilities include:
Rounding daily on all cardiology inpatients (general cardiology, cardiac transplant, cardiac ICU, and consults)
Providing the initial response to consults from other services
Instructing pediatric housestaff and medical students in pediatric cardiac care
Outpatient Service
The outpatient rotation is designed to perfect skills of cardiac examination, diagnosis and treatment planning. Fellows maintain one-half day per week clinic throughout their fellowship. Each fellow identifies patients for their continuity clinic from the inpatient and outpatient services. Fellows will also participate in subspecialty clinics such as the lipid, transplant, cardiomyopathy, and electrophysiology and pacemaker clinics.
Echocardiography Laboratory
The Echocardiography Laboratory is an active lab with vast opportunities for becoming proficient in echocardiographic diagnosis and developing research skills. Fellows are assigned to echocardiography two months annually, performing studies with supervision commensurate to each fellow’s level of skill. There is extensive one-on-one training, both technical and theoretic. Two, one-hour didactic lectures are given weekly to the echo lab staff. Upon conclusion of training, fellows will be skilled in both transthoracic and transesophageal echocardiography. The echo lab operates entirely in digital format with ability for faculty and fellows to view studies from home. In addition, telemedicine echo transmission service is available to outlying hospitals.
Electrophysiology
Lee B. Beerman, MD
The electrophysiology (EP) service provides a full spectrum of care for patients with rhythm disturbances. Fellows become involved in management through inpatient consults, EP based catheterization procedures, and dysrhythmia/pacemaker clinic. Instruction in the interrogation and adjustment of pacemakers, interpretation of ambulatory ECG monitors, and exercise related rhythm phenomena is provided. During catheter rotations, fellows participate in diagnostic and therapeutic EP studies, including radiofrequency and cryotherapy ablations.
Exercise Physiology
Tyler H. Harris, MD
The Cardiology division has an exercise laboratory outfitted with state-of-the-art treadmill and metabolic equipment. Standard treadmill testing as well as cardio-pulmonary exercise testing are performed. Fellows will become proficient in both performance of all types of exercise tests and in the interpretation of the acquired data.
Cardiac Intensive Care
Fellows spend four months during fellowship in the cardiac intensive care unit (CICU). The unit is staffed by three, dedicated cardiac intensivists and a dedicated pediatric, cardiac nursing staff. During this rotation, the fellow takes in-house, overnight call not more frequently than every 3rd night caring for:
- Pre-operative congenital cardiac patients
- Post-operative congenital cardiac patients
- Post-operative heart, lung, and heart-lung transplants
- Patients requiring ECMO or VAD support
- Patients with severe, acquired cardiac conditions (myocarditis, cardiomyopathy, malignant arrhythmias, etc.)
Perinatal Cardiology
The perinatal program involves three clinical areas: fetal, neonatal and maternal cardiology. Fellowship training includes a one month scheduled rotation with the perinatal program in the first year with the option for additional (elective) rotations thereafter. This rotation provides experience in management of the fetus, pre-term, and term neonate with heart disease, as well as consultation on high-risk pregnancies because of maternal heart disease. During the rotation, the fellow becomes an active member of the Fetal Diagnosis and Treatment Center.
Heart Failure/Cardiomyopathy/Cardiothoracic Transplantation Program
Brian Feingold, MD, MS FAAP
The cardiac transplantation program at the CHP was established in 1982 and is currently one of the most active pediatric centers in the world. To date over 320 thoracic organ transplants have been performed. Fellows provide direct care for patients prior to, and following, cardiac transplantation while on the inpatient and CICU services. Fellows are also regularly involved in the post-transplant assessment of patients in the cardiac catheterization laboratory and in the clinic. Patients are referred from a wide geographic region, including complex cases referred because of staff expertise and experience. Transplantation and cardiomyopathy clinics are held weekly. A large body of research emanates from the transplant program. Fellows are encouraged to be involved in both clinical and basic science (transplant immunology) research. The program was awarded a 5 year $14 million research grant from the NIH in 2004.
Cardiac Catheterization Laboratory
Jacqueline Kreutzer, MD
Fellows are assigned to the cardiac catheterization laboratory for two months annually. Under close faculty supervision, each fellow assumes increasing responsibility so that ultimately procedures can be performed independently. Those fellows interested in interventional cardiology receive additional direct one-to-one instruction in therapeutic catheterization procedures including ASD, PFO, PDA, and VSD device closure. A second biplane state-of-the -art laboratory will be available when CHP moves to the new hospital in early 2009. The laboratory supports cutting edge, high-quality diagnostic, therapeutic and electrophysiologic procedures.
Preventive Cardiology
The preventive cardiology program is an ambulatory-based program that sees children with lipid disorders, hypertension, obesity and related disorders of the metabolic syndrome and type II diabetes. The lipid clinic follows several hundred children with more than 300 annual visits. All types of lipid disorder are seen, including rare severe genetic forms of hyperlipidemia.