Cincinnati Children's Hospital Medical Center Logo

Cardiology

Loading...

Fetal Cardiology Fellowship, Fourth Year

The Fetal Care Center at Heart
at Cincinnati Children's

The Fetal Care Center is the only full service fetal diagnostic and therapeutic center of its kind in the Midwest, and includes the nation’s first dedicated inpatient maternal-fetal unit.

The 4th year fellowship in Fetal Cardiology at Cincinnati Children's Hospital Medical Center represents a new advanced training opportunity, with a specific focus on training postgraduate fellows in diagnosis and management of fetal cardiovascular disease. 

The Heart Institute at Cincinnati Children's is a full service center for the care of cardiovascular disease in the young, housed within a tertiary care academic medical training center.

Fetal echocardiographic studies and cardiac consultations are performed on site at CCHMC, in a dedicated fetal echocardiography area. A dedicated, full-time sonographer—registered in both Pediatric and Fetal Echocardiography by the American Registry of Diagnostic Medical Sonographers—is employed by the Program. Offsite fetal cardiac consultations are also performed in conjunction with Maternal-Fetal Medicine Services at Good Samaritan and University Hospitals. 

The Fetal Heart Program also interacts closely with the Fetal Care Center of Cincinnati, a clinical collaboration between CCHMC, Good Samaritan Hospital, and University Hospital. The Fetal Care Center is the only full service fetal diagnostic and therapeutic center of its kind in the Midwest, and includes the nation’s first dedicated inpatient maternal-fetal unit. 

The Fetal Heart Program also conducts bi-monthly tele-echocardiography clinics with other Maternal-Fetal Medicine services in our region.

Teaching Staff: 
 

 

General Objectives:  The fellowship is designed to provide a balance of clinical training, didactic instruction, and clinical/basic science research experience.  The intended end-result is to produce a trainee who is well prepared to begin an academic career in Fetal Cardiology; the environment at CCHMC will provide the breadth and depth of experience necessary to obtain this training.

Clinical training: During the course of the 1 year fellowship training program, the trainee will be exposed to, and will learn to perform fetal echocardiography in a wide variety of clinical situations involving patients with congenital heart disease, fetal arrhythmias, noncardiac anomalies, and complications of twin pregnancies.  In addition to the diagnostic components, trainees will also participate in patient counseling and management planning. This will include, but is not exclusive of the following:

Comprehensive fetal echocardiography
The trainee will become skilled in performance of a comprehensive fetal echocardiographic study, which includes a complete anatomic assessment, a detailed evaluation of fetal cardiovascular function and rhythm, Doppler evaluation of fetal arterial and venous flows, and fetal biometry.

Patient counseling
The trainee will gain experience in the counseling of families with fetal cardiac disease, which will include discussion of the anatomic or functional abnormality, expected course and outcome, management plan, genetic issues, and delivery planning.  The experience will also include participation in team counseling sessions conducted within the Fetal Care Center of Cincinnati, when appropriate, e.g., when significant cardiac issues exist in patients being evaluated at that center.

Intraoperative fetal cardiovascular monitoring
Trainees will participate in intraoperative fetal cardiac asssessments, conducted during both ex-utero intrapartum (EXIT) procedures and open fetal surgery, in conjunction with the Fetal Care Center of Cincinnati.

Tele-echocardiography
The trainee will also participate and gain exposure to our tele-echocardiographic fetal cardiac screening programs, gaining experience in screening and triage of fetal cardiac abnormalities.

Fetal cardiac interventional procedures
The Program has a limited experience in fetal therapeutic interventions for cardiovascular abnormalities.  The trainee will be expected to participate fully in the diagnostic and clinical aspects of these opportunities, as they arise during the training period.

Research/Academic Training
In addition to the technical skill and clinical components required in fetal cardiology, the trainee will also be expected to participate in and be productive from a research perspective. Prospective trainees will be requested to provide outlines of potential research projects prior to entering the program, so as to expedite completion of the research during the course of the year. It is expected that trainees will present findings of research in abstract form at a national meeting relevant to fetal cardiology during the course of the year, and to develop their research for publication in peer reviewed journals.

Examples of current research activities within the Fetal Heart Program include:

 

  • Echocardiographic Identification of Highly Restrictive/Intact Atrial Septum in the Fetus with Hypoplastic Left Heart Syndrome
  • Quantitative Evaluation of Cardiovascular Abnormalities in Twin-Twin Transfusion Syndrome
  • The Relationship Between Cardiovascular Status and Recipient Twin Outcomes in Twin-Twin Transfusion Syndrome
  • Evaluation of Cerebrovascular Flow Characteristics in the Fetus With Single Ventricle: Relationship to Neurodevelopmental Outcomes
  • Evaluation of Cardiovascular Function During Experimental Cardiopulmonary Bypass in the Sheep Fetus


Recent publications and presentations:


Kinsel ML, Crombleholme TM, Michelfelder EC.  Fetal Cardiovascular Findings in the “Pump” Twin in Twin Reversed Arterial Perfusion Sequence.  Presented at the 18th Annual Sessions of the American Society of Echocardiography, Seattle, WA, June 2007.

Eghtesady P, Michelfelder EC, Altaye M, Ballard E, Hirsch R, Beekman RH III.  Revisiting Animal Models of Aortic Stenosis in the Early Gestation Fetus.  Annals of Thoracic Surgery 2007;83(2):631-9

Hinton RB, Michelfelder EC.  Significance of Reverse Orientation of the Ductus Arteriosus in Neonates with Pulmonary Outflow Tract Obstruction for Early Intervention.  American Journal of Cardiology 2006;97(5):716-719

Gottliebson WM, Border WL, Franklin CM, Meyer RA, Michelfelder EC.  Accuracy of Fetal Echocardiography: A Cardiac Segment-Specific Analysis.  Ultrasound in Obstetrics and Gynecology 2006; 28(1):15-21.

Livingston JC, Crombleholme T, Michelfelder EC.  An Improved Staging System for Twin to Twin Transfusion Syndrome Incorporates Recipient Twin Cardiomyopathy.  Presented at 26th Annual Scientific Meeting of the Society for Maternal Fetal Medicine, Miami Beach, FL, February 2006.

Kinsel ML, Border WL, Michelfelder EC.  Myocardial Performance Index in the Fetus: An Assessment of Diagnostic Feasibility and Reproducibility of Both Pulsed-Wave and Doppler Tissue Imaging Methods.  Presented at the 17th Annual Sessions of the American Society of Echocardiography, Baltimore, MD, June 2006.

Hor KN, Gomez-Fifer CA, Michelfelder EC.  Assessment of Longitudinal Trends in Pulmonary Venous Doppler Between Second and Third Trimester in the Fetus With Hypoplastic Left Heart Syndrome.  Presented at the 17th Annual Sessions of the American Society of Echocardiography, Baltimore, MD, June 2006.

Shah AD, Border WL, Crombleholme TM, Michelfelder EC.  The Relationship Between Cardiovascular Status and Recipient Twin Outcomes in Twin-Twin Transfusion Syndrome: Assessment by Fetal Cardiovascular Profile Score.  Presented at the 79th Annual Scientific Sessions of the American Heart Association, Chicago, IL, November 2006.


The trainee will also be expected to participate fully in all didactic opportunities available, which would be pertinent to training in fetal cardiology.  These include, but are not limited to:

  • Weekly Cardiology/Cardiac Surgical Conference
  • Echocardiography Conference, conducted 4X weekly
  • Weekly Fetal Care Center Case Conference
  • Monthly Fetal Cardiac Conference
  • Yearly Advances in Fetology Conference (CCHMC sponsored)