The fellow on the cardiac catheterization rotation is responsible for comprehensive care of children prior to, during, and after cardiac catheterization. The fellow is responsible for the review of all relevant clinical, echocardiographic, and prior catheterization data before the patient visit, which are reviewed with the catheterization faculty member before the procedure. With the oversight of the catheterization faculty, the fellow creates a plan for the catheterization that includes: the proposed sedation, venous and arterial access sites required, the hemodynamic data to be collected, the appropriate angiography, and any proposed interventions. As the vast majority of pediatric cardiac catheterizations are now performed on an ambulatory basis, the fellow performs the pre-admission history and physical and coordinates the pre-testing, which might include blood work, ECG, echocardiography, and/or a quantitative lung perfusion scan. The fellow also obtains the informed consent for the procedure, first reviewing the potential complications of the planned procedure with the catheterization faculty member. Finally, the fellow provides the patient and family with appropriate instructions for the day of catheterization, such as remaining NPO and how to manage medication dosing.
During the month of his/her cardiac catheterization rotation, the assigned fellow participates in every catheterization performed. The catheterization faculty member emphasizes the hemodynamics and physiology pertaining to each case, using these didactic interactions to further assess the skills and needs of the fellow. Depending on the experience and skill level of the particular fellow, the catheterization faculty member will allow the resident increasing responsibility during the case. In the first year, residents are expected to master the fundamental skills and techniques required for pediatric cardiac catheterization. These include: appropriate sterile technique, basic technique for establishing venous and arterial access, the use of various hemodynamic and physiologic monitoring devices, and operation of basic catheterization equipment (the table, foot pedals, image intensifiers, thermodilution computer). The fellow also learns about catheter selection and manipulation, beginning with right heart catheterization with normal and abnormal anatomy. The fellow also masters the techniques for performing endomyocardial biopsy in transplant patients. At the conclusion of the procedure, the fellow is instructed in sheath removal and hemostasis, assessment of femoral arterial patency, management of arterial hypoperfusion, as well as management of basic anticoagulation, when required.
In the second and third years, as the fellow's abilities improve, more advanced techniques are mastered. These include alternative forms of venous access (PICC lines, subclavian, transhepatic, and axillary access), balloon atrial septostomy, balloon valvuloplasty, basic angioplasty techniques and strategies, occlusion techniques (coil occlusion of PDA, coil embolization of aortopulmonary, and venous collaterals), as well as transcatheter closure of ASDs, PFOs, Fontan fenestrations, and muscular VSDs. Broviac catheter insertion with subcutaneous tunneling is also taught.
After the catheterization procedure, the fellow is responsible for the post-procedure care. This care includes transferring the care of the patient to the recovery area staff, providing them with a care plan, as well as discharge planning and arranging for follow-up care. The fellow is also responsible for reviewing all of the data from the procedure. This review includes performing the hemodynamic calculations of flow and resistance based on the Fick equations and interpreting the angiograms. These calculations and interpretations are reviewed with the catheterization faculty member.
The pediatric cardiology fellow also participates in all invasive electrophysiologic studies performed during his/her month on the catheterization rotation. This includes both intracardiac and transesophageal catheter studies. After the procedure, the electrophysiologic data are reviewed with Dr. Barry Love, including the determination of relevant parameters (e.g., SACT and SNRT) and analysis of the mechanism underlying a tachyarrhythmia.
Icahn School of Medicine
One Gustave L. Levy Place
New York, NY 10029
Application Review Deadline:
January 15, 2014
Advanced Imaging Deadline:
September 1, 2013
September 1 - November 12, 2013