Goals

The goal of our program is to provide a personalized environment which will permit and encourage the fellow to become a well rounded pediatric cardiologist with excellent clinical and laboratory skills and have a basis on which to build a career in patient care, research and teaching. We accomplish this through a three to four-year program, balancing extensive clinical exposure to a broad spectrum of congenital and acquired heart defects and cardiac arrhythmias, and time spent in active clinical or basic research. Interested fellows may take a fourth year of training in order to extend their research experience or develop expertise in areas such as interventional catheterization, electrophysiology, noninvasive imaging or basic research.

We hope the following information will provide you with a sense of the clinical and research opportunities available at Indiana University and Riley Hospital for Children.

Medical Inpatient Service

Responsibilities include rounds with the pediatric cardiology team, management of inpatients with an attending's supervision, admitting new cardiology patients to various units and teaching basic cardiology topics to residents and medical students. In addition, fellows receive calls from referring hospitals and physicians, and provide referring physicians with follow-up and discharge information. Night call is shared among all fellows. By the end of the first year, fellows will have learned acute medical management of infants and children who suffer from congenital and acquired heart disease, how to interpret various imaging modalities for the diagnosis and management of heart disease and when to refer patients for cardiac surgery. During the second and third year of the fellowship, these skills are refined and fellows will acquire the experience necessary to manage patients independently after completion of training.

Outpatient Clinics

Throughout the 3 years of training fellows manage a biweekly Pediatric Cardiology clinic affiliated with the county hospital on the medical center campus. This clinic serves as a consultation clinic for pediatric outpatients with murmurs, chest pain and other common symptoms and complaints, as well as for continuity care of patients with congenital or acquired heart defects. A Pediatric Cardiology faculty member is available as consultant to help fellows accompany staff at satellite clinics in the community to gain outpatient clinical assessment skills and experience. Early in the first year and at the end of their third year, fellows spend at least a 1-month rotation in the Riley Pediatric Cardiology outpatient clinics. By the end of their training, fellows should be skilled in the performance of a complete cardiovascular examination, the interpretation of common out patient diagnostic modalities, and understand appropriate outpatient management of common pediatric cardiac problems.

Cardiac Catheterization 

Fellows spend six months on the Catheterization Laboratory rotation over three years. Approximately 400 procedures (not including Electrophysiology/Ablation procedures) are performed each year. These include the full spectrum of diagnostic and interventional procedures. Currently used occluder devices include CardioSeal and Amplatzer Occlusion devices.  Trainees are assigned to assist and perform procedures under the guidance of a staff physician. With each successive rotation through the lab, fellows assume more responsibility for performing procedures. All fellows attend angiography review sessions and participate in cardiac catheterization and pre-surgery conferences. Fellows participate in approximately 150 catheterization procedures during their training. By the completion of the fellowship, trainees are able to plan, perform and interpret a complete diagnostic study. Interested fellows may extend interventional catheterization training during a 4th year.

Electrophysiology

There is an active electrophysiology and arrhythmia service with approximately 175 tilt tests, 200 twenty-four hour ECG tests, 6,000 ECG's, and 60 radio frequency catheter ablations done annually. There is early implementation of new ablation techniques performed in collaboration with adult cardiology researchers at the Krannert Institute of Cardiology/Indiana University School of Medicine. These have included the use of an "atrial basket" catheter for ablation of atrial flutter in Fontan patients. Currently 175-200 patients with various types of pacemakers/AICD's are followed through our program. During the EP rotation, trainees participate in outpatient arrhythmia visits, pacemaker clinics, intracardiac electrophysiology studies and radio-frequency ablation procedures. Fellows also gain experience with the electrocardiographic interpretation of complex arrhythmias on standard electrocardiograms, 24-hour ambulatory monitors,
transtelephonic monitors and the acute and chronic management of patients with arrhythmias. Over the course of the 3 year fellowship, 3 months are spent on this rotation. In addition, fellows may initiate arrhythmia-related research projects.
A position is available for fourth year fellows to obtain intensive electrophysiology training.

Exercise Physiology

Experience through the cardiovascular exercise physiology laboratory is part of the electrophysiology and arrhythmia rotation. The exercise stress laboratory performs approximately 150 tests annually. Metabolic measurement of oxygen
uptake and carbon dioxide output is performed in the majority of patients. Fellows will attend and be supervised in the interpretation of exercise testing for a wide range of children with both cardiovascular and non-cardiovascular diagnoses.
In addition, fellows will attend lectures/discussions on basic exercise physiology and the principles of exercise testing and interpretation. By the end of the fellowship, trainees should know the indications and contraindications to exercise testing in children, and be able to interpret basic cardiopulmonary exercise data. The exercise physiology laboratory also offers fellows the opportunity to design and carry out research projects.

Echocardiography

About 7,000 transthoracic, 700 fetal and 250 transesophageal echocardiograms are performed annually. Fellows spend six months during the fellowship on this rotation. Fellows learn basic fundamentals of Echo-Doppler studies, necessary skills to perform complete 2-dimensional and Doppler echocardiograms, and attend daily reading sessions. During the second and third years there is introduction to principles, indications and interpretation of transesophageal and fetal echocardiography. Fellows also present echo derived anatomical and physiologic data at pre-surgical conferences. By the fellowship's end, trainees should be familiar with the instrumentation and physics of echocardiography, proficient in the performance and interpretation of 2D, pulsed, continuous wave and color Doppler examinations. Fellows can spend an additional focused year developing further echocardiography skills and knowledge in transesophageal and fetal echocardiography. Opportunities to pursue related clinical research projects are available, employing various
echocardiographic modalities.

Research

The trainee will spend the equivalent of at least one year during the 3 year fellowship in activities related to a clinical or laboratory research project. Exploration of a "topic" for research endeavors begins during the first year. Fellows should acquire a depth of understanding in an area of research, learn specific research techniques and generate questions about their study. Additional goals include the submission and acceptance of at least one firstauthor, peer-reviewed manuscript. Preparation of a research grant and presentation of findings at a national meeting are encouraged. A clinical project can be done in cooperation with and under the guidance of a pediatric cardiology faculty or a faculty person of an allied specialty. A basic science project can be arranged in one of the research laboratories of the Indiana University Medical Center including: adult electrophysiology; radiologic imaging; myocardial metabolism and cardiac cell physiology; molecular genetics; and developmental molecular biology. The fellow will be supported by the pediatric cardiology division during this research.