Cardiology-Cardiothoracic Surgery Rotation

This rotation (at Akron Children's Hospital) is designed for the fellow to gain knowledge about and participate in the care of neonates requiring cardiac surgical procedures and their post-operative complications. Fellow will spend time observing fetal ECHOs and outpatient antenatal consultations for counseling of families expecting a baby with congenital malformations, including congenital heart disease.

Educational Objectives

Patient Care

1. Observe the counseling of families expecting a baby with congenital heart disease or other malformation/problem diagnosed antenatally.
2. Learn how to diagnose, stabilize, and manage infants with congenital heart disease, arrhythmia, other heart disease.
3. Apply information about cardiac disease presentation and progression gained from interdisciplinary Cardiology conferences to patient care in the NICU, CTICU, CTSDU and pediatric floor.
4. Participate in consultation and rounds on neonates with cardiac disease in the CTICU/CTSDU.
5. Have an active role as Cardiology “service fellow” (supervise resident, participate in rounds, etc.) for any Cardiology service patient < 30 DOL

Medical Knowledge

1. Describe the anatomy, physiology, clinical presentation, and management of patients with congenital heart disease
2. Gain an understanding of the various treatments and procedures done for neonates with congenital or acquired heart conditions
3. Recognize the possible post-operative complications of various cardiothoracic surgeries and how to manage these
4. Learn about uses and limitations of fetal echocardiography
5. Learn basics of neonatal electrophysiology and echocardiography

Communication

1. Learn to work as a team with Cardiology, CT surgery, CVICU staff to manage infants who are post-op from cardiothoracic surgery.
2. Learn to effectively communicate with families having a baby with congenital or acquired heart disease, creating a therapeutic relationship.
3. Observe communication between cardiologist and parents during fetal ECHO.
4. Observe the counseling of families expecting a baby with congenital heart disease or other malformation/problem diagnosed antenatally.

Practice-Based Improvement

1. Work with cardiology, CT surgery, and CVICU staff to understand evidence-based decisions made to treat neonates with congenital and acquired heart disease.
2. Work with MFM, Neonatology, and other subspecialties to understand evidence-based decisions made in antenatal care, delivery plans, and immediate post-delivery care.

Systems-Based Care

1. Learn to coordinate delivery room and immediate post-delivery plans with family, MFM, Cardiology, CT Surgery, and other Pediatric subspecialists.
2. Learn to coordinate care of infants in the NICU with Cardiology and CT surgery.
3. Participate in the coordination of care of infants in the CVICU.
4. Understand the complexities of home-going planning for neonates who have undergone cardiac procedures.

Professionalism

1. Use appropriate resources (textbooks, journal articles, internet search engines) to develop a fund of knowledge of congenital malformations and neonatal heart conditions including congenital heart disease, their presentations, treatment options, and pre- and post-operative complications.
2. Foster relationships between subspecialty services involved in the care of neonates with heart disease and other congenital malformations or antenatally diagnosed problems.
3. Attend the expected conferences and activities for the rotation, construct and maintain a calendar of activities for the rotation and adhere to it.

Expected Activities 

• Attendance at deliveries of patients with known congenital heart disease and   assistance in NICU in care of these patients, assistance in transfer of patients from NICU to CTICU when applicable
• Daily rounds and consultations on infants in the CTICU/CTSDU
• Attendance at CT surgeries for those patients < 2 years of age.
• Attendance at fetal echo clinics on Tuesdays and Fridays
• Attendance at outpatient antenatal Neonatology consultations (sometimes done with other Pediatric subspecialists)
• Attendance at cardiac catheterization procedures for patients < 2 years of age.
• Attendance at any surgery or procedure of interest
• Observation of any neonate post-operatively in the CTICU with the option of taking night call in the CTICU to monitor complications/care overnight. Neonatal fellows will not have any direct care responsibilities for patients overnight.
• Serve as Cardiology service fellow for any Cardiology service patient <30 DOL.