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  • 1. FELLOWSHIP TRAINING PROGRAM in PEDIATRIC CARDIOLOGY and CARDIOVASCULAR RESEARCH 2005 - 2006 Department of Cardiology Children's Hospital Boston Department of Pediatrics Harvard Medical School Boston, MA USA
  • 2. CONTENTS Page Cardiology Roster 1 Cardiac Surgery Roster 3 Cardiac Anesthesia Roster 4 Clinical Fellowship Training Program 5 Core Clinical Rotations 6 The Second Eighteen Months 8 Research Training 9 Senior Clinical Fellowship Training 9 Information for Fellowship Applicants 10 History of Cardiology at Children's Hospital 10 Department of Cardiology Today 12 Cardiology Inpatient Service - 8 East 12 Cardiac Intensive Care Unit - 8 South 13 Cardiology Outpatient Service 13 Cardiology Consultation Service 14 Heart Failure/Transplantation 14 Boston Adult Congenital Heart Service 14 Cardiac Catheterization 15 Electrophysiology 15 Echocardiography 16 Exercise Physiology 16 Cardiovascular Magnetic Resonance Imaging 17 Computing Facility 17 Clinical Research 17 Department of Cardiac Surgery 18 Division of Cardiac Anesthesia 19 Cardiac Registry 19 Cardiac Physiology Research Facility 20 Laboratory of Molecular and Cellular Cardiology 20 Cardiology, Cardiac Surgery, and Cardiac Anesthesia Faculty (Alphabetical Listing) 22 Appendix I: Cardiology Rounds and Clinical Conferences 62
  • 3. Appendix II: Fellowship Policies 63 1. Fellow Selection Policy 63 2. Fellow Duty Hour Policy 64 3. Fellow Evaluation and Remediation Policies 65 4. Fellow Promotion and Non-Renewal Policy 66 5. Program/Faculty Evaluation by Fellows 67 6. Medical/Family/Maternity Leave Program 68
  • 4. DEPARTMENT OF CARDIOLOGY James E. Lock, M.D. Cardiologist-in-Chief Jane W. Newburger, M.D., M.P.H. Associate Chief Chief, Basic Cardiovascular Laboratories David Clapham, M.D., Ph.D. Chief, Inpatient Service Michael D. Freed, M.D. Chief, Non-Invasive Laboratories Steven D. Colan, M.D. Chief, Cardiovascular Intensive Care Unit Peter C. Laussen, M.B.B.S. Chief, Invasive Cardiology James E. Lock, M.D. Chief, Electrophysiology Laboratories Edward P. Walsh, M.D. Chief, Outpatient Services David R. Fulton, M.D. Director, Clinical Training Program Peter Lang, M.D. Research Administrator Edward V. Cosgrove, Ph.D. Senior Associates Charles I. Berul, M.D. John F. Keane, M.D. Steven D. Colan, M.D. Peter Lang, M.D. Michael D. Freed, M.D. Peter C. Laussen, M.B.B.S. David R. Fulton, M.D. Gerald R. Marx, M.D. Donald Fyler, M.D., Emeritus Jonathan Rhodes, M.D. Walter Gamble, M.D., Emeritus John K. Triedman, M.D. Robert L. Geggel, M.D. Edward P. Walsh, M.D. Tal Geva, M.D. David L. Wessel, M.D. Kathy J. Jenkins, M.D. Associates Mark E. Alexander, M.D. Audrey C. Marshall, M.D. Elizabeth Blume, M.D. Andrew J. Powell, M.D. Roger E. Breitbart, M.D. Tajinder P. Singh, M.B.B.S. Frank Cecchin, M.D. Marcy Schwartz, M.D. Kimberlee Gauvreau, Sc.D. Ravi R. Thiagarajan, M.D. Grigory Krapivinsky, Ph.D. Wayne Tworetzky, M.B.Ch.B. Ronald V. Lacro, M.D. Richard Van Praagh, M.D., Emeritus Michael J. Landzberg, M.D. Stella Van Praagh, M.D., Emeritus Jami C. Levine, M.D. 1
  • 5. Assistants Catherine K. Allan, M.D. Renee E. Margossian, M.D. Oscar J. Benavidez, M.D., M.P.P. Audrey C. Marshall, M.D. Lisa J. Bergersen, M.D. Mary P. Mullen, M.D. Laura M. Bevilacqua, M.D. William T. Pu, M.D., Ph.D. David W. Brown, M.D. Michael N. Singh, M.D John M. Costello, M.D. Leslie B. Smoot, M.D. Sarah D. deFerranti, M.D., M.P.H. Elif Seda S. Tierney, M.D. Adam L. Dorfman, M.D. Wayne Tworetzky, M.B.Ch.B. Alison L, Knauth, M.D., Ph.D. Rachel M. Wald, M.D. Part-Time Clinical Lucy P. Buckley, M.D. Sharon E. O'Brien, M.D. David DeMaso, M.D. Phyllis Pollack, M.D. Lars C. Erickson, M.D. Amy E. Roberts, M.D. Michael F. Flanagan, M.D. Laurence J. Sloss, M.D. Amy L. Juraszek, M.D. Scott B. Yeager, M.D. Helen N. Lyon, M.D., M.S. First Year Fellows Puja Banka, M.D. Vasum S. Peiris, M.D., M.P.H. Michael D. Day, M.D. Tara M. Swanson, M.D. Stéphane L.J. Moniotte, M.D., Ph.D. Elizabeth S. Yellen, M.D. Christina Y. Miyake, M.D. Second Year Fellows Elizabeth B. Fortescue, M.D. Juan-Carlos G. Muñiz, M.D. David M. Harrild, M.D., Ph.D. Lynn F. Peng, M.D. Tarun Mahajan, M.D. Sarah A. Teele, M.D. Third Year Fellows Margaret A. MacMillan, M.D. Andrew Y. Shin, M.D. Jeffery J. Meadows, M.D. Brian D. Soriano, M.D. Susan F. Saleeb, M.D. Vamsi V. Yarlagadda, M.D. 2
  • 6. Senior Fellows Mohamad K. Al-Ahdab, M.D. Doff B. McElhinney, M.D. Christopher S.D. Almond, M.D., M.P.H. Giuseppe Martucci, M.D. Margarita K. Burmester, M.D. Ronald G. Pompeu, M.D. Kirsten B. Dummer, M.D. Satish K. Rajagopal, M.D. Patricia Frangini, M.D Mark S. Scheurer, M.D. Bernhard Kühn, M.D. Research Fellows Vassilous Bezzerioes, Ph.D. Davide Marini, Ph.D. Nat Blair, Ph.D. Betsy Navarro, Ph.D. Susan Cibulsky, Ph.D. Elena Oancea, Ph.D. Markus Delling, Ph.D. Huayu Qi, Ph.D. Bimal Desai, Ph.D. Scott Ramsey, Ph.D. Felix Engel, Ph.D. Antonio Riccio, Ph.D. Jinlan Huang, Ph.D. Paul Smith, Ph.D. Anna Jazwinska, M.D. Stephanie Stotz, Ph.D. Yuri V. Kirichok, Ph.D. Haoxing Xu, Ph.D. Sakakatsu Ikeda, M.D. Hao Zhou, Ph.D. DEPARTMENT OF CARDIAC SURGERY Pedro J. del Nido, M.D. Chairman, Department of Cardiac Surgery John E. Mayer, M.D. Senior Associate in Cardiovascular Surgery Emile Bacha, M.D. Senior Associate in Cardiovascular Surgery Frank A. Pigula, M.D. Associate in Cardiovascular Surgery Francis Fynn-Thompson, M.D. Assistant in Cardiovascular Surgery 3
  • 7. DEPARTMENT OF ANESTHESIA Paul R. Hickey, M.D. Anesthesiologist-in-Chief Francis X. McGowan, Jr., M.D. Chief, Division of Cardiac Anesthesia Alfonso Casta, M.D. Kirsten C. Odegard, M.D. Senior Associate in Cardiac Anesthesia Senior Associate in Cardiac Anesthesia James A. DiNardo, M.D. Peter C. Laussen, M.B.B.S Senior Associate in Cardiac Anesthesia Senior Associate in Cardiac Anesthesia Douglas S. Gould, C.R.N.A. Barry K. Kussman, M.B.Ch.B., FFA (SA) Staff Nurse Anesthetist Associate in Cardiac Anesthesia James S. Harrington, M.D. Avinash C. Shukla, M.B.B.S. Assistant in Cardiac Anesthesia Associate in Cardiac Anesthesia Dolly D. Hansen, M.D., Emeritus Research Associate in Cardiac Anesthesia . 4
  • 8. FELLOWSHIP TRAINING PROGRAM IN PEDIATRIC CARDIOLOGY & CARDIOVASCULAR RESEARCH Cardiologist-in-Chief James E. Lock, M.D. Co-Directors Peter Lang, M.D. Jane W. Newburger, M.D., M.P.H. David E. Clapham, M.D., Ph.D. Fellowship Selection Michael D. Freed, M.D. The fellowship program of the Department of Cardiology has as its main goal the training of academically oriented leaders in the clinical care and laboratory and clinical investigation of cardiovascular disease in the young. One of the central tenets of the department philosophy is the exposure of trainees to the approaches and techniques that represent the current state of the art. The program aims to prepare trainees to work at the forefront of the field. In order to build on the recent dramatic advances in pediatric cardiology, it is fundamental to gain a better understanding of cardiovascular structure and function at the molecular, cellular and organ system levels with respect to development, morphogenesis, physiology, pathology and pharmacology. These approaches are expected to have a significant impact on the most pressing issues in pediatric cardiology including: the “natural history” of surgically corrected complex cardiac malformations, antenatal diagnosis and therapy of congenital defects, the cellular basis of cardiac development and the cellular response to abnormal physiology; and, ultimately the effective prevention of both congenital and degenerative cardiovascular disease. With these expectations, the cardiology department maintains that thorough training in basic research will be essential for all pediatric cardiologists who are to assume positions of leadership. It is the goal of this program to participate in the education of such individuals and to graduate exceptionally trained clinically oriented fellows with particular expertise in focused areas that match their interests and aptitude. To meet these goals the training program combines the unique resources of the Cardiovascular Program with the clinical and research opportunities of both Children's Hospital, Harvard Medical School and the Longwood medical community to give an unparalleled opportunity to explore virtually any area of clinical or basic research. With well developed divisions of interventional cardiology, cardiac imaging, electrophysiology, preventive cardiology, prospective clinical research, intensive care cardiology, transplant cardiology and adult congenital heart disease, along with the unparalleled resource of the Cardiac Registry, the program offers trainees a range of approaches within each clinical subspecialty that allows an introduction to the core problems and frontiers of clinical pediatric cardiology. The patient population reflects the Program's long history of leadership in caring for congenital and acquired heart disease in the young, and includes large local, regional, national, and international referral sources. This patient base, combined with a highly-evolved 5
  • 9. interdisciplinary approach among cardiology, cardiac surgery, and cardiac anesthesia, represents the greatest strength of the fellowship training program. The research opportunities are even more diverse, combining intramural expertise in molecular genetics, cardiac morphogenesis and cellular adhesion with an exceptionally wide range of laboratory investigation occurring throughout the Boston medical community. The core fellowship involves three years in training, comprising twenty-four months of clinical rotations and twelve of elective and research experience. Fellows may reverse the usual sequence and start their training in the laboratory, deferring clinical training for one or more years. An increasing proportion of trainees spend one or more additional year of training as “senior clinical fellows” in the subspecialty areas of pediatric cardiology. There is a reasonable amount of flexibility in scheduling and individualized programs may be possible, particularly for those with prior training in pediatric cardiology. New fellows are assigned a faculty advisor who helps with initial orientation and provides ongoing guidance in the form of performance review, selection of clinical electives, and identification of a research mentor (see below). CORE CLINICAL ROTATIONS The first eighteen months of training constitute an intensive immersion in clinical cardiology with a focus on caring for a large number of patients in the inpatient and outpatient settings and on learning what information is important in making clinical decisions. Fellows rotate through five clinical services and a night float position at approximately monthly intervals. Two core rotation fellows are on call in the hospital every night: one to cover the cardiac intensive care unit as his or her sole responsibility, and a night float to supervise cardiac medical and surgical patients on the cardiology floor, and to respond to urgent consults from other services. At present, fellows are expected to take every fourth night coverage in the ICU for approximately three months and perform night float coverage for two months (divided time) during the first eighteen months of training. Ample back- up support is available from more senior fellows on call and from staff cardiologists covering the subspecialty services within the Department. Cardiac Medicine/Surgery: The fellow leads a team of three or four pediatric residents in the care of cardiac medical patients on 6 East, the cardiac inpatient floor. The fellow also assists the surgical team (which includes nurse practitioners) in the postoperative care of cardiac patients convalescing on the floor, assuming the role of consulting cardiologist and pediatrician. The fellow runs morning rounds, manages patient care in tandem with attending cardiologists, and teaches the residents on an informal basis during the day. More formal teaching and supervision of patient care is provided by the attending cardiologist assigned each month. Additional daily teaching sessions are conducted by the cardiology faculty. Cardiac Intensive Care: One core rotation cardiology fellow is scheduled each month on the cardiac intensive care unit. Over the first eighteen months of training, each fellow will have three clinical months on the CICU. (In addition, each month more senior cardiology fellows and a critical care fellow rotate through the ICU and share the call schedule.) The clinical commitment is less than 80 hours/week including call. The fellows in the CICU are responsible for the intensive care management of the cardiac surgery, cardiac medical, and select patients with cardiac disease 6
  • 10. undergoing non-cardiac surgery. Two attending intensive care staff are responsible for providing direct supervision of patient care and teaching during daily rounds. Fellows receive training in cardiac pathophysiology, intensive care management, and critical care monitoring and procedures Electrophysiology: In conjunction with an electrophysiology staff physician, the core rotation fellow functions as a consultant for all inpatients and selected outpatients with arrhythmias. The fellow is responsible for coordinating patient management, helping to plan and execute drug trials, esophageal electrophysiology studies, cardioversions and exercise studies, as well as review of all Holter studies. Although the more senior fellows on this service are primarily responsible for intracardiac electrophysiology studies, ablations and intraoperative procedures, the core fellow participates in these procedures as well. Two months of electrophysiology occur during the first eighteen months of fellowship; an additional one month rotation, which includes training in exercise physiology, occurs during the second eighteen months. Echocardiography: Core rotation fellows are introduced to cardiac ultrasound through hands-on experience guided by the echocardiography staff, senior fellows and experienced technologists. Additionally, a comprehensive tape library and didactic sessions are provided for the fellows. The fellow is expected to take an active role in the laboratory performing echocardiographic scanning, spending several half day sessions each week to gain experience in the interpretation of anatomic, Doppler and ventricular function studies. Four of the initial eighteen months of training are devoted to echocardiography. Catheterization Laboratory: Three days a week are spent performing catheterizations under staff guidance. Responsibilities of the core rotation fellow include: preparation of the case and review of informed consent with the patient's family the day prior to the procedure, presentation of the case at morning conference, performance of the catheterization with a staff physician, and analysis and review of the data at the end of the day. The fellow participates in two or three catheterizations per day. As the rotation progresses, the fellow learns to obtain a complete set of hemodynamic, saturation and angiographic data in a safe and expedient manner. Training in catheterization of the newborn infant and interventional procedures begins during the core rotation. There are there months of catheterization during the core clinical rotations. Night Float: A first year fellow is available in the hospital from 7 P.M. to 7 A.M. to assume patient care responsibilities for the cardiac medical, surgical, and consult services, as well as handling referrals or questions from outside physicians. Extensive clinical backup is available from a more senior fellow on call, staff cardiologists on service and the cardiac ICU. A staff physician regularly reviews any outstanding patient management issues with the fellow. Cardiology Clinic: Each fellow is assigned to a weekly half day clinic session, which are supervised by two attending cardiologists. Fellows evaluate and plan the care of patients referred to the clinic for outpatient evaluation, and also provide long term continuity care for patients with more serious lesions whose care they have assumed while on their various clinical rotations. 7
  • 11. THE SECOND EIGHTEEN MONTHS Midway through the second year of training, fellows have been exposed to each of the main sub- specialties of pediatric cardiology and generally have a good sense of how cardiology is practiced at a single institution. The goal of the next eighteen months is to build on the technical and cognitive skills to allow increasing independence, expand the fellows knowledge to allow a broader understanding of the controversies and challenges of the field, and most importantly to identify a specific initial career path that allows for the focusing of research and clinical energies. To this end, this period is flexible in combining clinical requirements and protected time for research and study. During ICU rotations, fellows take in-house call. The remainder of the time the fellows share "back-up" call from home on nights and weekends, acting as a resource for the core rotation fellows in the hospital. The primary responsibility of this fellow is to perform night and weekend echocardiograms and selected catheterizations under supervision of the appropriate staff cardiologist. Scheduling of clinical responsibilities is generally decided by the fellows themselves. There is always a second or third year fellow, or a senior clinical fellow with comparable experience, assigned to the cardiac catheterization laboratory and the ICU. In the cardiac catheterization laboratory, the fellows take increasing responsibility for organizing the daily laboratory schedule with a goal of performing hemodynamic cases independently and becoming more involved in interventional procedures. In the ICU, second and third year fellows perform many of the echocardiographic examinations and catheterize children as the schedule allows. There is always an experienced fellow on the consult service, providing cardiology consultation to Children's Hospital patients and infants at the affiliated neonatal units at Brigham and Women's Hospital and the Beth Israel/Deaconess Medical Center. This fellow sees all new referrals and provides continuing cardiology coverage on the floors and outpatient clinics as appropriate. In addition, the fellow may perform echocardiograms needed by the consult service. Rounds are conducted with the supervision of a staff cardiologist. During the second eighteen months of training there are opportunities for advanced rotations in echocardiography, electrophysiology, cardiac transplant medicine, intensive care medicine, adult congenital heart disease, and pathology. During these rotations the fellows assume broader responsibilities based on their interest and abilities. First Eighteen Months Echocardiography: 4 months (vacation) Cardiac Intensive Care: 3 Catheterization: 3 Inpatient: 2 Night Float: 2 Electrophysiology: 2 Consults: 1 Specialty Clinics/Adult Congenital: 1 8
  • 12. Second Eighteen Months Echocardiography: 3 months Cardiac Intensive Care: 2 Catheterization: 1 Pulmonary Hypertension/Transplant/Heart Failure (8S Call) 1 Electrophysiology (and Exercise): 1 Consults: ½ Research/Elective: 9 ½ (vacation) RESEARCH TRAINING The Department maintains that experience in cardiovascular research is an essential component of fellowship training in cardiology. In addition to their patient care responsibilities, fellows are expected to become involved in a clinical research project during the core rotations, under the guidance of one of the faculty. Such projects, either new or ongoing, are often of the chart review type, and may form the basis for a future prospective study for those fellows interested in clinical research. Fellows should identify a clinical or basic science research mentor from among the faculty by the end of the first year. The Fellows Research Committee assists fellows in identifying projects, resources, and monitors progress throughout fellowship training. More than one-half of the second eighteen months of fellowship are dedicated to ongoing research training. During the first half of the second year, it is expected that each fellow will, with appropriate guidance, write and submit a proposal for a research project which: (1) addresses an important question; (2) applies available state-of-the-art techniques to answering that question; and (3) is practical within the time and other constraints of the fellowship. The project may be either basic science or clinical; clinical research will in all probability entail a prospective study. Fellowship training in the Department beyond the third year is predicated on the identification of a suitable mentor and appropriate research project(s). The Department has an institutional NIH training grant, which permits selected fellows to train in basic research laboratories throughout the Harvard Medical Area, as well as in clinical research. Fellows are also encouraged to write individual grant applications, but fellowship funding is not dependent upon such grants being funded. Fellows interested in higher-level training in clinical research can take part in the Program in Clinical Effectiveness at the Harvard School of Public Health or the Scholars in Clinical Science Program at Harvard Medical School. SENIOR CLINICAL FELLOWSHIP TRAINING The department offers advanced clinical training in the major subspecialty disciplines of pediatric cardiology. This program is open to individuals who have completed much or all basic pediatric cardiology training at other institutions. In general, these trainees are funded by a sponsoring institution or grants, although some departmental resources are available. The period of training varies from 6 months to two years, based on individual needs. 9
  • 13. Senior clinical fellowships are available in cardiac catheterization, echocardiography, MRI, electrophysiology, cardiac intensive care, adults with congenital heart disease, and heart failure and transplantation. INFORMATION FOR FELLOWSHIP APPLICANTS Physicians seeking subspecialty training in pediatric cardiology are eligible to enter the program following a minimum of three (rarely two) years of internship and residency in pediatrics. Fellowship applicants are evaluated on the basis of (1) performance during medical school, residency and other postgraduate training, (2) letters of recommendation, and (3) clinical or basic science research experience, where applicable. Candidates are also asked to visit the Department for a series of interviews. Applications are best submitted at least 18 months prior to the anticipated start date, although positions may be available on shorter notice from time to time. Interested individuals are invited to contact Dr. Michael D. Freed, Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. Applicants for Senior Clinical Fellowships positions should contact Dr. Peter Lang, at the same address. The fellowship training program in pediatric cardiology and cardiovascular research at the Children’s Hospital participates in the Specialties Matching Services of the National Resident Matching Program. For 2007 appointments, applicant agreements will be available in October, 2005. A schedule of dates and other information can be obtained from: Specialties Matching Services National Resident Matching Program 2501 M Street, NW, Suite 1 Washington, DC 20037-1307 (202) 862-6077 www.nrmp.org HISTORY OF CARDIOLOGY AT CHILDREN'S HOSPITAL The cardiology program at Children's Hospital, among the oldest in the country, was founded in 1949 by Alexander S. Nadas. Just eleven years earlier, a major milestone had been achieved at Children's when Robert E. Gross ligated a patent ductus arteriosus in a young girl, the world's first successful surgery for congenital heart disease. Faced with the increasing numbers of patients with congenital heart disease who were being drawn to the Hospital as a result of Dr. Gross' achievement, Dr. Nadas began in earnest to build the rigorous program in pediatric cardiology that he was to head for 33 years. Dr. Nadas' program attracted a growing body of fellows, both pediatricians and internists, seeking experience in pediatric cardiology. The learning curve was steep for students and teachers alike. The training program was based on the strength of the clinical service and its contributions to the diagnosis, classification, and management of pediatric cardiovascular disease. The knowledge and 10
  • 14. experience accumulated at that time formed much of the infrastructure of modern pediatric cardiology, culminating in Dr. Nadas' first textbook published in 1957. The cardiology program at Children's grew rapidly during the next decade. This period was marked by the return of one of Dr. Nadas' first fellows, Donald C. Fyler, who initiated the New England Regional Infant Cardiac Program, the first study of its kind to prospectively document the incidence, natural history, and treatment outcome of structural heart disease. Indeed, with this and other work, the emphasis of the cardiology program expanded on its base of outstanding patient care to include substantial clinical and whole organ physiology research efforts. By the mid-1960s, Children's Hospital had become the largest center for pediatric cardiology in the United States, with fifteen staff physicians and as many fellows, and achieved national recognition for its cardiac research. In 1972, Dr. Gross was succeeded as chief of cardiac surgery by Aldo R. Castaneda, who pioneered infant and neonatal heart surgery for the early correction of congenital defects. Successes in the operating room were paralleled by rapidly advancing diagnostic and technical skills in cardiology that permitted earlier and more detailed diagnosis and improved survival. Through the efforts of Drs. Castaneda and Nadas, an extraordinarily cooperative working relationship was forged between the Cardiac Surgery and Cardiology Departments at Children's Hospital, a rapport that flourishes today. Following the retirement of Dr. Nadas in 1982, Bernardo Nadal-Ginard was appointed chairman of the Department of Cardiology. Dr. Nadal-Ginard's commitment to a strong basic science research effort in pediatric cardiology resulted in the development of an outstanding research group focusing on the most fundamental problems of cardiovascular biology. The Laboratory of Molecular and Cellular Cardiology established an international reputation in the vanguard of basic cardiovascular research. During Dr. Nadal-Ginard's tenure, the research division of the Department grew to include nearly forty investigators, comprising M.D. and Ph.D. faculty, postdoctoral fellows, and graduate students. The clinical service of the Department, including both patient care and clinical investigation, was also strengthened and expanded during this time. Critical to this process was the work of several well-qualified young cardiologists, including Dr. James E. Lock, who together have spearheaded highly productive efforts in experimental physiology, therapeutic innovation, and patient-based research. The first five decades of cardiology at Children's Hospital, therefore, have witnessed enormous progress in both clinical and research activities. The Department has remained a fertile training ground, having graduated more than 200 fellows. Many have become leaders in pediatric cardiology worldwide. With Dr. Lock's appointment as Cardiologist-in-Chief in 1993, the Department retains an unwavering commitment to patient care and clinical and basic research in pediatric cardiology. These efforts, and the training of outstanding young academic pediatric cardiologists, are fundamental to the mission of the Department. 11
  • 15. DEPARTMENT OF CARDIOLOGY TODAY The Department of Cardiology has over fifty staff physicians and scientists with faculty appointments at Harvard Medical School, over fifty clinical and research fellows, and a full complement of administrative and technical personnel. The faculty and fellows regularly attract major research support from granting agencies including the National Institutes of Health and the American Heart Association. They have also been the recipients of prestigious training and research awards and have been recognized with a number of named lectureships and visiting professorships. Children's Hospital is, today, a cardiac center of international stature, in the forefront of patient care, clinical innovation and research, and basic cardiovascular science. Approximately 1000 cardiac operations and 1600 cardiac catheterizations are performed annually, including the greatest number of pediatric interventional catheterizations in the world. In addition, there has been substantial growth of the physical plant. A new clinical building was dedicated in the spring of 2005. A cardiac imaging floor includes four new catheterization laboratories, a dedicated Magnetic Resonance Imaging suite, an inpatient echocardiography area as well as procedure rooms, and a ten bed recovery area. The cardiac intensive care unit moved to a new 24 bed floor. Three new operating suites are dedicated to the cardiovascular program. CARDIOLOGY INPATIENT SERVICE – 8 EAST Cardiac patients (excluding those requiring critical care) are admitted to a 28 bed cardiac floor of the hospital tower. The facility includes ECG telemetry with central monitoring, two fully equipped procedure rooms, interview rooms, space for parent rooming-in, and both physician and nursing conference rooms. The division is staffed by nurses dedicated to the care of children with heart disease. More than 1300 patients were admitted to 6 East in 2003, 60% of whom underwent surgery. The average daily census was 22.4 patients. The management of the cardiac medical patients is coordinated by the rotating first year cardiology fellow, who leads a team of three pediatric residents on the service. Teaching and supervision are provided by the attending cardiologist, rotating among Drs. Michael D. Freed, Jane W. Newburger, Peter Lang, Robert L. Geggel, and Roger E. Breitbart. Seven nurse practitioners, Patricia O'Brien, RN, MSN, PNP, Patricia Lawrence RN, MS, PNP, Meaghan Rull RN, MS, FNP, Clare O’Connor, RN, MS, PNP, Christine Hiller, RN, MS, CPNP, Amy Delaney, RN, MSN, CPNP and Jean Connor, DNSc, RN, CPNP coordinate the care of the children recovering from surgery and heart transplantation. 12
  • 16. CARDIAC INTENSIVE CARE UNIT—8 SOUTH The 24-bed Cardiac Intensive Care Unit treats approximately 1,200 patients with congenital and acquired cardiac disease each year. Full-time critical care cardiologists and intensivists work in close collaboration with cardiovascular surgeons, anesthesiologists, and nurses. Supervision and teaching is provided by two attending staff each day. The CICU staff are directly responsible for the perioperative care of all cardiac surgery patients in close collaboration with the cardiac surgery staff. In addition to the usual intensive care management, fellows develop an understanding of the variable pathophysiology and postoperative course for patients undergoing complex cardiac procedures. All forms of pharmacologic support, mechanical ventilation, mechanical support of the circulation (ECMO and VAD) and renal replacement therapies are used in the CICU. A wide spectrum of patients are managed in the CICU, including newborns to adults with congenital heart disease, and patients with acquired heart disease and heart failure, acute and chronic pulmonary hypertension, and following cardiac transplantation. Dr. Peter Laussen is the director of the CICU and staff include Dr. David Wessel, Dr. Ravi Thiagarajan, Dr. John Costello, Dr. Mary Mullen, Dr. Catherine Allan, Dr. James DiNardo, and Kristi Thomas, MS, RN. CARDIOLOGY OUTPATIENT SERVICE The outpatient service provides evaluation and follow-up care for more than 14,000 clinic visits yearly. The clinic at Children’s Hospital, located adjacent to the echocardiography and EKG laboratories on Farley 2, is the central site for the majority of these encounters. Each Fellow attends two half day sessions monthly, which includes the assessment of new patients with cardiovascular complaints as well as follow-up visits. Several staff cardiologists supervise these sessions and serve as resources for discussion related to these patients when clinics are not meeting. Two additional half days are spent in the clinics of a staff cardiologist. Sub-specialty clinics including lipid, transplant, myopathy, adult congenital, arrhythmia, pacemaker and genetics are held on a weekly basis. Arrangements may be made to participate in sub-specialty clinics during elective time and second year fellows have an outpatient rotation dedicated solely to these clinics. The outpatient program has expanded its focus with the establishment of satellite cardiology clinics throughout eastern Massachusetts. The current 11 sites are staffed by teams composed of a staff cardiologist, nurse, nurse practitioner and sonographer and meet at least once a month. Participation in these clinics provides an excellent opportunity for fellows to spend uninterrupted time with a senior cardiologist, evaluating a variety of cardiac problems. Fellows work with two different staff cardiologists on an alternating basis weekly. The director of the outpatient services is David R. Fulton, M.D. with coordination supplied by Cheryl O’Connell, R.N., and Betty Brown, R.N. 13
  • 17. CARDIOLOGY CONSULTATION SERVICE The Cardiology Consult Service performs approximately 1800 consults annually. Consults are requested from three active nurseries (Children’s 7 North, Brigham & Woman’s Hospital, and Beth Israel/Deaconess Hospital) as well as from the emergency room and the various in-patient services at Children’s Hospital. This rotation provides excellent exposure to cardiac issues associated with general medical conditions. Consults are evaluated by a fellow (second, third, or fourth year level) and an attending staff cardiologist. Consults are seen on the day of the request. The night float assumes responsibilities for consults after 7:00 PM on weeknights. The 6 East fellow performs consults on weekends. Appropriate cardiac testing (electrocardiography, echocardiography, cardiac catheterization) is performed by the divisions of the Department of Cardiology. The fellow is responsible for preparing a monthly conference at which consult activities are reviewed. HEART FAILURE/TRANSPLANTATION The Heart Failure/Transplantation Program at Children's Hospital, Boston, is a jointly administered program of the Cardiology and Cardiac Surgery Departments, under the direction of Dr. John E. Mayer (Surgical Director), Dr. Elizabeth D. Blume (Medical Director) and Transplant Coordinator Heather Bastardi, RN, MSN, PNP. The Program is staffed by two additional nurses and transplant cardiologists, T.P. Singh, M.D. and Leslie Smoot, M.D. All the cardiac surgical staff participate in patient evaluation and transplant surgery. The Program consists of a multidisciplinary team of consultants from nursing, social work, infectious disease, and psychiatry as well as other allied health professionals. The service evaluates and manages patients with end-stage heart failure secondary to cardiomyopathy or congenital heart disease for potential candidacy for heart transplant. Since its inception, the team has transplanted >150 patients. The Program is responsible for the pre-, peri-, and postoperative management of the recipients. Multidisciplinary Transplant Conference occurs weekly and Solid Organ Transplant Conference is held monthly. Fellows participate in the care of these patients on all of their first year rotations including pre-operative management on the medical floor, post-operative care in the cardiac intensive care unit, routine endomyocardial biopsies in the cardiac catheterization laboratory, and function surveillance by echocardiography. Second and third year fellows are encouraged to rotate on the heart failure/transplant service as an elective. BOSTON ADULT CONGENITAL HEART (BACH) AND PULMONARY HYPERTENSION SERVICE The Boston Adult Congenital Heart Service is a multi-institutional (Children's Hospital/Brigham and Women's Hospital) inpatient and outpatient program designed to provide for the long-term care of patients with congenital heart disease or pulmonary hypertension as they reach and progress through adulthood. On a monthly basis, either Drs. Michael Landzberg, Mary Mullen or Laurence Sloss with the assistance of Disty Pearson, PA-C, Caitlyn O’Brien, PA-C, and Susan M. Fernandes, PA-C and Drs. Alison Knauth and Michael Singh is responsible for the inpatient BACH service 14
  • 18. (cardiovascular service admissions and consultations on all adult patients with congenital heart disease) and acts in concert with the medical teams. Drs. John Mayer, Pedro Del Nido, Lawrence Cohn, Tom Mihaljevic and John Byrne as well as Drs. Peter Lang and Edward Walsh participate in weekly patient care oriented conferences. Outpatient care is provided in a specialty clinic at both participating institutions. Cardiology fellows participate during medical inpatient and cardiac ICU rotations. Senior clinical electives are encouraged. CARDIAC CATHETERIZATION The Cardiac Catheterization Laboratory comprises five state-of-the-art angiographic suites, installed between 1991 and 2005. The laboratory is staffed by Drs. James E. Lock, Michael J. Landzberg, Peter Lang, Audrey C. Marshall, and Lisa T. Bergersen. In addition, Drs. Edward P. Walsh, John K. Triedman, Charles I. Berul, Mark E. Alexander, Laura M. Bevilacqua and Frank Cecchin staff electrophysiologic studies and ablations. Approximately 1500 cardiac catheterizations were performed last year, at least 55% of which were interventional. Interventional procedures performed include balloon valvotomy of mitral pulmonary and aortic valves, including infants with critical pulmonary and aortic valvar stenoses; balloon angioplasty of coarctation of the aorta and pulmonary artery stenosis; transcatheter closure of PDAs, PFOs, ASDs, VSDs, Fontan fenestrations and aortopulmonary collaterals; stent placement in pulmonary arteries, aortic coarctations and venous obstructions; endocardial biopsies; and radiofrequency ablation of bypass tracts. A cardiology fellow is assigned to each catheterization, under the guidance of one of the staff cardiologists. In addition to participating fully in all aspects of the procedure itself, the fellow evaluates the patients prior to catheterization, obtains consent, reviews the previous data and angiograms at the morning precath conference, interprets the hemodynamic data and angiograms from the study, and summarizes the results in a formal report for the patient record. ELECTROPHYSIOLOGY The electrophysiology service includes Drs. Edward P. Walsh (Chief), John K. Triedman, Charles I. Berul, Mark E. Alexander, Laura Bevilacqua and Frank Cecchin. The team is further supported by four full-time nurse specialists experienced in the care of young patients with arrhythmia and pacemaker issues. Cardiology fellows rotate through the service during both the first and second year, and there are positions for senior clinical fellows to obtain more intense electrophysiology training during their third and/or fourth years. The division is directly involved in the care of all inpatients and outpatients with cardiac arrhythmias, including those in the cardiac intensive care unit. There is a dedicated electrophysiology catheterization suite with state-of-the-art recording and ablation equipment where over 400 procedures are performed annually. Non-invasive rhythm evaluation by Holter monitor monitoring, event recording, signal averaged ECG, T-wave alternans analysis, tilt-table testing, and 15
  • 19. esophageal EP testing are included in the division's activities. Outpatient care is delivered in specialized arrhythmia and pacemaker clinics which meet three days per week. The division's research activities span a broad range of interests, including the molecular genetics of arrhythmias, autonomic physiology, computer modeling of reentry circuits, whole-animal mapping and ablation studies, as well as human clinical protocols for the development and testing of catheters, drugs, and anti-tachycardia devices. Fellows at all levels of training are invited to participate in these ongoing projects. ECHOCARDIOGRAPHY The Department's echocardiography laboratory is staffed by Drs. Steven D. Colan (Director), David W. Brown, Adam L. Dorfman, Tal Geva, Ronald V. Lacro, Jami C. Levine, Renee E. Margossian, Gerald R. Marx, Sharon E. O'Brien, Andrew J. Powell, Marcy L. Schwartz, Elif Seda S. Tierney, Wayne Tworetzky and Rachel D. Wald. It is an active facility with state-of-the-art technology for 3D, 2D and M-mode echo, pulsed, continuous wave, and color Doppler. Instrumentation includes six Philips Sonos 7500 cardiac imagers, four Philips Sonos 5500 cardiac imagers, one Accuson Sequoia, a PC-based off line analysis system developed in- house for M-mode, 2D, and Doppler analysis, a commercial 3-D image reconstruction workstation, and a sophisticated video editing and image processing system for creating and editing still and video images. The laboratory has recently implemented a digital image capture and archiving system to digitally record full-length echocardiographic exams and make them available via intranet throughout the institution. Laboratory personnel include 15 full time pediatric ultrasound technicians. The laboratory is certified by the Intersocietal Commission for the Accreditation of Echocardiographic Laboratories for pediatric transthoracic, transesophageal, and fetal imaging. Approximately 16,000 2D - Doppler echocardiograms (including 1400 fetal studies) are performed annually. We have a sustained annual growth rate of 10% per year over the past 18 years. In addition to clinical evaluations, the laboratory participates in numerous research protocols, including evaluation of ventricular function parameters in a variety of congenital and acquired heart diseases, evaluation of the utility and reliability of noninvasive imaging and Doppler in diagnosis and outcome determination, and evaluation of new and emerging technology such as 3-dimensional echocardiography and tissue Doppler. Cardiology fellows take an active role in performing and interpreting the full range of studies in the echocardiography laboratory (including transesophageal and fetal exams for the senior clinical fellows), initially under the supervision of experienced technologists, senior clinical fellows, and staff echocardiographers. Over time, fellows are incorporated into the emergency echocardiography process and eventually also participate in teaching and training the junior fellows. EXERCISE PHYSIOLOGY The exercise laboratory performs more than 1200 treadmill and bicycle tests annually, supervised by Drs. Jonathan Rhodes and Mark Alexander. The laboratory is equipped with a treadmill, a 16
  • 20. bicycle ergometer, ability to measure microvolt t-wave alternans, transcutaneous oxygen saturation monitor, blood pressure recording devices and a state-of-the-art computer-based, breath by breath expired gas analysis system for the measurement of oxygen consumption, carbon dioxide production, and anaerobic threshold. There are two graduate exercise physiologists on staff who perform the studies. Cardiac fellows participate in the exercise laboratory's activities during their electrophysiology rotation. During this time, they learn about the physiology of exercise, the methodology of exercise testing, and the potential uses of this technology. Research activities are available and encouraged. CARDIOVASCULAR MAGNETIC RESONANCE IMAGING The cardiovascular magnetic resonance imaging (MRI) program was established in 1995 and has experienced rapid growth in its clinical activities. In 2005, the program moved to the new clinical expansion building (Main South) where it operates a dedicated state-of-the-art 1.5T cardiac MRI scanner. Cardiac MRI examinations are performed in patients ranging in age from newborns to adults and include evaluation of cardiovascular anatomy, ventricular function, flow quantification, and myocardial perfusion and viability. The clinical volume has increased over the years with 700 cardiac MRI studies performed in 2005. Training in cardiovascular MRI is an integral part of the training curriculum of the Non-Invasive Division. Fellows participate in the clinical activities of the cardiac MRI program and attend a weekly conference. Advanced training (senior fellowship) is available. Research activities in cardiac MRI include clinical and laboratory projects. Fellow participation in MRI research is encouraged. COMPUTING FACILITY The Cardiology Department operates a local area network (LAN) of over 200 personal computers and printers, connected by network to cardiology servers as well as the central Oracle servers on which the hospital ISD is based. Personal computers provide desktop services such as word processing, spread sheets, graphics, statistics, literature searches, and e-mail as well as high speed internet access. Diagnostic digital images including x-rays, echocardiograms, and catheterizations are available on PCs and workstations throughout the hospital. Secure access to the network may be obtained from outside the Hospital. Four computer support personnel are dedicated to Cardiovascular Program personnel. Computer training is available through both the department and the hospital. An extensive historical electronic database with diagnostic and procedural codes has been accumulated to assist with clinical care and research. CLINICAL RESEARCH A considerable clinical research infrastructure in the Department of Cardiology supports the following functions: (1) to educate fellows and faculty with respect to study design, data analysis, and computer usage; (2) to facilitate implementation of protocols for research projects that require extensive data entry and coordination of patients or services; (3) to function as a resource for 17
  • 21. fellows who need information on grant applications; and (4) to maintain an active list of clinical projects that are ongoing or planned in the department. Administrative staff includes coordinators of grants and patient follow-up, study nurses, computer programmers, statisticians, and data entry personnel. Faculty members from all divisions in the Department of Cardiology lead or participate in prospective, multi-disciplinary and/or multi-center studies. Examples of such studies (ongoing or soon to begin) include: • A multi-center, open label study of Bosantan in patients with pulmonary hypertension (Drs. Mullen and Landzberg) • A prospective randomized trial of hemodilution strategy during cardiopulmonary bypass in infants undergoing corrective open heart surgery (Drs. Newburger and Laussen) • A prospective randomized trial of steroids in Kawasaki disease (Drs. Newburger, Fulton, and Colan) • The relationship between functional health status and laboratory parameters of ventricular performance after the Fontan procedure (Drs. Colan and Newburger) • Pediatric cardiomyopathy registry (Dr. Colan) • Role of chelation therapy in the treatment of cardiac dysfunction inpatients with thalassemia (Dr. Colan) • A multi-center placebo-controlled, randomized trial on carvedilol in children with symptomatic systemic ventricular dysfunction (Dr. Blume) • Noninvasive studies of autonomic control in normal children and adolescents and patients with active or potential cardiovascular pathology (Drs. Alexander and Triedman) • Use of anti-neoproliferative agents in children with refractory pulmonary vein stenosis (Dr. Jenkins) • Multi-center study on risk factors for sudden death after repair of tetralogy of Fallot (Dr. Walsh) • Mechanisms of right ventricular dysfunction due to chronic pulmonary regurgitation, as assessed with cardiac MRI (Drs. Geva and Powell) • A prospective randomized study evaluating use of the Cutting Balloon to treat refractory PA stenosis (Drs. Jenkins, Bergersen and Lock) DEPARTMENT OF CARDIAC SURGERY Five cardiovascular surgeons, Drs. Pedro J. del Nido (Chairman); John E. Mayer, Jr.; Frank A. Pigula; Emile Bacha and Francis Fynn-Thompson perform more than 1000 operations a year. The complexity of the cases covers a broad range and represents the state-of-the-art congenital heart surgery. A chief resident and four to five senior residents and fellows train in the Department. The Department of Cardiac Surgery also has an active research laboratory conducting both basic and bench to bed-side research including projects in the area of tissue engineering of heart valves and conduction tissue, myocardial metabolism in hypertrophy and heart failure, and image- guided intervention including surgical robotics. The Department has several post-doctoral 18
  • 22. research fellows, including MDs and PhDs and participates in the National Research Service Training Program of the Department of Cardiology. The Departments of Cardiology and Cardiac Surgery enjoy a cooperative, constructive working relationship at Children’s Hospital Boston. Joined efforts are an integral part of patient care, teaching and research. Several weekly combined conferences are held. The Cardiology Fellows are encouraged to spend time in the operating room where they are given every opportunity to view surgical anatomy and reconstructive procedures. DIVISION OF CARDIAC ANESTHESIA Ten attending cardiac anesthesiologists and five or six anesthesia fellows provide coverage each day for the cardiac operating rooms, cardiac catheterization laboratory, procedures in the CICU and cardiac MRI facility, as well as a consult service to evaluate and manage patients with cardiac disease undergoing non-cardiac surgery. The active areas of clinical investigation within the Division of Cardiac Anesthesia include control of cerebral blood flow and oxygenation in patients with congenital heart disease and during cardiopulmonary bypass, CNS monitoring and brain injury and protection during CPB, etiology and the pathophysiology of coagulation abnormalities in CHD patients and during CPB. The Division also maintains an active basic science and translational laboratory research program. Current areas of focus include bioengineering of cardiac conduction tissue, effects of hypoxia and abnormal flow upon endothelial function, myocardial inflammatory signaling, functional and energetic consequences of abnormal pressure loading of the infant fight and left ventricle and the genetic basis, mechanisms, and sequelae of the infant inflammatory response to CPB. Many of these projects are conducted in collaboration with attending and fellow staff in the Department of Cardiology and Cardiac Surgery. Cardiology fellows are also welcome to spend an elective clinical month as a fellow in pediatric cardiac anesthesiology. CARDIAC REGISTRY The Cardiac Registry is an internationally renowned resource for training and research in the pathologic anatomy of congenital heart disease. The Cardiac Registry collection consists of more than 3600 cases of congenital heart disease and 190 cases of acquired heart disease. In addition to the formalin-fixed cases of heart disease, there are 75 waxed heart specimens that are unparalleled for three-dimensional representation of the anatomy. There is also a collection of normal hearts, important for quantitation, from prematurity to adulthood. A series of teaching videotapes entitled Diagnostic and Surgical Pathology of Congenital Heart Disease (directed by Richard Van Praagh, M.D. and Stella Van Praagh, M.D.) is available for review. The Registry also has a library of relevant journals, textbooks, and theses. 19
  • 23. The Cardiac Registry is a unique, fully integrated teaching and research resource for congenital heart disease. The Heart Collection is now non-renewable and irreplaceable because large unoperated examples of virtually all forms of congenital heart disease are no longer seen at autopsy in this country. The specimens of the Heart Collection have been saved over the past half-century and represent all eras of pediatric cardiology and cardiac surgery - from presurgical, to closed heart, to open heart. Clinical summaries are available for most cases, which allows for an appreciation of the evolution of management strategies for congenital heart malformations. Fellows are encouraged to make full use of the Cardiac Registry throughout their training. An intensive anatomy overview course is offered each July. Formal teaching conferences are given each week that focus on specific malformations in depth. Additional conferences correlating anatomy in the clinical settings of the ICU and echo lab are also held weekly. Individual sessions on topics of interest and concern can be arranged. Fellows may also spend elective time in the Registry. The Cardiac Registry is an ideal correlation center between cardiac pathology and all imaging modalities. CARDIAC PHYSIOLOGY RESEARCH FACILITY The Cardiac Physiology Research Laboratory is the large animal laboratory for the Departments of Cardiology and Cardiac Surgery. This laboratory occupies more than 3,000 square feet of space, comprising three fully equipped surgical suites with cardiopulmonary bypass capability, two recording laboratories, and the Kresge Laboratory, a state of the art research imaging facility with digital monoplane fluoroscopy, and electrophysiologic and ultrasonic graphic recording equipment. An extensive array of computer interfaced instrumentation is available for recording and analysis of physiological data. There is adjacent to this space the facilities of ARCH (Animal Resources at Children’s Hospital), a veterinarian supervised facility for the care and boarding of experimental animals. Topics currently under investigation include the effects of different cardioplegia solutions and perfusion pressures on myocardial preservation, mechanisms of cerebral damage during bypass in neonatal animals, studies on the role of calcium and other second messengers and the affects of ischemia on immature myocardium, development of tissue engineered prosthetic cardiac valves and robotic techniques in cardiovascular surgery, and design and evaluation of electrophysiologic mapping techniques. LABORATORY OF MOLECULAR AND CELLULAR CARDIOLOGY: http://clapham.tch.harvard.edu/ The Laboratory of Molecular and Cellular Cardiology occupies more than 8,000 square feet on the 13th floor, and 5,000 square feet on the 12th floor of the Enders Research Building, including centrally organized core facilities. Dedicated equipment supports state-of-the-art techniques in molecular biology, protein biochemistry, microscopy and imaging, and basic electrophysiology, genetics, and regeneration. 20
  • 24. The molecular biology facilities are extensive. Other techniques are well supported including the use of transgenic mice, gene chip analysis, the yeast two-hybrid system, expression cloning, cDNA cloning, and site-directed mutagenesis. Basic protein biochemistry is also a major component of work. FPLC, cold rooms, and electrophoresis apparatus are used in these endeavors. The laboratory maintains its own computer network compromising a network linking Mac, PC and Unix machines. Extensive equipment supporting basic cardiac electrophysiology and imaging includes eight patch- clamp electrophysiology setups, an Olympus confocal microscope adapted for tissue slice work by using multiphoton illumination, a Zeiss confocal laser scanning microscope (LSM-410) adapted for two-photon imaging and caged release, conventional fluorescence microscopes, and evanescent field (TIRF) microscopy. 21
  • 25. CARDIOLOGY, CARDIAC SURGERY and CARDIAC ANESTHESIA FACULTY (Alphabetical Listing) MARK E. ALEXANDER, M.D. Associate in Cardiology, Children’s Hospital, and Instructor in Pediatrics, Harvard Medical School Dr. Alexander is a member of the arrhythmia service with particular interest in the mechanisms and consequences of syncope. Following initial pediatric training and five years of general pediatric practice with the U.S. Army, he completed fellowship in Pediatric Cardiology and Electrophysiology at Children’s Hospital. He directs the non-invasive electrophysiology program and assists with the exercise laboratory. Current research focuses on the role of circulatory control in Chronic Fatigue, fetal arrhythmias, risk assessment for ventricular arrhythmias in patients with congenital heart disease and assisting with evaluation of modern pacemaker and implantable defibrillator use on pediatric and congenital heart patients. Dr. Alexander’s recent publications include: Fortescue EB, Berul CI, Cecchin F, Walsh EP, Triedman, JK, Alexander ME. Patient, Procedural, and Hardware Factors Associated with Pacemaker Lead Failures in Pediatrics and Congenital Heart Disease. Heart Rhythm, 2004, Vol 1/2 pp 150-159. Alexander ME, Cecchin F, Triedman, JK, Walsh EP, Berul CI. Implications of ICDs in Pediatrics and Congenital Heart Disease, J of Cardiovascular Electrophysiology 2004, 15 (1):72-176. Alexander, Mark E. Ventricular Arrhythmias in Cardiac arrhythmias in children and young adults with congenital heart disease. Ed. Walsh, EP, Saul, JP, Triedman, JK. Lippincott, Williams & Wilkins, Philadelphia, 2001. Alexander, ME, Berul, CI: Ventricular Tachycardia. E-medicine Pediatrics. www.emedicine.com Alexander, Mark E., Triedman, JK, Saul, JP, Epstein, MR ,Walsh, EP. Value of Programmed Ventricular Stimulation in Patients with Congenital Heart Disease. J Cardiovascular Electrophysiology, 10, pp 1033-1044, 1999. Saul, JP, Alexander, ME. Reflex and mechanical aspects of cardiovascular development: Techniques for assessment and implications. J of Electrocardiography. 30 (suppl), 57-63, 1998. Cook BA, Nomizu S, Alexander ME, Bass JW. Sedation of children for technical procedures: current standard of practice. Clinical Pediatrics (Phila), 1992 Mar; 31 (3):137-42. CATHERINE K. ALLAN, M.D. Assistant in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Allan is a member of the cardiac critical care division. She completed her pediatric cardiology training and a senior fellowship in cardiac critical care at Children’s Hospital, Boston in 2005. Her research focuses on understanding the complex interplay of cytokines and chemokines that contribute to the inflammatory reaction to cardiopulmonary bypass. She also does research on outcomes of support of the failing circulation with extracorporeal membrane oxygenation. Recent publications include: 22
  • 26. Allan CK, Thiagarajan RR, Armsby LR, del Nido PJ, Laussen PC. Emergent use of extracorporeal membrane oxygenation during pediatric cardiac catheterization. Pediatric Crit Care Med. In Press. Costello, JM, Thiagarajan RR, Dionne RE, Allan CK, et al. Initial experience with fenoldopam after cardiac surgery in neonates with an insufficient response to conventional diuretics EMILE BACHA, M.D. Senior Associate in Cardiac Surgery, Children’s Hospital and Associate Professor of Surgery Harvard Medical School Dr. Bacha trained in cardiothoracic surgery at the Massachusetts General Hospital and Children's Hospital. He was then an Instructor in Surgery at Children's in 1999. From 2000-2005, he was the Director of Pediatric Cardiac Surgery at the University of Chicago Children's Hospital. Dr Bacha's primary responsibility involves surgery for complex congenital heart disease. His research interests include Human Factors in patient safety, the development of new hybrid techniques, multi-site pacing and minimally invasive surgery. Selected recent publications: Bacha EA, Cao QL, Starr JP, Waight D, Ebeid MR, Hijazi ZM. Perventricular device closure of muscular ventricular septal defects on the beating heart: Technique and results. Journal of Thoracic and Cardiovascular Surgery 2003; 126;1718-23 Bacha EA, Zimmerman F, Mor-Avi V, Weinert L, Sugeng L, Starr JP, Lang R. Ventricular resynchronization by multisite pacing improves myocardial performance in the post-operative single ventricle patient. Ann Thor Surg 2005, 78:1678-83. Bacha EA, Daves S, Hardin J, Abdulla R, Anderson J, Kahana M, Koenig P, Mora BN, Gulecyuz M, Starr JP, Alboliras E, Sandhu S, Hijazi ZM. Single Ventricle Palliation for High-Risk Neonates: The Emergence of an Alternative Hybrid Stage I Strategy. J Thor Cardiovasc Surg 2006;131:163-171 Galvan C, Bacha EA, Mohr J, Barach P. Analysis of human factors during complex infant cardiac surgical repairs. Progress in Pediatric Cardiology 2005; 20:13-20 Bacha EA, Hijazi ZM. Hybrid procedures in pediatric cardiac surgery. Seminars in Thoracic and Cardiovascular Surgery, Pediatric Cardiac Surgery Annual 2005;8:78-85 LISA J. BERGERSEN, M.D. Assistant in Cardiology, Children's Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Bergersen is a member of the interventional catheterization division. She completed her pediatric interventional catheterization training at Children's Hospital Boston in 2004. She is developing skills in clinical study design and in performing outcomes studies for procedures used in the catheterization laboratory. Recent publications include: Bergersen LJ, , Perry, SB, Lock JE. Effect of cutting balloon angioplasty on resistant pulmonary artery stenosis. Am J Cardiol 2003;91:1-5. Bergersen L, Jenkins K, Gauvreau K, Lock J. Follow-up results of Cutting Balloon angioplasty used to relieve stenoses in small pulmonary arteries. Cardiol Young. 2005;15-605-10. Bergersen L, Gauvreau K, Lock J, Jenkins K. Recent results of pulmonary artery angioplasty: the differences between proximal and distal lesions. Cardiol Young. 2005;15:597-604. 23
  • 27. Bergersen L, Lock J. Pulmonary artery stenoses, angioplasty, stenting, or cutting balloon: what is the current treatment of first choice? A review. 2006 Cardiology in the Young, in press. Bergersen L, Nugent A, Keane J, Gauvreau K, Lock J, Jenkins K. Adverse event rates for pediatric cardiac catheterization procedures of high-risk populations. Abstract presented at the Eastern and National SPR annual meeting, March and May, 2005. Bergersen L, Nugent A, Keane J, Gauvreau K, Lock J, Jenkins K. Pediatric interventional catheterizataion: development of a risk adjustment model for preventable complications. Abstract presented at the Eastern and National SPR annual meeting, March and May, 2005. CHARLES I. BERUL, M.D. Senior Associate in Cardiology, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Berul is a member of the Electrophysiology Division, with specific clinical and research interests in hereditary arrhythmias. He completed his training in Pediatrics at Yale, followed by Pediatric Cardiology and Electrophysiology at the Children’s Hospital of Philadelphia. He is director of the pacing and defibrillator program at Children’s Hospital and his clinical areas of expertise include pacemaker and ICD implantation and follow-up, interventional electrophysiology, long QT syndromes and cardiac evaluation of the athlete. Dr. Berul also is an active researcher, and is the principal investigator of the mouse electrophysiology core laboratory, involving studies on genetically-manipulated mice Dr. Berul’s recent publications include: Zupancic JAF, Triedman JK, Alexander M, Walsh EP, Richardson DK, Berul CI. Cost-effectiveness and implications of newborn screening for QT prolongation for prevention of SIDS. J Pediatr 2000;136:481-489. Wakimoto H, Maguire CT, Kovoor P, Gehrmann J, Berul CI. Induction of atrial tachycardia and fibrillation in the mouse heart. Cardiovasc Res 2001;50:463-473. Love BA, Triedman JK, Alexander ME, Bevilacqua LM, Epstein MR, Triedman JK, Walsh EP, Berul CI. Supraventricular tachycardia in children and young adults with implantable cardioverter debrillators. Journal of Cardiovascular Electrophysiology 2001;12:1097-1101. Berul CI, McConnell BK, Wakimoto H, Moskowitz IPG, Maguire CT, Semsarian C, Vargas MM, Gehrmann J, Seidman CE, Sediman JG. Ventricular arrhythmia vulnerability in cardiomyopathic mice with homozygous mutant myosin biding protein C gene. Circulation 2001;104-2734-2739. Wakimoto H, Kasahara H, Maguire CT, Izumo S, Berul CI. Developmentally modulated cardiac conduction failure in transgenic mice with fetal or postnatal overexpression of DNA non-binding mutant Nkx2.5. Journal Cardiovascular Electrophysiology 2002;13:682-688. Stephenson EA, Collins KK, Dubin AM, Epstein MR, Hamilton RM, Kertesz NJ, Alexander ME, Cecchin F, Triedman JK, Walsh EP, Berul CI. Circadian and seasonal variation of malignant arrhythmias in a pediatric and congenital heart disease population. Journal Cardiovascular Electrophysiology 2002;13:1009-1014. Patel VV, Ardad M, Moskowitz IPG, Maguire CT, Branco D, Seidman JG, Seidman CE, Berul CI. Electrophysiological characterization and postnatal development of ventricular preexcitation in a mouse model of cardiac hypertrophy and Wolff-Parkinson-White syndrome. Journal American College Cardiology 2003;42:948- 957. 24
  • 28. LAURA M. BEVILACQUA, M.D. Assistant in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Bevilacqua is a member of the arrhythmia service. Her pediatric cardiology training was at Babies’ and Children’s Hospital of New York (Columbia Presbyterian Medical Center), followed by additional training in electrophysiology at Children’s Hospital, Boston. During her training, Dr. Bevilacqua conducted basic science laboratory work evaluating electrophysiologic phenotypes in transgenic mice. Her primary research interests include mechanisms of ventricular tachycardia in mouse models of hypertrophic cardiomyopathy. Dr. Bevilacqua’s recent publications include: Bevilacqua LM, Maguire CT, Seidman CE, Seidman JG, Berul CI. QT Dispersion in alpha-MHC familial hypertrophic cardiomyopathy mice. Pediatr Res 1999;45:643-647. Maguire CT, Bevilacqua LM, Wakimoto H, Gehrmann J, Berul CI. Maturational atrioventricular nodal physiology in the mouse. J Cardiovasc Electrophysiol 2000;11(5):557-563. Bevilacqua LM, Rhee EK, Epstein MR, Triedman JK. Focal Ablation of chaotic atrial rhythm in an infant with cardiomyopathy. J Cardiovasc Electrophysiol 2000;11(5):577-591. Bevilacqua LM, Berul CI. Familial Hypertrophic Cardiomyopathy Genetics, in Molecular Genetics of Cardiac Electrophysiology. Eds. Berul CI and Towbin JA. Kluwer Academic Publishers, Norwell, MA, 2000. Bevilacqua LM, Simon AM, Maguire CT, Gehrmann J, Wakimoto H, Paul DL, Berul CI. A targeted disruption in connexin40 leads to distinct atrioventricular conduction defects. JICE 2000;4:459-467. ELIZABETH D. BLUME, M.D. Associate in Cardiology, Children’s Hospital and Assistant Professor in Pediatrics, Harvard Medical School Dr. Blume is the Medical Director of the Heart Failure/Transplant Program at Children's Hospital, Boston. Her clinical and administrative efforts are focused on a growing end-stage failure and heart transplant population. Her research interests include the medical management of heart failure and the use of ventricular assist devices in pediatric patients. Dr. Blume’s recent publications include: DeMaso DR, Kelley SD, Bastardi H, OBrien P, Blume ED. The Longitudinal Impact of Psychological Functioning, Medical Severity, and Family Functioning in Pediatric Heart Transplantation. J of Heart Lung Transplant, 2004; 23(4):473-480. Rosenthal D, Chrisant MRK, Edens E, Mahony L, Canter C, Colan S, Dubin A, Lamour J, Ross R, Shaddy R, Addonizio, Beerman L, Berger S, Bernstein D, Blume ED et al. Practise Guidelines for Management of Heart Failure in Children. J Heart Lung Transplant, 2004; 23(12); 1313-1333. ED Blume, CE Canter, R. Spicer, SD Colan, K Jenkins. Prospective multi-center protocol of adjunct carvedilol in pediatric patients with moderate ventricular dysfunction. Pediatric Cardiology. In press 2005. SA Webber, P Bowan, D. Naftel, FJ Fricker, ED Blume, L Addonizio, J Kirklin, CE Canter. PTLD: Experience with 56 cases at 19 pediatric heart transplant centers. Lancet. 2006 Jan 21;367(9506):233-9 25
  • 29. ROGER E. BREITBART, M.D. Associate in Cardiology, Children's Hospital and Assistant Professor of Pediatrics, Harvard Medical School Dr. Breitbart's laboratory research interests have focused on mechanisms of cardiac gene regulation, and on the application of genomic strategies for identification of novel molecular pathways in the cardiovascular system. From 1996-2002 he headed the cardiovascular drug target discovery programs at Millennium Pharmaceuticals, Inc., in Cambridge, MA. Current research focuses on strategies to identify novel disease genes in congenital heart disease, particularly tetralogy of Fallot, and to elucidate genotype-phenotype correlations. Dr. Breitbart is the acting medical director of the cardiology inpatient ward service. His principal clinical activities involve the inpatient management of children referred with complex congenital heart disease. Recent publications include: Donoghue M, Hsieh F, Baronas E. Godbout K, Gosselin M, Stagliano N, Donovan M. Woolf B. Robison K, Jeyaseelan R, Breitbart RE, Acton S. A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin 1 to angiotensin 1-9. Circ Res 2000;87:E1-9 Acton S, Jeyaseelan R, Kadambi VJ, Breitbart RE. Array transcription profiling: molecular phenotyping of rodent cardiovascular models. In: Hoit BD, Walsh RA, eds. Cardiovascular Physiology in the Genetically Engineered Mouse, 2nd Ed. Boston: Kluwer, 2002:53-61. Herman MP, Sukhova GK, Libby P, Gerdes N, Tang N, Horton DB, Kilbride M, Breitbart RE, Chun M, Schoenbeck U. Expression of neutrophil collagenase (matrix metalloproteinase-8) in human atheroma: a novel collagenolytic pathway suggested by transcriptional profiling. Circulation 2001;104:1899-1904. Donoghue M, Wakimoto H, Maguire CT, Acton S, Hales P, Stagliano N, Fairchild-Huntress V, Xu J, Lorenz JN, Kadambi V, Berul CI, Breitbart RE. Heart block, ventricular tachycardia, and sudden death in ACE2 transgenic mice with downregulated connexins. J Mol Cell Cardiol 2003;35:1043-1053. Rodrigue-Way A, Burkhoff D, Geesaman BJ, Golden S, Xu J, Pollman MJ, Donoghue M, Jeyaseelan R, Houser S, Breitbart RE, Marks AR, Acton S. Sarcomeric genes involved in reverse remodeling of the heart during left ventricular assist device (LVAD) support. J Heart Lung Transplant. In press. Cua CL, Sanghavi D, Voss S, Laussen PC, del Nido P, Marshall AC, Breitbart RE. Right ventricular pseudo- aneurysm after modified Norwood procedure. Ann Thor Surg. 2004;78:E72-E73. DAVID W. BROWN, M.D Assistant in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Brown attended Williams College and subsequently Harvard Medical School and completed pediatric residency and pediatric cardiology fellowship training at Childrens Hospital, including a senior fellowship year in the non-invasive laboratory. His primary interests include transthoracic, transesophageal, and fetal echocardiography in the management of congenital heart disease, with special interest in the evaluation of patients with single ventricles. He is currently conducting a prospective study comparing cardiac MRI with cardiac catheterization in the evaluation of patients prior to superior cavo-pulmonary anastomosis. In addition to echocardiography, Dr. Brown serves as the cardiology liaison at Childrens Hospital for several pediatric cardiologists throughout New England. Publications include: 26
  • 30. Brown D, Gauvreau K, Moran A, Jenkins K, Perry S, del Nido P, Colan S. Clinical Outcomes and Utility of Cardiac Catheterization Prior to Superior Cavo-pulmonary Anastomosis. J Thorac Cardiovasc Surg 2003; 26:272-81. ALFONSO CASTA, MD Senior Associate in Cardiac Anesthesia, Children’s Hospital Boston, Lecturer on Anaesthesia, Harvard Medical School Dr. Casta received his undergraduate and medical degrees from the University of Puerto Rico. He completed a fellowship in Pediatric Cardiology at St. Christopher’s Hospital for Children. He was an Associate Professor in Pediatrics at the University of Texas Medical Branch at Galveston for eleven years. Later he completed an anesthesia residency at the University of Texas Medical Branch at Galveston. Before joining the Department of Anesthesia at Children’s Hospital in Boston, he completed a fellowship in Pediatric Anesthesia at Children’s Hospital in Boston. He is a Diplomat of the American Board of Pediatrics, Sub Board of Cardiology and the American Board of Anesthesiology. His clinical focus is to provide anesthesia for children with various congenital cardiac diseases. Selected publications: Casta A, Gruber EM, Laussen PC, McGowan FX, Odegard KC, Zurakowski D, Hansen DD. Parameters associated with perioperative baffle fenestration closure in the Fontan operation. J Cardiothorac Vasc Anesth. 2000; 14(5):553- 6. Chrysostomou C, Di Filippo S, Manrique AM, Schmitt CG, Orr RA, Casta A, Suchoza E, Janosky J, Davis PJ, Munoz. Use of dexmedetomidine in children after cardiac and thoracic surgery. Critical Care Medicine (in press). Sakhai H, Casta A. Use of nitric oxide for treatment of pulmonary hypertensive crisis in a child after protamine administration. J Cardiothorac Vasc Anesth (in press). FRANK CECCHIN,M.D. Associate in Cardiology, Children’s Hospital and Assistant Professor of Pediatrics, Harvard Medical School Dr. Cecchin is a member of the electrophysiology division and has special expertise in the implantation of pacemakers and defibrillators. Educating the fellows in electrophysiology is a top priority. His major research interests are clinical and focused at the utilization of medical devices for improving the health of children with cardiovascular disease. Current work involves the prophylactic use of ICDs for prevention of sudden death in children with hypertrophic cardiomyopathy, resynchronization therapy in pediatrics and congenital heart disease and cardiac resuscitation. Dr. Cecchin’s recent publications include: Van Hare GF, Chiesa NA, Campbell RM, Kanter RJ, Cecchin F, for the Pediatric Electrophysiology Society. Atrioventricular node reentrant tachycardia in children: effect of slow pathway ablation on fast pathway function. J Cardiovasc Electrophysiol. 2002;13:203-209. Cecchin F, Jorgenson D, Berul I, Pery JC, Zimmerman AA, Duncan BW, Lupinetti FM, Snyder D, Lyster TD, Rosenthal GL, Atkins D. Accuracy of Automatic External Defibrillator Arrhythmia Analysis Algorithm in Children. Circulation. 2001;103:2483-8. Davis JA, Cecchin F, Jones TK, Portman MA: Major coronary artery anomalies in a normal pediatric population: Incidence and clinical importance. Journal of American College of Cardiology: 2001;37(2):593-7. 27
  • 31. Harris JP, Cecchin F, Perry JC. Infantile chaotic atrial tachycardia: Association with viral infections. Annals of Non- Invasive Electrophysiology: 2000;5(3):279-83. Stefanelli CB, Stevenson JG, Jones TK, Lester JR, Cecchin F: A case for routine screening of coronary artery origins during echocardiography: Fortuitous discovery of a life threatening coronary anomaly. Journal of American Society of Echocardiography. 1999;12(9):769-72. Cecchin F, Johnsrude CL, Perry JC, Friedman RA: Effect of age and surgical technique on symptomatic arrhythmias after the Fontan procedure. The American Journal of Cardiology. 1995;76:386-91. DAVID E. CLAPHAM, M.D., Ph.D. Aldo R. Castañeda Professor of Cardiovascular Research, Director of Cardiovascular Research, Children’s Hospital, Professor of Neurobiology, Harvard Medical School. David E. Clapham, M.D., Ph.D., is the Aldo R. Castañeda Professor of Cardiovascular Research at Children’s Hospital Boston, a Professor of Neurobiology at Harvard Medical School, Investigator of the Howard Hughes Medical Institute, and an elected member of the American Academy of Arts and Sciences. He earned his Electrical Engineering degree at the Georgia Institute of Technology and his M.D. and Ph.D. in Anatomy/Cell Biology from Emory University School of Medicine. He completed his residency in Internal Medicine at Brigham and Women’s Hospital of Harvard Medical School. Dr. Clapham was a senior Fulbright Fellow during his postdoctoral training with Erwin Neher at the Max Planck Institute for Biophysical Chemistry in Göttingen, Germany. Dr. Clapham established his independent research laboratory in the Department of Medicine at Brigham and Women’s Hospital of Harvard Medical School in 1985. He moved to the Mayo Clinic in 1987 and became Distinguished Investigator. He received the American Heart Association Basic Science Prize and the Cole Award from the Biophysical Society. Dr. Clapham’s major research interest is the signal transduction control of ion channels. This encompasses identification of genes encoding novel ion channels, proteins interacting with these channels, and elucidation of their roles in cardiac and vascular function. The laboratory’s major interest is in understanding calcium-permeant ion channels that regulate intracellular calcium and appear to have important roles in development and cell migration. Recent work also includes the development of knockout mouse models for understanding G protein gated channel control of heart rate and the role they play in atrial arrhythmias. For a review of research in the Clapham lab, see http://clapham.tch.harvard.edu/. Sample of recent publications: Xu, H, Ramsey, IS, Kotecha, SA, Moran, MM, Chong, JA, Lawson, D, Ge, P, Lilly, J, Silos-Santiago, I, Xie, Y, DiStefano, PS, Curtis, R, and Clapham, DE. TRPV3 is a calcium-permeable temperature-sensitive cation channel. Nature. 2002, 418, 181-186. Oancea, E, Bezzerides, VJ, and Clapham, DE. Protein Kinase D acts as a memory sensor to increase cellular motility. Developmental Cell, 2003, 4, 561–574. Greka, A, Navarro, B, Oancea, E, Duggan, A, and Clapham, DE. TRPC5 is a regulator of hippocampal neurite length and growth cone morphology. Nature Neuroscience. 2003. 6, 837-845. Kirichok, Y, Krapivinsky, G, and Clapham, DE. The mitochondrial calcium uniporter is a novel Ca2+-selective ion channel. Nature, 2004, 427(6972): 360-364. 28
  • 32. Bezzerides, V, Ramsey, S, Kotecha, S, Greka, A, and Clapham, DE. Rapid vesicular translocation and insertion of TRP channels. Nature Cell Biology, 2004, 6, 709-720. Xu, H, Blair, N, and Clapham, DE. Camphor activates and strongly desensitizes the transient receptor potential vanilloid subtype 1 channel in a vanilloid-independent mechanism. Journal of Neuroscience, 2005, 25(39): 8924-8937. Oancea, Elena, Wolfe, Joshua T., and Clapham, DE. Functional TRPM7 channels accumulate at the plasma membrane in response to fluid flow. Circulation Research, 2006, 98(2): 245-253. Kirichok, Y, Navarro, B, and Clapham, DE. Whole-cell patch clamp measurements of spermatozoa reveal an alkaline-activated Ca2+ channel. Nature 2006, 439 (7077); 737-740. STEVEN D. COLAN, M.D. Senior Associate in Cardiology, Children’s Hospital, and Professor of Pediatrics, Harvard Medical School Dr. Colan is the Associate Chief for Clinical Operations. In addition to his administrative and research activities, he shares staffing responsibilities in echocardiography. His major interests relate to the assessment and treatment of myocardial diseases, including evaluation of left ventricular systolic and diastolic function, clinical aspects of cardiomyopathies, and myocardial performance in congenital and acquired heart disease. The development and validation of non-invasive diagnostic methodologies and instruments remains an important aspect of his clinical and investigative activities. He has spent considerable effort, as well, on the application and implementation of computer-based computational techniques to the analysis of cardiac physiology. A sample of recent publications include: Gentles TL, Colan SD. End-systolic wall stress misrepresents afterload in ventricles with abnormal chamber geometry. J Appl Physiol 2002; 92: 1053-1057. Colan SD. Systolic and diastolic function of the univentricular heart. Progress in Pediatric Cardiology 2002; 16: 79-87. Lipshultz SE, Sleeper LA, Towbin JA, Lowe AM, Orav EJ, Cox GF, Lurie PR, Mccoy KL, Mcdonald MA, Messere JE, Colan SD. The incidence of pediatric cardiomyopathy in two geographic regions of the United States: the Prospective Pediatric Cardiomyopathy Registry. N Engl J Med 2003; 348: 1647-1655. Lipshultz SE, Lipsitz SR, Sallan SE, Dalton VM, Mone SM, Gelber RD, Colan SD. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. J Clin Oncol 2005; 23: 2629-2636. McElhinney DB, Lock JE, Keane JF, Moran AM, Jonas RA, Colan SD. Left heart growth, function and reintervention after balloon aortic valvuloplasty for neonatal aortic stenosis. Circulation 2005; 111: 451-458 Sluysmans T, Colan SD. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 2005; 99: 445-457 Nugent AW, Daubeney PEF, Chondros P, Carlin JB, Colan SD, Cheung M, Davis AM, Chow CW, Weintraub RG. Clinical features and outcomes of childhood hypertrophic cardiomyopathy: results from a national population-based study. Circulation 2005; 112: 1332-1338. 29
  • 33. JOHN M. COSTELLO, M.D. Assistant in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Costello completed a residency in Pediatrics and fellowships in Pediatric Cardiology and Pediatric Critical Care Medicine at Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine in Chicago. He joined the Division of Cardiac Intensive Care in 2003. He is currently receiving formal training in clinical investigation through the Harvard School of Public Health’s Master of Public Health Degree Program. His primary research interest involves an examination of the effects of cardiopulmonary bypass on the natriuretic hormone system, and the investigation of new therapies following congenital heart surgery. Recent publications include: Costello JM, Backer CL, De Hoyos A, Binns HJ, Mavroudis C. Aprotinin reduces operative closure time and blood product use after pediatric bypass. Ann Thorac Surg 2003;75:1261-6. Costello JM, Wax DF, Binns HJ, Backer CL, Mavroudis C, Pahl E. A comparison of intravascular ultrasound with coronary angiography for evaluation of transplant coronary disease in pediatric heart transplant recipients. J Heart Lung Transplant 2003;22:44-9. Costello JM, Backer CL, Checchia PA, Mavroudis C, Seipelt RG, Goodman DM. Alterations in the natriuretic hormone system related to cardiopulmonary bypass in infants with congestive heart failure. Pediatr Cardiol 2004;25:347-53. Checchia PA, Bronicki RA, Costello JM, Nelson DP. Steroid use before pediatric cardiac operations employing cardiopulmonary bypass: An international survey of 36 centers. Pediatr Crit Care Med 2005;6:441-444. Costello JM, Backer CL, Checchia PA, Mavroudis C, Seipelt RG, Goodman DM. Effect of cardiopulmonary bypass and surgical intervention on the natriuretic hormone system in children. J Thorac Cardiovasc Surg 2005;130:822-829. Costello JM, Thiagarajan RR, Dionne RE, Allan CK, Booth KL, Burmester M, Wessel DL, Laussen PC. Initial experience with fenoldopam following cardiac surgery in neonates with an insufficient response to conventional diuretics. Pediatr Crit Care Med 2006;7:28-33. Cua CL, Thiagarajan RR, Gauvreau K, Lia L, Costello JM, Wessel DL, del Nido PJ, Mayer JM, Newburger JW, Laussen PC. Post-operative outcomes in a concurrent series of infants with hypoplastic left heart syndrome undergoing stage I palliation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit. Pediatric Critical Care Medicine (in press). SARAH D. DEFERRANTI, M.D., M.P.H. Assistant in Cardiology, Children's Hospital and Instructor in Pediatrics, Harvard Medical School Dr. de Ferranti is an active practitioner in the Preventive Cardiology Clinic and participates in the Clinical Cardiology service. She sees patients with hyperlipidemia and other atherosclerotic risk factors both in the Lexington satellite and the Thursday morning Preventive Cardiology Clinic. On Thursday afternoons she sees patients with general pediatric cardiology complaints and also supervises the fellow’s clinic. Her research interests focus on hyperlipidemia, atherosclerosis - particularly the inflammatory mechanism of disease, hypertension, childhood obesity, the metabolic syndrome and insulin resistance, and the familial aspects of these factors in children and young adults. Recent publications include: 30
  • 34. Yu HH, Markowitz R, de Ferranti SD, Neufeld EJ, Farrow G, Bernstein HH, Rifai N. Direct measurement of LDL-C in children: performance of two surfactant-based methods in a general pediatric population. Clinical Biochemistry 2000;33:89-95. de Ferranti SD, Neufeld E. Hyperlipidemia, Cardiovascular Disease and Nutrition in Childhood. In: Walker WA, Watkins JB, Duggan C, editors. Nutrition in Pediatrics. 3rd ed. Hamilton: BC Decker, Inc; 2003. de Ferranti SD, Rifai N. “CRP and Cardiovascular Disease: A Review of Risk Prediction and Interventions” Clinica Chimica Acta 2002;317:1-15. de Ferranti SD, Gauvreau K, Hickey PR, Jonas RA, Wypij D, du Plessis A, Bellinger DC, Kuban K, Newburger JW, Laussen PC. Intraoperative Hyperglycemia during Neonatal Cardiac Surgery Is Not Associated with Adverse Neurodevelopmental Outcomes at 1, 4 and 8 Years. Anesthesiology 2004 Jun;100(6):1345-52. de Ferranti, SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the Metabolic Syndrome in American Adolescents: Findings from the Third National Health and Nutrition Examination Survey. Accepted for publication, Circulation, October 2004. PEDRO J. del NIDO, MD Chairman, Department of Cardiac Surgery, Children’s Hospital Boston; Professor of Surgery, Harvard Medical School Dr. del Nido’s laboratory research work has focused on two areas related to cardiac surgery. The first area involves investigation of mechanisms of injury from myocardial ischemia and on developing techniques for heart preservation during cardiac surgery. Current work includes investigation of mechanisms responsible for decreased tolerance to ischemia in hypertrophied myocardium and the role angiogenesis plays in progression of hypertrophy to apoptosis or programmed cell death, in the post-ischemic heart. The second area of investigation aims to develop techniques for performing reconstructive surgery inside the beating heart using 3D echocardiography. This project is a research partnership between the Department of Cardiac Surgery, two engineering laboratories (Harvard and Boston University) and industry. The goal is to design and implement new technology and instrumentation to facilitate repair of intracardiac defects, obviating the need for open-heart surgery. Friehs I, Cao-Danh H, Nathan M, McGowan FX, del Nido PJ. Impaired insulin-signaling in hypertrophied hearts contributes to ischemic injury. Biochem Biophys Res Commun. 2005 May 27;331(1):15-22. Suematsu Y, Martinez JF, Wolf BK, Marx GR, Stoll JA, DuPont PE, Howe RD, Triedman JK, del Nido PJ. Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass: atrial septal defect closure in a swine model. J Thorac Cardiovasc Surg. 2005 Nov;130(5):1348-57 Baumgartner WA, Burrows S, del Nido PJ, Gardner TJ, Goldberg S, Gorman RC, Letsou GV, Mascette A, Michler RE, Puskas JD, Rose EA, Rosengart TK, Sellke FW, Shumway SJ, Wilke N; National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery. Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery. Circulation. 2005 Jun 7;111(22):3007-13. 31
  • 35. McElhinney DB, Salvin JW, Colan SD, Thiagarajan R, Crawford EC, Marcus EN, del Nido PJ, Tworetzky. Improving outcomes in fetuses and neonates with congenital displacement (Ebstein's malformation) or dysplasia of the tricuspid valve. Am J. Cardiol. 2005 Aug 15;96(4):582-6. Suematsu Y, Mora BN, Mihaljevic T, del Nido PJ. Totally endoscopic robotic-assisted repair of patent ductus arteriosus and vascular ring in children. Ann Thorac Surg. 2005 Dec;80(6):2309-13. Padalino MA, Saiki Y, Tworetzky W, del Nido PJ. Pulmonary venous pathway obstruction from recurrent restriction at atrial septum late after Fontan procedure. J Thorac Cardiovasc Surg. 2004;127(1):281-3. Cannon JW, Stoll JA, Salgo IS, Knowles HB, Howe RD, Dupont PE, Marx GE, del Nido PJ. Real time three- dimensional ultrasound for guiding surgical tasks. Comp Aided Surg. 2003;8(2):82-90. Collins KK, Rhee EK, Delucca JM, Alexander ME, Bevilacqua LM, Berul CI, Walsh EP, Mayer JE, Jonas RA, del Nido PJ, Triedman, JK. Modification to the Fontan procedure for the prophylaxis of intra-atrial re-entrant tachycardia: short-term results of a prospective randomized blinded trial. J Thorac Cardiovasc Surg. 2004;127(3):721-9. Suematsu Y, Marx GR, Triedman JK, Mihaljevic T, Mora BN, Takamoto S, del Nido PJ. Three-dimensional echocardiography-guided atrial septectomy: an experimental study. J Thorac Cardiovasc Surg. 2004 ;128(1):53- 9. JAMES A. DINARDO, MD Senior Associate in Cardiac Anesthesia, Director, Cardiac Anesthesia Fellowship Program, Children’s Hospital Boston and Associate Professor of Anaesthesia, Harvard Medical School Dr. DiNardo graduated from Dartmouth College and Dartmouth Medical School (with honors). He completed his anesthesia residency, a fellowship in Cardiac Anesthesia, and was Chief Resident in Anesthesia at Beth Israel Hospital in Boston. He has served as Co-Director of Cardiac Anesthesia at Beth Israel Hospital in Boston, as well as Director of Cardiothoracic Anesthesiology, Associate Department Chief, and Clinical Director of Anesthesiology, all at Arizona Health Sciences Center, and Chief of Anesthesiology, Tucson Heart Hospital. He has received numerous teaching awards. Dr. DiNardo has received certification in perioperative transesophageal echocardiography by the National Board of Echocardiography and is an exam editor for this board; he is also a senior examiner of the American Board of Anesthesiology. His major clinical interests are perioperative echocardiography and abnormalities of coagulation in patients with congenital heart disease and during cardiopulmonary bypass. His major research interest is coagulation. Current research involves: 1) incidence and outcome of HIT in infants and children, 2) temporal evolution of coagulation abnormalities in infants during and following cardiac surgery utilizing CPB, and 3) efficacy of T3 supplementation in reducing inotropic support and duration of ICU stay in infants, 4) risk factors for procedural sedation failure in children. His ongoing research includes comparison of cerebral blood flow dynamics in HLHS utilizing the MBTS and the Sano shunt. He is the author of a major textbook on anesthesia for cardiac surgery, is an editor for 2 others, and has authored or co- authored more than 40 peer-reviewed articles and book chapters. Selected recent publications: Lerner A, Dinardo JA, Comunale ME. Anesthetic management for repair of Ebstein's anomaly. J Cardiothorac Vasc Anesth 2003; 17:232-235. Odegard KC, McGowan FX, Jr., Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 2003; 125:1260-1267. 32
  • 36. Odegard KC, DiNardo JA, Tsai-Goodman B, Powell AJ, Geva T, Laussen PC. Anaesthesia considerations for cardiac MRI in infants and small children. Paediatr Anaesth 2004; 14:471-476. DiNardo, JA. Masses and Defects. In: Konstadt SN, Shernan S, Oka Y (eds): Clinical Transesophageal Echocardiography. 2nd Edition. Philadelphia: Lippincott Williams and Wilkins. DiNardo JA. Cardiac Anesthesia. HEAL. New York: Lippincott, Williams and Wilkins; 2001. DiNardo JA. Anesthesia for Cardiac Surgery, 2nd Edition. Stamford: Appleton and Lange; 1998. ADAM L DORFMAN, M.D. Assistant in Cardiology, Children’s Hospital Boston, Clinic Instructor in Pediatrics, Harvard Medical School Dr. Dorfman’s clinical interests are in non-invasive imaging, including echocardiography and cardiac MRI, as well as out-patient cardiology, with a clinic in the Waltham satellite office. He completed his pediatric training in the Boston Combined Residency program in Pediatrics (Children’s Hospital Boston and Boston Medical Center), and his cardiology fellowship, as well as a senior fellowship in echocardiography and cardiac MRI at Children’s Hospital Boston. Research interests have included the use of non-invasive imaging in the population with congenital heart disease. Selected publications include: Dorfman AL, Levine JC, Colan SD, Geva T. Accuracy of Echocardiography in Premature and Low Birth Weight Infants with Congenital Heart Disease. Pediatrics 2005;115:102-107. Dorfman A, Powell AJ, Geva T. Complex congenital heart disease. In: Hundley GW, Editor. Cardiovascular Magnetic Resonance Self Assessment Program (CMR-SAP). Am College of Cardiology, 2004. Dorfman AL, Powell AJ, Odegard KC, Laussen PC, Geva T. Incidence of Adverse Events during Cardiac Magnetic Resonance Imaging in Congenital Heart Disease. Society for Cardiac Magnetic Resonance, Miami, 2006, moderated poster competition. MICHAEL D. FREED, M.D. Senior Associate in Cardiology, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Freed is Chief of the Inpatient Cardiovascular Service at Children’s Hospital and Chair of the Graduate Medical Education Committee of the Hospital. He has held positions of leadership on the Executive Board and Program committee of the American Academy of Pediatrics, American Heart Association, Cardiovascular Disease of the Young, and the Pediatric Cardiology Committee of the American College of Cardiology and the Sub-Board of Pediatric Cardiology of the American Board of Pediatrics where he was chair of its credentials committee. He is currently a Trustee of the American College of Cardiology. In addition to maintaining a large clinical practice, Dr. Freed has written extensively on the variety of topics in pediatric cardiology. Dr. Freed’s recent publications include: 33
  • 37. Bonow RO, Carabello B, De Leon AC, Edmonds LH Jr Fedderly BJ, Freed MD et al. ACC/AHA guidelines for the management of patients with valvar heart disease. J Am Coll Cardiol 1998;32: 1486-1588. 2nd edition in press, 2006. Long WA, Frantz EG, Henry GW, Freed MD, Brook M. Evaluation of newborns with possible cardiac problems in Taeusch and Ballard, eds. Avery’s Diseases of the Newborns 7th edition; WB Saunders Company, Philadelphia 1998. Freed MD. The pathology, pathophysiology, recognition and treatment of congenital heart disease in eds. Alexander RW, Schlant RC, Fuster V. Hurst’s the Heart 10th edition; McGraw-Hill, NY 2000. Freed MD. Aortic stenosis in Allen HD, Gutgesell Hp, Clark EB, Driscoll DJ, eds. Moss and Adam’s Heart Disease in Infants, Children and Adolescents, 6th edition; Baltimore, 2001. DAVID R. FULTON, M.D. Senior Associate in Cardiology, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Fulton is Chief of Outpatient Cardiology Services. After completing his fellowship in cardiology at Children’s, he was a staff cardiologist at Floating Hospital for Children later serving as chief of the division of Pediatric Cardiology and Associate Chairman for Network and Development of the Department of Pediatrics. In addition to a large clinical practice, he has specific interest in Kawasaki disease. His major focus is the establishment of a network of satellite cardiology clinics integrating primary care with the tertiary and quaternary cardiology intervention at the Children’s campus. His recent publications include: Leung DYM, Meissner HC, Fulton DR, Murray DL, Kotzin BL, Schlievert PM. Toxic shock syndrome toxin- secreting Staphylococcus aureus in Kawasaki syndrome. Lancet 1993;342:1385-88. Fulton DR, Marx GR, Romero BB, Mumm B, Krauss M, Wollschläger H, Ludomirsky A, Pandian NG. Dynamic three-dimensional echocardiographic imaging of congenital heart defects in infants and children by computer controlled tomographic parallel slicing using a single integrated ultrasound instrument. Echocardiography 1994; 11:155-164. Hijazi ZM, Geggel RG, Marx GR, Rhodes J, Fulton DR. Balloon angioplasty for native coarctation of the aorta: acute and mid-term results. J Invas Cardiol 1997;9:344-348 Hill SL, Evangelista JK, Pizzi AM, Mobassaleh M, Fulton DR, Berul CI. Proarrhythmia associated with cisapride in children. Pediatr 1998;101:1053-1056. FRANCIS FYNN-THOMPSON, M.D. Assistant in Cardiac Surgery, Children’s Hospital and Instructor in Surgery, Harvard Medical School Dr. Fynn-Thompson is a member of the Department of Cardiac Surgery. He attended the University of Pennsylvania and subsequently Harvard Medical School and completed general surgery residency and cardiothoracic surgery fellowship at the Massachusetts General Hospital. His clinical work focuses on the surgical treatment of all forms of congenital heart disease with special interest in arrhythmia surgery. Dr. Fynn-Thompson’s major research interest includes 34
  • 38. robotic resynchronization therapy and other minimally invasive approaches to congenital heart disease KIMBERLEE GAUVREAU, Sc.D. Research Associate in Cardiology, Children’s Hospital, Assistant Professor of Pediatrics, Harvard Medical School and Assistant Professor of Biostatistics, Harvard School of Public Health Dr. Gauvreau provides biostatistical support to members of the Cardiovascular Program. She collaborates on a wide variety of projects focusing on such areas as short- and long-term outcomes following cardiovascular surgery and the effects of patient and hospital characteristics on mortality and resource use for children with congenital heart disease. Her duties also involve consulting on diverse statistical analyses, and providing biostatistical instruction to fellows and staff. Publications include: Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. Journal of Thoracic and Cardiovascular Surgery 2002; 123:110-118. Allen SW, Gauvreau K, Bloom BT, Jenkins KJ. Evidence-based referral results in significantly reduced mortality after congenital heart surgery. Pediatrics 2003; 112:24-28. Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC. Risk factors for readmission following neonatal cardiac surgery. Annals of Thoracic Surgery 2004; 78:1972-1978. Schwartz ML, Gauvreau K, del Nido P, Mayer JE, Colan SD. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation 2004; 110:II128-II132. Connor JA, Gauvreau K, Jenkins KJ. Factors associated with increased resource utilization for congenital heart disease. Pediatrics 2005; 116:689-695. ROBERT L. GEGGEL, M.D. Senior Associate in Cardiology, Children’s Hospital, and Associate Professor of Pediatrics, Harvard Medical School Dr. Geggel is an active participant in the Outreach Cardiology Program, Director of the Cardiology Consult Service, and Attending Physician on 6E. He was the former Associate Chief of Pediatric Cardiology at the New England Medical Center and former attending in the catheterization laboratory. He has a large clinical practice and evaluates out-patients at Children’s Hospital as well as in satellite sites including Lexington, Norwood, Brockton, Methuen and Nashua. He supervises the Tuesday afternoon fellow’s clinic. He has participated in the introduction of new catheterization equipment and techniques. His research interests include interventional cardiac catheterization and pulmonary hypertension. Dr. Geggel’s recent publications include: Hijazi ZM, Geggel RL. Transcatheter closure of patent ductus arteriosus using coils. Am J Cardiol 1997;79:1279- 1280. 35
  • 39. Hijazi ZM, Ata IA, Kuhn MA, Cheatham JP, Latson L, Geggel RL. Balloon atrial septostomy using a new low profile balloon catheter: initial clinical results. Cathet Cardiovasc Diag 1997;40:187-190. Geggel RL, Hijazi ZM. Reduced incidence of ventricular ectopy using a 4F Halo catheter during pediatric cardiac catheterization. Cathet Cardiovasc Diag 1998;43:55-57. Geggel RL. Ebstein’s anomaly associated with severe pulmonary stenosis - successful palliation with balloon pulmonary valvuloplasty in an adult. Cathet Cardiovasc Intervent 1999;46:441-444. Geggel RL, Gauvreau K, Lock JE. Balloon dilation angioplasty of peripheral pulmonary stenosis associated with William's syndrome. Circulation 2001;103:2165-2170. Geggel RL, Gauvraeu K, Lock JE. Balloon dilation angioplasty of peripheral pulmonary stenosis associated with Williams syndrome. Circulation 2001; 103:2155-2170 Rosales AM, Lock, JE, Perry SB, Geggel RL. Interventional catheterization managements of perioperative peripheral pulmonary stenosis: balloon angioplasty of endovascular stenting. Cathet Cardiovasc Intervent 2002; 56:272-277. Geggel RL, Horowitz, LM, Brown EA, Parson M, Wang PS, Fulton DR. Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still's murmur. J Pediatric 2002; 140:747-752. TAL GEVA, M.D. Senior Associate in Cardiology, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Geva heads the Non-Invasive Division and shares staffing responsibilities in the echocardiography laboratory and in cardiac MRI. His major clinical interest is diagnostic imaging of congenital heart disease, including anatomic and functional assessment of complex malformations using echocardiography and magnetic resonance imaging. His research has focused on the use of echocardiography and magnetic resonance imaging to define quantitative morphometric predictors of course and outcome of either native or postoperative congenital cardiac lesions. Recent publications include: Geva T. Greil GGF, Marshall AC, Landzberg M, Powell AJ. Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia: comparison with x-ray angiography. Circulation 2002; 106:473-8. Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 2004;43:1068-1074. Prakash A, Powell AJ, Krishnamurthy, R, Geva T. Magnetic resonance imaging evaluation of myocardial perfusion and viability in congenital and acquired pediatric heart disease. Am J Cardiol 2004;93:657-661. McMahon CJ, Gauvreau K, Edwards JC, Geva T. Risk factors for aortic valve dysfunction in children with discrete subvalvular aortic stenosis. Am J of Cardiol 2004;94:459-464. Dorfman AL, Levine JC, Colan SD, Geva T. Accuracy of echocardiography in low birth weight infants with congenital heart disease. Pediatrics 2005; 115:102-107. 36
  • 40. Nielsen JC, Powell AJ, Gauvreau K, Marcus EN, Prakash A, Geva T. Magnetic resonance imaging predicators of the hemodynamic severity of coarctation severity. Circulation 2005;111:622-628. DOUGLAS S. GOULD, CRNA, MS Staff Nurse Anesthetist Mr. Gould earned a B.A. in American Studies, a B.S. in Nursing and an M.S. in Biology/Anesthesia. Since becoming a nurse anesthetist in 1999, his clinical work has been limited to the anesthetic care of infants, children and adults with acquired and congenital heart disease. He is a member of the American Association of Nurse Anesthetists and has been involved in the clinical and didactic training of nurse anesthesia students. Gould DS, Montenegro LM, Gaynor JW, et al. A comparison of on-site and off-site patent ductus arteriosus ligation in premature infants. Pediatrics 2003; 112:1298-1301. JAMES S. HARRINGTON, MD Assistant in Cardiac Anesthesia, Children’s Hospital Boston, Instructor in Anaesthesia (Cardiac), Harvard Medical School Dr. Harrington completed his medical training at the University of Washington, Seattle and his anesthesiology training at Oregon Health Sciences University in Portland, Oregon. He then completed a Fellowship in Pediatric Anesthesia and Fellowship in Pediatric Cardiac Anesthesia at Children’s Hospital Boston and is a Diplomate of the American Board of Anesthesiology. Dr. Harrington’s primary clinical focus is the perioperative care of patients of all ages with congenital heart disease. He has a special interest in quality assurance issues regarding perioperative care of the pediatric cardiac patient, maintaining the Division’s incident database and monthly morbidity and mortality presentations to the Department of Anesthesia. PAUL R. HICKEY, MD Anesthesiologist-in-Chief, Children’s Hospital Boston, Professor of Anaesthesia, Harvard Medical School Dr. Hickey received his BA degree from Yale University and his MD degree from Columbia University. He trained in surgery at Columbia-Presbyterian Medical Center, New York, and in cardiac surgery at the National Heart and Lung Institute, National Institutes of Health, Bethesda, Maryland. He then trained in anesthesia and cardiac anesthesia at the Massachusetts General Hospital in Boston before joining the faculty in the Department of Anesthesia at Children’s Hospital Boston in 1981. Dr. Hickey assumed his present position in 1992. His clinical work is concentrated in pediatric cardiac anesthesia as a member of the Division of Cardiac Anesthesia at Children’s. He has authored over one hundred papers, chapters and reviews, particularly in the area of cardiac anesthesia. His research interests include brain injury with cardiac surgery in children, pain and stress responses in children, and the pathophysiology and modulation of inflammatory responses to surgery and cardiopulmonary bypass involving leukocyte and endothelial adhesion. He is a past Editor of the journals of Anesthesia and Analgesia and the Journal of Cardiothoracic Anesthesia. 37
  • 41. Selected recent publications: Schermerhorn ML, Tofukuji M, Khoury PR, Phillips L, Hickey PR, Sellke FW, Mayer JE, Jr., Nelson DP: Sialyl lewis oligosaccharide preserves cardiopulmonary and endothelial function after hypothermic circulatory arrest in lambs. J Thorac Cardiovasc Surg 2000; 120: 230-7. Gruber EM, Laussen PC, Casta A, Zimmerman AA, Zurakowski D, Reid R, Odegard KC, Chakravorti S, Davis PJ, McGowan FX, Jr., Hickey PR, Hansen DD: Stress response in infants undergoing cardiac surgery: a randomized study of fentanyl bolus, fentanyl infusion, and fentanyl-midazolam infusion. Anesth Analg 2001; 92: 882-90. Tabbutt S, Newburger JW, Hickey PR, Mayer JE, Neufeld EJ: Time course of early induction of intracellular adhesion molecule-1 messenger RNA during reperfusion, following cardiopulmonary bypass with hypothermic circulatory arrest in lambs. Pediatr Crit Care Med 2003; 4: 83-8. de Ferranti S, Gauvreau K, Hickey PR, Jonas RA, Wypij D, du Plessis A, Bellinger DC, Kuban K, Newburger JW, Laussen PC: Intraoperative hyperglycemia during infant cardiac surgery is not associated with adverse neurodevelopmental outcomes at 1, 4, and 8 years. Anesthesiology 2004; 100: 1345-52. Hansen DD, Hickey, PR. History of Pediatric Cardiac Anesthesia. In: Andropoulus D, ed. Pediatric Cardiac Anesthesia. Blackwell Publishing 2005. KATHY J. JENKINS, M.D., M.P.H. Senior Associate in Cardiology, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Jenkins is a senior member of the Department of Cardiology and is also the Director for the Program for Patient Safety & Quality for Children’s Hospital. She has developed a special expertise in the design and implementation of regulatory trials, evaluating the safety and usefulness of devices prior to FDA approval. She also has considerable expertise in evaluating variation in outcomes for cardiac surgical procedures and has more recently expanded this to include other types of pediatric procedures. She has created the RACHS-1 (Risk Adjustment for Congenital Heart Surgery), a method to adjust for case mix when evaluating mortality for pediatric heart surgery. She also has identified myofibroblastic proliferation as the putative cause for progressive pulmonary vein stenosis, and is running a novel treatment protocol with chemotherapeutic agents. She is actively involved in teaching clinical research methods within the department and teaches a longitudinal methods course in conjunction with her biostatistical colleague, Dr. Kim Gauvreau, to fellows or nurses each year. She also the Chairperson for the Cardiovascular Scientific Review Committee. In addition, she is an active member of the clinical department with a variety of patient care and teaching responsibilities. Jenkins KJ, Gauvreau K, Newburger JW, Spray T. Moller JH, Iezzoni LI Consensus-based method for risk adjustment for congenital heart surgery. J Thorac Cardiovasc Surg 2002;123:110-118. Jenkins KJ, Gauvreau K. Center-specific differences in mortality: preliminary analysis using the risk adjustment in congenital heart surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002;124-97-104. Allen SW, Gauvreau K, Bloom B, Jenkins KJ. Evidence based referral results in significantly reduced mortality after congenital heart surgery. Pediatrics 2003;112(1)24-28. 38
  • 42. AMY L. JURASZEK, M.D. Assistant in Cardiology, Medical Director of the Cardiac Registry, Children's Hospital and Assistant Professor of Pathology, Harvard Medical School Dr. Juraszek joined the departments of Pathology and Cardiology in January 2003. She attended medical school at the University of Pittsburgh, completed pediatrics residency at Children’s Hospital of Pittsburgh and pediatric cardiology fellowship at the Medical University of South Carolina. She also trained in cardiac pathology with Drs. Richard and Stella Van Praagh and in cardiac MRI at Children's Hospital, Boston. Her primary responsibilities are in the Cardiac Registry where she directs the educational program for fellows and residents, and serves as a cardiac pathologist and curator for the Registry collection. She also staffs a cardiology outreach clinic. Recent publications include: Davis, D.L., Edwards, A.V., Juraszek, A.L., Phelps, A., Wessels, A., Burch, J.B. A GATA-6 gene heart-region- specific enhancer provides a novel means to mark and probe a discrete component of the mouse cardiac conduction system. Mech Dev 108:105-19, 2001. Juraszek, A.L., Atz, A.M., Shirali, G.S. Echocardiographic diagnosis of partial obstruction of Blalock-Taussig shunts. Cardiol Young 12:189-91, 2002. Wessels, A., Phelps, A., Trusk, T.C., Davis, D.L., Edwards, A.V., Burch, J.B.E., Juraszek, A.L. Mouse models for cardiac conduction system development. Novartis Found Symp 250:44-59, 2003. Edwards, A.V., Davis, D.L., Juraszek, A.L., Wessels, A., Burch, J.B. Transcriptional regulation in the mouse atrioventricular conduction system. Novartis Found Symp 250:177-89. 2003 Pu, W.T., Ishiwata, T., Juraszek, A.L., Ma, Q., Izumo, S. GATA4 is a dosage sensitive regulator of cardiac morphogenesis. Developmental Biology 275:235-44, 2004. Juraszek, A.L., Cohn, H., Van Praagh, R., Van Praagh, S. Anomalous connection of all left pulmonary veins to the inferior vena cava without left-sided scimitar syndrome. Pediatric Cardiology, e pub July 4, 2005. Khairy, P., Treidman, J.K., Juraszek, A.L., Cecchin, F. Inability to cannulate the coronary sinus in patients with supraventricular arrythmias: congenital and acquired coronary sinus atresia. J IntervCard Electrophysiol, 12:123- 127, 2005. Zeisberg, E.M., Ma, Q, Juraszek, A.L., Moses, K., Schwartz, R.J., Izumo, S., Pu, W.T. Morphogenesis of the right ventricle requires myocardial expression of GATA4. J Clin Invest 115:1522-1531, 2005. Reidlinger, W.F.J., Juraszek, A.L., Jenkins, K.J., Nugent, A.W., Balasubramanian, S., Calicchio, M.L., Kieran, M.W., Collins, T. Pulmonary vein stenosis: Expression of receptor tyrosine kinases by lesional cells. Cardiovascular Pathology, in press. Moskowitz, I.P. and Juraszek, A.L. Cardiac Embryology and Genetics In: F. Sellke, S. Swanson, and P. Del Nido, editors, Sabiston and Spencer Surgery of the Chest, 7th ed. Philadelphia: Elsevier Saunders, 2005. p1751- 1762. 39
  • 43. JOHN F. KEANE, M.D. Senior Associate in Cardiology, Children's Hospital, and Professor of Pediatrics, Harvard Medical School Dr. Keane has retired from patient care. However, he still has considerable interest in the natural history of congenital heart defects. Recent publications include: Egito E, Moore P, O’Sullivan J, Colan S, Perry SB, Lock JE, and Keane JF. Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm results. J Am Coll Cardiol 1997;29:442-7. Yeager SB, Keane JF. Fate of moderate and large secundum-type atrial septal defect associated with isolated coarctation in infants. Am J Cardiol 1999, August; 84:362-363. Baker CM, McGowan FX Jr, Keane JF, Lock JE. Pulmonary artery trauma due to balloon dilation: Recognition, Avoidance and Management. JACC 2000, 36:1684-1690. Satou GM, Perry SB, Lock JE, Piercey GE, Keene JF. Repeat balloon dilation of aortic stenosis: Immediate results and midterm outcome. Cath and Cardiovasc Diag 1999; 47:47-51. Lock JE, Keane JF, Pery SB. Diagnostic and Interventional Catheterization in Congenital Heart DiseaseSecond Edition: Kluwer Academic Publishers (2000). Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae: Patient selection and results of transcatheter closure. J Am Coll Cardiol 2002; 39:1026-32. Martins JD, Sherwood MC, Mayer JE, Keane JF. Aortico-Left Ventricular Tunnel: 35-Year Experience. J Am Coll Cardiol 2004; 44:446-50. GRIGORY KRAPIVINSKY, Ph.D. Associate in Cardiology, Children’s Hospital and Assistant Professor of Pediatrics, Harvard Medical School Dr. Krapivinsky received his Ph.D. from Moscow State University under Professor M.V. Volkenstein. Dr. Krapivinsky is a protein biochemist and molecular biologist interested in cellular signal transduction mechanisms. He was Senior Research Scientist at the Institute of Cell Biophysics in the Russian Academy of Sciences at Pushchino, Russia where he focused on the G signaling protein in the mammalian visual system. In 1992, he joined the Mayo Clinic in Rochester, MN where he studied G- protein regulated potassium channels. At present he is studying molecular organization of native channel signaling complexes mainly focusing on TRP family ionic channels. Krapivinsky GB, Ackerman M, Gordon E, Krapivinsky L, and Clapham DE. Molecular characterization of swelling-induced chloride conductance regulatory protein, pICln. Cell 1994;76:439-448. Krapivinksy G, Gordon E, Wickman K, Velimirovic B, Krapivinsky L, and Clapham DE. The G protein-gated atrial K+ channel, IKACh, is a heteromultimer of two inwardly rectifying K+ channel proteins. Nature (article), 1995;374:135-141. Krapivinsky G, Krapivinsky L, Wickman K, and Clapham DE. G binds directly to the G protein-gated K+ channel, IKACh. Journal of Biological Chemistry 1995;270:29059-29062. 40
  • 44. Krapivinsky G, Pu W, Wickman K, Krapivinsky L, and Clapham DE. pIC1n binds to a mannalian homolog of yeast protein involved in cell morphology. Journal of Biological Chemistry 1998;273:10811-10814. Krapivinsky G, Medina I, Eng L, Yang Y, Krapivinsky L, and Clapham DE. A novel inward rectifier channel with unique pore properties. Neuron 1998;20(5):995-1005. Krapivinsky G, Kennedy M, Nemec J, Medina I, Krapivinsky L, and Clapham DE. Gβγ binding to GIRK4 subunit is critical for G protein-gated K+ channel activation. Journal of Biological Chemistry 1988;273:16946-16952. Pu W, Krapivinsky G, Krapivinsky L, and Clapham DE. PICLn inhibits snRNP biogenesis by binding core spliceosomal proteins. Mol Cell Biol 1999;19:4113-4120. Strübing C, Krapivinsky G, Krapivinsky L, and Clapham DE. TRPC1 and TRPC5 form a novel cation channel in mammalian brain. Neuron 2001;29:645-55. Medina I, Krapivinsky G, Arnold S, Kovoor P, Krapivinsky L, Clapham DE. A switch mechanism for G activation of IKACh. J Biol Chem. 2000; 275: 29709-29716. Strübing, C., Krapivinsky G., Krapivinsky L., and. Clapham D. E. TRPC1 and TRPC5 form a novel cation channel in mammalian brain. Neuron. 2001; 29: 645-55. Strubing, C., Krapivinsky, G., Krapivinsky, L., and Clapham, D. E.. Formation of novel TRPC channels by complex subunit interactions in embryonic brain. J Biol Chem (2003) 278, 39014-39019. Krapivinsky, G., Krapivinsky, L., Manasian, Y., Ivanov, A., Tyzio, R., Pellegrino, C., Ben-Ari, Y., Clapham, D. E., and Medina, I. The NMDA receptor is coupled to the ERK pathway by a direct interaction between NR2B and RasGRF1. Neuron (2003) 40, 775-784. Kirichok, Y., Krapivinsky, G., and Clapham, D. E.. The mitochondrial calcium uniporter is a highly selective ion channel. Nature (2004) 427, 360-364. Krapivinsky, G., Medina, I., Krapivinsky, L., Gapon, S., and Clapham, D. E.. SynGAP-MUPP1-CaMKII synaptic complexes regulate p38 MAP kinase activity and NMDA receptor-dependent synaptic AMPA receptor potentiation. Neuron (2004) 43, 563-574. BARRY D. KUSSMAN, MBBCh, FFA(SA) Associate in Cardiac Anesthesia, Children’s Hospital Boston, Assistant Professor of Anaesthesia, Harvard Medical School Dr. Kussman received his undergraduate medical degree and anesthesiology training in South Africa. He subsequently completed a Fellowship in Pediatric Anesthesia at Children’s Hospital Boston and a Fellowship in Cardiac Anesthesia at the Beth Israel Hospital, Boston and is a Diplomate of the American Board of Anesthesiology. His major clinical focus is the perioperative care of infants, children and adults with congenital heart disease. His major research interests center on central nervous system monitoring during pediatric cardiac surgery. Selected Publications: Kussman BD, Geva T, McGowan, Jr. FX. Cardiovascular causes of airway compression. Paediatric Anaesthesia 2004;14:53-59. Kussman BD, Wypij D, DiNardo JA, Newburger J, Jonas RA, Bartlett J, McGrath E, Laussen PC. Evaluation of bilateral monitoring of cerebral oxygen saturation during pediatric cardiac surgery. Anesth Analg 2005;101(5):1294-300. 41
  • 45. Kussman BD, Madril DR, Thiagarajan RR, Walsh EP, Laussen PC. Anesthetic management of the neonate with congenital complete heart block: A 16-year review. Pediatric Anesthesia 2005;15(12):1059-66. Subramaniam B, Soriano SG, Scott RM, Kussman BD. Anesthetic management of pial synangiosis and intracranial hemorrhage with a fontan circulation. Pediatric anesthesia 2006;16(1):72-6. RONALD V. LACRO, M.D. Associate in Cardiology, Children’s Hospital and Assistant Professor of Clinical Pediatrics, Harvard Medical School Dr. Lacro is clinically trained in dysmorphology/clinical genetics as well as pediatric cardiology. He directs the Cardiovascular Genetics Clinic, which provides cardiac and genetics services to patients with a variety of genetic conditions including Marfan Syndrome and Williams Syndrome. Dr. Lacro is on the staff of the echocardiography laboratory, which provides a full range of studies including transesophageal and fetal examinations. Additional clinical responsibilities include attending on the inpatient ward service and providing cardiology services at Franciscan Children’s Hospital and Rehabilitation Center. Research interests include pathogenesis of congenital cardiovascular malformations and management of patients with multiple malformation syndromes such as Marfan syndrome, other connective tissue disorders, and Williams syndrome. Dr. Lacro’s publications include: Mathias RS, Lacro RV, Jones KL. X-linked laterality sequence: Situs inversus, complex cardiac defects, splenic defects. Am J Med Genet 1987;28:111-116. Lacro RV, Jones KL, Benirschke K. Pathogenesis of coarctation of the aorta in the Turner syndrome: A pathologic study of fetuses with nuchal cystic hygromas, hydrops fetalis, and female genitalia. Pediatrics 1988;81:445-451. Bird LM, Billman GF, Lacro RV, Spicer RL, Jariwala LK, Hoyme HE, Zamora-Salinas R, Morris C, Viskochil D, Frikke MJ, Jones MC. Sudden death in Williams Syndrome. Report of ten cases. J Pediatr 1996;129:926- 931. Lacro RV. Genetics, tetralogy and syndromes of congenital heart disease. In Freedom R ed. Volume I: Congenital heart disease. In Braunwald E, ed. Atlas of heart diseases. Philadelphia: Current Medicine 1997:2.1-2.12. Lacro RV. Marfan syndrome and related disorders of fibrillin. In: Berul CI and Towbin JA eds. Molecular genetics of cardiac electrophysiology. Boston: Kluwer Academic Publishers, 2000. Lacro RV. Genetics of congenital cardiovascular malformations. In: Allan L, Hornberger LK, Sharland G eds. Textbook of fetal echocardiography. London: Greenwich Medical Media, 2000. MICHAEL J. LANDZBERG, M.D. Associate in Cardiology, Children’s Hospital; Associate Physician, Cardiovascular Division, Brigham and Women’s Hospital and Assistant Professor of Medicine, Harvard Medical School Dr. Landzberg is Medical Director of the Boston Adult Congenital (BACH) and Adult Pulmonary Hypertension (BACH-PHT) services. He shares attending responsibilities in the catheterization laboratories at Children’s Hospital and Brigham and Women’s Hospital. Dr. Landzberg’s major research interests relate to understanding congenital heart disease as it 42
  • 46. displays itself in the adult patient, with particular focus on (1) pulmonary hypertension and vascular disease, (2) heart failure/mechanics and (3) interventional catheterization. Dr. Landzberg’s recent publications include: Landzberg MJ, Roberts DJ, Mark EJ. Weekly clinicopathologic exercises: Case 4-1999: A 38 year-old woman with increasing pulmonary hypertension after delivery . N Engl J Med 1999;340:455-64. Hung J, Landzberg MJ, Jenkins KJ, King ME, Lock JE, et al. Transcatheter closure of patent foramen ovale for paradoxical emboli: Intermediate-term risk of recurrent neurologic events following transcatheter device placement. J Am Coll Cardiol 2000;35:1311-6. Feinstein JA, Goldhaber SZ, Lock JE, Fernandes SM, Landzberg MJ. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation 2001;103:10-13. Landzberg MJ, Murphy DJ, Davidson WR, Jarcho JA, Kurmholz HM, et al. Task force 4: Organization of delivery systems for adults with congenital heart disease. J Am Coll Cardiol 2001;37:1187-934. Rubin LJ, Badesch DB, Barst RJ, Galie N, Black CM, Keogh A, Pulido T, Frost A, Roux S, Leconte I, Landzberg M, Simonneau G. Bostentan therapy for pulmonary arterial hypertension. N Engl J Med 2002;346:896-903. Fernandes SM, Newburger JW, Lang P, Pearson DD, Feinstein JA, Gauvreau KK, Landzberg MJ. Usefulness of epoprostenol therapy in the severely ill adolescent/adult with Eisenmenger physiology. Am J Cardiol 2003;91:46-9. Khairy P and Landzberg M. Systemic Review of Transcatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli. Annals of Internal Medicine. In Press. November 2003 PETER LANG, M.D. Senior Associate in Cardiology, Children's Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Lang is Co-Director of the Fellowship Training Program in Pediatric Cardiology. He is the former director of the Cardiac Intensive Care Unit at Children's Hospital and was the Chief of Pediatric Cardiology at Massachusetts General Hospital. He has a large clinical practice and interest in interventional catheterization and the care of congenital heart disease in the adult. He has participated in the introduction of innovative medical and surgical treatment protocols. Dr. Lang's publications include: Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 1983;308:23. Roberts JD, Lang P, Bigatillo L, Vlahakes,GJ, Zapol WM. Inhaled nitric oxide in congenital heart disease. Circulation 1993 87:447-453. Hung J, Landzberg MJ, Jenkins KJ, King MEE, Lock JE, Palacios IF, Lang P. Transcather closure of patent foramen ovale for paraodixical emboli: incidence of recurrent neurologic events at intermediate-term follow-up. J Am Coll Cardiol 2000;35:1311-6. 43
  • 47. PETER C. LAUSSEN, M.B.B.S. Chief, Division Cardiac Intensive Care, Department of Cardiology; D.D. Hansen Chair of Pediatric Anesthesia, Children’s Hospital Boston; Associate Professor of Anaesthesia, Harvard Medical School Dr. Laussen graduated from Melbourne University Medical School, Australia in 1981 and completed fellowships in Anesthesia and Critical Care Medicine at the Austin Hospital and Royal Children’s Hospital Melbourne. He joined the Cardiac Anesthesia faculty at Children’s Hospital Boston in 1992 and the Division of Cardiac Intensive Care in 1993. He is the Director of the Cardiac Intensive Care Unit and Senior Associate in the Department of Cardiology. He also maintains a dual appointment in the Department of Anesthesia at Children’s Hospital and attends regularly on the Cardiac Anesthesia Service. He is the D.D. Hansen Chair of Pediatric Anesthesia at Children’s Hospital and an Associate Professor of Anesthesia at Harvard Medical School. Dr. Laussen’s clinical research interests include the mechanical support of the circulation in children with heart disease, pediatric resuscitation, the stress response to cardiac surgery and cardiopulmonary bypass in neonates and infants, and patient safety and quality insurance in pediatric critical care. Laussen PC, Roth PJ. Fast Tracking: Efficiently and Safely Moving Patients Through the Intensive Care Unit. Prog Ped Cardiol 2003;18;149-158 Booth KL, Roth SP, Thiagarajan RR, Almodovar MC, delNido PJ, Laussen PC. Extracorporeal Membrane Oxygenation Support of the Fontan and Bi-Directional Glenn circulations. Ann Thorac Surg 2004;77:1341-8 de Ferranti SD, Gauvreau K, Hickey PR, Jonas RA, Wypij D, du Plessis A, Bellinger DC, Kuban K, Newburger JW, Laussen PC. Intraoperative hyperglycemia during neonatal cardiac surgery is not associated with adverse neurodevelopmental outcomes at 1, 4 and 8 years. Anesthesiology 2004;100:1339-41 Sakamato S, Zurakowski D, Duebener LF, Lidov GW, Holes GL, Hurley RJ, Laussen PC, Jonas RA. Interaction of temperature with hematocrit level and pH determines safe duration of hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2004;128:220-32 Kussman BK, Zurakowski D, Sullivan L, McGowan FX Jr., Davis PJ, Laussen PC. Evaluation of Plasma Fentanyl Concentrations in Infants during Cardiopulmonary Bypass with Smaller-Volume Circuits. J Cardiothoracic Vasc Anesthes 2005;19:316-321 Cua CL, Thomas K, Zurakowski D, Laussen PC. Comparison of the Vasotrac with invasive arterial blood pressure monitoring in children following pediatric cardiac surgery. Anesth Analg 2005;100:1289-94 Kelleher DK, Laussen PC, Teixeira-Pinto A, Duggan C. Growth And Correlates Of Nutritional Status Among Infants With Hypoplastic Left Heart Syndrome (HLHS) following the Stage One Norwood Procedure. Nutrition (in press) Costello JM, Thiagarajan RR, Dionne RE, Allan CK, Booth KL, Burmester M, Wessel DL, Laussen PC. Initial experience with fenoldopam following cardiac surgery in neonates with an insufficient response to conventional diuretics. Pediatr Crit Care Med 2006;7:28-33 Booth KL, Guleserian KJ, Mayer JE, Laussen PC. Extracorporeal membrane oxygenation support of a neonate with percutaneous femoral arterial cannulation. Ann Thorac Surg (in press) Cua CL, Thiagarajan RT, delNido PJ, Mayer JE Jr, Newburger JW, Laussen PC. The Early Post-Operative Outcomes of Patients with Single Ventricle Cardiac Defects Undergoing Stage I Palliation Procedure with either a Modified Blalock-Taussig Shunt or a Right Ventricle To Pulmonary Artery Conduit. JACC (submitted) 44
  • 48. Allan CK, Thiagarajan RR, Armsby LR, del Nido PJ, Laussen PC. Emergent use of Extracorporeal Membrane Oxygenation during pediatric cardiac catheterization. Ped Crit Care Med (accepted) JAMI C. LEVINE, M.D. Associate in Cardiology, Children’s Hospital and Assistant Professor of Pediatrics, Harvard Medical School Dr. Levine’s primary clinical responsibility is as an echocardiographer. In addition, she sees patients in the faculty practice clinic at Children’s Hospital. Her research interests have focused on non- invasive cardiac imaging including transthoracic, transesophageal and fetal imaging. Recent publications include: Levine JC, Saul JP, Walsh EP. Radiofrequency ablation of accessory pathways associated with congenital heart disease including Heterotaxy syndrome. Am J Cardiol 1993;72(9):689-693. Levine JC, Mayer JE, Keane JF, Spevak PJ, Sanders SP. Anastomotic pseudoaneurysm of the ventricle after homograft placement in children. Ann Thorac Surg 1995;59:60-66 Levine JC, Sanders SP, Colan SD, Jonas RA, Spevak PJ. Coarctation of the aorta: Morphology and the risk for additional late left sided obstructive lesions. J Am Coll Cardiol 1995;2:141A. Rhodes J, Fulton D, Levine J. Marx G. Comparison between mean dP/dt during isovolumetric contraction and other echocardiographic indexes of ventricular systolic function. Echocardiography 1997;14:215-222. Bartram U, Van Praagh S, Levine J, Hines M, Bensky A, Van Praagh, R. Absent right superior vena cava syndrome: Literature Review and 9 new cases. Am J Cardiol 1997;7;80(2):175-183 Levine J, Geva T. Echocardiographic assessment of common atricoventricular canal. Prog Pediatr Cardiol 1999;10:137-151 Levine J, Sanders S, Colan S, Jonas R, Spevak P. The risk for additional left sided obstructive lesions in neonatal coarctation of the aorta. Cardiology in the Young. 2001;11:44-53. JAMES E. LOCK, M.D. Chairman, Department of Cardiology and Physician-in-Chief, Children’s Hospital; and Alexander S. Nadas Professor of Pediatrics, Harvard Medical School Dr. Lock has developed and provided the initial descriptions of nearly a dozen new techniques in interventional cardiology, including angioplasty of pulmonary arteries, percutaneous dilation of mitral valves in children, transcatheter closure of ventricular septal defects and transcatheter correction of paravalvar leaks. He holds six U.S. patents for new device ideas, and has several patents pending. He performs over 400 interventional procedures per year, and continues to explore new approaches to catheter therapy. Dr. Lock's recent publications include: Knauth AL, Lock JE, Perry SB, McElhinney DB, Gauvreau K, Landzberg MJ, Rome J, Hellenbrand W, Ruiz C, Jenkins KJ. Transcatheter device closure of congenital and post-operative residual ventricular septal defects. Circulation 2004;110:501-507. Marshall AC, van der Velde ME, Tworetzky W, Wilkins-Haug L, Benson CB, Jennings RW, Lock JE. Creation of 45
  • 49. an atrial septal defect in utero for fetuses with hypoplastic left heart syndrome and intact or highly restrictive atrial septum. Circulation 2004;110:253-258. Tworetzky W, Wilkins-Haug L, Jennings RW, van der Velde ME, Marshall AC, Colan SD, Benson CB, Lock JE, Perry SB. Balloon dilation of severe aortic stenosis in the fetus: Potential for prevention of hypoplastic left heart syndrome. Candidate selection, technique, and results of successful intervention. Circulation 2004;110:2125- 2131. McElhinney DB, Sherwood MC, Keane JF, del Nido PJ, Almond CSD, Lock JE. Current management of congenital mitral stenosis: Outcomes of transcatheter and surgical therapy in 108 infants and children. Circulation 2005;112:707-714. Marshall AC, Tworetzky W, Bergersen L, McElhinney DB, Benson CB, Jennings RW, Wilkins-Haug LE, Marx GR, Lock JE. Aortic valvuloplasty in the fetus: Technical characteristics of successful balloon dilation. J Pediatr 2005;147(4):535-539. Bergersen L, Jenkins KJ, Gauvreau K, Lock JE. Follow-up results of cutting balloon angioplasty used to relieve stenoses in small pulmonary arteries. Cardiol Young 2005;15:605-610. RENEE E. MARGOSSIAN, M.D. Assistant in Cardiology, Children's Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Margossian's primary clinical and research interest is in echocardiography, including fetal and transesophageal echocardiography in the assessment of congenital heart disease. She completed her pediatric training at Southwestern Medical Center in Dallas, and her cardiology fellowship at Columbia-Presbyterian in New York as well as a senior fellowship in echocardiography at Children's Hospital, Boston. In addition to echocardiography, her primary research interests include clinical evaluation and treatment of cardiomyopathies and clinical trials in Pediatric Cardiology through the NHLBI sponsored Pediatric Heart Network. Publications include: Friehs I, Margossian RE, Moran AM, Cao-Danh H, Moses MA, Del Nido PJ. Vascular endothelial growth factor delays onset of failure in pressure-overload hypertrophy through matrix metalloproteinase activation and angiogenesis. Basic Res Cardiol. 2005 Dec 23. Danhaive O, Margossian R, Geva T, Kourembanas S. Pulmonary hypertension and right ventricular dysfunction in growth-restricted, extremely low birth weight neonates. J Perinatol. 2005 Jul 25(7): 495-9. Tworetzky W, McElhinney DB, Margossian R, Moon-Grady AJ, Sallee D, Goldmuntz E, van der Velde ME, Silverman NH, Allan LD. Association between cardiac tumors and tuberous sclerosis in the fetus and neonate. Am J Cardiol. 2003 Aug 15;92(4):487-9. Margossian R, Solowiejczyk D, Bourlon F, Apfel H, Gersony W, Hordof A, Quaegebeur J. Septation of the Single Ventricle: Revisited. J Thorac Cardiovasc Surg. 2002 Sep;124(3):442-7. Marcus EN, Munoz RA, Margossian R, Colan SD, Wessel DL. Echocardiographic Assessment of the Right Ventricular Response to Hypertension in Neonates Based on Average Shape Contraction Models. J Am Soc Echocardiogr. 2002 Oct;15(10 Pt 2):1145-53. AUDREY C. MARSHALL, M.D. Associate in Cardiology, Children’s Hospital and Assistant Professor in Pediatrics, Harvard Medical School 46
  • 50. Dr. Marshall serves as a staff member in the cardiac catheterization laboratory. She completed her fellowship and interventional training at Children’s Hospital. She has helped to build the fetal cardiac interventional program, and is a member of the Advanced Fetal Care Center. Current interests include the development of instruments and devices specific to fetal intervention. Recent publications include: Marshall AC, Tworetzky W, Bergersen L, McElhinney DB, Benson CB, Jennings RW, Wilkins-Haug LE, Marx GR, Lock JE. Aortic valvuloplasty in the fetus: Technical characteristics of successful balloon dilation. J Peds, 2005; 147:535-539. Marshall AC, Lock JE. Structural and compliant anatomy of the patent foramen ovale in patients undergoing transcatheter closure. American Heart Journal 2000; 140:303. Marshall AC, Love BA, Lang P, Jonas RA, del Nido P, Mayer JE, Lock JE. Staged repair of tetralogy of Fallot and diminutive pulmonary arteries using a fenestrated ventricular septal defect patch. J Thorac Cardiovasc Surg; 2003; 126:1427-33. Marshall AC, van der Velde ME, Twortezky W, Gomez CA, Wilkins-Hang L, Benson CB, Jennings RW, Lock JE. Creation of an atrial septal defect in utero for fetuses with hypoplastic left heart syndrome and intact or highly restrictive atrial septum. Circulation 2004; 110:529-33. GERALD R. MARX, M.D. Senior Associate in Cardiology, Director of Ultrasound Imaging Research, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Marx has a clinical practice at Boston Children’s Hospital and at St. Anne’s Hospital in Fall River, MA. Additionally, he is a member of the echocardiography staff. He has been part of the development and clinical application of two-dimensional and Doppler echocardiography in the care of patients with congenital heart disease. Presently, he is the director of the three- dimensional echocardiography laboratory which is integrally involved in aortic and mitral valvuloplasties, reconstruction of color flow jets in three-dimensional formats, and currently in the development of real-time three-dimensional echocardiography. Dr. Marx’s recent publications include: Acar P, Laskari C, Rhodes J, Pandian N, Warner K, Marx G. Three-dimensional echocardiographic analysis of valve anatomy as a determinant of mitral regurgitation after surgery for atrioventricular septal defects. Amer J of Card. 1999;83:745-749. Bacha EA, Satou GM, Moran AM, Zureakowski D, Marx GR, Keane JF, Jonas RA. Valve-sparing surgery for balloon-induced aortic regurgitation in congenital aortic stenosis. J Thoracic and Cardiovascular Surgery. 122(1):1628, 2001. Acar P, Marx GR, Saliba Z, Sidi D, Kachaner. Three-dimensional echocardiographic measurement of left ventricular stroke volume in children: comparison with Doppler method. Pediatr Cardiol 2001; 22:116-120. Marx GR, Sherwood MC, Fleishman C, Van Praagh, R. Three-dimensional echocardiography of the atrial septum. Echocardiography 2001; 18(5):433-443. Marx GR, Sherwood MC. Three-dimensional echocardiography in congenital heart disease. A continuum of unfulfilled promises? No! A current technology with clinical applications and an important future. Yes! Pediatric Cardiology. 23(3):266-85, 2002. 47
  • 51. JOHN E. MAYER, JR., M.D. Senior Associate in Cardiac Surgery, Children’s Hospital Boston. Professor of Surgery, Harvard Medical School Dr. Mayer’s primary clinical responsibilities involve surgery for complex forms of congenital heart defects. He is the Surgical Director of the Cardiac Transplantation Service. Dr. Mayer serves as the Special Assistant to the CEO of Children’s Hospital and is the Chair of the Physician Organization’s Contracting and Quality Committees. Dr. Mayer’s major research interests include (1) the short and long-term outcome of the Fontan operation and (2) tissue engineering of cardiovascular structures, and cardiac transplantation. Recent publications include: Wu X, Rabkin-Aikawa E, Guleserian KJ, Perry TE, Masuda Y, Sutherland FW, Schoen FJ, Mayer JE Jr, Bischoff J. Tissue-engineered microvessels on three-dimensional biodegradable scaffolds using human endothelial progenitor cells .Am J Physiol Heart Circ Physiol 2004; 287 (2):H480-7. Sutherland FWH, Mayer JE Jr. Ethical and regulatory issues concerning Engineered Tissues for Congenital Heart Repair. Pediatric Cardiac Surgery Annual of the Seminars in Thoracic and Cardiovascular Surgery. 2003;6:152-163. Engelmayr GC, Hildebrand DK, Sutherland FW, Mayer JE Jr, Sacks MS. Anovel bioreactor for the dynamic flexural stimulation of tissue engineered heart valve biomaterials. Biomaterials 2003; 24:2523-32. Perry TE, Kaushal S, Sutherland FW, Guleserian KJ, Bischoff J, Sacks M, Mayer JE Jr. Thoracic Surgery Directors Association Award. Bone marrow as a cell source for tissue engineering heart valves. Ann Thorac Surg. 2003;75:761-7; discussion 767. FRANCIS X. MCGOWAN, JR., MD Chief, Division of Cardiac Anesthesia, Senior Associate in Anesthesia, Director of the Anesthesia/Critical Care Medicine Research Laboratory, Staff Physician, Boston Adults with Congenital Heart Disease (BACH) Program, Children’s Hospital Boston and Professor of Anaesthesiology (Pediatrics), Harvard Medical School Dr. McGowan attended Brown University and Duke University Medical School. He completed residencies in pediatrics and anesthesiology at Yale University School of Medicine, where he was also Chief Resident in Anesthesiology and a research fellow in pediatric cardiology/pathology. Dr. McGowan has been at Children’s Hospital for eleven years. His clinical work is centered on the perioperative management of patients with congenital heart disease, with particular interests in neonates, adults with congenital heart disease, and patients with CHD having non-cardiac surgery. His research efforts are focused on defining mechanisms of cellular injury due to ischemia- reperfusion, hypertrophy, and inflammation. He is the principal investigator on 3 RO-1s from the NIH, and co-investigator on 3 others in these areas. Dr. McGowan has authored or co-authored over 100 original articles and book chapters on topics in pediatric anesthesia and myocardial pathophysiology. He is currently President of the Society for Pediatric Anesthesia. Representative recent publications: 48
  • 52. Cowan DB, Poutias DN, Del Nido PJ, McGowan FX, Jr. CD14-independent activation of cardiomyocyte signal transduction by bacterial endotoxin. Am J Physiol Heart Circ Physiol 2000; 279:H619-629. Cowan DB, Noria S, Stamm C, et al. Lipopolysaccharide internalization activates endotoxin-dependent signal transduction in cardiomyocytes. Circ Res 2001; 88:491-498. Stamm C, Cowan DB, Friehs I, Noria S, del Nido PJ, McGowan FX, Jr. Rapid endotoxin-induced alterations in myocardial calcium handling: obligatory role of cardiac TNF-alpha. Anesthesiology 2001; 95:1396-1405. Stamm C, Friehs I, Cowan DB, et al. Inhibition of tumor necrosis factor-alpha improves postischemic recovery of hypertrophied hearts. Circulation 2001; 104:I350-355. Chanani NK, Cowan DB, Takeuchi K, et al. Differential effects of amrinone and milrinone upon myocardial inflammatory signaling. Circulation 2002; 106:I284-289. Choi Y-H, Stamm C, Moran AM, Cowan DB, del Nido PH, Colan SD, McGowan FX. Cardiomyocyte apoptosis occurs early during progression of left ventricular hypertrophy in the developing rabbit. Ann Thor Surg (in press). MARY P. MULLEN, M.D., Ph.D. Assistant in Cardiology, Children’s Hospital, Instructor of Pediatrics, Harvard Medical School Dr. Mary Mullen is a staff member of the Cardiac Intensive Care Unit and the Boston Adult Congenital Heart Service and specializes in the care of patients with pulmonary hypertension. She is board certified in Pediatrics, Internal Medicine and Pediatric Cardiology. Her research interests include clinical trials in pulmonary hypertension, critical care of adults with congenital heart disease, coronary artery anomalies and the molecular basis of cardiovascular disease. Mullen, MP (2000). Adult Congenital Heart Disease, Scientific American Medicine, March 2000, 1-10. Kamisago M., Sharma, SD, DePalm, SR, Solomon S, Sharma P, McDonough B, Smoot L, Mullen MP, Woolf PK, Wigle ED, Seidman JG, Seidman CE (2000). Mutations in sarcomere protein genes as a cause of dilated cardiomyopathy. N Eng J Med 343:1688-1695. Mullen, MP, Landzberg, MJ. Care for Adults with Congenital Heart Disease. In Antman E. et al, eds., Cardiovascular Therapeutics, W.B. Saunders, 2002;1048-1074. Mullen, MP, VanPraagh R, Walsh EP Development and anatomy of the cardiac conducting system. In Walsh EP et al, eds., Cardiac Arrhythmias in Children and Young Adults with Congenital Heart Disease, New York: Lippincott, Williams &Wilkins, 2001;3-22. JANE W. NEWBURGER, M.D., M.P.H. Associate Cardiologist-in-Chief, Children's Hospital and Professor of Pediatrics, Harvard Medical School Dr. Newburger is Associate Cardiologist-in-Chief, Co-Director of the Fellowship Training program, and Director of the Clinical Research Service in the Department of Cardiology. After graduating from Harvard Medical School, she completed her training in Pediatrics and Pediatric Cardiology at Children’s Hospital Boston. She maintains an active practice comprised of patients with congenital heart disease, Kawasaki disease and lipid disorders, and serves on a number of national committees concerned with heart disease in children. 49
  • 53. Dr. Newburger’s research expertise is in the coordination of clinical trials and prospective clinical research studies. Research interests include neurologic and developmental effects of open heart surgery; pathogenesis, treatment, and long-term sequelae of Kawasaki Disease; and clinical aspects of hyperlipidemias and preventive cardiology in children. Dr. Newburger’s recent manuscripts include: Bellinger DC, Wypij D, duPlessis AJ, Rappaport LA, Jonas RA, Wernovsky G, Newburger JW. Neurodevelopmental status at eight years in children with D-transposition of the great arteries: The Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg; In Press. Jonas RA, Wypij D, Roth SJ, Bellinger DC, Laussen PC, dePlessis AJ, Goodkin H, Farrell D, Bartlett J, McGrath E, Rappaport LA, Newburger JW. The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: Results of a randomized trial in infants. J Thorac Cardiovasc Surg; In Press. Cottrell S, Morris K, Davies P, Bellinger DC, Jonas RA, Newburger JW. Early Postoperative Body Temperature and Developmental Outcome Following Open Cardiac Surgery in Infants. Annals of Thoracic Surgery. In Press. Bartlett JM, Wypij D, Bellinger DC, Rappaport LA, Jonas RA, Newburger, JW. Effect of prenatal diagnosis on one- year neurologic and developmental outcomes in D-TGA. Pediatrics. In Press. Newburger JW, Wypij D., Bellinger DC, Rappaport LA, duPlessis AJ, Almirall D, Wessel DL, Jonas RA, Wernovsky G. Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J. Pediatr 2003; 143:67-73. Sundel RP, Baker AL, Fulton DR, Newburger JW. Corticosteroids in the initial treatment of Kawasaki disease: Report of a randomized trial. J. Pediatr. 2003; 142: 611-6. SHARON E. O'BRIEN, M.D. Assistant in Cardiology, Children’s Hospital, Chief of Pediatric Cardiology, Boston Medical Center, Assistant Professor of Pediatrics, Boston University Medical School Dr. O’Brien’s clinical responsibilities are divided between directing the division of Pediatric Cardiology at Boston Medical Center and attending in the echocardiographic laboratory at Children’s Hospital. She completed her pediatric training at Tufts University and her cardiology fellowship at Yale University. Her primary interest is in clinical patient care with a focus on echocardiography including fetal and transesophageal assessment of congenital heart disease. Her research interests include the cardiovascular effects of HIV and its therapies. Selected publications include: Rhodes, J., O’Brien, S., Banerjee, A., Patel, H., Hijazi, Z: Palliative Balloon Pulmonary Valvuloplasty in Tetralogy of Fallot: Echocardiographic Predictors of Successful Outcome. Journal of Invasive Cardiology, vol 12, no 9, September 2000. O’Brien, S.E., Apkon, M., Berul, C.I., Patel, H.T., Saupe, K., Spindler, M., Ingwall, J.S., Zahler, R: Phenotypical features of long Q-T syndrome in transgenic mice expressing human Na-K-ATPase α3-Isoform in hearts. Am J Physiology, vol 279, issue 5, H2133-2142, Nov, 2000. Fujii, A., Brown, E., Mirochnick, M., O’Brien, S., Kaufman, G: Neonatal necrotizing enterocolitis with intestinal perforation in extremely premature infants receiving early indomethacin treatment for patent ductus arteriosus. Journal of Perinatology, 2002; 22:535-540 50
  • 54. Feltes, Timothy F. MD et al, Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease: The Journal of Pediatrics Volume 143(4) October 2003 pp 532-540 KIRSTEN C. ODEGARD, MD Senior Associate in Anesthesia, Co-Director, Division of Cardiac Anesthesia,Children’s Hospital Boston and Assistant Professor in Anaesthesia, Harvard Medical School Dr. Odegard completed a residency in internal medicine at Lenox Hill Hospital in New York, followed by a residency in anesthesiology at NYU Medical Center. She then completed a fellowship in cardiothoracic anesthesia at NYU, including a two-month fellowship in pediatric cardiac anesthesia at Children’s Hospital Boston. Her main area of research is the understanding of the coagulation system in patients with congenital heart disease undergoing cardiopulmonary bypass, with special interest in perioperative thromboembolic complications in Fontan patients. Recent Publications: Odegard KC, McGowan FX, Jr., DiNardo JA, et al. Coagulation abnormalities in patients with single-ventricle physiology precede the Fontan procedure. J Thorac Cardiovasc Surg 2002; 123:459-465. Odegard KC, McGowan FX, Jr., Zurakowski D, et al. Coagulation factor abnormalities in patients with single-ventricle physiology immediately prior to the Fontan procedure. Ann Thorac Surg 2002; 73:1770-1777. Odegard KC, McGowan FX, Jr., Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 2003; 125:1260-1267. Sarkar M, Laussen PC, Zurakowski D, Shukla A, Kussman B, Odegard KC. Hemodynamic responses to etomidate on induction of anesthesia in pediatric patients. Anesth Analg 2005; 101:645-650. Odegard KC, Laussen PC. Approach to the premature and full term infant. In: Andropolous DB, Stayer SA, Russel IA, eds. Anesthesia for congenital heart disease, 2005. Odegard KC, Laussen PC. Pediatric anesthesia and critical care. Pediatric cardiac surgery. In:Sabiston & Spencer's Surgery of the Chest. 7th ed, 2005. FRANK A. PIGULA, M.D. Associate in Cardiac Surgery, Children’s Hospital Boston; Assistant Professor of Surgery, Harvard Medical School Dr. Pigula recently joined the Department of Cardiac Surgery from Children’s Hospital of Pittsburgh, where he was Director of Pediatric Cardiac Surgery. His clinical work is devoted to the surgical treatment of all forms of congenital heart disease, with special interest in diseases of the aorta and the aortic valve. Dr. Pigula’s major research interests include the cerebrovascular response to cardiopulmonary bypass, and surgical approaches to fetal cardiac intervention. Mahnke CB, Boyle GJ, Janosky JE, Siewers RD, Pigula FA. Anticoagulation and Incidenc of Late erebrovascular Accidents Following the Fontan Procedure. Pediatr Cardiol. 2004 Jun 4; [Epub ahead of pint] 51
  • 55. Ashburn DA, Blackstone EH, Wells WL, Jonas RA, Pigula FA, Manning PB, Lofland GL, Williams WG, McCrindle BW, Members of the Congenital Heart Surgeons Society. Determinants of mortality and type of repair in neonates with pulmonary atresia and intact ventricular septum. Journal of Thoracic and Cardiovascular Surgery. 2004;127:1000-1008. Fenton KN, Pigula FA, Duncan K, Gandhi SK. Interim Mortality in Pulmonary Atresia with Intact Ventricular Septum Ann Thorac Surg 2004; 78(6): 1994-8. Pigula FA, Invited Editorial: CHD Competing Perfusion Strategies: Effect on Microvascular Oxygen Tension. J. Thorac and Cardiovasc Surg 2003;125:456. ANDREW J. POWELL, M.D. Associate in Cardiology, Children’s Hospital, and Assistant Professor of Pediatrics, Harvard Medical School Dr. Powell’s primary clinical interest is non-invasive anatomic and functional assessment of congenital heart disease using echocardiography, magnetic resonance imaging, and computer tomography. His responsibilities including attending in the echocardiography laboratory, cardiac MRI (Director), and outpatient clinic. His current research focuses on the application of new MRI techniques to patients with congenital heart disease including quantitation of ventricular function, blood flow, and iron content. Dr. Powell’s recent publications include: Greil GF, Stuber M, Botnar RM, Kissinger KV, Geva T, Newburger JW, Manning WJ, Powell AJ. Coronary magnetic resonance angiography in adolescents and young adults with Kawasaki disease. Circulation 2002;105:908- 911. Geva T, Greil GF, Marshall AC, Landzberg M, Powell AJ. Gadolinium-enhanced 3-dimensional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia: comparison with x- ray angiography. Circulation 2002;106:473-478. Powell AJ, Tsai-Goodman B, Prakash A, Greil GF, Geva T. Comparison Between Phase-Velocity Cine Magnetic Resonance Imaging and Invasive Oximetry for Quantification of Atrial Shunts. American Journal of Cardiology 2003;91:1523-1525. Tsai-Goodman B, Geva T, Odegard KC, Sena LM, Powell AJ. Clinical role, accuracy, and technical aspects of cardiovascular magnetic resonance imaging in infants. American Journal of Cardiology, American Journal of Cardiology 2004;94:69-74. Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ. Factors associated with impaired clinical status in long- term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. Journal of the American College of Cardiology 2004;43:1068-74. WILLIAM T. PU, M.D., Ph.D. Assistant in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Pu's research is focused on understanding the transcriptional network that regulates cardiac morphogenesis and postnatal cardiac function. Specifically, he studies the function of the essential cardiac transcription factors GATA4 and FOG2 in both cardiac development and in the adaptation of the postnatal heart to biomechanical stress. Using conditional and hypomorphic alleles of GATA4 and FOG2, he is dissecting the subregion-specific requirements for these genes in the 52
  • 56. developing a mature heart. This work will broaden our understanding of the mechanisms that regulate heart development and the response of the heart to hypertrophic stress. Dr. Pu's recent publications include: Pu WT, Wickman K, Clapham DE. ICln Is Essential for Cellular and Early Embryonic Viability. J. Biol. Chem. 2000; 275: 12363-6. Kovoor P, Wickman K., Maquire CT, Pu WT, Gehrmann, J, Berul CI, Clapham DE. Evaluation of the Role of IKACh in Atrial Fibrillation Using a Mouse Knockout Model. J. Am. Coll. Cardiol 2001; 37: 2136-43. Pu WT, Izumo, S. Transcription Factors in Hypertrophy: Does the Stressed Heart Need a Hand? Journal of Molecular and Cellular Cardiology.2001; 33: 1765-7. Wickman K, Pu WT, Clapham, DE. Structural characterization of the mouse Girk genes. Gene 2002; 284:241-50. Pu WT, Ma Q, Izumo S. NFAT transcription factors are critical survival factors that inhibit cardiomyocyte apoptosis during phenylephrine stimulation in vitro. Circ Res 2003: 92: 725-31. Izumo S, Pu WT. ³Molecular Basis of Heart Failure² in Heart Failure, D. Mann, ed.; in press. Ishiwata T, Nakazawa M, Pu WT, Tevosian SG, Izumo S. Developmental Changes in Ventricular Diastolic Function Correlate with Changes in Ventricular Myoarchitecture in Normal Mouse Embryos. Submitted. Pu* WT, Ishiwata*T, Juraszek AL, Ma Q, Izumo S. GATA4 and FOG2 Are Essential for Normal Ventricular Morphogenesis and Diastolic Function. Submitted. Pu WT, Ishiwata T, Sherwood MC, Branco D, Juraszek AL, Berul CI, Izumo S. GATA4 expression level critically regulates cardiac morphogenesis and function. In preparation. JONATHAN RHODES, M.D. Associate in Cardiology, Children's Hospital and Assistant Professor of Pediatrics, Harvard Medical School Dr. Rhodes is the co-director of the exercise physiology laboratory. His major clinical interests are ventricular function and the effect of congenital heart disease on the cardiopulmonary response to exercise. Dr. Rhodes is also an active participant in the Outreach Cardiology Program and has a large clinical practice, including several satellite clinics. Prior to arriving at Children’s Hospital in November, 2002, Dr. Rhodes was the Chief of Pediatric Cardiology at New England Medical Center. Selected recent publications: Rhodes J, Curran TJ, Cassul L, Robideau NC, Fulton DR, Gauthier NS, Gauvreau K, Jenkins KJ. Impact of cardiac rehabilitation upon the exercise function of children with serious congenital heart disease. Pediatrics 2005; 116:1339-45. Rhodes J, O’Brien S, Patel H, Cao QL, Banerjee A, Hijazi ZM. Palliative balloon pulmonary valvuloplasty in tetralogy of Fallot: Echocardiographic predictors of successful outcome. J Inv Cardiol 2000:12:448-51 Rhodes J, Fischbach PS, Patel H, Banerjee A, Hijazi Z. Factors affecting the exercise capacity of pediatric patients with aortic regurgitation. Pediatr Cardiol 2000;21:328-33 Rhodes J, Dave A, Pulling MC, Geggel RL, Marx GR, Fulton DR, Hijazi ZM. Effect of pulmonary artery stenosis on the cardiopulmonary response to exercise following repair of tetralogy of Fallot. Am J Cardiol, 1998;81:1217-9 53
  • 57. Rhodes J, Warner KG, Fulton DR, Romero BA, Schmid CH, Marx GR. Fate of mitral regurgitation following repair of atrioventricular septal defect. Am J Cardiol 1997;80:1194-7. Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM. Excessive anaerobic metabolism during exercise following repair of coarctation. Evidence for functionally significant residual arch obstruction. J Pediatr, 1997;131:210-214. Rhodes J, Udelson JE, Marx GR, Schmidt CH, Konstam MA, Hijazi ZM, Bova SA, Fulton DR. A new noninvasive method for the estimation of peak dP/dt. Circulation 1993;88:2693-2699. MARCY L. SCHWARTZ, M.D. Asociate in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Schwartz’s primary clinical and research interest is in echocardiography, including fetal and transesophageal echocardiography for the anatomic and functional assessment of congenital heart disease and cardiomyopathy. Her clinical research has focused on echocardiographic predictors of outcome in congenital heart disease. Her interests also include the evaluation of children with cardiomyopathy. Dr. Schwartz’s publications include: Schwartz ML, Cox GF, Lin AE, Korson MS, Perez-Adayde A, Lacro RV, Lipshultz SE. Clinical approach to genetic cardiomyopathy in children. Circulation 1996;94:2021-2038. Schwartz ML, Jonas RA, Colan SD. Anomalous origin of the left coronary artery from the pulmonary artery: Recovery of left ventricular function after dual coronary repair. J Am Coll Cardiol 1997;30(2):547-553. Schwartz ML, Gauvreau K, Geva T. Predictors of outcome of biventricular repair in infants with multiple left heart obstructive lesions. Circulation 2001; 104:682-687. Schwartz, ML, Colan SD. Familial restrictive cardiomyopathy with skeletal abnormalities. Amer J Cardiol, 2003. In Press. Schwartz ML, Gauvreau K, del Nido P, Mayer JE, Colan SD. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation 2004; 110 [suppl II]:II-128-II-132. AVINASH C. SHUKLA, MBBS Associate in Cardiac Anesthesia, Children’s Hospital Boston, Instructor in Anaesthesia, Harvard Medical School Dr Shukla received his medical degree from Kings College London and subsequently completed his anesthetic training in London, as well. In addition, he completed a research Fellowship in Intensive Care at University College London and a clinical Fellowship in Pediatric Cardiac Anesthesia at Childrens Hospital Boston. Following his training he joined the staff at The London Chest Hospital rapidly becoming Chairman of the Department. In 2001, he returned to join the staff of the Cardiac Anesthesia Division. His interests include robotics, transplantation and perioperative arrhythmias. Selected Publications: Hamilton-Davies C, Salmon J, Mythen M, Jacobsen D, Shukla AC, Webb A. A Comparison of commonly used indicators of hypovolemia with gastrointestinal tonometry. Intensive Care Medicine 1997;23(3):276-81. 54
  • 58. Barnard MJ, Shukla AC, Lovell AT, Goldstone JC. A comparison of airway and oesophageal triggering of pressure support ventilation. Chest 1999;115(2):482-9. Gruber EM, Shukla AC, Reid RW, Hansen D. Synthetic antifibrinolytics are not associated with an increased incidence of baffle fenestration closure after the modified Fontan procedure. Journal of Cardiothoracic and Vascular Anesthesia 2000;14:257-9. Shukla, AC, et al. Anesthesia for Pediatric Organ Transplantation. In: Smith’s Anesthesia for Infants and Children, 7th ed. Mosby 2005. LAURENCE J. SLOSS, M.D. Associate in Cardiology, Children's Hospital, Physician, Brigham and Women's Hospital and Assistant Professor of Medicine, Harvard Medical School Dr. Sloss has been at Children's Hospital for thirty years, during which time he has been active in the Pathology Department and established a teaching collection of paraffinized heart specimens. He helped found and remains active in the Boston Adult Congenital Heart (BACH) service. He is also been responsible for teaching and interpreting Holter monitor studies in the EKG monitoring service. Dr. Sloss has a long-standing appointment at Brigham and Women's Hospital where he formerly served as chief of the noninvasive cardiac laboratory, and has a freestanding private practice in cardiovascular disease. Dr. Sloss' interests lie primarily in clinical cardiovascular medicine, with special emphasis on noninvasive diagnosis and adult congenital heart disease. LESLIE B. SMOOT , M.D. Assistant in Cardiology, Children's Hospital and Instructor in Pediatrics, Harvard Medical School Dr. Smoot has been a member of the cardiology staff since 1994. She received her medical degree from the University of Minnesota, followed by pediatrics residency at Northwestern University and Harbor-UCLA Medical Center. Her pediatric cardiology training began at Royal Children’s Hospital (Melbourne, Australia) followed by fellowship at Childrens Hospital in 1990. Dr. Smoot’s work focuses on cardiovascular genetics as it relates to both developmental abnormalities and cardiomyopathy. She is the director of the Cardiovascular Genetics Registry at Childrens Hospital and attending physician for Cardiovascular Genetics, Heart Failure and Cardiac Transplantation and general cardiology services. Recent publications include: Kamisago M, Sharma SD, DePalma SR, Solomon S, Sharma P, McDonough B, Smoot L, Mullen MP, Woolf PK, Wigle ED, Seidman JG, Seidman CE. Mutations in sarcomere protein genes as a cause of dilated cardiomyopathy. N Engl J Med 2000 Dec 7;343(23):1688-96. Metcalfe K, Rucka AK, Smoot L, Hofstadler G, Tuzler G, McKeown P, Siu V, Rauch A, Dean J, Dennis N, Ellis I Reardon W, Cytrynbaum C, Osborne L, Yates JR, Read AP, Donnai D, Tassabehji M Elastin: mutational spectrum in supravalvular aortic stenosis. Eur J Hum Genet 2000 Dec;8(12):955-63 55
  • 59. ELIF SEDA S. TIERNEY, M.D. Assistant in Cardiology, Children's Hospital Boston and Instructor in Pediatrics, Harvard Medical School Dr. Tierney is a staff member of the non-invasive laboratory. Her major clinical and research interests include fetal cardiology, outcomes research in children with congenital heart disease, 3D imaging and assessment of peripheral vascular function. Publications to date: Selamet SE, Hsu DT, Thaker HM, Gersony WM. Complete atresia of coronary ostia in pulmonary atresia and intact ventricular septum. Pediatr Cardiol. 2004; 25 (1):67-69. Selamet Tierney ES, Gersony WG, Altmann K, Solowiejczyk D, Alfayyad M, Bevilaqua L, Khan C, Krongrad E, Quaegebeur JM, Apfel HD. Pulmonary position cryopreserved homografts: Durability in Ross and non-Ross patients. J Thorac and Cardiovasc Surg. 2005, 282-86. Selamet Tierney ES, Mital S. Cardiovascular Genetics. In: Kleinman CS, editor. Fetal and Neonatal Cardiology. Philadelphia: W.B.Saunders In press RAVI R. THIAGARAJAN, M.D. Associate in Cardiology, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School Dr. Thiagarajan is a member of the Cardiac Intensive Care team and the Heart Transplantation Service. He is board certified both in Pediatrics Critical Care and Pediatric Cardiology. His research interests include the study of respiratory mechanics and ventilator weaning in children, severity of illness scoring systems in children, and ischemia re-perfusion injury following cardiopulmonary bypass. His recent publications include: Thiagarajan RR, Bratton SL, Ramamorrthy C, Gettman T. Efficacy of peripherally inserted central venous catheters placed in non-central veins. Archives of Pediatrics and Adolescent Medicine 1998; 152:436-439. Thiagarajan RR, Bratton SL, Martin LD, Brogan TV, Taylor D. Predictors of successful extubation in children. American Journal of Respiratory and Critical Care Medicine 1999; 160(5):1562-1566. Thiagarajan RR, Stephens KE, Williams G, Ramamoothy C, Lupinetti FM. Pulmonary function following modified veno-venous ultrafiltration in infants. Journal of Thoracic & Cardiovascular Surgery 2000; 119(3):501-505. Thiagarajan RR, Roth SJ, Mackie A, Margossian S, Laussen PC, Neufeld EJ, Blume ED. Extracorporeal membrane oxygenation in a patient with dilated cardiomyopathy and Hemophilia A. Intensive Care Medicine 2003;29(6):985 - 988. K.L. Booth, S.J. Roth, R.R. Thiagarajan, M.C .Almodovar, P.J. del Nido, P.C. Laussen. Extracorporeal membrane oxygenation support of the Fontan and Bidirectional Glenn Circulations. Annals of Thoracic Surgery 2004; 77: 1341- 1348. R.R. Thiagarajan, D.M. Coleman, S.L. Bratton, R.S. Watson, L.D .Martin. Inspiratory work of breathing is not decreased by flow triggered sensing during spontaneous breathing in children receiving mechanical ventilation: A preliminary report. Pediatric Critical Care Medicine 2004; 5: 375-378. 56
  • 60. C.L. Hancock Friesen, D. Zurakowski, R.R. Thiagarajan, J. M. Forbess, P.J. del Nido, J.E. Mayer, R.A. Jonas. Total Anomalous Pulmonary Venous Connection: An analysis of current management strategies in a single institution. Accepted, Annals of Thoracic Surgery, July 2004. R.R. Thiagarajan, D.P. Nelson. Should we be satisfied with outcomes for cardiac ECMO? Accepted, Pediatric Critical Care Medicine August 2004. JOHN K. TRIEDMAN, M.D. Senior Associate in Cardiology, Children’s Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Triedman is a staff member on the Electrophysiology Service. His research interests are the mechanisms and therapy of atrial reentrant tachycardia and modeling and numerical analysis of cardiovascular electrophysiology. Current projects include development of techniques for the visualization of electrophysiological properties of the right atrium and development of therapies for prevention and treatment of postoperative arrhythmia. Recent publications include: Alexander ME, Walsh EP, Saul JP, Epstein MR, Triedman JK. Value of programmed ventricular stimulation in patients with congenital heart disease. J Cardiovasc Electrophysiol 10:1033-1044, 1999. Triedman JK, Alexander ME, Berul CI, Bevilacqua LM, Walsh EP. Estimation of the atrial response to entrainment pacing using electrograms recorded from remote sites. J Cardiovasc Electrophysiol 11:1215-1222, 2000. Triedman JK, Alexander ME, Berul CI, Bevilacqua LM, Walsh EP. Electroanatomical mapping of entrained and exit zones in patients with repaired congenital heart disease and intraatrial reentrant tachycardia. Circulation 103:2060-2065, 2001. Triedman JK, Alexander ME, Love BA, Collins KK, Berul CI, Bevilacqua LM, Walsh EP. Influence of patient factors and ablative technologies on outcomes of radiofrequency ablation of intra-atrial reentrant tachycardia in congenital heart disease patients. J Am Coll Cardiol, 39:1827-1835, 2002. Kirsh JA, Walsh EP, Triedman JK. Prevalence of and risk factors for atrial fibrillation and intraatrial reentrant tachycardia among patients with congenital heart disease. Am J Coll Cardiol, 90:40-43, 2002. WAYNE TWORETZKY, M.B.CH.B. Associate in Cardiology, Children’s Hospital and Instructor in Pediatrics, Harvard Medical School Dr Tworetzky is an Attending in the Echo Lab. He also attends on the consult service and has two outpatient clinics per week. His time in the Echo Lab is divided between performing fetal echocardiograms, reading transthoracic echos and performing transesophageal echos in both the Cath lab and operating room. He also performs exercise and Dobutamine stress echocardiograms in children with coronary artery disease and certain forms of cardiomyopathy. Dr Tworetzky completed both his Pediatric Residency and Cardiology Fellowship training at the University of California, San Francisco where he developed his research interest in fetal cardiology. Dr Tworetzky's main research interest is in the impact of fetal diagnosis on the in-utero and perinatal management of congenital heart disease. More recently Dr Tworetzky has been instrumental in starting up a fetal cardiac intervention program in affiliation with the Advanced Fetal Care Center and the Division of Maternal-Fetal Medicine at Brigham and Women's. The program is seeking to treat fetuses with severe aortic stenosis and other serious congenital heart 57
  • 61. defects. He is also working closely with the fetal surgeons in the animal research lab to develop techniques for fetal cardiac access and therapy. Publications include: Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation. 2001 Mar 6;103(9):1269-73. Tworetzky W, Bristow J, Moore P, Brook MM, Segal MR, Brasch RC, Hawgood S, Fineman JR. Inhaled nitric oxide in neonates with persistent pulmonary hypertension. Lancet. 2001 Jan 13;357(9250):118-20. Tworetzky W, McElhinney DB, Burch GH, Teitel DF, Moore P. Balloon arterioplasty of recurrent coarctation after the modified Norwood procedure in infants. Catheter Cardiovasc Interv. 2000 May;50(1):54-8. Tworetzky W, Moore P, Bekker JM, Bristow J, Black SM, Fineman JR. Pulmonary blood flow alters nitric oxide production in patients undergoing device closure of atrial septal defects. J Am Coll Cardiol. 2000 Feb;35(2):463-7. Tworetzky W, McElhinney DB, Brook MM, Reddy VM, Hanley FL, Silverman NH. Echocardiographic diagnosis alone for the complete repair of major congenital heart defects. J Am Coll Cardiol. 1999 Jan;33(1):228-33. Lester SJ, McElhinney DB, Viloria E, Reddy GP, Ryan E, Tworetzky W, Schiller NB, Foster E. Effects of losartan in patients with a systemically functioning morphologic right ventricle after atrial repair of transposition of the great arteries. Am J Cardiol. 2001 Dec 1;88(11):1314-6. No abstract available. McElhinney DB, Reddy VM, Tworetzky W, Petrossian E, Hanley FL, Moore P. Incidence and implications of systemic to pulmonary collaterals after bidirectional cavopulmonary anastomosis. Ann Thorac Surg. 2000 Apr;69(4):1222-8. McElhinney DB, Tworetzky W, Hanley FL, Rudolph AM. Congenital obstructive lesions of the right aortic arch. Ann Thorac Surg. 1999 Apr;67(4):1194-202. Review. McElhinney DB, Petrossian E, Tworetzky W, Silverman NH Hanley FL. Issues and outcomes in the management of supravalvar aortic stenosis. Ann Thorac Surg. 2000 Feb;69(2):562-7. Seddio F, Reddy VM, McElhinney DB, Tworetzky W, Silverman NH, Hanley FL. Multiple ventricular septal defects: how and when should they be repaired? J Thorac Cardiovasc Surg. 1999 Jan;117(1):134-9; discussion 39-40. McElhinney DB, Reddy VM, Tworetzky W, Silverman NH, Hanley FL. Early and late results after repair of aortopulonary septal defect and associated anomalies in infants <6 months of age. Am J Cardiol. 1998 Jan 15;81(2):195-201. RICHARD VAN PRAAGH, M.D. Director, Emeritus, Cardiac Registry, Research Associate in Cardiology and Cardiac Surgery, Children’s Hospital and Professor of Pathology, Emeritus, Harvard Medical School Dr. Richard Van Praagh was the Director of the Cardiac Registry (the cardiac pathology laboratory) at Children’s Hospital, Boston until June 30, 2001. Trained in pediatrics, pediatric cardiology, pathology, and embryology, Dr. Van Praagh’s main interests involve congenital cardiovascular pathology and its many correlations-diagnostic, therapeutic, developmental, and etiologic. He pioneered the widely used segmental anatomic and developmental approach to the diagnosis and classification of complex congenital heart disease. He has contributed to a better understanding of many different forms of congenital heart disease including single ventricle, double-outlet left 58
  • 62. ventricle, and anatomically corrected malposition of the great arteries. Dr. Van Praagh has developed two new surgical operations – for totally anomalous pulmonary venous connection to the coronary sinus, and for interrupted aortic arch. Dr. Van Praagh has held numerous visiting professorships and invited lectureships, and has served on the editorial boards of several major cardiology journals. Dr. Van Praagh’s recent publications include: Vizcaino A, Campbell J, Litovsky S, Van Praagh R. Single origin of right and left pulmonary artery branches from ascending aorta with nonbranching main pulmonary artery: relevance to a new understanding of truncus arteriosus. Pediatr Cardiol 2002;23:230-4. Van Praagh, S, Geva T, Lock JE, del Nido PJ, Vance MS, Van Praagh R. Biatrial or left atrial drainage of the right superior vena cava: anatomic, morphogenetic, and surgical considerations. Report of three new cases and literature review. Pediatr Cardiol 2003;24:350.63. Van Praagh S, Geva T. Lock JE, del Nido PJ, Vance MC, Van Praagh R. Biatrial or left atrial drainage of the right superior vana cava: anatomic, morphogenetic, and surgical considerations. Report of three new cases and literature review. Pediatr Cardiol 2003; 24-350-363. Van Praagh S, Porras D, Oppido G, Geva T. Van Praash R. Cleft mitral valve without ostium primum defect: anatomic data and surgical considerations bsed on 41 cases. Ann Thorac Surg 2003; 75:1752-1762. Porras D, Kratz C, Loukas M. van Doesburg NH, Davignon A, Van Praagh R. Superoinferior ventricles with superior left ventricle and inferior right ventricle: a newly recognized form of congenital heart disease. Pediatr Cadriol 2003; 24:604-607. Konstantinov IE, Alexi-Meskishvile VV, Williams WG, Freedom RM, Van Praagh R. Atrial switch operation: past, present, and future. Ann Thorac Surg 2004; 77:2250-8. Konstantinov IE, Lai L, Colan SD, Williams WG, Li J, Jonas RA, Van Praagh R. Atrioventricular discordance with ventriculoarterial concordance: A remaining indication for the atrial switch operation. J Thorac Cardiovasc Surg 224;128:944-5. Van Praagh R. Chapter 101: Segmental Anatomy. In Sabiston & Spencer Surgery of the Chest, Selke FW, del Nido PJ, Swanon SJ (eds), Elsevier Saunders, Philadelphia 2005; pp 1763-1772. EDWARD P. WALSH, M.D. Senior Associate in Cardiology, Children's Hospital and Associate Professor of Pediatrics, Harvard Medical School Dr. Walsh is Chief of the Electrophysiology Division. He is principally involved in clinical patient care, particularly transcatheter ablation of arrhythmias, along with fellow training and administration of the electrophysiology service. He has been active in the development of radiofrequency ablation since the inception of the technique, and has helped promote its use in the pediatric age group. His research efforts have concentrated on the development of new catheter technologies to improve mapping and ablation of complex arrhythmias. In addition, he has special interests in postoperative arrhythmias, fetal arrhythmias, and the adult with congenital heart disease. Recent publication include: Triedman JK, Saul JP, Weindling SN, Walsh EP. Radiofrequency ablation of intraatrial reentrant tachycardia following surgical palliation of congenital heart disease. Circulation 1995:91:707-714. 59
  • 63. Walsh EP, Saul JP, Sholler GF, Triedman JK, Jonas RA, Mayer JE, Wessel DL. Evaluation of a staged treatment protocol for rapid junctional ectopic tachycardia after surgery for congenital heart disease. J Am Coll Cardiol 1997;29:1046-53. Weindling SN, Gamble WJ, Mayer JE, Walsh EP. Duration of complete atrioventricular block after congenital heart disease surgery. Am J Cardiol 1998;82:525-527. Alexander ME, Walsh EP, Saul JP, Epstein MR, Triedman JK. Value of programmed ventricular stimulation in patients with congenital heart disease. J Cardiovasc Elecropysiol 1999;10:1033-1044. Walsh EP, Saul JP, Triedman JK (editors), Cardiac Arrhythmias in Children and Young Adults with Congenital Heart Disease. Lippincott Williams & Wilkins, Philadelphia. 2001. Walsh EP, Saul JP, Hulse JE, Rhodes LA, Hordof AJ, Mayer JE, Lock JE. Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation 1992;86:1138-1146. Kugler JD, Danford DA, Deal B, Friedman R, Gillette PC, Silka MJ, VanHare GF, Walsh EP. Radiofrequency catheter ablation in children and adolescents: Early results in 572 patients from 24 centers. N Engl J Med 1994;330:1481-1487. Triedman JK, Saul JP, Weindling SN, Walsh EP. Radiofrequency ablation of intra-atrial reentrant tachycardia following surgical palliation of congenital heart disease. Circulation 1995;91:707-714. Walsh EP. Radiofrequency catheter ablation for cardiac arrhythmias in children. Cardiol Rev 1996;4:200-207. Walsh EP, Saul JP, Sholler GF, Triedman JK, Jonas RA, Mayer JE, Wessel DL. Evaluation of a staged treatment protocol for rapid junctional ectopic tachycardia after surgery for congenital heart disease. J Am Coll Cardiol 1997;29:1046-53. DAVID L. WESSEL, M.D. Senior Associate in Cardiology and Anesthesia and Associate in Cardiovascular Surgery, Children’s Hospital and Professor of Pediatrics (Anaesthesia), Harvard Medical School Dr. Wessel is board certified in pediatrics, pediatric critical care, pediatric cardiology and anesthesia. He is a senior clinician in the Division of Cardiac Intensive Care, with a special interest in evolving strategies in the treatment of pulmonary hypertensive disorders and perioperative care of the newborn. He is past president of the Pediatric Cardiac Intensive Care Society and involved in curriculum structure for those interested in dual training in cardiology and critical care. He is involved in establishing and running multi-center and multi-national trials in the management of pulmonary hypertension and postoperative care of newborns. Recent publications include: Wessel DL. Managing low cardiac output syndrome after congenital heart surgery. Crit Care Med 2001;29(10):S220-30. Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, Bailey JM, Akbary A, Kocis JF, Kaczmarek R, Spray TL, Wessel DL. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003;107(7):996-1002. Wessel DL. Current and future strategies in the treatment of childhood pulmonary hypertension. Progress in Pediatric Cardiology 2001;12:289-318. 60
  • 64. Atz AM, Adatia I, Lock JE, Wessel DL. Combined effects of nitric oxide and oxygen during acute pulmonary vasodilator testing. J Am Coll Card 1999;33(3):813-819. Atz AM, Wessel DL. Sildenafil ameliorates effects of inhaled nitric oxide withdrawal. Anesthesiology 1999;91:307-310. Pediatric Cardiac Intensive Care. Chang AC, Hanley FL, Wernovsky G, Wessel DL, eds. Williams and Wilkins, 1998. Wessel DL and Laussen PC. Critical Care for Congenital Cardiac Disease. In: Furhman BP, Zimmerman JJ, ed. Pediatric Intensive Care 3rd Edition. Elsevier Science, St. Louis, MO, 2006. Kulik T, Giglia TM, Kocis KC, Mahoney LT, Schwartz SM, Wernovsky G, Wessel DL. ACCF/AHA/AAP recommendations for training in pediatric cardiology. Task forces 5: requirements for pediatric cardiac critical care. J Am Coll Cardiol 2005; vol 46(7): 1396-1399. 61
  • 65. Appendix I: CARDIOLOGY ROUNDS AND CLINICAL CONFERENCES Cardiology Inpatient Work Rounds (daily) Cardiology Inpatient Teaching Rounds (daily) Cardiac Intensive Care Unit Work Rounds (twice daily) Morning Catheterization Conference (daily) Cardiac Pathology Teaching Sessions (several per week) Cardiology/Cardiac Surgery Combined Conference (weekly) Fellows’ Core Lecture Series (weekly) Echocardiography Teaching Conference (weekly) Cardiac Surgery Grand Rounds (weekly) Cardiac Surgery Morbidity and Mortality Conference (weekly) Heart Transplantation Conference (weekly) Angiography Review Conference (weekly) Cardiac Catheterization Data Review Conference (weekly) Electrophysiology Case Discussion Conference (monthly) Catheterization Complications Conference (monthly) Cardiology Ward and Consult Morbidity and Mortality Conference (monthly) Cardiac ICU Morbidity and Mortality Conference (monthly) Cardiology Fellows’ Research Seminar (monthly) 62
  • 66. Appendix II: FELLOWSHIP POLICIES 1. FELLOW SELECTION POLICY PURPOSE This policy is designed to establish guidelines and standard practices by which the Department of Cardiology will recruit, select, and appoint clinical trainees in a fair and non-discriminatory manner. FELLOW ELIGIBILITY AND SELECTION CRITERIA Medical School: Applicants to Children’s Hospital GME Programs must be graduates of an LCME (Liaison Committee on Medical Education), AOA (American Osteopathic Association) accredited medical school, or international medical school. International Medical School Graduates must have a current, valid certificate from the ECFMG (Educational Commission for Foreign Medical Graduates). Class standings, grades and Dean’s letters will be considered in the selection process. Medical Science Examinations: Applicants to Fellowship positions must have passed Step 3 of the USMLE. Exceptions may be made only for International Medical Graduates who are not yet eligible to take Step 3. Medical Licensure: Applicants must be eligible for a Massachusetts Limited License, and must submit an application for licensure immediately upon notification of an appointment to a Children’s Hospital GME program. All appointments are contingent upon the Fellow obtaining and maintaining a Massachusetts license. Applicants with a Massachusetts Full License must submit a copy of their license and license application upon notification of an appointment. Prerequisite Training: Applicants must be in good standing in the required preliminary or prerequisite program. Appointment will be contingent upon satisfactory completion of the prerequisite training requirement. Visas: Foreign citizens who are permanent residents (Green Card holders) or who are graduates of a U.S. medical school are eligible for appointment on the same basis as U.S. citizen graduates of U.S. medical schools. Programs are not obligated, but may agree, to sponsor a successful applicant for a J-1 (exchange visitor) visa. Children’s Hospital will not sponsor Fellows for an H-type (employment) visa, except under special circumstances. 63
  • 67. Non-Discrimination: The Department of Cardiology will not discriminate with regard to race, religion, color, sex, marital status, sexual orientation, age, ancestry, disability or veteran status. APPLICATION AND SELECTION PROCEDURES National Matching Programs: The Department of Cardiology participates in the National Resident Matching Program for the selection of first year fellows. Applicants apply directly to the Department and register with the NRMP. Initial Application Screening/Interviews: Completed applications are reviewed by the Department's fellowship selection committee. Selected applicants are invited to visit the Department for interviews and to observe the activities of the Department. There are biweekly meeting of the selection committee to review the process and prepare the rank order list for the NRMP. Rank Order List/Final Selection: The fellowship selection committee ranks the applicants on the basis of prior performance, letters of recommendations, personal interviews, and academic promise. 2. FELLOW DUTY HOUR POLICY PURPOSE This policy is designed to describe the total number of hours per week and days per week each Fellow may be scheduled for active clinical duty in Children’s Hospital and any affiliated training sites, and for all scheduled rotations. These policies apply to scheduled hours, and may be waived in emergency or unusual circumstances. CONSECUTIVE HOURS Fellows must not be on active clinical duty for more than 24 consecutive hours. In addition, Fellows must have at least 12 hours free of any clinical responsibilities after more than 18 hours of consecutive clinical duty. HOURS PER WEEK The Program Director will ensure assignment of reasonable in-hospital duty hours. Clinical duties must not be so pressing or consuming that they preclude ample time for educational activities, other important phases of the training program, or personal needs. CALL When averaged over a four week period, Fellows will not be scheduled for in-hospital call more frequently than every third night. Call from home may not be so frequent as to infringe on a reasonable amount of personal time. During the "night float" rotation, there will be no day time responsibilities and there will be one day per week with no call. 64
  • 68. DAYS OFF/WEEK: When averaged over a four-week period, Fellows must have at least one full day out of every seven free of all clinical responsibilities. VACATION Each Fellow will be granted one month of vacation per year. The scheduling of vacation time will be coordinated by the chief fellows. 3. FELLOW EVALUATION AND REMEDIATION POLICIES PURPOSE This policy is designed to provide a uniform, minimum institutional standard regarding the evaluation of Fellows appointed to the Cardiology Program. This policy is intended to conform to and supplement ACGME Institutional and Program Requirements and to serve as a guideline for implementing an effective system for Fellow performance appraisals. FREQUENCY: A. Formative or Feedback Evaluations are designed primarily to assist Fellows in achieving educational and professional development goals and must be provided, in writing, within two weeks of the completion of each scheduled rotation. These evaluations will be given to the Program Director and are intended to serve as the primary basis for the Summarative Evaluations. B. A Summarative Evaluation of each Fellow’s professional growth, progress, and competence, including knowledge, skills, and performance, will be conducted at the end of one of each six-months of training. . This evaluation will be in writing, and will be provided to and discussed with the Fellow. The Fellow must sign the evaluation, which will be placed in the fellow’s file. C. A Written Final Evaluation will be completed for each Fellow who completes the Program. This evaluation will include a review of the Fellow’s performance during the final period of training and will verify that the Fellow has demonstrated sufficient professional ability to practice medicine competently and independently. This final evaluation will be part of the Fellow’s permanent record that is maintained by the department. EVALUATION STANDARDS The faculty evaluate the performance each fellow for each rotation based on competence, using a quintile scale. For clinical rotation, components of the evaluation include: Gathering data by history Gathering data by physical evaluation Technical skills Assessing data and arriving at a diagnosis Managing problems and monitoring health Interpersonal relationships with patients and families 65
  • 69. Interpersonal relationships with other members of the health team Work habits and competence REMEDIATION It is the Program’s responsibility to notify each Fellow in a timely fashion if his/her performance is substandard, and to document in writing the specific issues the Fellow must address in order to raise performance to an acceptable standard. A remedial course of study and training, with a reasonable timetable, will be established for addressing these deficits. Any such remedial course of study and training must be reviewed with the Fellow. In the event that a Fellow is placed on probation, the Fellow will be so notified in writing. The notice will include a fair summary of the reasons for the action, the areas of performance to be improved, a fair summary of the minimum criteria for adequate improvement, and a date upon which the probationary status will be reviewed. RECORDS A Fellow shall have the right to examine the material in his/her personnel file. A copy of any material in the Fellow’s file shall be furnished to the Fellow at her/his request. A Fellow has the right to place in his/her file a written response or commentary to his/her evaluations. 4. FELLOW PROMOTION AND NON-RENEWAL POLICY PURPOSE This policy is designed to provide a standard regarding the advancement or promotion of clinical trainees to the next higher Post-Graduate Year (PGY) level, and to establish reappointment procedures. PROMOTION Fellows will be advanced to the next PGY level on the basis of evidence of satisfactory scholarship and professional growth. Written offers of reappointment for the next academic year (beginning the following July 1st) will be provided to each Fellow on or before March 1st. CONDITIONAL RENEWAL AND NON-RENEWAL If the Program Director determines that additional time is required to determine the eligibility of a Fellow for promotion, they may offer the Fellow a written conditional reappointment; this conditional reappointment must include an appropriate remediation plan. If it is determined that a Fellow’s appointment will not be renewed, the Fellow must be notified in writing no less than four months prior to the reappointment date (on or before March 1st). A Fellow may be terminated from his/her training program at any time if the Fellow’s evaluations document substandard performance and the Fellow has failed to satisfy the terms of his/her remediation plan. Such notice will be provided as early as possible. 66
  • 70. REAPPOINTMENT PROCEDURES: Each year, Fellows must submit their reappointment profile and limited license application to the Medical Staff Registrar and have a TB test done with Occupational Health in order to complete their reappointment. 5. PROGRAM/FACULTY EVALUATION BY FELLOWS PURPOSE This policy is designed to provide a standard regarding the frequency and procedure by which all clinical trainees appointed to Cardiology are provided an opportunity to submit written, confidential evaluations of the program, including evaluation of the faculty and all aspects of the curriculum. This policy is intended to conform to ACGME Program Requirements and to be a guideline for implementing an effective system for appraising the educational effectiveness and outcomes within the Program. FREQUENCY A. Rotation Evaluations: Within two weeks following completion of each required rotation, each Fellow should have the opportunity to submit written confidential, evaluations of the faculty and the educational effectiveness of the rotation. B. Annual Evaluation: An Annual Evaluation of the faculty and of the educational effectiveness of the program should be completed by each Fellow in writing and in a confidential manner. STANDARDS The Department of Cardiology is revising the fellow's faculty evaluation process. Standards, forms, and most particularly assurance of confidentiality will be developed prior to July 1, 2001. RESPONSIBILITIES A. Program Directors are responsible for developing confidential processes and providing forms to facilitate completion of faculty, rotation, and program evaluations by the Fellows. Fellows should be encouraged to participate in the evaluation of their educational program by the Program Director. The Program Director should utilize these evaluations by the Fellows in the review of the educational effectiveness of the program and in the review of each faculty member’s effectiveness as a teacher of Fellows. B. Fellows have an individual, professional responsibility to submit written program evaluations and faculty evaluations at least annually and at the end of each rotation. 67
  • 71. 6. MEDICAL/FAMILY/MATERNITY LEAVE PROGRAM ♦ Harvard/Children’s Hospital Joint Appointees (JAs), under the Federal and Medical Family Leave Act (FMLA), are entitled to up to 12 weeks of leave for: ♦ the birth of a child, or the placement of a child with an employee for adoption, ♦ a serious health condition that makes an employee unable to perform the essential functions of his/her job, or ♦ a serious health condition affecting an employee’s spouse or same sex spousal equivalent, child, or parent, for which the employee is needed to provide care. ♦ Joint Appointees, who are unable to work due to maternity, will be eligible to receive up to eight weeks of paid Maternity Leave. These eight weeks are considered part of the Federal and Medical Family Leave Act (FMLA). The department/Division will continue to pay the faculty member as if actively at work. (Note that other types of leave are unpaid.) ♦ If an employee is unable to work prior to delivery, and uses more than 4 weeks of leave, under the Massachusetts Maternity Law, the employee must still be given at least 8 weeks following delivery. If a faculty member is in this situation, any additional time beyond the total of 8 weeks (pre and postpartum) would be unpaid. ♦ JAs, however, may elect to use paid accrued vacation benefits to pay for any unpaid portion of the maternity leave. Rules and policies for taking accrued vacation time may differ among services, and faculty should consult with their Department/Division Chief. 68