The Pediatric Cardiology fellowship program at Washington University School of Medicine and St. Louis Children's Hospital is accredited by the Council for Medical Graduate Education. The goal of the training program in Pediatric Cardiology is to prepare fellows to become pediatric cardiologists able to independently supervise the diagnosis and care of infants, children and teenagers/young adults with all forms of congenital and acquired cardiac disease. This includes care of patients after cardiac surgery in the intensive care unit, hospital floor, and outpatient settings. In addition, fellows will gain experience in research and teaching to prepare them for a career in academic medicine. The program offers three positions a year through the National Resident Matching Program. Nine fellows are currently in the training program with 3 additional fellows matched for July, 2010. Former fellows from the program have obtained positions in academic pediatric cardiology, including grant funded investigators, and in private practice. Fellows later recruited for faculty positions at Washington University are eligible for a student loan repayment program. Details of the training program are available on this webpage and the highlighted links to other pages.
As of August 2008 we welcome Dr. George Van Hare as our new division director. Dr. Van Hare was previously director of electrophysiology and fellowship director at Stanford and serves as President of the Pediatric Electrophysiology Society and member of the board of trustees of the Heart Rhythm Society.
Most fellows will complete 2 years of clinical rotations and 1 year of research/electives. Selected fellows with a commitment to a career in basic science research can spend 18 months in a focused research program. All fellows complete a research project that usually results in a publication in a peer reviewed journal. Fellows often present abstracts of their work at major meetings. Additional focused clinical or basic research experience is available with research mentors within the department and in other departments at the Washington University School of Medicine. Previous fellows have been successful at obtaining grant supported research experience past the 3 years of fellowship in order to become independent investigators. Extensive research facilities and opportunities are available to fellows at Washington University. Interdepartmental research in cardiac imaging is available. A fellowship research oversight committee is involved early in training to help fellows select research mentors.
Fellows participate in evaluation of outpatients in the cardiology clinics at St. Louis Children's Hospital and in satellite outreach clinics in Missouri. Each fellow is assigned to a weekly clinic at St. Louis Children’s Hospital. Fellows also attend a monthly satellite clinic for at least two 6 month blocks. Fellows also rotate through a specialty clinic for pediatric cardiac transplantation/heart failure at Children’s Hospital. Elective time is available in a busy pediatric pulmonary hypertension clinic at Children’s Hospital and the adult congenital heart disease center at the adjacent Barnes-Jewish Hospital. The adult congenital heart disease center was established in 1992 and provides ongoing care for 400 patients.
McBride ME, Fehr JJ, Murray DJ. Pediatric Resident Skill Survey: Designing a Simulation-based Curriculum for Pediatric Acute Care. Presented at International Meeting on Simulation in Healthcare, Lake Buena Vista, FL. Jan 2009.
McBride ME, Trehan I, Boschert TA, Moorhead SL, Gandhi SK, Huddleston CB, Ewald GA, Canter CE. Outcomes of Pediatric Heart Transplant Recipients Transitioned to Adult Transplant Centers. Presented at the International Society for Heart and Lung Transplantation in Boston, MA. March 2008.
Muyskens S, Foerster S, Balzer D. Efficacy and Safety of Intracardiac Echocardiography for the Transcatheter Closure of Atrial Septal Defects in Children. Oral presentation, Pediatric Interventional Cardiac Symposium (PICS). Las Vegas, Nevada. July 2008. Catheterization and Cardiovascular Interventions, 2008; 71 (7): S8-9.
Muyskens S, Holt T, Balzer D, Woodard P, Ludomirsky A, Singh G. RV to PA Homograft Patency: Catheter, Echo, and CT Angiogram Correlative Study. Oral Presentation, Washington University Early Research Symposium. St. Louis, Missouri. November 2007.
Muyskens S, Nicolas R, Foerster S, Balzer D. Endovascular stent placement for right ventricle to pulmonary artery stenosis in the Sano modified Norwood. Oral presentation, Midwest Pediatric Cardiology Society Meeting. St. Louis, Missouri. September 2007.
Muyskens S, Nicolas R, Foerster S, Balzer D. RV to PA conduit stenosis in the Sano modified Norwood: An institutional experience with endovascular stenting. Oral presentation, Pediatric Interventional Cardiac Symposium (PICS). Las Vegas, Nevada. July, 2007. Catheterization and Cardiovascular Interventions, 2007; 70 (1): S2.
Lorch SM, Cupps BP, Hicks D, Woodard PK, Holland MR, Pasque MK, Ludomirsky A, Singh GK. Accuracy of Myocardial Strain Measurements in Pediatric Hearts by 2D Speckle Tracking Echocardiography: A Validation Study with Magnetic Resonance Imaging. Presented at ASE June 2007, Seattle, WA.
Lorch SM, Singh GK, Ludomirsky A. Are there Maturational Alterations in Myocardial Strain and Strain Rate in Children: A Vector Velocity Imaging Study? Presented at ASE June 2007, Seattle, WA.
Kulikowska A, Boslaugh S, Gandhi S, Huddleston C, Gumbiner C, Canter C. Infant Heart Transplant Recipients as Children and Adolescents: A Study of Long-term Medical Morbidities. Presented at ISHLT in Madrid in April 2006.
Kulikowska A, Boslaugh S, Huddleston C, Gandhi S, Canter C. Infectious, Malignant and Autoimmune Complications in Long Term Followup of Infant and Older Pediatric Heart Transplant Recipients. Presented at WTC in Boston in July 2006.
Singh GK, Gibson A, Kulikowska A, Wallace KD, Hoffman JJ, Ludomirsky A, Miller JG, Holland MR. High-frequency (50MHz) Ultrasonic Integrated Backscatter Imaging Defines Myocardial Architecture in Fetal Hearts. Presented at ASE in May 2006.
Jone Liao P, Coleman RD, Nicolas RT, Johnson MC, Sharkey AM. Myocardial Injury and Diastolic Dysfunction Following Repair of Tetralogy of Fallot in Pediatric patients. – Abstract poster presentation in American Society of Echocardiography Meeting in Baltimore June, 2006.
Jone Liao P, Johnson MC, Sharkey AM. Tricuspid E/E’: A Novel Tool for Evaluation of Pediatric Patients with Pulmonary Hypertension. – Oral presentation in American Heart Association Scientific Sessions in Chicago November, 2006.
Jone Liao P, Singh G, Johnson MC, Sharkey AM, Ludomirsky A. Does Myocardial Strain and Strain Rate in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation Predict Outcome? A Velocity Vector Imaging Study. – Oral presentation in American Heart Association Scientific Sessions in Chicago November, 2006.
Holt DB, Moller JH, Larson S, Johnson MC. Primary Pulmonary Vein Stenosis in Children: Multi-Institutional Data of Thirty-One Patients. Abstract, oral presentation: 2005 Scientific Sessions of the American Heart Association. in Dallas, November 13-16, 2005.
Holt DB, Foerster SR, Nicolas RT, Balzer DT. Tissue Plasminogen Activator and Heparin Protocol for Arterial Thrombolysis in Pediatric Patients Following Cardiac Catheterization. Abstract, poster presentation: The Fourth World Congress of Pediatric Cardiology and Cardiac Surgery. Buenos Aires, September 18-22, 2005.
Holt DB, Lublin DM, Phelan DR, Huddleston CB, Saffitz JE, Canter C. Rejection in Presensitized Pediatric Heart Transplant Recipients with a Positive Donor Crossmatch Utilizing Perioperative Plasmapheresis and Cytolytic Therapy. Abstract, oral presentation: The International Society for Heart and Lung Transplantation 25th Annual Meeting and Scientific Sessions in Philadelphia April 5-9, 2005.
Holt DB, Liapis H, Phelan DR, Gandhi SK, Huddleston CB, Canter CE. Complement Fragment C4d and C3d Deposition Does Not Correlate With Rejection in Pediatric Heart Transplant Recipients With a Positive Crossmatch. Oral Presentation at the International Society for Heart and Lung Transplantation Annual Meeting and Scientific Sessions, April 25-28, 2007, San Francisco, CA.
Recent Pediatric Cardiology Fellow Publications
Muyskens S, Lasala J, Balzer D. Percutaneous Closure of a Complex Post-Traumatic Muscular Ventricular Septal Defect. Catheterization and Cardiovascular Interventions, 2008. (In Press).
Muyskens S, Nicolas R, Foerster S, Balzer D. Endovascular stent placement for right ventricle to pulmonary artery stenosis in the Sano modified Norwood. Congenital Heart Disease, 2008; 3 (3): 185-90.
Gazit A, Gandhi, S. Pediatric primary cardiac tumors: diagnosis and treatment. Current Treatment Options in Cardiovascular Medicine 2007.
Lorch SM, Sharkey AM. Myocardial velocity, strain and strain rate abnormalities in health obese children. J Cardiometabolic Syndrome 2007; 2;1:30-34.
Gazit A, Avari JN, Balzer DT, Rhee EK. Electrocardiographic Diagnosis of Myocardial Ischemia in Children: is a diagnostic ECG always diagnostic? Pediatrics 2007.
Holt DB, Lublin DM, Phelan DR, Boslaugh SE, Gandhi SK, Huddleston CB, Saffitz JE, Canter CE. Mortality and Morbidity in Presensitized Pediatric Heart Transplant Recipients with a Positive Donor Crossmatch Utilizing Perioperative Plasmapheresis and Cytolytic Therapy. The Journal of Heart and Lung Transplantation 2007.
Gandhi SK, Canter CE, Kulikowska A, Huddleston CB. Infant Heart Transplantation Ten Years Later – Where Are They Now–The Annals of Thoracic Surgery, 2007;83: 169-172.
Gazit A, Singh GK, Shumway J, Johnson MC, Ludomirsky A. Fetal cardiac rhabdomyoma: A sheep or a wolf? J Mat-Fet Med 2007;20: 343-8.
Holt DB, Moller JH, Larson S, Johnson MC. Primary pulmonary vein stenosis. Am J Cardiol. 2007; 99:568-572.
Grange DK, Lorch SM, Cole PL, Singh GK. “Cantu Syndrome in a Woman and Her Two Daughters: Further Confirmation of Autosomal Dominant Inheritance and Review of the Cardiac Manifestations.” American Journal of Medical Genetics Part A 140A:1673-1680, 2006.
Shaoul R, Gazit A, Weller B, Berman S, Jaffe M. Neurological manifestations of an acute abdomen in children. Pediatr Emerg Care. 2005; Sep;21(9):594-7.
Gazit A, Charpie JR, Dekeon MK, Goldberg CS, Mosca RS, Bove EL, Kulik TJ. Serial blood lactate levels predict early outcome after neonatal repair or palliation for congenital heart disease. J Thorac Cardiovasc Surg 2000 Jul;120(1)73-80. In the PedsCCM Evidence-based journal club, March 6, 2005.
Holt DB, Singh GK, Rhee EK, Billadello J, Ludomirsky A. Prinzmetal Angina in an Adolescent: Adjunctive Role of Tissue Synchronization Imaging. Circulation 2005; 112:e91-e92.
Lin ND, Landt ML, Trinkaus KM, Balzer DT, Kort HW, Canter CE. The relationship of age, severity of illness, and hemodynamics with brain natriuretic peptide levels in pediatric heart disease. Am J Cardiol, 2005;96: 847-50.
Nicolas R, Huddleston C, Hills C, Moller JH, Johnson MC. Early outcome after glen shunt and Fontan palliation and the impact of operation during viral respiratory season: analysis of a 19 year multi-institutional experience. Ann Thorac Surg 2005; 79:613-7.
Farra H, Kort HW. Hypoplastic left heart syndrome and valvar pulmonary stenosis: presentation and management. Pediatric Cardiology. 2004.
McComber DE, Ibrahim JE, Lublin D, Ong C, Huddleston CB, Mendeloff EN, Canter CE. Non-ischemic left ventricular dysfunction (NILVD) after pediatric cardiac transplantation: treatment with plasmapheresis and OKT3. J Heart Lung Transplant 2004; 23: 552-7.
Tsirka AE, Trinkaus K, Chen SC, Lipshultz SE, Towbin JA, Colan SD, Exil V, Strauss AW, Canter CE. Improved outcomes of pediatric dilated cardiomyopathy with utilization of heart transplantation. J Am Coll Cardiol 2004;44: 391-397.
Research Facilities and Opportunities
The Department of Pediatrics at Washington University School of Medicine has received a five-year renewal of its designation as a Child Health Research Center of Excellence by the National Institutes of Health. This Center, supported by a $2 million grant, is using models developed at the Center to study pathology of diseases that affect children. This center focuses on human developmental biology. As of June 2000, all basic research laboratories within the Department are located in the new McDonnell Pediatric Research Building, adjacent to St. Louis Children's Hospital. This building is a 10-story, 250,000 square-foot biomedical research facility with common core facilities.
The Patient Oriented Research Unit (PORU) has dedicated space on the 11th floor of the McDonnell Pediatric Research Building and serves as an academic base for the interaction and collaboration of clinical investigators within the Department of Pediatrics. Administrative members of the PORU assist members of the Department with submission of human studies protocols to the Internal Review Board (IRB) and with preparation of clinical research grants and contracts. PORU investigators are studying a variety of clinical topics, including diabetes, asthma, sickle cell disease, hypertension, cancer predisposition, organ transplantation, smoking cessation, and many others. Beyond physicians, participants in these studies include psychologists, epidemiologists, and biostatisticians.
The Center for Clinical Studies (CCS) at Washington University also has educational resources available to fellows and faculty. The Clinical Experimentation On-Line Course provides a comprehensive introduction to basic principles in designing and implementing an experimental clinical research study (i.e. a study involving an intervention initiated by the investigator) with the express purpose of studying normal function or disease mechanisms in humans. Topics include the basics of how to design, implement, analyze, interpret, and report a clinical experimental study. The CCS also has an on-line course entitled Responsible Conduct of Research: Human Subjects that provides education in the protection of human research participants for investigators.
Fellows have worked with faculty mentors from the Center for Cardiovascular Research (CCR). The CCR provides an environment for translating advances in basic science to progress in the prevention, diagnosis and treatment of cardiovascular disease, as well as enhancing the training and development of young investigators. A Mouse Cardiovascular Physiology Core facility capable of high resolution echocardiographic imaging, microsurgery of the cardiovascular system, exercise testing, and ECG monitoring is being used to characterize the mouse models of cardiovascular disease.
Sample Fellow Schedule
1st Year
Inpatient Service: 4 months
Cardiac Catheterization: 3 months
Echocardiography/Imaging: 3.5 months
Electrophysiology: 1 month
Anesthesiology: 0.5 month
2nd Year
Cardiac Intensive Care: 3 months
Cardiac Catheterization: 2 months
Echocardiography/Imaging: 2 months
Congestive Heart Failure/Transplant: 1 month
Research/Elective: 4 months
3rd Year
Research/Elective: 8 months
Cardiac Intensive Care Unit: 1 month
Cardiac Catheterization: 1 month
Echocardiography/Imaging: 1 month
Congestive Heart Failure/Transplant: 1 month
This schedule represents a general guideline and is adapted to the individual fellow’s goals and training needs. Additional elective time in cardiac catheterization, advanced imaging, adult congenital heart disease, transplant cardiology and electrophysiology is available during research/elective months.
Postoperative Cardiac Surgery Experience
Postoperative care is provided in the CICU for all age groups with joint team care by critical care medicine, cardiology, and cardiothoracic surgery. The CICU has separate physician and nursing teams that care for all cardiothoracic surgical and cardiology patients. The cardiothoracic/cardiology team is lead by an intensive care attending and cardiology attending. This team includes the pediatric cardiology fellow on the inpatient rotation, a critical care fellow, and a cardiac surgery resident. Rounds are conducted each day with the attending cardiologist, attending cardiothoracic surgeons, critical care attending, critical care fellow, cardiac surgery resident, and cardiology fellow on the inpatient rotation.
The postoperative team on the cardiology ward cares for postoperative cardiac patients when the level of care allows for transfer out of the intensive care unit. The cardiology ward is adjacent to the CICU. The cardiology ward team is headed by the cardiology attending who rounds with the inpatient cardiology fellow and pediatric cardiology floor resident each day. This team is primarily responsible for postoperative care on the ward with daily input from cardiothoracic surgery attendings.
This organization is designed to provide two educational experiences by the pediatric cardiology fellows. During the inpatient rotation, 1st year cardiology fellows have a continuity experience with involvement in preoperative evaluation, postoperative care in the CICU, and postoperative care on the ward and discharge planning. In the second and third years, cardiology fellows have a more detailed involvement in all aspects of intensive postoperative care including ventilator management, sedation, and use of vasoactive drugs. Several fellows have completed joint fellowships with dual board eligibility in pediatric cardiology and pediatric critical care.
Pediatric Cardiology Fellow Call Schedule
Cardiology fellows have 2 forms of call. Cardiology floor call is taken from home by beeper at night. Cardiac intensive care call is taken in the hospital. In house intensive care call is only taken by 2nd and 3rd year fellows during their CICU rotations.
During the cardiology floor rotation, fellows take call from home Monday, Wednesday, and Friday nights. Each week an alternate call fellow (shared among all 3 years of fellowship) takes call from home Tuesday, Thursday, Saturday and Sunday nights. This alternate call fellow also rounds on patients Saturday and Sunday days. During the 4 months of floor rotations, first year fellows are free of all call duties from Saturday at 7am until Monday at 6:30am for all weekends. Typical number of cardiology call nights from home per year are 84 for first year fellows, 20 for second year fellows and 12-16 for third year fellows.
The 2nd and 3rd year cardiology fellows have on-site cardiac intensive care call only during their 4 months of CICU rotations (3 months in the second year and 1 month in the third year) with a day/night float system and some 24 hour calls Saturday or Sunday. They do not take cardiology call nights during these CICU months.
Conferences for Pediatric Cardiology Fellows
| Conference | Frequency |
| Wednesday morning Cardiology/CT Surgery Cases: Fellows and faculty from cardiology and cardiac surgery review and discuss interesting and challenging cases after presentation of history, echocardiogram, EKG, and cardiac catheterization. | 1/week |
| Friday morning Cardiology/Cardiac Surgery Journal Club: Fellows present a selected article that is discussed by fellows and faculty. | 1/month |
| Friday morning Cardiology Teaching Conference: Didactic series on basic cardiology topics. | 2/month |
| Friday morning Morbidity and Mortality Conference: Cases from the previous month are reviewed by fellows and faculty from cardiology, cardiac surgery, and critical care. | 1/month |
| Tuesday morning Angiography Conference: Selected angiograms from the previous week are reviewed. | 1/week |
| Tuesday Pediatric Fellows Conference: Departmental conference that includes core educational series and research topics. | 1/week |
| Friday morning Cardiac Critical Care Conference: Bedside teaching conference for 1 or 2 selected cardiac cases in the CICU. | 1/month |
| AM Pre-catheterization conference: Cases for the upcoming day are reviewed with fellow, cath attending and cath staff of the day. | 1/day |
| Echocardiography Conference: Instructional echocardiographic studies from the previous week are reviewed with the ECHO attending. | 2/week |
| Fellows Conference: Meet with program director and division chief to discuss administrative and other issues regarding the fellowship program. | Q 6th month |
| Thursday morning Fellows Board Review Conference: All fellows meet with a faculty member and discuss material that may be on the pediatric cardiology board exam usually through review by chapter of several cardiology textbooks. | 1/week |
Where to Mail Completed Applications
Send applications to:
Jane Rondeau
One Children's Place
Department of Pediatrics
Campus Box 8116-NWT
St. Louis, MO 63110