Cardiology | Pediatric Cardiology Fellowship

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 now offers three positions a year through the National Resident Matching Program. Eight fellows are currently in the training program with two additional fellows matched for July, 2008. 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.

The full spectrum of pediatric cardiology is covered by the faculty. St. Louis Children's Hospital is a regional and national referral center with approximately 300 open heart and 50 closed heart procedures per year performed by two full-time pediatric cardiovascular surgeons. Approximately 15 heart and 20 lung transplantations are performed each year. Extensive experience in the cardiac catheterization laboratory is available with 500 procedures per year including 200 interventional cases (including ASD closure device, VSD closure device, stent placement, balloon angioplasty, ASD creation) and 60 radiofrequency ablations. The echocardiography lab performs 5,000 imaging studies per year including transesophageal and fetal studies. A fully digital echocardiography lab and 3-dimensional ECHO will be added in the next year. More than 4,600 outpatient visits occur in clinics at Children's Hospital and outreach sites throughout the region.

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 the 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.

The standard schedule of rotations will give fellows a solid preparation in basic catheterization skills, imaging, arrhythmia management, outpatient evaluation, and in the care inpatients including postoperative cardiac patients. Fellows are actively involved in post-operative care in the intensive care unit and the floor. A separate team of attending, fellow, and residents coordinates the care of cardiothoracic patients in the Pediatric Intensive Care Unit. The call schedule gives fellows experience in the full range of urgent problems in pediatric cardiology and a focused experience in postoperative cardiac care in the 2nd and 3rd years. Several fellows have arranged combined fellowships in cardiology and pediatric critical care leading to dual board eligibility. A fourth year position in interventional cardiac catheterization is available to one selected fellow per year. Clinical experiences are complemented by a series of conferences available in the division and in the department of pediatrics. Nursing, administrative, and clerical staff are available to support the clinical and research efforts of the division (personnel page).

Fellows participate in evaluation of outpatients in the cardiology clinics at St Louis Children's Hospital and in satellite outreach clinics in Missouri and Illinois. Each fellow is assigned to a weekly clinic at St. Louis Children's Hospital and to a monthly satellite clinic that they attend throughout their training. Fellows also rotate through specialty clinics for fetal cardiac evaluation and cardiac transplantation at St. Louis Children's Hospital, and the adult congenital heart disease at the adjacent Barnes-Jewish Hospital. The adult congenital heart disease center was established in 1992 and provides ongoing care for 400 patients.

Applications are available by downloading in a PDF format or by contacting Jane Rondeau. Prerequisites for application are 3 years of post-graduate medical training in pediatrics. Applications for fellowship are due in January in the year prior to the fellowship starting date. Applicants are asked to provide medical school Dean's letter, medical school transcript of grades and 3 letters of reference. Letters of reference from the pediatric program director (or chairperson), and a pediatric cardiologist familiar with the candidate are especially helpful. Candidates selected for interview are invited to spend a day in St. Louis to become more familiar with opportunities at our program. We hope to complete interviews sometime between December and mid-April. Interview days usually run from 8 a.m. to 4 p.m. but we can be flexible to meet travel needs. Additional details regarding fellowship agreements are available at the Washington University Graduate Medical Education Website. The program director is Mark C. Johnson, M.D.

Related Links

• Current Cardiology Fellows
• Former Cardiology Fellows
• Cardiology Faculty
• Heart Transplantation
• Cardiac Catheterization Laboratory
• Echocardiography Laboratory
• Fellow Publications
• Research Facilities and Opportunities
• Sample Fellow Rotations
• Post-operative Care Experience
• Fellow Call Schedule
• Conferences
• Cardiology Personnel
• Application for Fellowship
• Where to Mail Completed Applications
• Washington University Graduate Medical Education Web Site.
• McDonnell Pediatric Research Building
• Center for Cardiovascular Research (CCR)
• Pediatric Intensive Care Unit Tour
• Uniform Application Form
• Cardiac ICU

Current Fellows (As of 7/2007)

Jennifer N. Avari, M.D.  c

Robert S. Barlow, M.D.  c

Martin J. LaPage, M.D.  c

Mary McBride, M.D.  c

Steve Muyskens, M.D.  c

Chetana M. Reddy, M.D.  c

Amir Toib, M.D.  c

Sudhir Vashist, M.D.  c

Past Fellows and Current Position:

R. Mark Payne, MD

Wake Forest University, Winston-Salem, NC

Catherine Ong, MD

Children’s Mercy Hospital, Kansas City, MO

Nicole Hunkeler, MD

Pediatric Cardiology, Switzerland

Brad Raisher, MD

Pediatric Cardiology Associates, New Mexico

Jack Stevens, MD

Emory University, Atlanta, GA

Mark Johnson, MD

Washington University, St. Louis, MO

David Balzer, MD

Washington University, St. Louis, MO

R. Mark Grady, MD

Washington University, St. Louis, MO

Sylvia Santos-Ocampo Angtuaco, MD

Arkansas Chidlren’s Hospital, Little Rock, AK

Joel Hardin, MD

Children's Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ

Matha Clabby, MD

Emory University, Atlanta, GA

David Waight, MD

Akron Children’s Hospital, Akron, OH

Russell Hirsch, MD

Cincinnati Children’s Hospital, Cincinnati, OH

Arif Hussain, MD

Pediatric Cardiology, Saudi Arabia

Mark Vranicar, MD

University of Kentucky, Lexington, KY

Mindee Flippin, MD

Pediatric Cardiology, Lubbock, TX

Vernat Exil, MD

Vanderbilt University, Nashville, TN

Catherine Dent, MD

Cincinnati Children’s Hospital, Cincinnati, OH

Jill Ibrahim, MD

The Children’s Hospital, Denver, CO

Matthew Kimberling, MD

Pediatric Cardiology, Tulsa, OK

Luke Bruns, MD

Pediatric Cardiology, St Johns’ Mercy Hospital, St. Louis, MO

Anna Tsirka, MD

University of Minnesota

Henry Kort, MD

Pediatric Cardiology, Dallas, TX

Delwyn McOmber, MD

Pediatric Cardiology, Louisville, KY

Ramzi Nicolas, MD

Pediatric Cardiology, Southern Illinois University, Springfield, MO

Hassan Farra, MD

Pediatric Cardiologist, Damascus, Syria

Nancy Lin, MD

Pediatric Cardiologist and Pediatric Critical Care, Dallas, TX

D. Byron Holt, MD

Pediatric Cardiology of Austin, Austin, TX

Pei-Ni Jone, MD

Pediatric Cardiologist, Cardinal Glennon Children’s Hospital, St. Louis, MO

Avihu Gazit, MD

Pediatric Cardiologist and Pediatric Critical Care, St. Louis, MO

Agnieszka Kulikowska, MD

Critical Care Fellowship, Washington University School of Medicine, St. Louis, MO

Steve Lorch, MD

University of Texas, Houston, Texas

Recent Pediatric Cardiology Fellow Abstracts Presented at Meetings

Recent Pediatric Cardiology Fellow Publications

Gazit A, Gandhi, S. Pediatric primary cardiac tumors: diagnosis and treatment. Current Treatment Options in Cardiovascular Medicine (2007, in press).

Gazit A, Avari JN, Balzer DT, Rhee EK. Electrocardiographic Diagnosis of Myocardial Ischemia in Children: Is a diagnostic ECG always diagnostic? Pediatrics (2007, in press)

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, in press)

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 glenn 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 plasmapharesis 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 months
Cardiac Catheterization: 1 months
Echocardiography/Imaging: 1 months
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 PICU for all age groups with joint team care by critical care medicine, cardiology, and cardiothoracic surgery. The PICU has a separate team that cares 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 PICU. 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 PICU, 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.

The cardiology night call from home averages approximately one in 3.5 nights in the first year and 1 night per month during the 2nd and 3rd years. During the cardiology floor rotation fellows take call from home Monday to Thursday nights. During the 4 months of floor call each fellow takes during the first year they are free of all call duties from Friday at 5pm until Monday at 6:30am for all weekends. Therefore they average a minimum of 2 days in 7 away from all duties during these call months.

The 2nd and 3rd year cardiology fellows have on-site intensive care call that averages a maximum of once every 6th night over the year. In the 2-3 months of their intensive care rotations fellows have a maximum of 9 nights per 31 day month of on-site call with 24 hours off after each call with no other call duties as well as an additional 24hr weekend day off per month. Therefore with 10 days free per 31 day month fellows have an average of 2.25 days per week free of all duties during intensive care call months.

Call for all other rotations is less frequent. First year fellows on the catheterization, ECHO/outpatient, and electrophysiology rotations are available for 1 or 2 weekend cardiology calls per month, which involves beeper call from home from Friday at 6pm until Monday at 6:30am with a typical total of 12 weekends per year per fellow. Fellows therefore have a minimum of 2 weekends free of all duties per month during these months with no call nights Monday-Thursday. Weekend days when on call for cardiology are typically 7am -4pm with beeper call from home in the evening.

Second and 3rd year fellows (senior fellows) on the catheterization, ECHO/outpatient, electrophysiology, CHF/transplant, and research/elective rotations are available for 2 forms of night call. Currently they take only 3 weekends per year per fellow of the weekend call from home described in the above paragraph. They also take single nights of on-site call in cardiac intensive care from 5pm-7am on weekdays and 7am-7am on weekend days. Each fellow takes from 1-2 of these on-site calls per month during these rotations. They are excused from all duties for the 24 hours after an on-site call. Therefore, senior fellows have from 1 to 5 nights (average 2-3) of call per month during these rotations.

Conferences for Pediatric Cardiology Fellows

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