Cardiology – Structural Heart Disease Fellowship

Overview

Structural heart disease is congenital or acquired pathologies outside of atherosclerosis. The growth of percutaneous therapies for the treatment of structural heart disease has led to the need to train high-quality physicians with expertise in these diseases and procedures. The Interventional Structural Heart Disease Fellowship at Brown is a 1 year, non-ACGME, program designed for fellows that desire further training in structural heart disease, non-coronary interventions, and high risk percutaneous coronary intervention. The experience includes clinical, diagnostic, and catheter-based therapy. To be eligible, fellows must complete an ACGME approved 1 year training program in Interventional Cardiology.

The program will provide multidisciplinary training in the evaluation and treatment of patients with:

• Valvular Heart Disease including balloon valvuloplasty, transcatheter aortic valve replacement (TAVR) and percutaneous mitral and tricuspid valve repair
• Congenital heart disease including closure of atrial septal defect and patent foramen ovale
• Complex coronary disease including treatment of left main disease and use of percutaneous left ventricular assist device
• Transseptal catheterization and Left atrial appendage occlusion

Paul Gordon, MD
Director, Structural Heart Disease Fellowship

Faculty

Barry Sharaf, MD
Intervention and Structural Cardiology

Frank Selke, MD
Cardiothoracic Surgery

Afshin Ehsan, MD
Cardiothoracic Surgery

Neel Sodha, MD
Cardiothoracic Surgery

Philip Haines, MD
Interventional Echocardiography

Athena Poppas, MD
Interventional Echocardiography

Eirini Apostolidou, MD
Interventional Echocardiography

Katharine French, MD
Interventional Echocardiography

Franklin Schneider, MD
Interventional Echocardiography

Program Description

• Positions

  One position is available each year in the Advanced Interventional Structural Heart Disease Fellowship at Brown. Individuals are selective based on a competitive application process.

• Overall Goals and Objectives

  The purpose of the training program in interventional structural heart disease is to prepare fellows to care for patients with acquired or congenital cardiovascular pathologies that involve the major central cardiovascular structures outside of the acquired atherosclerotic coronary and peripheral vascular pathologies. The program also includes a research component.

• Conferences

  • TAVR multidisciplinary conference (weekly)
  • Cardiology grand rounds (weekly)
  • Morbidity and Mortality conference (quarterly)
  • Cardiac projects research conference (monthly)
  • Clinical cardiac cath conference (weekly)
  • Interventional didactic conference (weekly)

Curriculum

• Overall Educational Goals

  • To understand the effectiveness and limitations of noncoronary cardiovascular interventional procedures to select patients and procedure types appropriately.
  • To acquire the cognitive knowledge base required for the field, i.e., the topics that comprise the core curriculum in structural cardiac interventions.
  • To achieve the appropriate technical skills needed to perform interventional cardiovascular procedures with emphasis on procedural performance, pre- and post-adjunctive strategies, and complication management.
  • To foster an attitude of life-long learning and critical thinking skills needed to gain from experience and incorporate new developments.
  • To understand and commit to quality assessment and improvement in procedure performance.
  • Identify an area of scholarly interest and gain experience in clinical research and writing manuscripts.

• Procedural Goals and Objectives

  • Develop interventional skills for TAVR including: 1. Interpreting hemodynamics of aortic stenosis in the cath lab. 2. Optimal percutaneous access. 3. How to cross a stenotic aortic valve. 4. Sheaths, wires, and catheters to use. 5. Balloon catheters for valvuloplasty and TAVR devices. 6. Rapid RV pacing during intervention. 7. Closing devices. 8. Managing complications (vascular occlusion, dissections, thromboembolisms, hemodynamic collapse, retroperitoneal bleeds, cardiac perforations, arrhythmias/ heart blocks, coronary occlusions, etc.). 9. Acute and long-term post-procedural care.
  • Develop ability to perform transseptal catheterization including: 1. Percutaneous access for transseptal puncture. 2. Transseptal sheath, wires, needles, and other access devices. 3. Echo-guided selective puncture. 4. Acute and long-term post-procedural care.
  • Develop interventional skills for percutaneous mitral and tricuspid valve repair using Mitraclip including : 1. Interpreting imaging of mitral valve for patient selection and procedural planning. 2. Selective transseptal puncture. 3. Sheaths, wires and catheters to use. 4. Closing devices. 5. Managing complications. 6. Acute and long-term post-procedural care.
  • Develop ability to perform ASD/PFO including: 1. Crossing the defect, sheaths, wires, and catheters to use. 2. Image guidance (TEE, ICE, and fluoroscopy).3. When and how to use sizing balloons. 4. Occlusive devices. 5. Retrieval of embolized devices.6. Acute and long-term post-procedural care.
  • Develop ability to perform LAA exclusion including: 1. Interpreting images of LAA. 2. Optimal percutaneous access. 3. Selective transseptal puncture. 4. How to safely access the LAA. 5. Sheaths, wires, and catheters to use. 6. Occlusive devices. 7. Managing complications 8. Acute and long-term post-procedural care.

Salary and Benefits

Salary is commensurate with PGY8 level.

Fellows receive four weeks paid vacation each year and each fellow’s attendance at one national meeting or conference each year is supported. The hospital provides fellows with professional liability insurance, a limited state license and state controlled substance license. Medical, dental, and life insurance costs are shared with the hospital.

Application Information

Please reference the attached application form and submit to our office. Three letters of reference are required, including one from your Interventional Cardiology Fellowship Program Director.

If you have any questions please contact:

Teresa Gadouas
Division of Cardiology
Program Coordinator
The Miriam Hospital
164 Summit Avenue
Providence, RI 02906
Tel: (401) 793-4102
Fax: (401) 793-4049