Rotations

Pediatric Cardiac Intensive Care: During this rotation, the fellow is responsible for medical, preoperative and postoperative patients in the state-of-the-art 14 bed dedicated pediatric cardiac intensive care unit.  This rotation provides an excellent opportunity to be exposed to the nuances of perioperative management and the team approach. The fellow is supervised by dedicated pediatric cardiac critical care faculty as well as the cardiacthoracic surgeons.  The pediatric cardiac intensive care team consists of the fellow, the attending, pharmacist, and dietician.

Cardiac Stepdown Unit:  The goal of the inpatient unit is to have fellows competent at managing multidiscipline teams caring for patients with all forms of pediatric heart disease. This includes post-operative cardiac surgical care, complex congenital heart disease, heart failure, heart transplant and ventricular assist device patients. The team consists of nurses, medical students, residents, dietician, advanced practice providers, pharmD, social worker, case managers, and other allied health providers. Fellows are expected to both manage the team and educate residents and med students on the rotation. Additionally, the fellow on the inpatient unit has primary responsibility for our consult service. This includes patients across the hospital and in the emergency department.  Fellows are under the supervision of attendings with progressive independence throughout fellowship.

Cardiac Catheterization:  The purpose of the cardiac catheterization rotation is to provide an empirical experience of basic and complex cardiac anatomy and physiology. Over the course of the fellowship, the fellow will advance his/her understanding of cardiac anatomic variations and varying cardiac physiology based on the anatomic variation. The rotation will expose the fellow to diagnostic and cutting edge interventional procedures, including trans-catheter closure of septal defects, percutaneous valve implantation, hybrid procedures, and congenital heart disease palliation in the preterm infant.

The rotation in the first cath months of fellowship provides an orientation and basic understanding of the principles applicable to the cardiac catheterization lab. The fellow will evaluate and provide continuity of care for all patients undergoing cardiac catheterization, developing an understanding of the pre-procedural assessment, the peri-procedural needs of the patient, and the post-procedural outcomes following catheterization.

In the remaining cath rotations during fellowship, the fellow hones his/her procedural skill with  increasing maturity in the cath lab, and establishes his/her ability to link hemodynamic and angiographic data to the patient's clinical picture. In combined cardiac and cardiac surgical weekly conferences, the cath fellow marries the patient’s clinical summary with the catheterization summary.   At the completion of his/her cath rotations, the fellow appropriately understands the role of cardiac catheterization in patient care, interprets the catheterization findings, and can plan for any future need for further care/intervention.

Non-invasive Imaging: The fellow performs and interprets trans-thoracic echocardiograms; on this rotation, pediatric sonographers and faculty work together to train fellows in scanning and interpretation. As the fellow advances in training, advanced techniques such as transesophageal echocardiography, fetal echocardiography, cardiac computed tomographic angiography, and cardiac magnetic resonance imaging are learned.

Electrophysiology:  The fellow will be exposed to the care of electrophysiology patients both in outpatient clinic and on the inpatient consult service. The fellow develop skills in reading electrocardiograms and holter monitors in addition to event monitors and pacemaker checks. Additionally the fellow participates in intracardiac electrophysiology studies and begins to understand and interpret intracardiac electrograms. The fellow also scrubs to assist with pacemaker and implantable cardioverter defibrillator placement in the cath lab.

Adult Congenital Heart Disease: The fellow will be exposed to the care of adult patients with congenital heart disease. The fellow will see adult congenital heart disease patients in the outpatient setting, inpatient setting, participate in adult congenital conference and be supervised by adult congenital cardiology specialists. The fellow will also be exposed to outpatient adult general cardiology.

Outpatient Clinics:  The outpatient experience consists of one day a week for the entire duration of the fellowship. During the first year the fellow rotates through different specialty clinics every four months to gain a broad exposure to the field. Outpatient clinics include:

• General cardiology clinic
• Electrophysiology clinic
• Heart failure/transplant clinic
• Adult congenital cardiology clinic
• Cardiac neurodevelopment clinic 
• Longitudinal Fontan care clinic
• Adolescents and young adults with congenital heart disease transitions clinic
• In the second and third years, the fellow may tailor their outpatient experience based on their career plans, including participating in outreach clinics throughout the state of South Carolina.