The Adult Congenital Heart Disease (ACHD) Fellowship at IU School of Medicine is committed to the individual trainee. Commensurate with the ACGME guidelines, ACHD fellows should have completed a three-year adult or pediatric cardiovascular disease fellowship. The curriculum is organized to meet the needs of each trainee. The ACHD fellow who has completed subspecialty training in pediatric cardiology will spend additional time developing core competencies in internal medicine (inpatient service, adult ECHO lab). Those with subspecialty training in adult cardiovascular medicine will spend additional time developing core competencies in pediatric medicine (pediatric ECHO lab, inpatient service, transition clinic). This unique fellowship training allows all graduating fellows to pursue ABIM ACHD subspecialty board certification upon completion of their fellowship training.
Training and Curriculum
Cardiovascular imaging is invaluable to the understanding of complex anatomy and physiology in adults with a variety of congenital heart defects. Dr. Stephen Cook is a co-author of the appropriate use criteria for multimodality imaging for patients with congenital heart disease. Therefore, it is expected that ACHD trainees will gain experience in how to obtain critical information and hemodynamic data from echocardiography, cardiovascular computed tomography (CCT), and cardiovascular magnetic resonance (CMR). ACHD fellows participate in two to three months of advanced imaging (CCT and CMR) during training. At the conclusion of their training, the ACHD fellow should gain the knowledge to choose the proper diagnostic test that can address the clinical question, adapt the technology to the patient’s needs, and remain cost effective.
A myriad of post-processing imaging applications, ranging from high-resolution volumetric analysis in complex geometries to three dimensional (3D) reconstructions of the extracardiac vasculature has made CMR the gold-standard in the evaluation of the adult with CHD. Our adult congenital CMR program is led by Tiffanie Johnson, MD, who is a leader in the field of ACHD imaging and is a site co-PI for the NIH/NHLBI Pediatric Heart Network. Our program has dedicated faculty trained to perform and interpret CMR examinations in ACHD patients. Our adult congenital CCT program is led by Matt Cooper, MD. Matt is the Division Chief of Pediatric Radiology and leads a select faculty trained to perform and interpret CCT examinations in ACHD patients.
Cardiovascular Critical Care
The ACHD fellow will spend one month participating in the post-operative management of ACHD patients undergoing surgical repairs. The ACHD fellow will have the opportunity to work and communicate with ACHD faculty, congenital CT Surgery team, and the cardiovascular critical care team (physicians, advanced practice providers, nurses) to develop the post-operative plan of care for each ACHD patient. ACHD fellows benefit from this rotation by working within a multidisciplinary team which continues to develop their communication and teaching skills.
Our fellowship curriculum includes six months of elective time for additional procedural training. This provides the ACHD fellow to develop a specific clinical interest within the field of ACHD medicine. This includes advanced imaging (echocardiography, CCT/CMR), preventive cardiology, and cardio-obstetrics. ACHD fellows that express an interest in a specific field within ACHD and request dedicated time, may be available by arrangement and approval by the ACHD fellowship director, Pediatric and Adult Cardiovascular Medicine fellowship directors to develop a curriculum that meets the goals of the ACHD fellow.
Interventional cardiology of adults with CHD has become a well-established field of its own and is fundamental to not only centers providing care to these patients, but also fellows seeking a career pathway in the management of ACHD patients. Our interventional labs perform a variety of interventions for the ACHD patient from transcatheter closure of an atrial septal defect to the most current technologies to address late-onset pulmonary regurgitation in adults with a variety of complex congenital defects.
Inpatient Consult Service
The ACHD fellow will provide consultative management for all ACHD patients receiving in-hospital care regardless of the service they are admitted to. Participation in this service at Riley Hospital for Children and IU Health Methodist Hospital provides a broad experience for ACHD fellows in managing both acute and chronic cardiac problems requiring consultation. ACHD fellows will need to appreciate the cardiovascular changes that occur during pregnancy and the post-partum period as we participate in the consultative care in women with CHD at the Riley Maternity Tower. Ultimately, this service allows the ACHD fellow to attain sufficient inpatient experience training coupled with the ability to provide attention to the specific needs of the ACHD patient.
Today, there are numerous areas in ACHD research that require further investigation. High priority areas for research include heart failure in adults with tetralogy of Fallot, risk-factor related outcomes in adults with coarctation, psychological outcomes in ACHD patients, and pregnancy. As such, we include dedicated research time for our ACHD fellows. Research guidance is provided by all faculty. ACHD fellows are paired with a faculty member for research mentorship. Fellows also receive personalized instruction in research methodologies specific to their scholarly activities.
The IU School of Medicine Honor Code outlines the core values governing research, education, and clinical practice that all IU School of Medicine community members, including students, faculty, and staff, are expected to uphold. These include:
- Excellence that is reflected in the innovative conduct and advancement of education, research and patient care.
- Respect for individuals who are affiliated with, or come in contact with, Indiana University School of Medicine: staff, students, residents, fellows, faculty, staff, partners, communities, patients and families.
- Integrity that embraces the very highest standards of ethical behavior and exemplary moral character.
- Diversity that is reflected in actions that appreciate all individuals
- Cooperation that is manifested by collegial communication and collaboration.
Commitment to Diversity, Equity and Inclusion
At Indiana University School of Medicine, the commitment to diversity includes race, ethnicity, gender and gender identity, religion, socio-economic status, age, geography of origin and residence, sexual orientation, disability, work style and other aspects of human attributes and behaviors. The school offers focused, systematic and sustained programs that are aligned with the three foundational pillars: representational diversity, inclusive working and learning environment, and cultural competence.