Greg Ensing, MD, FASE

As the snow falls and the year draws to an end, the time is right to summarize what has happened recently, what is happening currently, and what we can look forward to in pediatric and congenital heart disease within the American Society of Echocardiography. This is an exciting and dynamic time.

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  Knowledge of echocardiography of congenital heart disease is growing exponentially with the Council on Pediatric and Congenital Heart Disease (PCHD) helping to lead the way. The 2017 Scientific Sessions, led by Mark Friedberg, MD, FASE, and Craig Fleishman, MD, FASE, spread the word in an amazingly clear and cohesive program focusing more around disease state and less around imaging modality. An emphasis on original research was highlighted by inclusion of pertinent abstracts in each session and a new “rapid fire” abstracts session highlighting the best posters. In full Olympic fashion, I declare this the “best pediatric sessions ever” and challenge new program chair Craig Fleishman, MD, FASE, and co-chair Mike Puchalski, MD, FASE, to again raise the bar at the 2018 Scientific Sessions in Nashville- June 22-26, 2018. Early forecasts are that the pediatric learning opportunities and atmosphere will be beyond compare. We look forward to a focus on new science, new guidelines, new results of multi-institutional investigations, and new horizons such as machine learning. In addition, we will honor one of our very best teachers both at the council meeting and at the ASE Foundation Gala. Please make us better by attending and by submitting your abstract by the February 10, 2018 deadline.

  
  
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  Congenital echo technology has advanced to an image quality never seen before, from the largest adults with a classic Fontan to transesophageal images in the tiniest neonate. Most excitingly, three dimensional echo has become a routine part of echocardiograms both in the lab and in the operating room. Taking best advantage remains a works in progress. Towards facilitating implementation, the Three Dimensional Echo of Congenial Heart Disease Task Force delivered a beautiful guidelines statement published in January of this year. This, and all PCHD guidelines are easily accessed on the ASE guidelines website ( http://asecho.org/pediatricsneonatalcongenital ).

  
  
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  While our technology is wonderful, many in the PCHD Council have requested improvements in 3D image quality, workflow, and pediatric transesophageal imaging. Towards making these part of near-future reality, a PCHD technology forum at the 2017 Scientific Sessions matched leaders in congenital heart disease imaging with leaders of many of the companies providing and developing our technologies. Discussions of needs, impediments to implementation, and acceptable compromise were both dynamic and constructive.

  
  
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  Toward organizing implementation of our new knowledge, several new guidelines are here with more around the corner. The advancing use of stress echo in PCHD was part of the “Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease” ASE publication in February. Pediatric use of contrast will be part of the ASE Contrast Guidelines Statement now in development. The Writing Group on echocardiographic imaging of coronary arteries in congenital heart disease, led by Peter Frommelt, and the Writing Group on revision of the guidelines for transesophageal echo in congenital heart disease, led by Mike Puchalski, are nearing completion of their work. As these groups wrap up, the PCHD steering committee looks forward to developing new writing groups perhaps related to the multimodality assessment of cardiac function in oncology patients, and guidelines for multimodality assessment of the functional single ventricle. We are excited about the new ImageGuideEcho Registry and look forward to pediatric involvement.

  
  
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  The character of our practice is in a period of hyperdynamic change related to both the appropriate use of echocardiography and new certification requirements. Many labs are learning to use and document effects of implementation of the “2014 Appropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Cardiology” document (1). Similarly, many nervously anticipate deadlines for required maintenance of certification practice improvement (MOC 4) activities to maintain credentialing. Toward facilitating appropriate use implementation and easing MOC, Dr. Ritu Sachdeva and the PCHD Steering Committee developed an easy-to-use Appropriate Use of Pediatric Echo MOC 4 module. This is presently working its way through the approval process but should be available on the ABP and ASE websites soon. In the meantime, please know that there is another echo-related quality assessment module worth 20 MOC4 points available through IAC. Pediatric echocardiographers should know that our near future will involve the implementation of similar appropriate use criteria for patients with known congenital heart disease. Representatives of the PCHD Council will be active in the development.

Suffice to say “the times they are a changing.” The PCHD Council and ASE leadership are working to keep us current with advances in knowledge, practice modification, and doing our best to make changes helpful rather than painful. It is the involvement of Council members, whether dedicated sonographer or physician, that makes this happen. We will continue to need gifted task force and Council members to make us better. All committees, members, guidelines, and opportunities are easily found on the ASE website ( http://asecho.org ).

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  Writing Group for Echocardiography in Outpatient Pediatric Cardiology, Campbell, R.M., Douglas, P.S., Eidem, B.W., Lai, W.W., Lopez, L., and Sachdeva, R. ACC/AAP/AHA/ASE/HRS/SCAI/SCCT/SCMR/SOPE 2014 Appropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology. A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Academy of Pediatrics, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr. 2014; 27: 1247-66.

Dr. Greg Ensing, MD, FASE, is the chair of the ASE Council on Pediatric and Congenital Heart Disease Steering Committee. Dr. Ensing is a pediatric cardiologist with the University of Michigan C. S. Mott Children’s Hospital in Ann Arbor, Michigan.