Leo Lopez, MD, FASE

The ASE Council on Pediatric and Congenital Heart Disease (PCHD) Board of Directors held a retreat on March 28, 2014, in Washington, DC, to identify issues and challenges affecting the pediatric and congenital echocardiography community in the current era. In attendance were current leaders in the field. In an effort to align the PCHD Council objectives with the ASE Strategic Goals for 2014, the Board identified four areas for discussion as they relate to pediatric and congenital echocardiography: research, training, quality, and education.

Research has flourished significantly over the past several decades, though it is still not as well developed as research involving cardiovascular ultrasound in the adult population. In 2013, the ASE published a special report on the results of a recent Cardiovascular Technology and Research Summit, which established a “roadmap” for research activities from the present time to 2020. Because the document focused primarily on issues affecting adult patients, several council board members surveyed leaders in pediatric and congenital echocardiography regarding knowledge gaps and research priorities within our community. The most popular topics included valve dysfunction in children and timing for intervention; universally applicable normal values for established and newer methodologies; correlation between echocardiographic quantification and clinical outcomes; early detection of left and right ventricular dysfunction; and description of normal single ventricular function. A preliminary gap analysis then identified the most important topics on which research initiatives will be focused over the next few years: valve function, ventricular function and pediatric heart disease, and new technologies. With this in mind, the PCHD Council Board will draft a report discussing these priorities, outlining specific medium and long-term goals, and establishing the infrastructure (such as image transfer and storage, data anonymization, legal issues, and funding) for future research initiatives in pediatric and congenital echocardiography.

Standards for training in our subspecialty have evolved over the past decade. Although recommendations for training in pediatric noninvasive cardiac imaging have been published in the past, advances in imaging technology and management of pediatric and congenital heart diseases have necessitated revision of these recommendations, and members of the PCHD Council Board are actively involved in establishing the new guidelines for core training and advanced 4 ^th year training in noninvasive imaging. Although the elements of core training can be readily identified, remaining challenges include standardized assessment of competency at all levels and availability of noninvasive imaging jobs after training. In addition, standardization of training requirements during an advanced imaging fellowship is further complicated by the fact that some centers focus on different modalities (such as cardiac magnetic resonance imaging, fetal echocardiography, transesophageal echocardiography) during this 4 ^th year of training, resulting in heterogeneous curricula and expertise among the different institutions that provide advanced training. One initiative that the council plans to implement is a mentorship program for fellows, and a pilot program will pair PCHD Council travel grant applicants as well as fellows presenting oral abstracts at ASE 2014 with established mentors.

Quality in health care delivery has become a priority in the present day, and quality metrics are being developed in all fields of medicine to help quantify quality improvement initiatives that are safe, effective, patient-centered, timely, efficient, and equitable. The American College of Cardiology (ACC) and American Heart Association have jointly developed a methodology for developing quality metrics in cardiology, and the ACC Adult Congenital and Pediatric Cardiology Council Quality Metric Working Group is currently developing six metrics in noninvasive imaging in coordination with members of the PCHD Council. These metrics include critical results reporting, sedation adverse events, echo quantification variability, diagnostic accuracy, comprehensive study, and echo image quality. In an effort to promote excellence and quality in pediatric and adult echocardiography laboratories, the ASE has recently published a statement supporting accreditation as an established method to achieve these goals, and the PCHD Council Board is actively involved in refining the guidelines and standards in pediatric accreditation so that they are feasible, effective, and meaningful for our community.

Lastly, the retreat focused on challenges in education for pediatric and congenital echocardiographers, particularly in terms of increasing the availability of continuing medical education (CME) activities. Initiatives such as establishing an online PCHD University with a specific pediatric and congenital echocardiography curriculum and utilizing articles from JASE as CME activities have been proposed and are being explored. The council will continue to develop pediatric and congenital guidelines and standards documents to follow recent publications such as the guidelines for multimodality imaging of the patient after tetralogy of Fallot repair, echocardiography in the neonatal intensive care unit, and quantification methods during a pediatric echocardiogram.