Developmental  Cardiovascular Research Program

Cardiovascular pathology constitutes an important component of the management of neonates in the Neonatal Intensive Care Unit. The fECHO lab rotation is meant to supplement the experience of the neonatology fellows with experience in a setting to support their medical knowledge and clinical practice skills. This rotation provides 1 week functional echocardiography course once a year and one-two month rotation at Echo Lab at Los Angeles General Medical Center.The fellows may choose this rotation for one additional month during their regular three-year training in Neonatal Perinatal Medicine. Neonatal division has made arrangements for the neonatology fellows to be able to take the fEcho course and rotate through the Echo Lab doing a hands-on rotation. The course and rotation are supervised by Drs. Noori, Siassi and Mac Ebrahimi.

Upon completion of this course, the fellows are expected to have practical knowledge of basic principles of ultrasonography, able to recognize basic features of echocardiographic scanners, identify correctly basic echocardiographic views recorded on video clips, evaluate blood flow direction and velocity by directional, continuous wave and color flow Doppler, identify correctly shunts through patent ductus arteriosus and foramen ovale, be familiar with indices used in measurement of systolic and diastolic function of the heart as well as quantitative measurements of blood flow through aortic valve, pulmonary valve and superior vena cava and estimation and measurement of pulmonary arterial pressure by doppler ultrasound. They are also able to recognize presence of hypertrophic cardiomyopathy in infants of diabetic mothers, identify presence of pericardial effusion and early signs of cardiac tamponade as well as dilatation and flow reversal in inferior vena cava and presence of congenital heart defects.

The fellows are also introduced to the techniques of hand-on echocardiography in the neonate. However, development of competence to obtain independently high quality echocardiograms requires 3 to 6 months of training under supervision of Dr. Noori, Siassi and Mac Ebrahimi in our echocardiography laboratory or at the bedside.

Functional Echocardiography Course

Course Director – Bijan Siassi MD

Assessment of cardiovascular function at the bedside is a fundamental part of neonatal medicine. Accordingly, an increasing number of neonatology programs are utilizing functional echocardiography (fECHO) as an assessment tool for evaluating function and structure of the heart in preterm and term newborns. fECHO also provides neonatologists with real time and longitudinal information on neonatal hemodynamics that may contribute to a better understanding of the complex pathophysiological processes and may aid in the cardiovascular management of critically ill neonates. The test is non-invasive and available twenty-four hours a day if neonatologists are appropriately trained and equipment is available.

In neonatal-perinatal medicine, fECHO has been used in diagnosis of patent ductus arteriosus, pulmonary hypertension and neonatal shock/cardiovascular compromise and for the assessment of the response to pharmacologic management. In addition, fECHO has contributed to a better understanding of cardiac function in the immediate postnatal transitional period in preterm and term neonate. Furthermore, fECHO has been shown to be a valuable tool in the diagnosis of pericardial or pleural effusions and confirmation of central line position. A well-defined structure for providing training, skill maintenance and quality control for neonatologists performing fECHO has not yet been developed in the U.S. although a comprehensive guideline has already been published. The present program provides both didactic education and an opportunity for bedside demonstration of the use of fECHO in the NICU, and participants will gain an insight into the benefits and limitations of this imaging modality in a practical setting.

This program is designed for neonatologists, fellows in neonatal-perinatal medicine, neonatal nurse practitioners and nurses working in neonatal intensive care units.

Course Objectives

  • Upon completion of this course, the participants are expected to:
  • Understand basic principles of ultrasonography
  • Recognize basic features of echocardiographic scanners
  • Identify correctly basic echocardiographic views recorded on video clips
  • Evaluate blood flow direction and velocity by directional, continuous wave and color flow dopplers
  • Identify correctly shunts through patent ductus arteriosus and foramen ovale
  • Be able to apply indices used in measurements of systolic and diastolic function of the heart
  • Be able to do quantitative measurements of blood flow through aortic valve, pulmonary valve and superior vena cava
  • Be able to do estimation and measurement of pulmonary arterial pressure by Doppler ultrasound
  • Recognize presence of hypertrophic cardiomyopathy in infants of diabetic mothers
  • Identify presence of pericardial effusion and early signs of cardiac tamponade
  • Identify dilatation and flow reversal in inferior vena cava

The participants are also introduced to the techniques of hands-on echocardiography in the neonate using a simulation model.  However, development of competence to independently obtain quality echocardiograms may require 6 to 9 months of training under supervision in our or any other echocardiography laboratory.