Video Library

From Infants to Adults: New Horizons in Medical and Surgical Fontan Management

Aired on 6.28.2017
FREE
From Infants to Adults: New Horizons in Medical and Surgical Fontan Management

Join the team from Cincinnati Children’s Heart Institute as they discuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.

Description

Join the team from Cincinnati Children’s Heart Institute as they discuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.

Directors & Faculty

Directors

Andrew Redington, MD

Executive Co-Director, Heart Institute; Chief, Pediatric Cardiology
Dr. Redington graduated from the University of London in 1981. He obtained his MRCP (UK) in Internal Medicine in 1984. In 1986 he was awarded a British Heart Foundation Research Scholarship and subsequently received his Doctorate of Medicine in 1988 (UK). He was appointed Consultant Pediatric Cardiologist at the Royal Brompton Hospital, London in 1990, became a fellow of the Royal College of Physicians (UK) in 1994, and became a full professor in the University of London in 1995. In 1998, he transferred his clinical practice and research team to Great Ormond Street Hospital in London. He moved to Canada in August 2001, to take the position of Head of Cardiology at The Hospital for Sick Children, Toronto. In 2014, he moved to Cincinnati to take on the role as Executive Co-Director of the Heart Institute and Chief of Pediatric Cardiology at Cincinnati Children’s.Dr. Redington is the holder of the Kindervelt-Samuel Kaplan Chair of Pediatric Cardiology and Cardiac Research at Cincinnati Children’s Hospital Medical Center. He has a long history of translational and clinical research having published over 350 peer-reviewed papers in the field of cardiology and critical care. He has mentored many researchers, many of whom have gone on to successful independent research careers and leadership positions. His research in children concentrates on the origins, assessment and modification of ischemia-reperfusion injury, right-left heart interactions, and multi-organ dysfunction after cardiac surgery.

James Tweddell, MD

Executive Co-Director, Heart Institute; Director of Cardiothoracic Surgery. Dr. Tweddell is currently Professor of Surgery at the University of Cincinnati and Director of Cardiothoracic Surgery and Executive Co-Director of the Heart Institute at Cincinnati Children’s Hospital Medical Center. Before coming to Cincinnati, he was Chair of the Cardiothoracic Surgery at the Children’s Hospital of Wisconsin and the Medical College of Wisconsin. Tweddell’s research has focused on the following areas:
• Measurement of total and regional oxygen delivery in the perioperative period in the neonate with complex congenital heart disease. His work has included the use of novel monitoring techniques such as continuous venous oximetry and near infrared spectroscopy.
• Development of home monitoring strategies to improve interstage survival among patients with hypoplastic left heart syndrome undergoing the Norwood procedure.
• Anticoagulation and procoagulants in pediatric cardiac surgical patients with a special focus on neonates and patients requiring extracorporeal circulatory support.
• Multi-institutional and multidisciplinary collaborative learning and quality improvement. Dr. Tweddell is the Surgical Lead and Advisory Council Member of the Joint Council on Congenital Heart Disease, National Pediatric Cardiology Quality Improvement Collaborative. Dr. Tweddell was recently bestowed the Warren W. Bailey Endowed Chair of Congenital Heart Surgery at Cincinnati Children’s Hospital and Medical Center.

Gruschen Veldtman, FRCP, MBChB

Director, Adolescent and Adult Congenital Heart Disease.Dr. Veldtman is the Director of the Adult Congenital Heart Disease Program in the Heart Institute at Cincinnati Children's Hospital Medical Center. He graduated from Cape Town University, following which he trained in Pediatrics and Pediatric Cardiology in Scotland and United Kingdom, respectively. He completed his adult congenital heart disease training in Toronto and Mayo Clinic, Rochester. Dr. Veldtman has been instrumental in the development of the Fontan Management Clinic at Cincinnati Children’s. This multidisciplinary clinic is based on an understanding that the Fontan circulation is fundamentally a condition that affects all organ systems, and that early screening is most likely to lead to better prevention of longer term complications. Veldtman’s group led the way in defining the spectrum and phenotype of end-organ injury in Fontan circulation, particularly as it pertains to liver disease. He has a long track history of clinical and hemodynamic research in single ventricle and other complex circulations. His team also started a minimally invasive exercise program to screen Fontan patients for detection of unfavorable hemodynamics. Dr. Veldtman and his team have developed a number of multinational collaborative trials in Fontan physiology as well as in adult congenital heart disease.


Additional Faculty

Todd Ponsky, MD

Associate professor of surgery and pediatrics at Akron Children's Hospital, in Akron, OH. Currently Associate Professor of Surgery and Pediatrics and a Pediatric Surgeon at Akron Children's Hospital. Dr. Ponsky attended Medical School at Case Western Reserve University in Cleveland, Ohio from 1995-1999, Residency in General Surgery at The George Washington University in Washington, DC from 1999-2005, Pediatric Surgery Fellowship at Children's National Medical Center in Washington, DC from 2005-2007, and an Advanced Minimally Invasive Pediatric Surgery Fellowship at The Rocky Mountain Hospital for Children in Denver, CO from 2007-2008.

Nicole Brown, MD

Attending Cardiologist, Heart Institute
Dr. Brown is an Assistant Professor of Pediatrics and serves as an attending cardiologist for the Adult Congenital Heart Disease (ACHD), Cardiovascular Genetics and Pediatric Pulmonary Hypertension teams. She is a native of Louisville, Kentucky and later graduated Summa Cum Laude from the University of Dayton with a degree in Biochemistry. Following completion of her medical degree at University of Cincinnati College of Medicine, she stayed in Cincinnati for a combined residency in Internal Medicine and Pediatrics. Dr. Brown then completed her Pediatric Cardiology Fellowship at Children’s Hospital of Pittsburg of University of Pittsburgh Medical Center before returning to Cincinnati to be the first Adult Congenital Heart Disease Fellow from 2013 to 2015. She has since been on faculty at Cincinnati Children’s and participates in a variety of clinical services within the Heart Institute. Dr. Brown’s primary clinical interests include all forms of congenital heart disease, management of pregnancy in the setting of cardiovascular disease, pulmonary hypertension and genetically-mediated aortic disease. Her research interests have thus far focused on obstacles to the care of ACHD patients and cardiovascular complications of Turner syndrome. She is also very active educating cardiology and maternal-fetal medicine fellows at both Cincinnati Children’s and University of Cincinnati Medical Center.  

Angela Lorts, MD

Medical Director, Ventricular Assist Device Program ​
Dr. Lorts is an Associate Professor of Pediatrics and Medical Director of the Ventricular Assist Device and Total Artificial Heart Program at Cincinnati Children’s Hospital Medical Center where she serves as faculty on the heart failure and transplant team. Dr. Lorts earned her medical degree from Creighton University in 1998. She completed both her pediatric residency training and a portion of pediatric cardiology fellowship training at Denver Children’s Hospital. Additional pediatric cardiology training was completed at Cincinnati Children’s and she completed a pediatric critical care fellowship at C.S. Mott Children’s Hospital University of Michigan. Dr. Lorts has been a faculty member in the Division of Cardiology at Cincinnati Children’s since completion of her training in 2006. She has worked in the Cardiac Intensive Care Unit as well as on the heart failure/transplant service. Currently she is leading the Ventricular Assist Device Program and the Quality and Safety component of the Solid Organ Transplant Center. Dr. Lorts has focused her clinical and research endeavors on mechanical support of children and young adults with end stage heart failure with and without complex congenital heart disease. Dr. Lorts is currently leading a learning collaborative focuses on improving the outcomes of children who require mechanical support. She is a member of the Fontan Complex Care team and involved in a variety of heart failure/transplant single ventricle projects.

Richard Czosek, MD

Director, Cardiac Rhythm Device Management Program
​Dr. Czosek is an Associate Professor of Pediatrics and Director of the Cardiac Rhythm Device (CRD) Management Program at Cincinnati Children’s Hospital Medical Center. Dr. Czosek earned his medical degree from the Medical College of Georgia in 2001. He completed both his pediatric residency training and pediatric cardiology fellowship training at Cincinnati Children’s Hospital Medical Center. Following his general cardiology training, he completed cardiology subspecialty training in pediatric electrophysiology (EP) at Boston Children’s Hospital. Dr. Czosek has been a faculty member in the Division of Cardiology at Cincinnati Children’s since completion of his training in 2008. Dr. Czosek has focused his clinical and research endeavors on outcomes-based investigation of arrhythmic issues in pediatric and adult patients with congenital heart disease. He is the primary EP physician within the Fontan Complex Care team and involved in a variety of ACHD research and clinical endeavors.

Anisa Chaudhry, MD


Clinical Cardiology Fellow, Adult Congenital Heart Disease
Dr. Chaudhry graduated with honors from Johns Hopkins University. Dr. Chaudhry obtained her medical degree from the University of Virginia School of Medicine then moved to Pennsylvania State University/Milton S. Hershey Medical Center where she completed both her residency in internal medicine and fellowship in cardiology. Dr. Chaudhry is completing a two-year advanced subspecialty fellowship in the Adult Congenital Heart Disease Program at Cincinnati Children’s Hospital Medical Center. Dr. Chaudhry’s clinical specialties include echocardiography and cardiac MRI as well as adult cardiovascular disease and adult congenital heart disease. Her research interests involve Fontan associated liver disease and the utilization of stress echo in screening for ischemic heart disease.

Stacey Morrison, PsyD

Psychologist, Developmental and Behavioral Pediatrics
​Stacey Morrison, PsyD, is a Clinical Psychologist, with specialized training and/or expertise in several areas. She has served as a multidisciplinary team member at Cincinnati Children's Hospital Medical Center since 2009. Dr. Morrison provides psychological evaluations and intervention for a wide range of developmental disorders including ADHD, learning disorders, social skills and executive functioning. Dr. Morrison also provides clinical services for LGBTQ adolescents and young adults and works closely with the Transgender Clinic at Cincinnati Children's. Currently, Dr. Morrison provides psychological assessment and treatment within the Behavioral Medicine and Clinical Psychology and the Heart Institute at Cincinnati Children's. She is a member of the Neurodevelopmental Education Clinic team, the Coronary Artery Clinic team and a consulting psychologist for a spectrum of adult congenital heart disease. Dr. Morrison works with individuals and families from pediatric to adults, with the goal of improving patient self-management and quality of life. She continues to collaborate in this area and looks forward to developing quality improvement projects within the Heart Institute to improve psychological care and the transition to adult care for patients with congenital heart disorders.

Joseph Palumbo, MD

Director, Comprehensive Thrombophilia Center
Dr. Palumbo graduated Magna cum Laude from Georgetown University in 1989. He obtained his medical degree from Pennsylvania State University College of Medicine in 1993. He moved to Cincinnati to complete his residency in general pediatrics and fellowship in hematology/oncology at Cincinnati Children’s Hospital Medical Center. In 2000 he joined Cincinnati Children’s as a research associate in hematology and has progressed to full professor of pediatrics with the University of Cincinnati College of Medicine. Dr. Palumbo is a member of the American Society of Hematology, International Society on Thrombosis and Hemostasis, Scientific Subcommittee on Cancer and Thrombosis and has received xxx awards including National Research Service Award, William Cooper Proctor Scholarship and the Golden Spoon Award for excellence in teaching. The focus of Palumbo’s research program is defining the underlying mechanisms by which hemostatic system components influence disease pathogenesis. Recent studies have revealed key mechanisms by which hemostatic proteins regulate both coagulation and inflammatory processes. While his primary research focus is in the basic science laboratory, Dr. Palumbo has ongoing clinical collaborations with members of the Cincinnati Children’s Heart Institute focused on limiting thromboembolic complications in patients with complex heart disease, as well as patients requiring mechanical circulation.

Andrew Crean, MD

Professor of Medicine, Sanghvi Endowed Chair in Cardiovascular Imaging at the University of Cincinnati Medical Center. Dr. Crean was appointed to UC as the inaugural Sanghvi Endowed Chair in Cardiovascular Imaging and Director of the Advanced Cardiac Imaging Center. He also holds a cross-appointment in Pediatrics at Cincinnati Children's Hospital Medical Center. Dr Crean trained as both a Cardiologist and Radiologist. He received training in Radiology at the Universities of Edinburgh and Cambridge, UK. His Cardiology training was at the University of Leeds, UK. He also undertook a 2 year fellowship in all modalities of cardiac imaging at Papworth Hospital, UK. He then completed a further year in Cardiac CT and MRI at Toronto General Hospital, Canada. His Adult Congenital Heart Disease training was at Leeds General Infirmary, Royal Brompton Hospital and St Thomas Hospital - all in the UK. In 2008 he took up a Staff position in both Cardiology and Radiology at Toronto General Hospital where he was an Associate Professor until the end of 2016. His area of cardiology focus is in Inherited and Congenital Cardiac Conditions. He also maintains his interest and expertise reading cardiac MRI and CT.

Bryan Goldstein, MD, FACC, FSCAI, FAAP

Associate Director, Cardiac Catheterization Laboratory at Cincinnati Children’s Hospital. Dr. Goldstein is an Associate Professor of Pediatrics and Associate Director of the Cardiac Catheterization and Intervention Program at Cincinnati Children’s Hospital Medical Center. He obtained his medical degree at Boston University and went on to obtain his pediatric residency at Boston Children’s Hospital. His fellowships in pediatric cardiology and pediatric interventional cardiology were both obtained at C. S. Mott Children’s Hospital at University of Michigan. Dr. Goldstein has a strong academic and clinical interest in single ventricle physiology. He has American Heart Association funding for the study of vascular function in Fontan circulation and is the principal investigator at Cincinnati Children’s for a number of multi-center prospective investigations in Fontan circulation.

Agenda

8:00 am - 8:15 am
Welcome
8:15 am - 8:30 am
How does the blood go round in single ventricles and Fontans?
8:30 am - 8:55 am
Case Review
Dynamic Assessment of the Fontan

8:55 am - 9:15 am
Trans-catheter Interventions
9:15 am - 9:35 am
Advanced imaging of the Fontan, what is driving Fontan failure
9:35 am - 9:50 am
Transplantation and VADs
9:50 am - 10:10 am
The role of trans-catheter arrhythmia management - patient based decision making
10:10 am - 10:30 am
Update on surgical practice and current state on Fontan conversion surgery
10:30 am - 10:40 am
Break
10:40 am - 10:55 am
Case Review - Psychosocial Outcomes
10:55 am - 11:10 am
Pregnancy in a Fontan Patient

11:10 am - 11:30 am
How do we manage thrombogenicity and thrombosis in the Fontan?
11:30 am - 11:50 am
The liver is my 2nd favorite organ – role of a Fontan clinic
11:50 am - 12:00 pm
Program Close

Objectives

  • To understand the physiology of the fontan circulation and it’s points of failure
  • Discuss the new methods of assessing fontan physiology dynamically
  • Describe the indications for revision surgery
  • Discuss the long term non-cardiac implications

Accreditation Statement

Cincinnati Children’s Hospital Medical Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Cincinnati Children's designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

MOC: Successful completion of this CME activity, which includes participation in the activity, with individual assessments of the participant and feedback to the participant, enables the participant to earn 4.0 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program.

Show Disclosure