UTHealth Medical School

Program Description

  1. Program Demographics
    • Name of Host Institution: University of Texas/Houston Medical School
    • Program Specialty/Subspecialty: Pediatric Cardiology
    • Program Address (Mailing): Division of Pediatric Cardiology, 6410 Fannin, Suite #425, Houston, TX 77030
    • Program Address (Physical location, if different from mailing)
    • Program Telephone Number: 713.500.5738
    • Program Fax Number: 713.500.5751
    • Program E-mail:  John.P.Breinholt@uth.tmc.edu
    • Program Director: John P. Breinholt III, M.D.
    • Alternate Program Contact: Linda.C. Matthews@uth.tmc.edu
  2. Introduction
    • History:
      The program has been in existence since July 1, 2008. There have been 10 individuals who have completed the program since its inception.
    • Duration:
      3 years
    • Prerequisite Training/Selection Criteria:
      A prospective applicant should have successfully completed three years of training in an ACGME-accredited pediatric training program or its equivalent and be recommended by his/her program director. Selection is based on merit from among the applicants. The program is nationally advertised. Selection process includes application, letters of reference, and a personal interview. The final selection of the candidates is made by the Program Director/Director, Division of Pediatric Cardiology.
    • Goals and Objectives for Training:
      The goal of the Pediatric Cardiology Fellowship Program is to provide pediatricians who have completed formal training in general pediatrics with an understanding of normal cardiovascular physiology, pathophysiology of the congenital and acquired cardiac abnormalities, and to diagnose and manage cardiac problems in neonates, infants, children, and adolescents.The training is imparted through various methods including history, physical examination, chest x-ray, electrocardiogram, exercise testing, Holter monitor recordings, event (arrhythmia) monitor recordings, echocardiogram, pulsed, continuous wave and color Doppler studies, cardiac catheterization, electrophysiology studies, interventional catheterization, transesophageal echocardiography, fetal echocardiography, post-operative intensive care. and clinical and/or basic research.
    • Program Certifications:
      The fellowship program is ACGME-accredited.
  3. Resources
    • Teaching Staff:
      • P. Syamasundar Rao, MD,  Emeritus Chief
        General pediatric cardiology, Electrocardiography, Echocardiography, Cardiac catheterization, Interventional cardiac catheterization and Clinical research
      • John P. Breinholt III, MD, Director, Program Director
        General pediatric cardiology, Electrocardiography, Echocardiography, Cardiac catheterization, Interventional cardiac catheterization, and Clinical research
      • Mohinder K. Thapar, MD
        General pediatric cardiology, Electrocardiography, Echocardiography and Arrhythmias
      • Gurur Biliciler-Denktas, MD
        General pediatric cardiology, Electrocardiography, Echocardiography, Transesophageal echocardiography, Fetal echocardiography and Clinical research
      • Steven Lorch, MD
        General pediatric cardiology, Electrocardiography, Echocardiography, Transesophageal echocardiography, Fetal echocardiography and Clinical research
      • Mousumi Moulik, MD
        General pediatric cardiology, Electrocardiography, Echocardiography, Cardiomyopathy and Basic and Clinical research
      • Mathew D. Brown, MD
        General pediatric cardiology, Electrocardiography, Echocardiography, Cardiac catheterization, Interventional cardiac catheterization and Clinical research
      • M. T. Numan, MD
        General pediatric cardiology, Electrocardiography, Echocardiography, Arrhythmias, Electrophysiology Ablation and Clinical research
      • M. Silvana Horenstein, MD
        General pediatric cardiology, Electrocardiography, Echocardiography, Fetal echocardiography, Clinical Electrophysiology, Clinical research
      • William I. Douglas, MD
        Surgical aspects of congenital heart disease and post-operative care
      • Felix Tsai, MD
        Surgical aspects of congenital heart disease and post-operative care
    • Facilities:
      Children’s Memorial Hermann Hospital, Lyndon B. Johnson Hospital, and University of Texas Professional Building.
  4. Educational Program—Basic Curriculum
    Describe the following elements of the training program:

    1. Clinical and research components:
      • Clinical Science:
        Clinical training in pediatric cardiology will include organized and progressive responsibility for care and study of patients in all age groups. Exposure to acute emergency cases and nonemergency cases is required. The disease categories will include congenital defects as well as the acquired diseases such as rheumatic fever, infective endocarditis, myocarditis and Kawasaki syndrome. The training will include responsibility for medical care of pediatric cardiac and cardiovascular surgical patients. Follow-up of patients will be emphasized to attain understanding of the natural history of cardiac diseases. A complete understanding of the primary and secondary preventive aspects of bacterial endocarditis, rheumatic fever and atherosclerosis will be required.Adequate training will be required in noninvasive studies such as electrocardiography; chest roentgenography; M-mode, 2-D and Doppler echocardiography; Holter monitoring, fetal and transesophageal echocardiography and electrophysiology.Training in the cardiac catheterization laboratory will be required. Each Fellow will have participated in a minimum of 125 cardiac catheterizations over the three-year training period. The Fellow will be involved in both right heart and retrograde left heart catheterizations and electrophysiology studies. Exposure to transcatheter techniques such as balloon atrial septostomy, blade atrial septostomy, balloon dilatation of stenotic lesions, implantation of stents, device closure of cardiac septal defects, coil embolization, cardiovascular foreign body retrieval, pacemaker implantation and ablation will be provided.A balanced view of relative merits of invasive and noninvasive evaluation of cardiac disease in infants and children will be an essential part of the curriculum.
      • Basic Science:
        Basic science training in pediatric cardiology will provide background in anatomy, embryology, physiology, biochemistry, pharmacology, pathology, genetics and statistics. Although no formal courses will be offered, the disciplines will be emphasized in organized conferences, rounds, and seminars. Monographs, books, and journal articles will be identified as required reading by the teaching staff. Fellows will be encouraged to attend graduate courses to gain greater basic science knowledge.
      • Research:
        Fellows will be involved in ongoing clinical research in pediatric cardiology. Fellows will prepare protocols, conduct clinical research, and write manuscripts under guidance from the staff. Fellows with interest in basic research will be involved in collaborative basic science investigations with faculty in the Medical School. Approximately one-third of the time will be directed to research activities.
      • Teaching:
        Fellows will be provided the opportunity to teach medical students, residents and nursing/paramedical staff.
    2. Participant’s supervisory and patient care responsibilities:
      The fellow on inpatient service will (with the attending on-service) provide care for inpatients at Children’s Memorial Hermann Hospital which include: all patients on Pedi Cardiology service, all consultations to Pedi Cardiology service and all in-patient procedures such as electrocardiograms, Holters, exercise tests and transthoracic echocardiograms. These originate from our 100-bed NICU, step-down nursery, 20-bed Pediatric ICU, 80-bed General Pediatric Service, Pediatric Surgery Service, and Pediatric Subspecialties (e.g. Nephrology, Pulmonary). The fellow will assign some patients to be followed by 4th-year elective students and pediatric residents; however, all patients will be followed by the fellow and supervise the 4th-year elective students and pediatric residents. The fellow in turn will be supervised by the attending.Cardiac catheterization procedures (diagnostic, electrophysiology and interventional) are performed by the fellow who is on Cath service and is directly supervised by the Interventional Pediatric Cardiologists and Pediatric Electrophysiologist, as appropriate. The fellow on Echo service will participate in obtaining and interpreting transesophageal and fetal echocardiograms under direct supervision Pediatric Cardiology attendings that specialize in echocardiography.Fellows are responsible for seeing outpatients in the clinic eight half-days weekly when on outpatient service. The fellow will obtain history, perform physical examination and review the results of laboratory tests and formulate a management plan and present the data to the Pediatric Cardiology attending. The fellow is directly supervised by the Pediatric Cardiology attending.
    3. Procedural requirements:
      The fellows will learn to perform and interpret transthoracic, transesophageal and fetal echocardiograms, cardiac catheterization and electrophysiology studies. They will also participate in interventional catheterization, ablation procedures and pacemaker implantations. Other non-invasive procedures that they are required to perform and interpret will include ECGs, Holter and event recordings, stress testing, tilt-table test and pacemaker-checks.
    4. Didactic components:
      Throughout the fellowship program, lectures will be given by the staff covering important aspects of pediatric cardiology. Visiting pediatric cardiologists will be invited to deliver lectures on areas of their special expertise. Attendance will be required at Pediatric Cardiology Section rounds, combined pediatric cardiology/cardiac surgery meetings, cardiology/cardiac surgery morbidity and mortality conferences, and organized conferences related to pediatric cardiology.Fellows will be required to present seminars and discussions on selected pediatric cardiology topics, and are encouraged to attend national conferences on pediatric cardiology during the second and/or third year of the fellowship.
    5. If the program is more than twelve months in duration, please describe the progression in responsibilities by PGY level:
      The second and third year fellows will have progressively greater responsibility both with regard to patient care and teaching. For example, there is a limited exposure to cardiac catheterization and interventional catheterization for the first year fellow whereas the second year fellows will have a greater participation in these procedures. The third year fellows will almost independently perform these procedures, although under close supervision of the attending pediatric cardiologists. Similarly the second year fellow will have a higher responsibility in echocardiography and exercise testing. While the first year fellows may not have significant involvement in performing and interpreting transesophageal and fetal echocardiograms, the second and third year fellows will be involved in these procedures.
  5. Evaluation
    Describe the formal evaluation process used to assess the educational performance of program participants.A mechanism has been developed to evaluate the following areas: a) degree of attainment of program objectives; b) assessment of fellow performance and c) assessment of staff performance. The evaluations will be used to provide feedback to correct the detected deficiencies.Faculty from the Division of Pediatric Cardiology who are involved in the fellow’s training will participate in evaluating the fellows on a quarterly basis. A standardized evaluation instrument will be used to assess progress in acquisition of knowledge, skills and attitudes.The fellow will evaluate the experiences and training received. He/she will evaluate teaching skills of faculty in assisting the fellow’s acquisition of knowledge, attitude and skills.

For further information, you may contact:
John P. Breinholt, III, MD
Associate Professor of Pediatrics                                                                                                                                                                                                                                                                                                                                                                                Director, Division of Cardiology

University of Texas-Houston Medical School
6410 Fannin, Street, UTPB Suite # 425
Houston, TX 77030
E-mail: John.P.Breinholt@uth.tmc.edu