缅北强奸

Background

In 2006, the MUHC concentrated all cardiology interventional activities at a single site (the Royal Victoria Hospital), and opened three state of the art cardiac catheterization laboratories, including a bi鈥恜lane unit. The two single鈥恜lane rooms were entirely updated in 2013 with new flat鈥恜lane image intensifiers, one of which is large enough to allow for structural and peripheral vascular interventions. Current equipment allows the performance of diagnostic studies (coronary disease, cardiomyopathies, valvular disease, pericardial disease, adult congenital disease), including ultra specialised diagnostic procedures such as intravascular and intracardiac ultrasound and fractional flow reserve. Therapeutic interventional procedures performed at the MUHC include coronary angioplasty and stent implantation, rotablation, use of percutaneous ventricular assist devices, ASD & VSD closure, LAA closure, balloon valvuloplasty, percutaneous valve implantation, and renal denervation.

This concentration of activities and standardization of care, with much tighter integration and professional formation of support staff, i.e. nursing and X鈥怰ay technologists, has allowed us to provide level three interventional formation for suitably qualified cardiologists (ACC interventional task force). As well, it has allowed us to recruit well trained interventionists, with varied procedural and research interests.

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Research Activity

We currently have 2 full time research nurses, and are involved more than 10 collaborative trials. Dr. Piazza and Dr. Martucci are mentoring a team of more than 7 local and international juniors (undergraduate students, medical students, residents, and fellows) in the field of structural heart disease research with a focus towards transcatheter valve therapies, amongst others.

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Mission

缅北强奸 Health Center provides interventional cardiology level three formation.

We are in the midst of collaborating on more than 10 clinical national and international trials, performing first鈥恑n鈥恏uman procedures while critically appraising the risks/benefits, and housing a team of local and international juniors to perform research in the field of structural heart disease.

The intent in now providing interventional structural heart disease formation is to prepare suitable candidates for independent performance of interventional structural interventions such as, but not limited to, trans鈥恠eptal catheterization, mitral valve balloon valvuloplasty, aortic valve balloon valvuloplasty, transcatheter aortic鈥� mitral鈥恆nd鈥恜ulmonary valve interventions, ASD/PFO closures, and left atrial appendage closure.

Thus, the candidate will develop a mastery of the indications, contraindications, and limitations of the various procedures. The candidate will learn to work within a multidisciplinary team (cardiologists, surgeons, anesthetists, nurses and technicians, and trainees of various levels).

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Academic Facilities

The MUHC cath lab facilities are concentrated at the Royal Victoria Hospital. The facilities consist of three cath lab suites (including a biplane room), integrated secretariat, and dedicated fellow conference room with AV equipment. As well, there is a fully monitored seven bed ward for pre鈥� and post鈥恈ath procedures, a dedicated staff room and suitable sanitary accommodations. This produces a privileged working and learning environment, with close access to a reserved reading space and immediate, moment to moment access to staff physicians.

Our labs perform roughly 3,000 or more procedures per year, including 1,400+ interventional procedures. Within this, we perform approximately 40 transcatheter aortic valve interventions, 20鈥�30 balloon aortic and mitral valvuloplasties, 20鈥�30 ASD/PFO closures, and 30鈥�40 complex congenital interventions per year.

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Fellows Duties and Responsibilities

The interventional fellow(s) will be expected, over the year, to develop satisfactory expertise in case selection, procedural judgment and technical ability, gathering and interpretation of hemodynamic and angiographic data in the following: valvular, congenital and left atrial appendage related procedures.

The candidate will be expected to master all aspects of large bore vascular access and closure, cardiac chamber and angiography, pericardiocentesis, temporary pacemaker insertion, trans鈥恠eptal catheterization, aortic and mitral balloon valvuloplasty, transcatheter aortic valve implantation, PFO/ASD and left atrial appendage closure.

The candidate will be expected to perform at least 75鈥�100 structural heart disease interventions 鈥� the vast majority as first operator. This will not be a problem with our present caseload. Furthermore, the fellow will keep a formal journal of completed procedures.

The candidate will be evaluated after the first 3 months to ensure that basic interventional skills have been already acquired prior to embarking on complex structural heart procedures. Thereafter, every 3鈥�6 months the fellow will be evaluated on the following criteria: competent clinical follow鈥恥p, availability and reliability, complications, and quality of interpersonal (patients, staff and peers) and interdisciplinary re鈥� lations, initiative, teaching and mentoring ability.

The candidate will become competent with pre鈥恜rocedure evaluation, timely and informative reporting of results and therapeutic recommendations.

The candidate will be expected to arrive at work at 07:30 every working day, except for specified out of lab teaching opportunities (conferences, research activities) holiday or illness.

The candidate will be responsible for organizing the weekly hour long structural heart disease conference, with case presentations, including all major complications or difficult clinical cases during the preceding week. Furthermore, the fellow will collaborate with formal cath lab teaching to cardiology trainees. The candidate will be an active participant in the cath lab journal club.

The candidate will be supervised and directly responsible to the program director, but will work with other staff interventionalists to widen the range of clinical experience.

We truly believe that our group has acquired the necessary infrastructure and MD experience and competence to now offer selected candidates an instructive and rewarding learning experience, at the end of which the candidate will fully meet the necessary qualifications required by the appropriate governing bodies.

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Educational Resources

- Weekly Cath Lab Rounds
- Manuscript writing
- Conference attendance
- Simulation Laboratory
- Animal laboratory

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Research Program

The 缅北强奸 Health Center is offering a 1鈥恲ear Structural Interventional Cardiology Fellowship Program with special focus on structural heart disease and transcatheter valve therapies. The program will have both a clinical and research component. The structural interventional fellowship program has a starting date of July 1st of every year.

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Fellowship Requirements

Applicants must have completed, (1) their basic cardiology residency and (2) at least one year of interventional cardiology training in coronary artery disease.

All fellows must undergo a period of observation of clinical performance lasting 3 months in the Cath Lab. This period of observation is done in the initial 3 months of the Clinical Fellowship. Successful completion of the observation period is mandatory in order to continue in the clinical fellowship.

Fellowship appointments are contingent upon being appropriately licensed to engage in clinical activities in the Province of Quebec.

The University of 缅北强奸 Post Graduate Medical Education Office will assist in the process of registering as a fellow with the Division of Cardiology.

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Program Description

The Structural Interventional Fellowship should provide the fellow with necessary knowledge to:

1. Understand the complete hemodynamic assessment of congenital cardiac defects, including left to right shunt and right to left shunt lesions.
2. Understand the various aspects of angiographic assessment of congenital cardiac defects and the best angiographic projections for each defect.
3. Understand the proper radiation protection measures for the patients and operators in the cath lab.
4. Understand how to stock the cardiac cath lab with appropriate equipment and tools so that a procedure can be done effectively.
5. Learn the essential echocardiographic assessments of various interventional therapeutic procedures (ASD鈥檚/PDA鈥檚/VSD鈥檚/AS/PS/etc.).
6. Learn step鈥恇y鈥恠tep how to close ASD鈥檚 using various devices.
7. Learn how to perform effective balloon valvuloplasty of the aortic, mitral and pulmonic valves.
8. Learn how to perform transcatheter aortic valve implantation.
9. Learn how to perform transcatheter mitral valve therapies.
10. Learn how to perform embolization therapies for AP collateries, coronary AV fistulas, pulmonary AVM鈥檚 etc.
11. Learn the various diseases that present in adults with congenital heart disease and their management.
12. Learn how to perform pericardiocentesis.
13. Learn how to perform myocardial biopsies.

Furthermore, the fellow will be responsible for the organization of the transcatheter aortic valve and mitral valve databases that will be the basis for publication of peer鈥恟eviewed articles. In particular, we expect the fellow to publish 2鈥�5 first author papers during the 1鈥� year period. We would expect the fellow to submit abstracts to interventional cardiology congresses for presentation.

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Teaching Faculty

The fellow will be closely mentored and supervised by Dr. Nicolo Piazza MD, PhD, FRCPC, FESC and Dr. Giuseppe Martucci MD, FRCPC who are co鈥恉irectors of the Interventional Structural Heart Disease and Transcatheter Valve Therapy program. Dr. Piazza obtained clinical and research training in transcatheter valve therapies from the Erasmus Medical Center from Rotterdam and the German Heart Center Munich under the supervision of Professor Patrick and Professor Ruediger Lange, respectively. Dr. Martucci obtained training from the Boston's Children's Hospital and the Brigham and Women's Hospital in congenital heart disease, structural heart disease, and pulmonary hypertension under the supervision of Professor James Lock and Dr. Michael Landzberg. He is currently the interim chief of the Cardiac Cath Lab at 缅北强奸.

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How to Apply

Please visit the 缅北强奸 for details