Important Documents Fellowship

Teaching Topics:

• Introduction to NH-TNE - orientation

• Ultrasound Physics, Knobology and Image Optimization

• Cardiovascular Physiology concepts.

• Blood Pressure, Heart Rate, SVR and PVR Physiology

• TNE Protocol and Standard Views

• Standardized Measurements and Normative Data, Reporting

• Advanced Imaging: Strain (2D), TDI, 3D Echocardiography

• Right Ventricle: Geometry and Function

• Left Ventricle: Geometry and Function

• Hypertrophy, IDM, Diastolic dysfunction

• Shock: Hypovolemia, Distributive Shock, Sepsis, NEC

• Cardiogenic and Obstructive Shock, Pericardiocentesis

• Pharmacotherapy (cardiovascular agents, pulmonary vasodilators, PGE, antihypertensive agents)

• Transition Physiology in Term and Preterm, acute PH and phenotypes

• BPD-Associated PH

• Post-Capillary PH, LV dysfunction, Inter-atrial shunting & Pulmonary Vein Stenosis

• Atypical PH Syndromes, Understanding a PH Cath Report

• Cardiac Morphology Session at Maude Abbott Museum

• CDH and PH

• PDA physiology, management strategies, caveats, directionality

• Post-ligation/Cath syndrome, Conservative Management of PDA

• Cerebrovascular Hemodynamics, NIRS in the NICU, Neuro-TNE Integration

• Neonatal ECG and Arrhythmias, Lupus/Heart Block, Pacing, Defibrillation, Cardioversion.

• Growth Restriction, Placental Dysfunction, Effect of PPROM, Pulmonary Hypoplasia

• Hypertensive Crisis and Cardiorenal Interactions, Twin-Twin Transfusion Syndrome

• Vein of Galen Malformation or Hepatic Arteriovenous malformation

• Establishing a TNE Program, Research and Career Planning.

• Ethical considerations, safety, multidisciplinary work in Neonatal Hemodynamics

• Cardiac MRI and Advanced Diagnostics

• Pulmonary Hemorrhage

• ECMO: Physiology and Clinical Application

Detailed objectives for 2025-2026 sessions: 

Please read on the topic prior to the session using the resources provided by the program. I have provided links to guide you in your reading. 

June 13, 2025 - Neonatal ECMO (Dr Karen Harrington - CHU Sainte Justine PICU/ECMO specialist)

• Recognize indications and contraindications of neonatal ECMO

• Understand differences in VA, VV and VAV ECMO

• Comprehend the ECMO circuit, flows, sweep gaz, clamp tests

June 26, 2025 — Orientation to NH-TNE program Part 1 by Dr Altit

• Introduce the structure, expectations, and competencies of the NH-TNE curriculum.

• Review the core principles of neonatal hemodynamics and TNE integration in clinical care.

• Familiarize fellows with key resources, logbooks, and assessment tools.

June 27, 2025 — Orientation to NH-TNE program Part 2  by Dr Altit

• Discuss the EPAs and milestones for performance evaluation in the TNE program.

• Provide practical guidance on case selection, documentation, and feedback.

• Review protocols for image acquisition, storage, and case submission.
  
  

July 8, 2025 — Ultrasound Physics, Knobology and Image Optimization  by Dr Altit

• Explain the basic physics principles of ultrasound relevant to TNE.

• Identify the impact of probe settings and machine controls on image quality.

• Demonstrate techniques for optimizing 2D, M-mode, and Doppler images.

July 22, 2025 — Cardiovascular Physiology Concepts  by Dr Altit

• Review determinants of blood pressure, heart rate, systemic and pulmonary resistance.

• Discuss fetal-to-neonatal circulatory transition and autonomic regulation.

• Correlate physiological parameters with echocardiographic findings.

August 5, 2025 — TNE Protocol and Standard Views - Part 1  by Dr Altit

• Master standard TNE imaging planes and anatomical landmarks.

• Learn how to perform and document a comprehensive TNE exam.

• Understand the importance of consistency and reproducibility in views.

August 12, 2025 — TNE Protocol and Standard Views - Part 2  by Dr Altit

• Apply standardized measurement techniques with reference to normative data.

• Develop skills in report generation and diagnostic synthesis.

• Review common errors in measurement and reporting.

August 19, 2025 — Right Ventricle: Geometry and Function  by Dr Altit

• Describe RV anatomy, shape, and adaptation in neonatal disease.

• Perform and interpret RV dimensional and functional parameters (TAPSE, FAC, RVO, TDI).

August 26, 2025 — Left Ventricle: Geometry and Function, Mass  by Dr Altit

• Analyze LV systolic and diastolic function in the neonatal population.

• Understand geometric assumptions and their limitations in neonates.

• Use echocardiography to assess volume loading and contractility.
  
  

September 2, 2025 — Shock: Hypovolemia, Distributive Shock, Sepsis, NEC  by Dr Altit

• Recognize the echocardiographic features of different shock phenotypes.

• Integrate clinical and imaging data for timely diagnosis and management.

• Understand the cardiovascular impact of systemic inflammation and NEC/sepsis.
  
  

September 16, 2025 — Pharmacotherapy  by Dr Altit

• Review the mechanisms and uses of common vasopressors, inotropes, PGE, pulmonary vasodilators, PDA modulation, antihypertensive.

• Recognize echocardiographic responses to PGE, milrinone, and vasodilators.

• Discuss risks, dosing, and weaning strategies.
  
  

September 23, 2025 — Hypertrophy, IDM, Diastolic Dysfunction - also here, here, here, here - By Dr Spenard

• Identify echocardiographic patterns of hypertrophy in neonates.

• Understand the physiology of impaired relaxation and filling.

• Review cases of IDM and their management implications.
  
  

September 30, 2025 — Transition Physiology, Acute PH - see also here - By Dr Spenard

• Review circulatory changes during transition in term and preterm infants.

• Identify acute PH phenotypes and mechanisms of maladaptation.

• Discuss implications for ventilation, oxygenation, and support.

October 8, 2024 - ECMO by Dr Samara Zavalkof

October 14, 2025 — BPD-Associated PH and here - By Dr Spenard

• Understand the pathophysiology of vascular remodeling in BPD.

• Learn how to screen and monitor PH in infants with evolving BPD.

• Integrate TNE and clinical markers for disease severity and progression.
  
  

October 28, 2025 — Post-Capillary PH, LV Dysfunction, PVS with Edmonton by Dr Altit. 

• Differentiate post-capillary from pre-capillary PH on TNE.

• Assess LA pressure and pulmonary venous flow patterns.

• Recognize signs of pulmonary vein stenosis in preterms.

November 25, 2025 — Cardiogenic and Obstructive Shock by Dr Altit

• Diagnose structural and acquired causes of cardiogenic shock

• Identify pericardial effusion and tamponade physiology.

• Review indications and technique for pericardiocentesis.

November 27, 2025 — Neonatal Systemic Hypertension by Dr Joey Mancini (Nephrology)

• Recognize the clinical presentation and diagnostic criteria for systemic hypertension in neonates. 

• Identify structural, renal, and iatrogenic causes of neonatal hypertension, including renovascular and parenchymal abnormalities. 

• Understand the hemodynamic impact of systemic hypertension on cardiac function and end-organ perfusion (LV function; LV hypertrophy).

• Interpret key diagnostic tools (e.g., Doppler ultrasound, echocardiography, renal imaging) in the evaluation of hypertensive neonates. 

• Review the principles of pharmacologic management and monitoring strategies for acute and chronic neonatal hypertension.

• Review articles: 

  • https://www.ncbi.nlm.nih.gov/books/NBK563223/

  • https://pmc.ncbi.nlm.nih.gov/articles/PMC6261698/ 

  • https://jpnim.com/index.php/jpnim/article/download/080207/620 

  • https://obgynkey.com/neonatal-hypertension/ 
    
    

December 9, 2025 — Advanced Imaging: Strain, TDI, 3D by Dr Altit

• Introduce strain imaging and tissue Doppler in neonatal TNE.

• Understand principles and limitations of deformation analysis.

• Explore the role of 3D echo in structural and volumetric assessment.

December 10, 2025 -  Pulmonary Hypertension with PICU (G. Altit)

Important Note - Teachings starting January 2026 are subject to change based on the modifications of the upcoming Neonatal Staff Schedule

January 6, 2026 — Congenital Diaphragmatic Hernia and here by Dr Altit

• Understand the hemodynamic impact of CDH on cardiac function.

• Review RV/LV interaction and PVR assessment in CDH infants.

• Discuss TNE utility in management of CDH
  
  

January 13, 2026 — PDA physiology, caveats, directionality and here by Dr Spenard

• Classify PDA hemodynamic significance using TNE.

• Recognize patterns of PDA: bidirectional, right to left, and the information it provides.
  
  

January 22, 2026 — PDA Pharmacotherapy, Ligation, Trials by Dr Spenard

• Understand the pharmacodynamics of ibuprofen, indomethacin, and acetaminophen.

• Review TNE before and after ligation or cath-based closure.

• Discuss evidence from PDA trials and evolving conservative approaches.
  
  

February 3, 2026 — Cerebrovascular Hemodynamics, NIRS by Dr Spenard

• Describe cerebral circulation and autoregulation in neonates.

• Review NIRS principles, placement, and interpretation.

• Integrate neuro-TNE findings in infants at risk of brain injury.

February 10, 2026 - Hemodynamic consequences of perinatal and postnatal HIE by Dr Spenard

•  Understand cardiac effects of perinatal hypoxic-ischemic injury. 

• Identify echocardiographic signs of postnatal hemodynamic compromise. 

• Review management strategies for HIE-related cardiovascular dysfunction.
  
  

March 12, 2026 — Neonatal ECG and Arrhythmias, Lupus/Heart Block, Pacing, Defibrillation, Cardioversion by Dr Altit

• Interpret neonatal ECGs, heart block patterns, and QTc.

• Recognize arrhythmias and correlate with hemodynamic compromise.

• Review pacing, cardioversion, and defibrillation indications.
  
  

March 24, 2026 — Establishing a TNE Program by Dr Altit

• Review the components needed for a sustainable TNE service.

• Discuss training, credentialing, and QA processes.

• Explore institutional pathways and research integration.

March 31, 2026 — Vein of Galen / Hepatic AVM by Dr Spenard

• Recognize echocardiographic clues to AVMs (high output states).

• Understand shunting physiology and multisystem involvement.

Discuss postnatal management and timing of embolization.

April 7, 2026 — Pulmonary Hypertension - Atypical, Cath, Genetics by Dr Altit

• Identify genetic and syndromic causes of neonatal PH.

• Discuss cath-based diagnostic strategies and AVT testing.

• Understand challenges in classifying mixed PH phenotypes.
  
  

April 21, 2026 — Cyanotic Cardiac Conditions by Dr Altit

• Review the physiology of cyanosis and differential diagnoses.

• Recognize ductal-dependent lesions on TNE.

• Plan stabilization and referral strategies using echo findings.
  
  

May 12, 2026 — Open Session by Dr Altit

• Case-based review and discussion.

• Opportunity for fellows to present and receive feedback.

• Address troubleshooting and uncommon scenarios in TNE.

• Peer-to-peer learning and reflection on clinical application.
  
  

May 26, 2026 — Pharmacology of Pulmonary Vasodilators by Dr Spenard

• Review sildenafil, bosentan, and inhaled NO in neonates.

• Understand TNE markers of response and safety monitoring.

• Integrate pharmacologic strategies with other supportive therapies.

May 29, 2026 — Session with Dr Beland at MAMM

• Morphological review of the heart with Dr Marie Beland, pediatric cardiologist, at the Maude Abbott Medical Museum on McGill campus.
  
  

June 2, 2026 — Pulmonary Hemorrhage: Physiology and Management by Dr Altit

• Understand pathophysiology and echocardiographic clues to pulmonary hemorrhage.

• Distinguish hemorrhage from cardiogenic pulmonary edema.

• Review ventilatory and pharmacologic strategies.
  
  

June 19 ( by Dr Spenard) - Twin-Twin Transfusion Syndrome

• Understand pathophysiology of twin-twin transfusion syndrome. 

• Recognize cardiovascular adaptations in donor and recipient twins. 

• Review echocardiographic assessment and hemodynamic management.

June 23 ( by Dr Altit), 2026 — Open Session

• Focus on complex cases and integration of multimodal monitoring.

• Consolidate learning through fellow-led presentations and reflective discussions.

For 2025-2026:

Rebook - Neonatal ECMO session with Dr Harrington

Rebook - Session with Dr Marie Beland (HKAP)