Success in pediatric cardiology fellowship requires a firm foundation in both the performance and interpretation of echocardiography. Recognizing this need, our institution introduced an “Echo Boot Camp” in 2009 to prepare incoming pediatric cardiology fellows for their first on-call echocardiograms and clinical experiences managing congenital heart disease. In this article, we describe the evolution of our institution’s echo boot camp over the past 17 years. We detail lessons learned, key elements, and technologies incorporated along the way to improve the educational experience. By sharing the history and essential components of our echo boot camp, we aim to provide a framework for other pediatric cardiology fellowships to construct or add to their own boot camps with many possible points of entry.

The American College of Cardiology, through its Adult Congenital Pediatric Cardiology Council, convened an in-person Adult Congenital Heart Disease (ACHD) Workforce Summit on October 6th and 7th, 2024, in Washington, DC. This report reflects perspectives from ACHD cardiologists across the United States, representing academic and private practice settings, diverse training pathways and all career stages. The Summit aimed to examine drivers of ongoing workforce shortages and to identify actionable solutions. Key challenges were grouped into 4 domains: 1) ACHD fellowship training, exposure, and mentorship; 2) defining and sustaining clinical competencies; 3) professional and financial considerations; and 4) equitable access to quality ACHD care. These proceedings are not formal recommendations but highlight the need to address ACHD workforce challenges through earlier exposure, enhanced mentorship, optimized training pathways, and financial realignment to support a sustainable workforce. (JACC Adv. 2026;5:102776) (c) 2026 Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The American College of Cardiology, through its Adult Congenital Pediatric Cardiology Council, convened an in-person Adult Congenital Heart Disease (ACHD) Workforce Summit on October 6th and 7th, 2024, in Washington, DC. This report reflects perspectives from ACHD cardiologists across the United States, representing academic and private practice settings, diverse training pathways and all career stages. The Summit aimed to examine drivers of ongoing workforce shortages and to identify actionable solutions. Key challenges were grouped into 4 domains: 1) ACHD fellowship training, exposure, and mentorship; 2) defining and sustaining clinical competencies; 3) professional and financial considerations; and 4) equitable access to quality ACHD care. These proceedings are not formal recommendations but highlight the need to address ACHD workforce challenges through earlier exposure, enhanced mentorship, optimized training pathways, and financial realignment to support a sustainable workforce.

Echocardiography is the mainstay for diagnosing congenital heart disease (CHD). Diagnostic errors can lead to suboptimal surgical outcomes. This multicenter pediatric echocardiography collaborative learning initiative explores reasons for diagnostic errors, investigates associations between patient- and center-specific factors and errors, and relays the benefits of a multicenter approach to decrease these errors as a first step to improve CHD surgical outcomes. Participating centers submitted diagnostic evaluations on patients prior to 2-ventricle repair into a central database. We held virtual meetings to revise variables and discuss cases to learn from each other. Fourteen pediatric echocardiography laboratories entered data on 1,476 consecutive patients with specific cardiac diagnoses who underwent a two-ventricle repair over 11 months. The mean error rate across centers was 7.1% (103 errors, 17/126-6/125). Seventy-six (74%) errors were preventable or possibly preventable. Cognitive (43%) and imaging factors (47%) commonly contributed to these errors. Moderate to severe impact on postoperative outcomes occurred in 19 (25%) preventable or possibly preventable errors. There were no statistically significant associations between patient- or center-specific factors and errors. This work represents the feasibility and advantages of a multicenter approach to preoperative diagnostic errors. Variability existed in sedated protocols, number of echos needed, use of other modalities, and in other processes. Common anatomic areas were found. Rather than undertaking isolated, single-center projects, this collaborative is poised to learn about novel changes that would improve diagnostic accuracy across centers as a first step to advancing surgical outcomes for patients with CHD.

Background: Deep learning algorithms for automated echocardiographic measurements have demonstrated strong performance in adult populations; however, their utility in pediatric echocardiography remains unclear. We evaluated the agreement between an FDA-approved software for automated adult echocardiogram measurements by Us2.ai and a pediatric core lab reader in assessing left ventricular (LV) size and function. Methods: We analyzed a retrospective dataset of pediatric echocardiogram DICOM files from 5 pediatric centers and corresponding core lab measurements collected from childhood cancer survivors under 21 years of age. The automated software processed the DICOM files, and agreement with core lab measurements for 17 2D and Doppler measurements was assessed using mean difference and intraclass correlation coefficient (ICC; two-way random effects, absolute agreement, single measures). Results: A total of 652 echocardiograms from 153 childhood cancer survivors were included. Median age at time of study was 13.4 (Q1 - Q3: 9.5 - 16.3) years, and 16% of studies showed depressed LV systolic function by core lab measurements (LV shortening fraction ≤28% or ejection fraction [EF] ≤50%). Table 1 summarizes the mean difference and ICC between the automated and core lab reader. Agreement was at least moderate (ICC > 0.5) across all variables. On average, the automated software underestimated biplane EF by 5 percentage points compared to the core lab reader with greater mean differences observed at higher EFs (-1 for core lab EF ≤ 50% and -5 for EF >50%; Figure 1). Conclusions: Independent validation of an automated echocardiographic measurement software in a pediatric dataset demonstrated at least moderate agreement of all measurements with gold-standard core lab measurements. The software exhibited a bias toward lower ejection fraction values; however, ICC for ejection fraction was comparable to previously reported interobserver variability among human pediatric readers.

Despite recent gender parity of physicians entering pediatric cardiology, representation of women leaders lags their male colleagues. We sought to better understand the variation in women in leadership roles in pediatric cardiology. The gender of physicians in 16 prespecified leadership positions was collected by survey between July 2022 and January 2023 from pediatric cardiology programs with >5 cardiologists in North America. We analyzed the association of women leaders with center size (based on surgical volume), geographic region, presence of categorical fellowship program, and gender of division chief and department chair. Across 99 centers, a median of 13 (Q1-Q3: 10-15) roles/center were identified. Women held 36.8% of all leadership roles and 35.1% of cardiology-specific roles. Only 13% of pediatric cardiology chiefs were women. Their programs had more women in subsection leadership roles than male-led centers (47% vs 36%, P = 0.028). A minority of leadership posts were shared among 2 physicians, yet more women than men shared their roles (5.4% women vs 2.5% men, P = 0.010). More men than women have dual leadership positions (15.1% men vs 9.9% women, P = 0.012). We found no association of center size, geographic region, presence of fellowship program, or gender of department chair with percent women leadership. Women hold fewer leadership positions across most subsections of pediatric cardiology programs, with more equitable distribution at centers led by women division chiefs. Women are more likely to share a leadership position with another cardiologist and less likely than men to hold more than 1 leadership post concurrently.

We evaluated quality characteristics of cardiac point-of-care ultrasound performed in our paediatric cardiac ICU. Of 47 included patients, diagnostic imaging was feasible in a high percentage of patients with good image quality. Intensivist interpretations of images were highly specific for dichotomised abnormal findings when compared to interpretation from a cardiologist with expertise in imaging but challenges in accurately assessing depressed ventricular function and the risk of discrepant interpretations exist even amongst frequent users with extensive training and experience. These findings may serve as a template for continued development of cardiac point-of-care ultrasound in a high-impact clinical environment.

Background Early echocardiographic indicators of cardiac remodeling may enhance cardiomyopathy risk prediction in childhood cancer survivors (CCS). Objectives The objective of the study was to assess whether influential echocardiographic measures can be combined to develop a robust cardiomyopathy risk prediction model in CCS. Methods Multicenter retrospective study of ≥1-year CCS with digitally archived surveillance echocardiograms, enrolled cardiomyopathy cases (left ventricular [LV] fractional shortening ≤28% or LV ejection fraction ≤50% on ≥2 occasions) and noncases (≥5-year CCS who maintained fractional shortening ≥ 30% and ejection fraction ≥55% without initiation of cardiac medications). Echocardiograms were centrally quantitated in a blinded fashion. Least absolute shrinkage and selection operator regression identified the most influential 2-year predictors of cardiomyopathy among 27 echocardiographic parameters. Logistic regression was used to generate ORs with 95% CIs. Estimates were applied to the training and test data sets to generate area under the receiver operating characteristic curves (AUC). Results Data from 146 CCS (52 cases; 94 noncases) with a median follow-up of 9.3 years post-cancer diagnosis and a total of 281 echocardiograms were included. A set of 7 echocardiographic measures were identified as the most influential predictors, with AUC of 0.82 (95% CI: 0.74-0.89) and 0.85 (95% CI: 0.74-0.95) in the training and test data sets, respectively. LV end-systolic dimension (ORmm: 1.2; 95% CI: 1.1-1.4), apical 4-chamber longitudinal strain (OR%: 1.2; 95% CI: 1.0-1.3), and septal A’ velocity (ORcm/s: 1.3; 95% CI: 1.1-1.6) were strongly predictive of cardiomyopathy. AUCs were similar if cancer treatment exposures were included. Conclusions Early abnormalities in echocardiographic parameters of structure and function predict subsequent cardiomyopathy in CCS and can identify high-risk survivors who warrant early intervention.

Since the introduction of the arterial switch operation (ASO) 5 decades ago, outcomes of patients with d-transposition of great arteries (d-TGA) have improved significantly. Advances in perinatal diagnosis, surgical techniques, and perioperative care have enabled most of these patients to survive well into their adulthood. As this cohort grows, so does the responsibility of the congenital cardiology community to provide life-long surveillance for complications such as neoaortic or neopulmonary valve stenosis or regurgitation, supravalvar pulmonary stenosis, branch pulmonary artery stenosis, neoaortic root dilation,

BACKGROUND Early echocardiographic indicators of cardiac remodeling may enhance cardiomyopathy risk prediction in childhood cancer survivors (CCS). OBJECTIVES The objective of the study was to assess whether influential echocardiographic measures can be combined to develop a robust cardiomyopathy risk prediction model in CCS. METHODS Multicenter retrospective study of >= 1-year CCS with digitally archived surveillance echocardiograms, enrolled cardiomyopathy cases (left ventricular [LV] fractional shortening <= 28% or LV ejection fraction <= 50% on >= 2 occasions) and noncases (>= 5-year CCS who maintained fractional shortening >= 30% and ejection fraction >= 55% without initiation of cardiac medications). Echocardiograms were centrally quantitated in a blinded fashion. Least absolute shrinkage and selection operator regression identified the most influential 2-year predictors of cardiomyopathy among 27 echocardiographic parameters. Logistic regression was used to generate ORs with 95% CIs. Estimates were applied to the training and test data sets to generate area under the receiver operating characteristic curves (AUC). RESULTS Data from 146 CCS (52 cases; 94 noncases) with a median follow-up of 9.3 years post-cancer diagnosis and a total of 281 echocardiograms were included. A set of 7 echocardiographic measures were identified as the most influential predictors, with AUC of 0.82 (95% CI: 0.74-0.89) and 0.85 (95% CI: 0.74-0.95) in the training and test data sets, respectively. LV end-systolic dimension (ORmm: 1.2; 95% CI: 1.1-1.4), apical 4-chamber longitudinal strain (OR%: 1.2; 95% CI: 1.0-1.3), and septal A' velocity (ORcm/s: 1.3; 95% CI: 1.1-1.6) were strongly predictive of cardiomyopathy. AUCs were similar if cancer treatment exposures were included. CONCLUSIONS Early abnormalities in echocardiographic parameters of structure and function predict subsequent cardiomyopathy in CCS and can identify high-risk survivors who warrant early intervention. (JACC Adv. 2025;4:102363) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND Despite recent gender parity of physicians entering pediatric cardiology, representation of women leaders lags their male colleagues. OBJECTIVES We sought to better understand the variation in women in leadership roles in pediatric cardiology. METHODS The gender of physicians in 16 prespecified leadership positions was collected by survey between July 2022 and January 2023 from pediatric cardiology programs with >5 cardiologists in North America. We analyzed the association of women leaders with center size (based on surgical volume), geographic region, presence of categorical fellowship program, and gender of division chief and department chair. RESULTS Across 99 centers, a median of 13 (Q1-Q3: 10-15) roles/center were identified. Women held 36.8% of all leadership roles and 35.1% of cardiology-specific roles. Only 13% of pediatric cardiology chiefs were women. Their programs had more women in subsection leadership roles than male-led centers (47% vs 36%, P = 0.028). A minority of leadership posts were shared among 2 physicians, yet more women than men shared their roles (5.4% women vs 2.5% men, P = 0.010). More men than women have dual leadership positions (15.1% men vs 9.9% women, P = 0.012). We found no association of center size, geographic region, presence of fellowship program, or gender of department chair with percent women leadership. CONCLUSIONS Women hold fewer leadership positions across most subsections of pediatric cardiology programs, with more equitable distribution at centers led by women division chiefs. Women are more likely to share a leadership position with another cardiologist and less likely than men to hold more than 1 leadership post concurrently. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

BACKGROUND:Echocardiography is the mainstay for diagnosing congenital heart disease (CHD). Diagnostic errors can lead to suboptimal surgical outcomes. OBJECTIVES:This multicenter pediatric echocardiography collaborative learning initiative explores reasons for diagnostic errors, investigates associations between patient- and center-specific factors and errors, and relays the benefits of a multicenter approach to decrease these errors as a first step to improve CHD surgical outcomes. METHODS:Participating centers submitted diagnostic evaluations on patients prior to 2-ventricle repair into a central database. We held virtual meetings to revise variables and discuss cases to learn from each other. RESULTS:Fourteen pediatric echocardiography laboratories entered data on 1,476 consecutive patients with specific cardiac diagnoses who underwent a two-ventricle repair over 11 months. The mean error rate across centers was 7.1% (103 errors, 17/126-6/125). Seventy-six (74%) errors were preventable or possibly preventable. Cognitive (43%) and imaging factors (47%) commonly contributed to these errors. Moderate to severe impact on postoperative outcomes occurred in 19 (25%) preventable or possibly preventable errors. There were no statistically significant associations between patient- or center-specific factors and errors. CONCLUSIONS:This work represents the feasibility and advantages of a multicenter approach to preoperative diagnostic errors. Variability existed in sedated protocols, number of echos needed, use of other modalities, and in other processes. Common anatomic areas were found. Rather than undertaking isolated, single-center projects, this collaborative is poised to learn about novel changes that would improve diagnostic accuracy across centers as a first step to advancing surgical outcomes for patients with CHD.