JCCHD Meeting Minutes
September 13, 2004
Attendees: Dr. Thomas Klitzner, AAP; Dr. John Kugler, ABP; Dr. Constantine
Mavroudis, CHSS and STS; Dr. Jack Colman, ISACCD; Lynn Colegrove, AAP
Representative; Dr. Catherine Webb, AHA; Dr. David Sahn, ACC
Business Meeting:
Lines of Succession:
1. John Kugler, American Board of Pediatrics (ABP): Currently Subboard
Chair, whose term expires this year.
2. Jack Coleman, ISACCD: Just elected as Chair-Elect for two years; will
become Chair in two years. Has one staff person, Peter Krala.
3. Constantine Mavroudis, Congential Heart Surgeons Society (CHSS): – In
November will become President for two years. One staff person from PRRI:
Aurelie Alger (978) 299-4509. Another contact is Karen Graham (773) 880
4378.
4. Tom Klitzner, American Academy of Pediatrics (AAP): Will be President of
the AAP Section of Pediatric Cardiology and Surgery on October 1 for two
years.
5. David Sahn, ACC: – His four-year term ends in March, replacement
suggested - M. Davenport.
6. Catherine Webb, American Heart Association (AHA): Attending for Steve
Daniels. Dr. Webb is currently Chair-elect. CVDY – currently sub-chair for
two years, then chair for two years. CVDY Staff Person: Navida Virani
navida.virani@heart.org
Dr. Mavroudis represents both the Society of Thoracic Surgeons (STS) and CHSS. STS
has two governing bodies that deal with congenital heart disease. CHSS has a congenital
heart disease database that contains all of the data on some of the patients (a longitudinal
database). The STS database has some of the data on all of the patients. He
recommends that the JCCHD does not expand to include to STS at this time since he
represents both. STS position was to engage the JCCHD meetings at this time since they
have a relevant database.
Future of JCCHD: This is the third annual meeting. Governance is now an issue. Dr.
Sahn was chair for the first 2 years. Dr. Klitzner became Chair last March. The timing
of the turnover was good because it allowed the new chair to plan the upcoming meeting.
 Should chair be a one or two year term? Should there be a chair-elect? Dr.
Mavroudis suggested that the chair should have a term of three years. Dr. Kugler
mentioned that many of the member chairs only have a two-year term. Dr.
Klitzner suggested that the JCCHD Chair could be an ex officio member in this
case. Ms. Colegrove mentioned that a one-year term is too short. Dr. Colman
suggested that he preferred a longer rather than shorter term; he believes the term
should be two years. Dr. Mavroudis suggested that a chair could be elected to 2,
two-year terms. The group decided by that a two-year term is appropriate, with
the next election held during the September 2005 meeting.
Updates:
JCCHD Meeting Minutes
September 13, 2004




Dr. Klitzner presented the AAP section update.
o The section is emphasizing residents and fellows in the following three
ways:
1. A research fellowship award has been established. It is funded for
10 years with funds to support one fellowship at a level of $35,000
per year.
2. Fellowship travel grants have also been established and funded.
3. Activities of the Pediatric Cardiology Training Program Directors
Society (currently headed by Tim McQuine and Paul Wineburg)
are being supported.
o The section is developing the following guidelines:
1. Cardiovascular effects of Muscular Dystrophy
2. Working jointly with Emergency Medicine on a statement of the
use of AED’s in children
3. The evaluation of children with syncope and suspected sudden
death syndromes.
o The section is developing a directory of all pediatric cardiologists in North
America for distribution to program directors. It will include pediatric
cardiologists and congenital heart disease surgeons. Dr. Colman
suggested that adult cardiologists be included if they also take care of
patients with congenital heart disease.
Dr. Webb presented the AHA update.
o Current interest in the education of the general public and the health care
personnel who care for children. Focus is on catheterization, congestive
heart failure.
 Papers: congenital heart disease, non-hereditary congenital heart
disease
 Brochure: Cardiomyopathy
 Conference: Congenital Heart Disease
 Advocate: Capitol Hill lobby for heart disease and congenital
heart disease.
o On February 17-20, 2005, the AHA is sponsoring a meeting in San Diego
to discuss Kawasaki Syndrome.
Dr. Colman presented the ISACCD update.
o ISACCD has a worldwide membership with just over 200 members.
o Has a formal affiliation with adult congential heart disease society, and
have jointly published a paper.
o Working on a project studying how centers are conforming to the
Bethesda guidelines.
o Also working on what to do with adults with congenital heart disease and
who should care for these patients.
Dr. Mavroudis presented the CHSS and STS updates.
o CHSS:
 Most of the congenital heart surgeons (180-230) belong to this
society. Initially, the society discussed patients. It has since
changed into an organization with an academic database
JCCHD Meeting Minutes
September 13, 2004


New Initiatives:
 Resident education
 Education committee has been established.
 Board membership
 “Friends of the Court”
 Established CHSS as the representative group.
o STS:
 Dr. Mavroudis is the chair of the Congenital Heart Surgery Task
Force. The task force oversees the registry database (some data on
all patients), which includes data collection, data verification,
reporting, and publication.
 Dr. Marshal Jacobs is the chair of the Congential Heart Surgery
Workforce. It is performing a manpower study to determine how
many congential heart surgeons are needed, and will make
workforce and program recommendations.
o Other: Aristotle committee has been formed to provide standards for
software systems.
 Currently working on determining the complexity of congenital
heart disease. The basic complexity score has been developed and
is in use. The basic complexity score was used to develop the
priority procedure. The comprehensive complexity score has been
developed.
 Combined the STS, ESTS, and the AEPC committees to assure
that the nomenclature is the same. Currently mapping out the 5%
of the dataset that is in disagreement. The comprehensive dataset
will be introduced at the world Congress meeting.
 JCCHD can fill the void to speak for the surgeons and
cardiologists for North America.
o This effort assures that residents perform the appropriate procedures
“teaches the teachers” with videos showing procedures. There is also a
congential heart disease resident training tracker that follows the residents
for one year instead of three months.
o Dr. Sahn asked who is considered a congenital heart surgeon. Dr.
Mavroudis replied if 80% of a cardiothoracic surgeon’s time is spent in
congenital heart surgery, then the person is considered a congenital heart
surgeon. The need for congential heart surgeons is between 8-12 new
surgeons a year; currently producing 30 new surgeons a year.
Dr. Kugler presented the ABP update.
o Recertification requirement to be discussed this afternoon.
o Next month there will be a meeting for the program directors on how
training programs can address the ABP’s new subspecialty certification
requirement. Dr. Mavroudis asked if there specific training has been
standardized. Dr. Kugler replied that the ACC and COCATS have
developing specific guidelines and they are under final review.
o Third Tier Certification (Dr. Klitzner clarified that what we call subsubspecialty, the ABP calls niching). The transplant hepatology third tier
JCCHD Meeting Minutes
September 13, 2004

certification is currently in the final approval stage. Item writers from the
adult and pediatric communities will be meeting to develop three
examination modules: adult, shared, pediatrics. This template has
rejuvenated interest in electrophysiology (EP). Dr. Kugler has presented
this to AHA and Heart Rhythms and both endorsed it. Dr. Kugler does not
know if there support for EP subcertification in the adult community.
o Combined certificates in cardiology and critical care. While training can
be done in four years, requests for certification after four years of
combined training are being rejected currently. Plans are moving forward
to finalize a proposal for a five-year training program.
o Subspecialty Fast Tracking. If a fellow has a PhD in the same field as
the subspecialty, then this would count for one research year out of the
three years of training.
o Dr. Sahn mentioned that there is a call in March with Dr. Roberta
Williams, Dr. McGuinness, Dr. Kugler, and himself about a dual adultpediatric-training program to produce specialists to care for the adult with
congenital heart with a focus on the transition from the pediatric to the
adult cardiologist. Dr. Williams will approach the ACC for numbers to be
brought back to this ad-hoc committee. At the Bethesda Conference, the
physician trained jointly in medicine and pediatrics was identified the
ideal person to care for such patients because these physicians have
completed both adult and pediatric training. However, there is a need to
cut the training time for this program and provide specific training
requirements to address this population.
o Dr. Klitzner asked about the requirements for the shared modules being
developed for the transplant hepatology third level examination. Dr.
Kugler responded that the RRC was concerned with the limited training
available for liver transplantation. This issue is not a concern for EP. Dr.
Klitzner asked who would be eligible for this board examination. Dr.
Kugler responded that a person could take the ABIM board and take the
adult and shared modules or the ABP board and take the pediatric and
shared modules. Dr. Klitzner stated that this model would not solve the EP
issue. Dr. Sahn stated that these patients are hospitalized on the adult
ward, and a pediatrician may not be able to write orders for them. Dr.
Colman stated that adult cardiologists should be involved in the third level
EP examination discussion.
Dr. Sahn presented the ACC update.
o The Pediatric Cardiology committee is evolving into the Congenital Heart
Disease and Pediatric Cardiology committee to address the congenital
heart disease across all ages. Surgeons have not specifically been brought
into this committee, but they need to be invited now to cover the full
spectrum of care. One third of the Pediatric cardiologists are members of
the ACC.
o Development of an endowment and lectureship.
JCCHD Meeting Minutes
September 13, 2004
o Activities include an expanded Web site with links to articles and job
opportunities, and an update in the Sunday Forum from a Program
Director’s Symposium to a “Selected Topics” curriculum.
o Consensus document is being developed.
o Two sections were established: Women in Cardiology, with 4000
members and Congenital Heart Disease, with 800 members. Dr. Webb
asked what is the benefit to establish a section. Dr. Sahn replied that
additional fees provide meeting and travel support. There is also the
possibility of establishing mentorships and fellowships as part of the
sections. Cardiologists will be invited to join the new sections during the
ACC National Meeting in March.
o Dr. Klitzner asked if the Congenital Heart Disease (CHD) section would
be involved with CHD coding. Dr. Sahn responded affirmatively and
noted that this may be a way to recruit members.
JCCHD Operational Issues:
1. Leadership: The leader of this committee is currently titled as Coordinator. It is
proposed to change the title to Chair. The Chair of this organization will serve for
two years, beginning in March of even years, with the selection of the Chair in the
fall of preceding year. This will allow for the transition between chairs prior to
the upcoming fall meeting. If the chair-elect’s term on the JCCHD expires, then
the chair-elect would be allowed to stay on as the chair of JCCHD for the full
term. Dr. Sahn supported this idea. In the beginning of JCCHD, a one-year term
was chosen because the sponsorship changed yearly. He also supports the title of
Chair; however, the group is too small to elect a chair. He suggests that the chair
rotate among organizations. Dr. Klitzner stated that the person who will be chair
should have the desire to be chair. Dr. Mavroudis stated that representatives from
STS or CHSS should not be chair, because they are advisors to this group. Dr.
Klitzner proposed that decisions should be made by consensus, and the JCCHD
committee would currently not require bylaws. This proposal passed by
unanimous decision.
2. Rotate meeting costs and minute taking responsibility yearly. On average, the
meeting and catering costs approximately $1000. Dr. Mavroudis stated that he
could not vote for this, but will take it back to his organization. Ms. Colegrove
asked if they could meet in conjunction with another meeting. Dr. Sahn stated that
JCCHD needed to have a separate meeting. Dr. Webb stated that there was too
much to do at the AAP meeting. Dr. Klitzner stated that the AAP is scheduled to
host this meeting next year, the AHA in 2006, and the ISACCD in 2007. Dr.
Colman stated that the ISACCD might not be able to support a meeting because
of its small size. Ms. Colegrove suggested that the JCCHD could meet at the
AAP. Dr. Klitzner asked if Ms. Colegrove could check into the costs if JCCHD
would hold the meeting at the AAP.
3. The current draft of a Mission Statement for the JCCHD suggests that the mission
of the JCCHD is to share information among member organizations. Do we want
to do more than this? Do we need to invite other organizations?
JCCHD Meeting Minutes
September 13, 2004
4.
a. CHSS participates as an advisor; maybe it should be an ex officio
member. Dr. Sahn suggested that there is a need to have surgeons and
adult congenital heart disease members on this committee. Dr. Mavroudis
asked what would come from this advisory body. Dr. Klitzner responded
that training suggestions from the pediatric perspective could be provided.
Dr. Klitzner did not see any initiatives that involve surgeons, but provides
advice on current activities, governance, and databases. Dr. Colman
reminded the group that the ISACCD is a small organization. Dr. Klitzner
asked Dr. Colman to inquire if his society would support the meeting in
2007. Dr. Kugler stated that surgeons, EP, and transplant societies might
band together to support a meeting. Dr. Klitzner summed up the
discussion that four core members (ACC, ABP, AAP, AHA) will host the
meetings; other societies will be invited based upon the agenda. Dr. Sahn
asked what would happen if another organization wants to join JCCHD.
A discussion of future membership was tabled for later discussion.
b. Dr. Kugler asked how is this information going to be disseminated to the
subsubspecialities like EP, transplant, and so forth. Should they be
liaisons? Dr. Klitzner responded that JCCHD does not have the
infrastructure to support a larger meeting. However it was suggested that
next year’s JCCHD meeting would be held in two parts: the business
meeting would be held in the morning and the afternoon meeting would
include the liaison organizations with the updates presented during this
meeting. Dr. Klitzner requested that everyone should send him the names
of the liaison organizations that might be interested in participating. Dr.
Mavroudis suggested that the presidents of these organizations be
contacted in order to convince them to participate. Dr. Webb suggested
that this group could also act in an advocacy role to develop topics for
discussion. Dr. Klitzner suggested that the JCCHD could act as the
contact point for pediatric cardiology issues. Information and issues could
be disseminated via e-mail. The Chair will invite liaison organization to
next year’s meeting. Dr. Mavroudis said that the JCCHD should be
viewed as a committee above all other committees to avoid competition
and to identify opportunities to join forces.
Dr. Sahn brought up two additional items.
a. Followup with the FDA with regard to implantable devices. According to
Dr. Sahn, Regulatory Affairs of the ACC have selected an attendee. Ms.
Colegrove stated that the AAP has a huge presence on this matter, and has
been successful when it has joined forces with other organizations.
JCCHD can serve an information coordinating function in this area. Dr.
Mavroudis stated that this is an area of interest to the surgeons, since they
insert the majority of these devices, which is a reason for STS to be
involved with JCCHD. Dr. Webb stated that the AHA has a large lobby
section.
b. Dr. Sahn stated that the cardiology research network organized by NHLBI,
is interested in focusing some attention on research regarding adult CHD.
They have developed guidelines and identified research needs. Dr.
JCCHD Meeting Minutes
September 13, 2004
Mavroudis asked if an adult CHD representative is needed to provide
feedback to the pediatric community. Dr. Webb stated that the AHA is
very involved in the transition of patients with CHD from the pediatrician
to the adult physician. Dr. Klitzner stated that adult CHD is a topic in
which JCCHD can play an important part.
Introduction to the Quality in Pediatric Subspecialty Care (QPSC) Project:
Dr. Kugler described the ABP’s Maintenance of Certification process. Two years ago, the
subspecialty advisory committee representing each of the thirteen subspecialties met to
determine how to meet the requirements of recertification. All of the 24 members of the
American Board of Medical Specialties endorsed the maintenance of certification as a
way to improve the medical care provided by North American physicians through
evidence-based medicine and quality improvement. The program has been evolving in
pieces, and this afternoon’s discussion will describe the process and quality
improvement. Some subspecialties have not made much progress; others have developed
databases and/or collaborative learning activities. The gastroenterologists are developing
their program, which will be used to build the model that all pediatric subspecialties will
use. Cardiology needs to select a topic or two in order to proceed to the next step in the
process. The subspecialty advisory committee members for cardiology included Drs. Jim
Berker, Steve Nesh, and John Kugler. Dr. David Sahn replaced Dr. Berker last year.
From this group, Dr. Kugler was selected as the point person for cardiology.
Quality in Pediatric Subspecialty Care Discussion:
Additional attendees: Thaddeus Anderson, Manager of eQIPP; Dr. Robert Beekman,
Director of Cardiology, Cincinnati Children's Medical Center; Dr. Carole Lannon, Codirector of the Center of Children’s Healthcare Improvement at the University of North
Carolina at Chapel Hill (NC CHI); Dr. Peter Margolis, Co-director of NC CHI; Dr. Paul
Miles, ABP Vice-President for Quality Improvement; and Michele Wall, Interim
Program Director for QPSC.
Dr. Klitzner opened the afternoon meeting with the charge to JCCHD to determine the
role of this leadership body, the topics to consider based upon the requirements for the
program, and the resources that will be provided by the Board to the subspecialty for
support. Dr. Miles presented the overview of the QPSC program.
Possible topics include Marfan syndrome (thought to be too rare), CHD in patients with
Down’s syndrome, exercise and cardiology, genetics, syncope and sudden death
syndromes (however, no guidelines exist), mild CHD, and Kawasaki’s syndrome.
Dr. Mavroudis explained how the STS’ CHD database was created. The society assigned
one person to research all publications on one diagnosis. Each person presented their
research to the society where issues were raised and resolved in order to arrive at the
agreed to definition. The total effort was published as a supplemental insert to the
journal.
JCCHD Meeting Minutes
September 13, 2004
Much discussion ensued. The following two lists contain possible improvement
variables:
1. Potential Process Measures:
a. Use of Anticoagulants (coumadin/aspirin)
b. Nutrition – weight, classification of status
c. Exercise guidelines/guidance
d. Self-management plan
e. Endocarditis prophylaxis
f. ACE inhibitors (Dose, adherence)
2. Outcome based project in patients with single ventricle, including those who
have heart failure and/or require heart transplantation. Potential outcome
variables include:
a. Exercise Capacity (minimums on Bruce Protocol)
b. Medication Effects (Bleeding, thromboembolism, Reye events)
c. Growth
d. Learning development
e. Infection/pneumonia
f. Hospitalization
g. ED visits
h. Quality of life
It was determined that any decision would have to be vetted through each of the member
organizations. Dr. Beekman suggested that the group select the topic of medical
management of patients with single ventricle after Fontan Operation and support the use
of eQIPP in a multicenter database. Dr. Sahn suggested that three topics be selected and
a global commitment be made that the JCCHD is supportive of improving care of patients
with CHD. Three topics were identified: Kawasaki’s syndrome, management of a
patient with single ventricle after a Fontan procedure, and the management of CHD in
patients with Down’s syndrome. The group reached consensus in support of Dr. Sahn’s
suggestion. Members will seek the endorsement of each of their organizations for the
project and prioritize the three topics. Members are to e-mail Dr. Kugler with the
commitment and the prioritized list.