Postgraduate Degree in Fetal Cardiology€¦ · functional evaluation of the fetal heart in...

Postgraduate Degree in Fetal Cardiology

Course duration: From April 12, 2021 to April 12 , 2022 First week calendar: October 18-24, 2021

Second week: March 7-13 ,2022

5 1. GENERAL INFORMATION

7 PRESENTATION

8 OBJECTIVES

9 INFORMATION OF INTEREST

10 TEACHING STRUCTURE

13 2. ACADEMIC PROGRAM

15 MODULE 1: ADVANCED ECHOCARDIOGRAPHY

16 MODULE 2: SEPTAL DEFECTS

17 MODULE 3: LEFT CHD

18 MODULE 4: RIGHT CHD

19 MODULE 5: CONOTRUNCAL ANOMALIES

20 MODULE 6: COMPLEX CHD-OTHER CARDIAC ANOMALIES

21 MODULE 7: VASCULAR / VENOUS SYSTEM ANOMALIES

22 MODULE 8: FETAL ARRHYTHMIAS AND FETAL CARDIAC THERAPY

24 MODULE 9: FETAL HEART ADAPTATION TO EXTRA-CARDIAC

CONDITIONS / NOVEL TECHNOLOGIES

25 MODULE 10: RESEARCH PROJECT

27 3. COMPLEMENTARY TOOLS

29 MASTERCLASSES

29 RESOLUTION OF CLINICAL CASES

29 FORUM

30 RULES FOR THE USE OF THE FORUM

33 4. PRACTICUM

37 IMAGE LIST AND ASSESSMENT CRITERIA

57 5. FACE TO FACE PERIOD IN BARCELONA

61 6. RESEARCH PROJECT (MODULE 10)

69 7. EVALUATION CRITERIA

TABLE OF CONTENTS

5

1. GENERAL INFORMATION

1 GENERAL INFORMATION

7

PRESENTATION

The aim of this course is to improve your skills and achieve excellence in the fetal diagnosis

and management of congenital heart defects (CHD) as well as in the morphological and

functional evaluation of the fetal heart in different conditions.

Through a comprehensive approach spanning from pathophysiology to detailed imaging,

the acquisition of knowledge is achieved through intensive exposure to a large number

of real cases representing all possible conditions and situations found in a fetal cardio-

logy unit.

With a strong focus in clinical decision-making, masterclasses and a face-to-face pe-

riod in Barcelona are designed to complement the specific skills in the performance of

high-quality echocardiography and the evaluation of prognosis, with transversal skills

in multidisciplinary interaction and parental counseling issues. The online practical part

aims to complement the theoretical training by acquiring and submitting certain images

in order to validate the acquisition of new competencies. Thus, the interactive program

provides ample opportunities to take part in open discussions via a forum, sharing your

own cases with experts in the field.

Two onsite weeks at the facilities of BCNatal (Hospital Clínic and SJDBarcelona Children’s

Hospital) will enable close interactions with the experts with “Meet-the-professor” ses-

sions, workshops on new technologies and practical training.

This unique academic program, endorsed by the University of Barcelona, addresses the ra-

pidly growing demands for sub-specialists with an in-depth knowledge in Fetal Cardiology.

GENERAL INFORMATION1

POSTGRADUATE DEGREE IN FETAL CARDIOLOGY8

OBJECTIVES

Main academic goal

• To enable participants to perform expert diagnosis and counseling of prenatal heart

anomalies by in-depth knowledge of fetal cardiac physiology

Specific objectives

• To achieve optimal prenatal acquisition of images for the evaluation of fetal cardiac

morphometry and function

• To efficiently incorporate to fetal echocardiographic evaluation all related techniques,

including 2D, M-mode, color and spectral Doppler, 4D-STIC, tissue Doppler, strain, and

magnetic resonance

• To enable participants to expert diagnosis and counseling of congenital prenatal heart

anomalies and fetal arrhythmias

• To enable participants to properly assess fetal cardiac function in a clinical context

• To recognize the indications, limitations, and benefits of in utero cardiac therapy in a

clinical context

• To make predictions on how the fetal heart adapts to an insult, and the consequent fetal

cardiac remodeling, dysfunction and failure

• To emphatically cope with the emotional needs of parents facing during pregnancy the

diagnose of a heart anomaly

9

INFORMATION OF INTEREST

Target audience

Advanced fetal cardiology training for Fetal Medicine specialists and ultrasound professi-

onals with experience in fetal echocardiography who want to improve their understanding

and clinical skills on Fetal Cardiology

Organized by

Fetal I+D Education Barcelona

Directors and scientific committee

Fátima Crispi/Olga Gómez/Josep M Martínez

Fetal I+D Academic Direction and Supervision

Francesc Figueras/Eduard Gratacós

Scientific coordinator and webmaster

Laura Nogué


TEACHING STRUCTURE

The Postgraduate Degree in Fetal Cardiology comprises 9 theoretical-practical modules

including the basics on prenatal cardiac imaging, advanced knowledge on CHD and ar-

rhythmias, and understanding on fetal cardiac function and therapy.

The online modules include theoretical lectures based on clinical cases, an interactive fo-

rum and a live masterclass with experts which guaranties close interaction with teachers

with the aim of solving all the doubts that may arise during the modules. Each module will

be complemented with the resolution of a practical clinical case in the forum, including

diagnosis, prognosis and parental counseling. The clinical case is based on a real case

that will be discussed during the Masterclass. Modules will be evaluated by an online

test and a final online exam. The details of the evaluation will be indicated throughout

this academic guide.

The practical part of the postgraduate course is designed for the students to acquire the

necessary skills to perform an advanced echocardiography, including a complete mor-

phometric and functional evaluation of the fetal heart. To complete this practical part, the

students will need to send more than 70 images and echocardiographic measurements

from three different fetuses. These images will be evaluated and scored by the Academic

Committee and the students will receive personalized feedback that will allow them to

improve their skills. It will also be required to submit 5 documented cases of congenital

heart defects obtained by the student at his/her workplaces. In addition, during the first

on-site week at our center, the students will have the opportunity to participate in two

“hands-on real patients” workshops with close supervision by the postgraduate directors

enabling to learn tips and tricks for an optimal acquisition.

The postgraduate training includes the completion of a research work under the guidance

and supervision of a mentor that will be evaluated by the Academic Committee.

The following section details the different modules of the course, as well as their specific

content, the coordinators of the online theoretical-practical parts, and the scheduled

dates for the on-site weeks. The calendar of the Masterclasses and the exams’ deadlines

will be available on the Virtual Campus, to which you will be granted access prior to the

course start date.

13

2. ACADEMIC PROGRAM

2 ACADEMIC PROGRAM

15

ONLINE CLASSES

1. Fetal echocardiography: Indications and content.

Josep Maria Martínez

2. Techniques/ modes to perform a fetal

echocardiography. Fátima Crispi

3. Fetal cardiac morphometry. Olga Gómez

4. Fetal cardiac rhythm/ heart rate. Olga Gómez

5. Fetal systolic function. Fátima Crispi

6. Fetal diastolic function. Fátima Crispi

7. Clinical application/integration. Fátima Crispi

8. Fetal heart anatomy: CHD classification. Olga Gómez

TUTORS ONLINE THEORETICAL AND PRACTICAL PARTS:

Fátima Crispi

[email protected]

Olga Gómez

[email protected]

FÁTIMA CRISPI /

OLGA GÓMEZ

Masterclass coordinators

IMAGES

Cardiac morphometry:

heart and 4-chamber view

MODULE 1:

ADVANCED ECHOCARDIOGRAPHY

ACADEMIC PROGRAM2

mailto:[email protected]



ONLINE CLASSES

1. Atrioventricular septal defects I-Complete AV defect.

Narcís Masoller

2. Atrioventricular septal defects II-Partial AV defect-

other forms. Narcís Masoller

3. Interventricular septal defects: perimembranous

defects. Narcís Masoller

4. Interventricular septal defects: muscular defectes.

Narcís Masoller

5. Interauricular septal defects. Narcís Masoller

6. Single double entry ventricle. Narcís Masoller

CLINICAL CASE

Septal defects


Narcís Masoller

[email protected]

NARCÍS MASOLLER /

JOSEP MARIA MARTÍNEZ


IMAGES


4-chamber view, 5-chamber view, 3-chamber view

MODULE 2:

SEPTAL DEFECTS

17

ONLINE CLASSES

1. Hypoplastic left heart-I: Mitral atresia. Olga Gómez

2. Hypoplastic left heart II-Aortic atresia. Olga Gómez

3. Aortic stenosis. Olga Gómez

4. Aortic coarctation. Olga Gómez

5. Aortic arch interruption. Olga Gómez

CLINICAL CASE

Left CHD


Olga Gómez

[email protected]

MODULE 3:

LEFT CHD

OLGA GÓMEZ /



IMAGES


3 vessel and traquea view



ONLINE CLASSES

1. Tricuspid atresia. Narcís Masoller

2. Ebstein Anomaly-Tricuspid displasia. Narcís Masoller

3. Pulmonary stenosis. Fátima Crispi

4. Pulmonary atresia - type I. Fátima Crispi

5. Pulmonary atresia - type II. Fátima Crispi

CLINICAL CASE

Right CHD


Narcís Masoller

[email protected]

Fátima Crispi

[email protected]

NARCÍS MASOLLER /

FÁTIMA CRISPI


IMAGES


sagital views

MODULE 4:

RIGHT CHD


19

ONLINE CLASSES

1. Fallot Complex. Mar Bennasar

2. Truncus arteriosus. Mar Bennasar

3. D-Transposition of great arteries. Mar Bennasar

4. L-Transposition of great arteries. Mar Bennasar

5. Double outlet right ventricle. Mar Bennasar

CLINICAL CASE

Conotruncal anomalies


Mar Bennasar

[email protected]

MODULE 5:

CONOTRUNCAL ANOMALIES

MAR BENNASAR /



IMAGES


M-mode and Pused-Doppler.



ONLINE CLASSES

1. Situs anomalies - Heterotaxy syndromes.


2. Fetal cardiac Tumors. Josep Maria Martínez

3. Cardiomyopathies / other myocardial abnormalities

(Congenital aneurysm / diverticulum).


4. Other anomalies: ductus arteriosus restriction,

pericardial effusion, ectopia cordis.


CLINICAL CASE

Complex CHD



[email protected]

NARCÍS MASOLLER /

FÁTIMA CRISPI


IMAGES

Right cardiac function

MODULE 6:

COMPLEX CHD-OTHER CARDIAC ANOMALIES


21

ONLINE CLASSES

1. Aortic arch anomalies: ARSA, RAA, DAA. Mar Bennasar

2. Systemic venous return anomalies I: PVCSI, IIVC.

Mar Bennasar

3. Systemic venous return anomalies II: Umbilical vein

drainage anomalies. Mar Bennasar

4. Pulmonary venous return anomalies. Mar Bennasar

CLINICAL CASE

Conotruncal anomalies


Mar Bennasar

[email protected]

MODULE 7: VASCULAR / VENOUS SYSTEM ANOMALIES

MAR BENNASAR /



IMAGES


M-mode and Pused-Doppler.



ONLINE CLASSES

1. Fetal arrhythmias: classification. Olga Gómez

2. Fetal irregular rhythms (premature atrial/ventricular

beats). Olga Gómez

3. Fetal Tachycardia I - Supraventricular tachycardia.

Olga Gómez

4. Fetal Tachycardia II - Atrial Flutter. Olga Gómez

5. Fetal Bradycardia I - Autoimmune block. Olga Gómez

6. Fetal Bradycardia II - Others (Long QT syndrome).

Olga Gómez

CLINICAL CASE

Fetal Arrhythmias


Olga Gómez

[email protected]

OLGA GÓMEZ /



IMAGES

Clinical case CHD 1 and 2

MODULE 8: FETAL ARRHYTHMIAS AND FETAL CARDIAC THERAPY

BLOC 1: FETAL ARRHYTHMIAS


23

ONLINE CLASSES

1. Fetal Aortic valvuloplasty. Josep Maria Martínez

2. Fetal Atrial septostomy. Josep Maria Martínez

3. Fetal Pulmonary valvuloplasty. Josep Maria Martínez

CLINICAL CASE

Fetal cardiac therapy



[email protected] MARIA MARTÍNEZ /

EDUARD GRATACÓS


IMAGES

Clinical case CHD 3 and 4

BLOC 2: FETAL CARDIAC THERAPY



ONLINE CLASSES

1. Fetal cardiovascular remodeling and programing-

concept. Eduard Gratacós

2. Fetal patterns - cardiovascular remodeling.

Fàtima Crispi

3. Fetal heart - IUGR. Fàtima Crispi

4. Fetal heart - Assisted Reproductive Technologies.

Fàtima Crispi

5. Fetal heart – Infections. Fàtima Crispi

6. Fetal heart - Monochorionic twins (Twin-to-twin

transfusion syndrome/sIUGR). Mar Bennasar

7. Machine learning applied to fetal cardiology.

Fàtima Crispi

CLINICAL CASE

Fetal heart adaptation to extra-cardiac conditions


Fátima Crispi

[email protected]

FÁTIMA CRISPI / OLGA GÓMEZ


IMAGES

Clinical case CHD 5

MODULE 9: FETAL HEART ADAPTATION TO EXTRA-CARDIAC CONDITIONS / NOVEL TECHNOLOGIES


25

TUTORS

Josep Maria Martínez, Olga Gómez, Fàtima Crispi, Mar Bennasar i Narcís Masoller

MODULE 10:

RESEARCH PROJECT

27

3. COMPLEMENTARY TOOLS

3 COMPLEMENTARY TOOLS

29

MASTERCLASSES

At the end of each theoretical module, a Masterclass will be given by the director/co-

ordinator of each module, with the aim of deepen the topics of greatest interest and

reinforcing the knowledge acquired from the theoretical classes.

These sessions will be in streaming and the students will be able to solve their doubts

with the experts online. The students can send their questions in advance to the scientific

coordinator who will coordinate the sessions.

Masterclasses will be scheduled in advance and the date and time will be announced on

the Virtual Campus.

RESOLUTION OF CLINICAL CASES

This part of the course is designed for the student to apply the theoretical knowledge

acquired in the different modules. For this, in each module the student will have the

opportunity to solve real clinical cases in the forum. It will include conducting a diffe-

rential diagnosis, establishing a study protocol and a follow-up plan for each case, taking

into consideration the prognostic evaluation. The high degree of expertise of the faculty

team will guide participants through cases of different complexity. This novel and dynamic

part of the course will allow acquiring the tools to carry out an exhaustive and systematic

evaluation of most congenital heart defects from a practical management point of view.

FORUM

A virtual forum will be created for each module using Moodle platform. The forum will be

supervised by the webmaster, who will ensure its correct use and functionality.

The students will be given access once the module is open and it will be the tool for sharing

questions and doubts regarding the studied topics.

COMPLEMENTARY TOOLS3


RULES FOR THE USE OF THE FORUM

The forum is a communication tool within the virtual campus. The participation is subject

to basic rules:

• It is expected from the students to be up to date on the messages and try to answer

their colleagues’ questions, even though there will be a teacher that will be present as

a moderator and may intervene if no student can help with a question.

• Before asking a question, we recommend making sure that the topic is appropriate to

the specific discussion forum and that the same question has not been asked before; if

this happens, the repeated question will be deleted by the webmaster.

• We recommend that new messages should be short, concise and self- explanatory.

• No administrative or technical related questions should be asked in the forums (for

example: I can’t watch the videos; I can’t download the presentations...). These messages

will be deleted.

• We will try to answer the questions within the period of open forum. Those questions

that remain pending will be discussed in the following masterclass.

• The messages in a specific forum must match the subjects related to that forum. Any

misplaced question will be deleted to keep the forums organized.

• To answer a question or reply on a topic, the post must be open first and then the Reply

link or button must be clicked on.

33

4. PRACTICUM

4 PRACTICUM

35

All the modules include a practical part that consists of obtaining and submitting a cer-

tain number of ultrasound images that must meet the criteria explained in the theoreti-

cal classes.

PRACTICUM4

• MODULE 1:

May 16, 2021. Recovery deadline:

August 8, 2021.

• MODULE 2:

June 13, 2021. Recovery deadline:

August 8, 2021.

• MODULE 3:

July 11, 2021. Recovery deadline:

August 8, 2021.

• MODULE 4:

August 8, 2021. Recovery deadline:

November 28, 2021.

• MODULE 5:

September 12, 2021. Recovery dea-

dline: November 28, 2021.

• MODULE 6:

October 17, 2021. Recovery deadline:

November 28, 2021.

• MODULE 7:

November 28, 2021. Recovery deadline:

April 4, 2022.

• MODULE 8:

January 30, 2022. Recovery deadline:

April 4, 2022.

• MODULE 9:

March 6, 2022. Recovery deadline:

April 4, 2022.

• MODULE 10:

March 23, 2022.

The calendar will be available on the virtual campus. If there are any changes in the dea-

dlines for any reason, it will be properly announced in the campus calendar.

The images will be assessed and scored by the tutors of the course; the students will

receive a personalized feedback that will allow them to detect possible pitfalls in order

to improve their clinical skills.


This part requires a lot of dedication from the student and it is incorporated to improve

his/her performance in ultrasound scanning during his/her daily clinical practice.

Some modules require also the submission of documented clinical cases with correspon-

ding images, obtained by the student at his/her workplace.

GENERAL GUIDELINES

1. Images from 3 different patients should be submitted for every required image in

each module.

Images from the same patient can be used in different modules.

For example, images from the 4-chamber view (Module 1) and 3 vessels trachea images

(Module 3) can be acquired from the same patient. It’s not necessary to obtain the

whole set of images of each module from the same patient.

2. The evaluation criteria are those defined in the algorithms for interpreting the images

described in the theoretical part of the course.

3. To obtain accreditation, at least 70% of the images must meet at least 70% of the

defined criteria.

4. The images will be uploaded for each module in the TASKS SUBMISSION section in

the virtual Campus.

5. All the images for each module must be submitted in a single PDF document, displayed

in the requested order for each module. The document’s size must not exceed 25 MB.

6. In order to preserve the confidentiality of the patients, the submitted images must

NOT show patient names or any identity related data.

37

IMAGE LIST AND ASSESSMENT CRITERIA

CARDIAC MORPHOMETRY

MODULE 1

Total: 9 images x 3 patients = 27 images

HEART

1. Cardiac area and thoracic area- 2D: measured in a

4-chamber view at end-diastole. Value and z-score.

Landmarks: external border of the ribs/right and left

lungs. Cardiothoracic ratio.

2. Cardiac Sphericity index: measured in a 4-chamber

view at end-diastole. Value and z-score.

3. Apical view (2d): showing right/left atria and right/left

ventricles at end-diastole.

4 CHAMBER VIEW


4. Apical view (color Doppler): showing atrioventricular

valvular flows at mid-diastole.

5. Transverse view (2D): showing interatrial/interventri-

cular septum

6. Transverse view (color Doppler): with adequate color

scale to demonstrate the integrity of the interventri-

cular septum.

7. Basal view (2D): showing atrioventricular septum or

integrity of the heart cross.

8. Basal view (color Doppler): demonstrating the absence

of atrioventricular valvular insufficiency.

9. Pulmonary veins (color Doppler): at least two (1 left

and 1 right)

39

MODULE 2

Total 12 images x 3 patients = 36 images

4 CHAMBER VIEW

10. Atrial dimensions, atrial sphericity index (2D): maxi-

mum diameters (end-systole). Value and z-score.

11. Atrial dimensions (2D): area (at end-systole). Value

and z-score.

12. Ventricular dimensions, ventricular sphericity in-

dex: basal, mid-transverse and longitudinal diame-

ters (at end-diastole). Value and z-score.

13. Ventricular dimensions: Areas (at end-diastole).

Value and z-score.


14. Left ventricle outflow tract (2d) Aortic valve: open

valve (mid-systole). Value and z-score.

15. Left ventricle outflow tract (color Doppler): confir-

ming continuity between the upper interventricular

setpum and the anterior wall of the aorta.

16. Ascending aorta: five-chamber view (distal portion

artery). Value and z-score.

5 CHAMBER VIEW

3 CHAMBER VIEW

17. Right ventricle outflow tract (2D): pulmonary valve/

trunk. Open valve (mid-systole). Pulmonary valve:

Value and z-score.

41

18. Right ventricle outflow tract (color Doppler): 3 ves-

sel view showing a transverse section of the aorta and

superior vena cava.

19. Pulmonary arteries (2D): at its bifurcation. Value

and z-score.

20. Pulmonary arteries (color Doppler)

21. Pulmonary trunk: at the 3 vessel view. Value

and z-score.


22. Apical view (2D): ductus arteriosus, Aortic Isthmus,

Superior vena cava and Trachea. Ductus arteriosus:

value and z-score. Aortic Isthmus: value and z-score

23. Apical view (color Doppler): showing anterograde

and symmetrical flows.

24. Transverse view (2D): ductus arteriosus, Aortic Isth-

mus, Superior vena cava and Trachea

25. Transverse view (color Doppler)

MODULE 3


3 VESSEL AND TRACHEA VIEW

43

26. Basal view (2D): ductus arteriosus, Aortic Isthmus,

Superior vena cava and Trachea.

27. Basal view (color Doppler): showing anterograde and

symmetrical flows.

28. Thymus (2D): at the 3 vessels and trachea view. Thy-

mus-thoracic ratio (value)

29. Thymus box (color Doppler): showing the inter-

nal mammary arteries at the external border of

the thymus.

30. Right subclavian artery (color Doopler): showing its

normal course in front of the trachea.

31. Innominate vein (color Doppler): showing its normal

drainage into the superior vena cava.


MODULE 4


SAGITAL

32. Ductal arch (2D): value and z-score of the pulmonary

valve and ductus arteriosus

33. Ductal arch (color Doppler): demonstrating normal

flow (“hockey stick” shape)

34. Aortic arch (2D): value and z-score of the ascending

Aorta, transverse arch and aortic isthmus.

35. Aortic arch (color Doppler): demonstrating normal

flow (“candy cane” shape)

36. Supra-aortic trunks (2D): common trunk, left carotid

artery and left subclavian artery. Left carotid-to-sub-

clavian distance: value

45

37. Supra-aortic trunks (color Doppler): demonstrating

normal flow.

38. Systemic venous return (2D): identification of the

superior and inferior vena cava showing their entry

into the right atrium. Measurement of inferior vena

cava. Value and z-score.

39. Systemic venous return (color Doppler): demonstra-

ting normal direction of flow.

40. Ductus venosus (color Doppler): confirmation of its

drainage at the level of inferior vena cava.

41. Suprahepatic veins (color Doppler): showing their

confluence al the level of the inferior vena cava (at

least two veins).

42. Portal system (color Doppler): showing the normal

course of the portal sinus to the right.


MODULE 5


M-MODE

43. Transverse 4-chamber view: atrial and ventricular

contraction. Measure Heart rate.

44. Transverse 4-chamber view: transverse ventricular

dimensions. Values and z-scores.

45. Transverse 4-chamber view: free lateral walls and

septum thickness. Values and z-scores.

47

46. Atrioventricular interval: inflow and outflow of the

left ventricle (value): from the onset of the “A” mitral

wave to the onset of the aortic wave.

47. Atrioventricular interval: pulmonary artery-vein

from the onset of the “A” wave on the pulmonary vein

to the onset of the pulmonary artery wave.

48. Atrioventricular interval: Aorta-cava: from the onset

of the “A” wave on the superior vena cava to the onset

of the aortic wave.

PULSED-DOPPLER


MODULE 6


RIGHT CARDIAC FUNCTION

2D-ECHOCARDIOGRAPHY

49. Right ventricle Fractional Area Change (FAC): end-di-

astolic area. Value and z-score. FAC = (end-diastolic

area – end-systolic area)/end-diastolic area * 100.

50. Right ventricle Fractional Area Change (FAC):

end-systolic area. Value and z-score. FAC = (end-dias-

tolic area – end-systolic area)/end-diastolic area *100.

PULSED-DOPPLER

51. Tricuspid flow: E/A velocities. Value.

52. Tricuspid flow: filling time fraction (FTF). Value and

z-score. FTF = filling time/cycle time)*100

49

53. Pulmonary flow: Systolic peak velocity. Value.

54. Pulmonary flow: ejection time fraction. Value and

z-score. ETF = ejecting time/cycle time)*100

55. Ductus arteriosus pulsatility index: Value

and z-score.

56. Ductus venosus pulsatility index: systolic, early

diastolic and atrial contraction velocities. Values.


M-MODE

57. TASPE: Tricuspid annular plane systolic excursion.

Value and z-score.

MODULE 7


RIGHT CARDIAC FUNCTION

PULSED-DOPPLER:

58. Mitral flow: E/A velocities. Value.

51

59. Mitral flow: filling time fraction. Value and z-score.

FTF = filling time/cycle time)*100

60. Aortic flow: systolic peak velocity. Value.

61. Aortic flow: ejection time fraction. Value and z-score.

ETF = ejection time/cycle time)*100


62. Myocardial performance index: isovolumic contrac-

tion, ejection and isovolumic relaxation times. Value

and z-score. MPI = isovolumetric contraction time +

isovolumetric relaxation time)/ejection time.

63. Aortic isthmus pulsatility index: Value and z-score.

64. Pulmonary veins flow: systolic, early diastolic and

atrial contraction velocities. Values.



M-MODE

65. MASPE: Mitral annular plane systolic excursion.

Value and z-score.

53

66. Left ventricle ejection fraction (EDV = (7/(2.4/EDD))

xEDD3) y systole (ESV = ((7/(2.4/ESD))xESD3): Ejection

fraction = (EDV – ESV)/EDV. (EDV: end-diastolic vo-

lume, ESV: end-systolic volume, EDD: end-diastolic

dimension, EDS: end-systolic dimension.

67. Left ventricle shortening fraction: Value. Shortening

fraction = (End-diastolic dimension – End-systolic di-

mension)/End-diastolic dimension * 100.


MODULE 8

BLOC 1 and 2

Total

2 clinical cases of CHD. The cases must be well documented ichnographically. The diagno-

sis must be justified by showing the specific key-points of the cardiac defect. In addition,

the complementary tests carried out and the summary of the antenatal advice recom-

mended to the pregnant woman must be also explained.

Module 9

Total

1 clinical case of CHD. The case must be well documented ichnographically. The diagnosis

must be justified by showing the specific key-points of the cardiac defect. In addition, the

complementary tests carried out and the summary of the antenatal advice recommended

to the pregnant woman must be also explained.

57

5. FACE TO FACE PERIOD

IN BARCELONA

5 FACE TO FACE PERIOD

IN BARCELONA

59

The face-to-face period consists of two weeks in Barcelona (two periods of one week

each). A visit to the Fetal Cardiology Unit of Hospital Sant Joan de Déu in BCNatal (Center

for Maternal-Fetal and Neonatal Medicine Barcelona) will be included. The first week will

take place halfway through the course in order to expand knowledge, improve skills on ec-

hocardiography and facilitate interaction with mentors, faculty members and colleagues.

The second week is scheduled at the end of the postgraduate to consolidate knowledge

and improve understanding on novel or more advanced techniques.

First week calendar: October 18-24 2021 and second weeks: March 7-13 2022.

During these two periods the participants will have the opportunity to meet the faculty

and their mentors. The stays will include the following activities:

* “Meet the professor” sessions that enable personal discussion on the most relevant

aspects of each module, based on clinical cases, with the faculty members.

* Invited lectures from international experts on a specific topic of interest including basis

of fetal cardiac magnetic resonance, core aspects on the assessment of the right ventricle,

electrocardiogram, genetics in CHD, impact of CHD on neurodevelopment, fetal-neonatal

transition and fetal cardiac programming. This will enable interaction with the postgra-

duate faculty members and also with invited professors from other universities experts

in a specific topic of interest.

* Practical training. Dedicated sessions with volunteer patients, with hands-on fetal ec-

hocardiography with reduced number of attendees, enabling to teach tips and tricks for

both structural and functional echocardiography.

* Workshops on 4D-STIC, strain quantification and 3D printed models of the heart to

gain advanced knowledge on particular cases of CHD.

* Specific meet with the mentor sessions in order to discuss any doubt on specific topics

and to define and plan the research work (fist onsite week at mid-course).

* Defense of the research work, enabling the discussion with colleagues and the faculty

members (second onsite week at the end of the postgraduate).

FACE TO FACE PERIOD IN BARCELONA5

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6. RESEARCH PROJECT

(MODULE 10)

6 RESEARCH PROJECT

(MODULE 10)

63

The postgraduate training includes the completion of a research work that will be evalu-

ated by the Academic Committee. The research work usually includes a critical literature

review of a specific topic that can be complemented by original data from the student’s

institution. The research work is conducted personally by the student, under the guidance

and supervision of a mentor. The topic is chosen and planned during the first onsite week

and defended at the second onsite week.

PRESENTATION & FORMAT

Deadline and submission method: The deadline for the project’s submission will be during

the last on-site week (March 7-13, 2022). The project must be submitted through the

virtual campus in a PDF format. A specific “TASK SUBMISSION” will be enabled to upload

it. Failure to submit it within the prescribed time limit means suspending the task. In case

of requesting deferment of delivery, for any justified reason, 2 points (about 100) will be

deducted, for each day of delay in delivery.

RESEARCH PROJECT (MODULE 10)6

FORMAT: The text must be formatted with 1.5 line spacing, Arial font, and size 12.

a) Margins: The margins must be set to: Upper: 2 cm. Lower: 2 cm. Left: 4 cm. Right: 2 cm.

b) Page numbering: Starting with the introduction, all pages must be numbered on the

top-right side.

c) Tables: They must be clear, numbered with Arabic numerals in relative order, titled cle-

arly stating their content, be self-explanatory and avoid duplicating content in the text.

d) Graphs: They must be clear, numbered with Arabic numerals in relative order, titled

clearly stating their content, be self-explanatory and avoid duplicating content in the

text or tables.

e) Figures: They must be numbered with Arabic numerals in a relative order and have a

short title. If the image or the photo has been published previously, the origin must be

mentioned in the title with appropriate citation of the reference.


CONTENTS OF THE RESEARCH PROJECT

0. COVER

1. INDEX

2. ABSTRACT

3. STATE OF THE ART – INTRODUCTION

4. HYPOTHESIS AND OBJECTIVES

5. MATERIALS AND METHODS

6. RESULTS

7. DISCUSSION

8. CONCLUSIONS

9. REFERENCES

10. ANNEXES AND APPENDICES

GUIDELINES FOR DEVELOPMENT OF THE RESEARCH PROJECT

1. SUMMARY

It must be written in English. It must demonstrate in a concise way the hypothesis and

the obtained results. The abstract must have a maximum of 350 words and be written in

a structured format including the following parts:

• Introduction: Define the problem and the aim of the project.

• Materials and methods: Describe how the project was done.

• Results: Describe briefly the main results of the project.

• Conclusions: Report the main findings of the results and the clinical implications,

if relevant.

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2. THEORETICAL FRAMEWORK

This section contextualizes the project developed within the current framework of

knowledge. It must be less than 10 pages long. It must clearly establish the problem being

investigated, the current knowledge about it and the motivation for further research.

It must summarize the relevant previous studies carried out on the subject and explain

how this project is different from the prior. The theoretical framework must be strongly

supported by recent scientific literature (preferably no older than 10 years).

3. HYPOTHESIS AND OBJECTIVES

A short affirmative sentence that could be accepted or rejected in an experimental or a

clinical research.

• General objective: It must start with an infinite verb (To determine..., To analyze...,

To know...) and it must be written in a way that implies the steps needed to prove

the proposed hypothesis.

• Specific objectives: They must be numbered according to the stages of the project.

They must be written as actions that, when executed consecutively, will allow the

different stages of the project to be carried out, with the aim of accepting or rejec-

ting the hypothesis of the project.

4. MATERIALS AND METHODS

This section must be written in the past tense, indicating:

• Type of study: experimental, descriptive, prospective, etc.

• Sample: Detailed description of the study sample, how it was obtained, source,

characteristics, size, etc.


• Procedures: The methods and procedures must be clearly described. The measure-

ment instruments (if any) must be included as annexes at the end of the project. If

methods or techniques from other authors have been used, they must be described

briefly with the citation of the corresponding reference. It must be clearly stated

how each of the specific objectives will be carried out.

If applicable, this section of the project must also include an explanation of the

statistical approach used to analyze the data, as well as the software used for

such purpose.

5. RESULTS

The research findings must be written in an objective and clear way, ideally following the

order of the specific objectives and methodology. The data must be analyzed in tables,

graphs, figures or images. Each of them must include an explanatory text. This section

must not include the interpretation of the results, this will appear in the discussion section.

When the research project compares original results with the results of other authors,

the source of the compared data must be clearly explained. When a statistical analysis is

included, the results must clearly state which variables are statistically different.

6. DISCUSSION

This section describes the meaning of the obtained results, in the context of what is known

about the studied topic. The proposed hypothesis must be discussed and accepted or

rejected. Emphasis should be given to the new and important findings of the study. The

research findings must be compared with previously published studies.

The limitations of the experimental methods must be discussed, as well as the possible

implications for future studies. When appropriate, the clinical relevance of the results

must be included.

67

7. CONCLUSIONS

The conclusions must be written as a series of short sentences, based directly on the

obtained results and the experimental or clinical evidence of the project. Speculation

from other projects must be avoided.

8. REFERENCES

Citations and references must follow Vancouver style.

9. ANNEXES AND APPENDICES

All the documents that are considered relevant for the research project must be included

in this part. They should be cited in the text in the corresponding section and proper-

ly numbered.

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7. EVALUATION CRITERIA

7 EVALUATION CRITERIA

71

The evaluation of the postgraduate degree in Fetal Cardiology is based on a continuous

evaluation. In order to obtain the final degree, all the parts must have been passed separa-

tely (theoretical exams, practicum, clinical cases, research project, participate in the forum

and final exam) within the agreed dates. Failure to comply with this rule for whatever

reason involves suspending the degree.

Resits: There will be only one opportunity to resit failed modules or tasks. The maximum

grade that can be obtained in resits will be the minimum grade set as required to approve.

This regulation does not allow exceptions of any kind.

The non-approval of a module means the failure to obtain the course degree. The pos-

sibility of enrolling in the next year of the pending module(s) is offered, provided that

the number of modules suspended is not greater than two but requires payment of the

module and all corresponding university fees. In the event of suspending more than two

modules there will be no option to recovery, and you would have to enroll in the Training

Course again and complete it in full.

The different evaluable points of the course are described below:

ONLINE EXAMS OF THE THEORETICAL MODULES

The aim of these exams is to explore the level of knowledge acquired in relation to the con-

tent explained in the theoretical classes. They consist of multiple-choice questions test with

only one valid answer per question. The different exams are composed of 15 questions.

Minimum Score: The minimum score to pass the self-assessment exams is 70%.

Duration: There is a time limit of 5 hours per exam. Time starts counting at the moment of

accessing the test and continues to progress despite disconnecting from the application.

EVALUATION CRITERIA7


The test can be repeated 5 times with a time interval between attempts of 4 hours. Despi-

te having passed the exam, it can be repeated in order to continue learning and improving

the obtained score. The system will consider the best score among the attempts.

The average score of all the self-assessment exams of the different modules will have an

impact on the overall score of the course contributing by 25%. It is necessary to pass each

module to be able to calculate the average. The exam must be carried out during the time

period defined in the Virtual Campus. The time used for the submission deadlines will be

Spanish time zone (GMT +1).

PRACTICUM

The images of the practicum must be submitted within the requested deadlines in order

to be evaluated. To obtain the final postgraduate degree this part must be passed.

Any submission after the deadline will entail the non-evaluation of the practicum and

will be considered as failed. There will be a recovery period at the end of the postgradu-

ate degree.

The students will have a calendar with the practicum’s submission deadlines of the prac-

ticum’s, the recovery deadlines and the expected dates to receive the practicum scores

from the teaching staff.

The final score of the practicum will be obtained by calculating the average of the 9 sub-

missions and will correspond to 25% of the overall score.

Resits: There will be a second opportunity to resubmit any failed practicum, either for not

having submitted it prior to the deadline or for not having reached the necessary score to

pass. The maximum score that can be obtained in the recovery will be 70%. If the student

fails the resit, there will be no more chance of resubmission, and therefore, it will not be

possible to obtain the final certificate of the ‘postgraduate degree in Fetal Cardiology.

73

Deferrals: If the student is unable to submit a task of a module, always before the stated

date, an extension can be requested by filling out a form available on the virtual campus for

consideration by the teaching coordinator. Extensions of deadlines will only be accepted

for larger and justifiable reasons.

RESOLUTION OF CLINICAL CASES, FORUM CONTRIBUTION AND MASTERCLASSES

The participation in the forum will be evaluated continuously throughout the course.

Those contributions that provide answers to the questions raised in the clinical cases and

the doubts generated by the rest of the participants will be positively valued. This part

represents 10% of the final score.

RESEARCH PROJECT

To obtain the final postgraduate degree this part must be passed and it will correspond

to 20% of the overall score.

To set the final project score, the evaluation criteria described above will be followed. To

approve the final project, a minimum grade of 7 will be required.

• Evaluation criteria (Maximum score):

• RELEVANCE OF THE PROPOSAL: Is the developed project relevant? 0,5

• ORIGINALITY OF THE PROPOSAL: Is the developed research project original? 0,5

• DRAFTING OF THE PROJECT: Is the project WELL written and follows the scien-

tific standards? 1

• OBJECTIVES: Are the objectives clearly defined and stated? 0,5

• HYPOTHESIS: Is the hypothesis clearly established? 1

• MATERIALS AND METHODS: Are the methods used in the development of the

project appropriate? 1

• RESULTS: Are the data properly and clearly presented? 1


• DISCUSSION: Are the obtained results critically analyzed? Are they properly com-

pared to the existing literature on the topic? 0,75

• CONCLUSIONS: Are the conclusions based on scientific evidence? 0,5

• REFERENCES: Are the project references written correctly? Are the references

updated and relevant to the subject? 0,25

• TOTAL SCORE: 10

FINAL EXAM

The aim of the final exam is to explore the level of knowledge acquired in the postgraduate

degree. It will correspond to 20% of the overall score. It consists of 50 multiple-choice

questions test with only one valid answer per question.

Minimum Score: The minimum score to pass the self-assessment exams is 70%.

Duration: There is a time limit of 2 hours. Time starts counting at the moment of acces-

sing the test and continues to progress despite disconnecting from the application. The

test can be repeated 5 times with a time interval between attempts of 4 hours. Despite

having passed the exam, it can be repeated in order to continue learning and improving

the obtained score. The system will consider the best score among the attempts.

The exam must be carried out during the time period defined in the Virtual Campus. The

time used for the submission deadlines will be Spanish time zone (GMT +1).

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FINAL EVALUATION

Average of the module’s exams 25%

Average of the practicum 25%

Clinical cases and Forum contribution 10%

Research project 20%

Final exam 20%

TOTAL 100%

GRADING

Score Grade Comment

0 – 6.9 Fail

7 – 7.9 Approved

8 – 8.9 Very good

9 – 10 Excellent The top two overall scores (as long as they are above 9) will be graded with an honor mention.

DEGREE

The students will be awarded two certificates:

1. A university “Postgraduate Degree in Fetal Cardiology”. The title will be issued by the

Institute of Continuing Education (IL3) of the University of Barcelona.

2. Certificate in Fetal Cardiology from the I+D Education Barcelona.

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