Interventional paediatric echocardiography: a call to action for training, competency, and sustainable practice standards

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Congenital heart disease. Intervention: Interventional paediatric echocardiography.

Tam  T. Doan; James C Wilkinson; Carolyn A. Altman; Anitha Parthiban; Ricardo H. Pignatelli

doi:10.1017/s1047951126124640

October 21, 2026Cardiology in the YoungOpen Access

Interventional paediatric echocardiography: a call to action for training, competency, and sustainable practice standards

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Key result

Interventional paediatric echocardiography requires dedicated paediatric-specific training pathways, competency frameworks, and updated reimbursement models beyond current CPT 93355 (4.66 wRVUs).

Key Points

Outline the necessity for pediatric-specific training pathways, competency frameworks, and sustainable practice models in interventional congenital cardiac imaging.
Expert editorial and framework proposal analyzing the procedural, ergonomic, and economic demands of pediatric interventional echocardiography.
Defined core competency domains encompassing preprocedural planning, real-time device guidance, radiation stewardship, complication recognition, and postprocedural care.
Emphasized size-specific imaging limits, noting micro-transesophageal echocardiography is feasible down to 2.5 kg, 3D transesophageal echocardiography from approximately 5 kg, and intracardiac echocardiography is restricted by 8–10F sheaths.
Identified that adult procedural volume benchmarks (recommendations of at least 75 guided procedures) fail to accommodate the lower case volumes and higher anatomical heterogeneity of congenital heart disease.
Reported reimbursement imbalances, as interventional transesophageal echocardiography generates 4.66 wRVUs compared to diagnostic studies (~2.3 wRVUs), while add-on intracardiac echocardiography (2.80 wRVUs) cannot be billed by imaging physicians.

Structured PICO

P

Population

Paediatric patients with congenital heart disease (CHD) undergoing complex catheter-based and hybrid interventions

I

Intervention

Interventional paediatric echocardiography (IPE), including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), micro-TEE (feasible in patients as small as 2.5 kg), 3D paediatric TEE (from approximately 5 kg), and intracardiac echocardiography (ICE)

Limitations

Editorial commentary without original empirical patient data
Paediatric-specific procedural volume thresholds remain undefined and require multicentre assessment

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Implication

This editorial calls for the formal recognition of interventional paediatric echocardiography as a distinct subspecialty with dedicated competency-based training frameworks and sustainable reimbursement models.

Abstract

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Cite This Study

Doan et al. (2026) conducted an editorial in Congenital heart disease. Interventional paediatric echocardiography was evaluated. Interventional paediatric echocardiography requires dedicated paediatric-specific training pathways, competency frameworks, and updated reimbursement models beyond current CPT 93355 (4.66 wRVUs).

synapsesocial.com/papers/6aee6c1771a7594806220d57 https://doi.org/10.1017/s1047951126124640

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Interventional paediatric echocardiography: a call to action for training, competency, and sustainable practice standards

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Interventional paediatric echocardiography: a call to action for training, competency, and sustainable practice standards

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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