Dr. Haeffele earned her medical degree from the Duke University School of Medicine in Durham, North Carolina. She completed a combined medicine and pediatric residency at Harvard University in Boston, Massachusetts at the Brigham and Women's Hospital and Boston Children's Hospital. She also completed the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine program, working on oncology infrastructure in Rwanda in partnership with the Rwandan Ministry of Health and Partners in Health. She completed her fellowship in adult cardiology and sub-specialized training in adult congenital heart disease and echocardiography at Stanford Hospital. She served one year as a chief fellow for the general cardiology fellowship at Stanford.
Dr. Haeffele is the Director of the Structural ECHO program at Stanford Hospital. She is an Assistant Program Director for the General Cardiology fellowship. Dr. Haeffele is also appointed Clinical Assistant Professor of Medicine and Pediatrics at Stanford University School of Medicine.
Dr. Haeffele is a board certified cardiology physician. Her research interests include management of adults with congenital heart disease, structural heart disease and catheter based interventions, and the complexities of heart transplant in the adult with congenital heart disease.
- Adult Congenital Heart Disease
- Interventional ECHO
- Fontan physiology
- Structural Heart Disease
Clinical Assistant Professor, Medicine - Cardiovascular Medicine
Director of Structural ECHO, Stanford CV Medicine (2019 - Present)
Assistant Program Director, General Cardiology Fellowship, Stanford University (2017 - Present)
Affinity Chief, General Cardiology Inpatient Service, Stanford Hospital (2016 - 2019)
Honors & Awards
Department of Medicine Teaching Award, Stanford Medicine (2020)
Timothy F. Beckett, Jr. Award, Best Clinical Teaching by a Medicine Fellow, Stanford University (2014)
Excellence in Cardiology Fellowship, American College of Cardiology (2015)
Outstanding Clinical Fellow Award, Stanford University, Division of Cardiology (2014)
Andrew C. Puckett Humanism in Medicine, Duke University (2007)
Outstanding Researcher, Department of Molecular and Cellular Biology, UC-Berkeley (2001)
Graduated with Honors, Molecular and Cellular Biology, UC-Berkeley (1997)
Boards, Advisory Committees, Professional Organizations
Member, American College of Cardiology (2012 - Present)
Member, American Heart Association (2012 - Present)
Member, International Society of Adult Congenital Heart Disease (2015 - Present)
Member, American Society of Echocardiography (2016 - Present)
Board Certification: American Board of Internal Medicine, Adult Congenital Heart Disease (2019)
Fellowship: Stanford University Cardiovascular Medicine Fellowship (2016) CA
Residency: Brigham and Women's Hospital Internal Medicine Residency (2012) MA
Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2016)
Board Certification: National Board of Echocardiography, Echocardiography (2016)
Fellowship: Stanford University Cardiovascular Medicine Fellowship (2015) CA
Board Certification: American Board of Internal Medicine, Internal Medicine (2014)
Medical Education: Duke University School of Medicine (2007) NC
Current Research and Scholarly Interests
Adult Congenital Heart Disease
ACURATE IDE: Safety and Efficacy Study of Acurate Valve for Transcatheter Aortic Valve Replacement
To evaluate safety and effectiveness of the ACURATE Transfemoral Aortic Valve System for transcatheter aortic valve replacement (TAVR) in subjects with severe native aortic stenosis who are indicated for TAVR.
Edwards CLASP TR EFS
Early feasibility study to assess the safety and performance of the Edwards PASCAL Transcatheter Valve Repair System in tricuspid regurgitation
Edwards PASCAL CLASP IID/IIF Pivotal Clinical Trial
To establish the safety and effectiveness of the Edwards PASCAL Transcatheter Valve Repair System in patients with degenerative mitral regurgitation (DMR) who have been determined to be at prohibitive risk for mitral valve surgery by the Heart Team, and in patients with functional mitral regurgitation (FMR) on guideline directed medical therapy (GDMT)
Transcatheter Mitral Valve Replacement With the Medtronic Intrepid™ TMVR System in Patients With Severe Symptomatic Mitral Regurgitation
Multi-center, global, prospective, randomized, interventional, pre-market trial with two subject groups: the randomized group will be randomized on 1:1 basis to either the study device or to conventional mitral valve surgery. Subjects in the single-arm group will receive the study device. Subjects will be seen at pre- and post-procedure, discharge, 30 days, 6 months, and annually through 5 years.
Does liver biopsy accurately measure fibrosis in Fontan associated liver disease? A comparison of liver biopsy pre-combined heart and liver transplant and liver explant post-transplant.
The accuracy of liver biopsy to stage fibrosis due to Fontan associated liver disease (FALD) remains unclear. We compared results of biopsy pre-combined heart and liver transplantation (CHLT) to results of whole liver explant. Liver biopsy and explants from 15 Fontan patients (ages 16 - 49, median 28 years) were retrospectively reviewed. Staging was as follows: stage 0: no fibrosis, stage 1: pericellular fibrosis, stage 2: bridging fibrosis, stage 3: regenerative nodules. There is no stage 4. Clinical characteristics including Model of End-stage Liver Disease eXcluding INR and Varices, Ascites, Splenomegaly, and Thrombocytopenia (VAST) scores were collected, and descriptive statistics and Mann-Whitney U tests used to analyze data. All patients had biopsies with at least bridging fibrosis, and all had nodularity on explant; transjugular biopsy never overestimated fibrosis. Explant showed higher grade fibrosis (Stage 3) than pre-CHLT biopsy (Stage 2) in 6 of 15 patients and equal grade of fibrosis (Stage 3) in 9 of 15 patients. Though clinical characteristics varied significantly, VAST score was ≥ 2 in all but two patients. Transjugular liver biopsy does not overestimate and can underestimate fibrosis in Fontan patients undergoing CHLT, likely due to the patchy nature of fibrosis in FALD.
View details for DOI 10.1111/ctr.14120
View details for PubMedID 33053213
Outcomes of Heart and Combined Heart-Liver Transplant in Pediatric Fontan Patients
ELSEVIER SCIENCE INC. 2020: S453–S454
View details for Web of Science ID 000522637203137
CLINICAL CHARACTERISTICS OF "FAILING" ADULT FONTAN PATIENTS ACROSS 14 CENTERS: A REPORT FROM THE FOSTER STUDY
ELSEVIER SCIENCE INC. 2020: 553
View details for Web of Science ID 000522979100541
MORBIDITY AND MORTALITY IN ADULT FONTAN PATIENTS AFTER HEART OR COMBINED HEART LIVER TRANSPLANT: A REPORT FROM THE FOSTER STUDY
ELSEVIER SCIENCE INC. 2020: 653
View details for Web of Science ID 000522979100641
MORBIDITY AND MORTALITY IN ADULT FONTAN PATIENTS REFERRED FOR TRANSPLANT: A REPORT FROM THE FOSTER STUDY
ELSEVIER SCIENCE INC. 2020: 546
View details for Web of Science ID 000522979100534
Heart failure in the adult Ebstein patient.
Heart failure reviews
Ebstein anomaly comprises approximately 1% of all congenital heart diseases. It occurs when the tricuspid valve fails to properly delaminate from the right ventricle, resulting in a clinical spectrum of abnormal tricuspid valve morphology and right ventricular dysfunction. Due to the anatomy of the tricuspid valve and right ventricle, as well as associated right- and left-sided pathology, patients are at risk for both right and left ventricular failure and the associated symptoms of each. Ebstein patients are also at risk for atrial arrhythmias, due to the atrial enlargement intrinsic to the anatomy, as well as the presence of potential accessory pathways. Arrhythmias are generally poorly tolerated, particularly in the setting of ventricular dysfunction. Cyanosis may also be present in Ebstein patients, due to the common occurrence of atrial communications, which can exacerbate other symptoms of heart failure. Treatment of heart failure can be through pharmacologic and procedural interventions, depending on the underlying cause of heart failure. While early heart failure symptoms may be treated with medical management, most Ebstein patients will require surgery. Various surgical and catheter-based interventions targeting the tricuspid valve and the atrialized right ventricular tissue have been developed to help treat the underlying cause of the heart failure. The optimal timing of transcatheter and surgical intervention in the Ebstein patient to prevent or treat heart failure needs further study.
View details for DOI 10.1007/s10741-020-09930-2
View details for PubMedID 32472521
- The Hidden Victims of the COVID-19 Pandemic: Congenital Heart Disease Patients. JACC. Case reports 2020; 2 (9): 1411–13
Fontan Liver Lesions: Not Always HCC
JACC: Case Reports
2020; 1 (12)
View details for DOI 10.1016/j.jaccas.2019.05.031
Percutaneous Pulmonary Vein Stenting to Treat Severe Pulmonary Vein Stenosis After Surgical Reconstruction.
Innovations (Philadelphia, Pa.)
A 36-year-old female underwent left lower lobectomy with left atrial and left upper pulmonary vein (LUPV) reconstruction with a bovine pericardial patch for an intrathoracic pheochromocytoma. Postoperatively, she developed shortness of breath and transesophageal echocardiography demonstrated LUPV stenosis with increased velocities. Computed tomography angiogram of the chest revealed LUPV stenosis at the left atrium ostium with an area of 39 mm2. Under angiographic and echocardiographic guidance, a 10 × 19 mm Omnilink Elite uncovered stent was deployed in the LUPV ostia. While reported following left atrial ablation, pulmonary vein stenting can be successful in a pulmonary vein surgically reconstructed with bovine pericardium.
View details for DOI 10.1177/1556984520933962
View details for PubMedID 32639846
Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease
AMERICAN JOURNAL OF CARDIOLOGY
2017; 119 (1): 112-118
The adult with congenital heart disease (CHD) is at risk of developing atherosclerotic cardiovascular disease (ASCVD). We performed a cross-sectional study to describe established ASCVD risk factors and estimate 10-year and lifetime risk of ASCVD in adults over age 18 with CHD of moderate or great complexity using 3 validated risk assessment tools-the Framingham Study Cardiovascular Disease Risk Assessment, the Reynolds Risk Score, and the ASCVD Risk Estimator. We obtained extensive clinical and survey data on 178 enrolled patients, with average age 37.1 ± 12.6 years, 51% men. At least 1 modifiable ASCVD risk factor was present in 70%; the 2 most common were overweight/obesity (53%) and systemic hypertension (24%). Laboratory data were available in 103 of the 178 patients. Abnormal levels of glycated hemoglobin, high-sensitivity C-reactive protein, and high-density lipoprotein were each found in around 30% of patients. The 10-year ASCVD predicted risk using all 3 tools was relatively low (i.e., at least 90% of patients <10% risk), yet the median estimated lifetime risk was 36%. In conclusion, ASCVD risk factors are prevalent in adults with CHD. The risk estimation tools suggest that this population is particularly vulnerable to ASCVD with aging and should undergo guideline-based screening and management of modifiable risk factors.
View details for DOI 10.1016/j.amjcard.2016.09.023
View details for PubMedID 28247847
- UTILIZATION OF SPECIALTY CARE CENTERS IN CALIFORNIA FOR LABOR AND DELIVERY IN WOMEN WITH CONGENITAL HEART DISEASE ELSEVIER SCIENCE INC. 2016: 950
Dextro-Transposition of the Great Arteries Long-term Sequelae of Atrial and Arterial Switch
2015; 33 (4): 543-?
Over the last 50 years, improved surgical techniques and progressive medical management have allowed patients with complete or dextro-transposition of the great arteries (D-TGA) to survive into adulthood. Older adult patients underwent an atrial switch procedure (Mustard or Senning operation), whereas the younger cohort of patients with TGA has undergone the arterial switch operation (ASO). The Mustard/Senning maintains the right ventricle as the systemic ventricle, whereas the more recently adopted ASO attempts to restore normal physiologic and anatomic relationships. Neither operation is without consequence. Neither is without consequence and require long term follow up.
View details for DOI 10.1016/j.ccl.2015.07.012
View details for Web of Science ID 000364729200006
View details for PubMedID 26471819
Receptor-selective coactivators as tools to define the biology of specific receptor-coactivator pairs
2006; 24 (5): 797-803
In the absence of specific high-affinity agonists and antagonists, it has been difficult to define the target genes and biological responses attributable to many of the orphan nuclear receptors (ONRs). Indeed, it appears that many members of this receptor superfamily are not regulated by classical small molecules but rather their activity is controlled by interacting cofactors. Motivated by this finding, we have developed an approach to genetically isolate specific receptor-cofactor pairs in cells, allowing us to define the biological responses attributable to each complex. This is accomplished by using combinatorial peptide phage display to engineer the receptor interacting domain of each cofactor such that it interacts selectively with one nuclear receptor. In this study, we describe the customization of PGC-1alpha and its use to study the biology of the estrogen-related receptor alpha (ERRalpha) in cultured liver cells.
View details for DOI 10.1016/j.molcel.2006.10.012
View details for Web of Science ID 000242812000015
View details for PubMedID 17157261