How did you become interested in pediatric cardiology?
One of my very first courses in medical school was embryology. I was fascinated by how the heart folds and grows, and decided right then and there that I wanted to go into pediatric cardiology. I completed all my training in New York and then came to Boston Children’s Hospital for my cardiology fellowship. Dr. Fulton was one of my most influential mentors during my fellowship training. He really inspired me to follow his footsteps and work in the outpatient clinic setting. I have been very happy with my choice.
What is your favorite part about your job?
One of the best parts of my job is easing the minds of worried parents. Almost irrespective of their reason for referral, parents are often nervous to see me and assume their child has a serious issue. I find that if I spend the time to explain things in a manner they comprehend, they leave relieved and are better able to put the issue in context. In some instances, a serious defect is detected; that initial visit can be challenging, but focusing on the period after surgery or catheterization can help them get through the rough patch. I find parents often realize, in retrospect, that the anticipation was worse than the reality.
What is something you wish more people knew about congenital heart disease?
I wish more people understood just how common congenital heart disease (CHD) actually is. When you learn your child is affected and hear “one in a hundred,” or “one percent of the population has congenital heart disease,” parents often fell terribly unlucky and alone. Actually, for a disease, that’s not really a small percentage. Parents and families should know that there is a huge community of people going through the same things they are, and we can put them in touch with parents who have been through the same thing.
Is there something you wish more pediatricians knew about cardiac disease?
The first thing that comes to mind is how rarely chest pain is related to a cardiac disease. We see hundreds of patients referred each year for chest pain and about one in a thousand have a cardiac reason for the pain. When a child says, “my heart hurts,” the instinct is to have the child evaluated by a cardiologist, when in reality, heart disease is near the bottom of the differential. At Boston Children’s, we have spent a great amount of time and effort in evaluating chest pain in children with the Standardized Clinical Assessment and Management Plan (SCAMP) and have found the data to be very reassuring. We have been sharing this data with our cardiology and primary care communities as well as families to further educate on the matter.
How do you help train residents and fellows?
I am primarily involved with the outpatient component of the Fellowship Training Program. I recently led an initiative to re-structure our outpatient clinics to improve educational opportunities and exposure to a range of diagnoses. Thus far, the changes have been well-received, though there is always room for further improvement. I also supervise fellows and residents while I attend on the inpatient ward. I find this to be a very fulfilling activity from a teaching perspective.
What kind of research are you involved in?
My most current research has focused on coarctation of the aorta and chest pain in children, which I mentioned earlier. Recently, in presentation of our quarterly outpatient morbidity and mortality conference, we discovered a bioprosthetic valve with the potential to fail in a previously unpredicted way in our young patients. The unusual manner of obstruction of the valve led us to track our other patients, and indeed we found a worrisome pattern of rapid and dangerous obstruction. Given the serious nature of our findings, we disseminated this information to the cardiology community at large as quickly as possible. We continue to follow the remaining patients who are at risk, and will publish an update on our findings in the near future.
What excites you about the future of pediatric cardiology?
In recent years, the movement to provide parents with easy, open access to their children’s medical records has really changed things for the better. It makes us much more of a team and gets parents more involved with their child’s care. Parents feel empowered and continue an open dialogue that extends beyond the clinic visit. I think this trend will continue to encourage a strong engagement between parents and providers that ultimately leads to a better experience for everyone.