Balancing ACHD and Other Cardiology Specialties: Part 1 – The Journey

September 29, 2016 | Jennifer Gerardin, MD, FAAP

This is the first of a three-part interview with five adult congenital heart disease (ACHD) physicians at Emory University and Texas Children’s Hospital. This article asks why they pursued this career pathway and who influenced their decision.

Maan Jokhadar, MD, FACC, is an associate professor of internal medicine and the ACHD fellowship program director at Emory University.  Dr. Jokhadar is board certified in internal medicine, adult cardiology, advanced heart failure (HF)/transplantation, echocardiography and ACHD.

Wilson Lam, MD, FAAP, FACP, is an assistant professor of internal medicine and pediatrics and the associate program director of the internal medicine residency program at Baylor College of Medicine. He works at Texas Children's Hospital/Texas Adult Congenital Heart Center.  He is board certified in internal medicine, pediatrics, pediatric cardiology, adult cardiology, echocardiography and clinical cardiac electrophysiology (EP).

Anurag Sahu, MD, FACC is an assistant professor of internal medicine and the director of coronary care unit at Emory University., He is board certified in internal medicine, adult cardiology, echocardiography, nuclear cardiology, cardiac CT, ACHD and finished level III cardiac MRI.

Dhaval Parekh, MD, is now pursuing a fourth fellowship in adult cardiology at Texas Heart Institute. Prior to his current fellowship, he worked at Texas Children’s Hospital as a pediatric interventional cardiologist, ACHD physician. He is board certified in internal medicine, pediatrics and pediatric cardiology and completed additional fellowships in ACHD and pediatric interventional cardiology.  

Wendy M. Book, MD, FACC, is a professor of internal medicine and the director of the Emory Adult Congenital Heart Center. She is board certified in internal medicine, adult cardiology, ACHD and advanced HF/transplantation.

Jennifer Gerardin, MD, FAAP, is an ACHD fellow-in-training at Emory University, Atlanta GA.

What inspired you to pursue an ACHD subspecialty and an additional cardiology subspecialty?

MJ - Although I was always interested in CHD, I did not realize that this would be my career choice until my general cardiology fellowship on the adult congenital rotation. The mentorship of Wendy M. Book, MD, FACC, and Michael E. McConnell, MD, FACC, guided me toward this field. Also, ACHD is a complementary field to advanced HF/transplantation.

 WL - With advances in surgery and interventional procedures, the ACHD population is surviving longer and often developing rhythm issues and HF. From my first cardiology class in medical school, I’ve enjoyed the analytical approach to EKGs and vector loop analysis. In training, my interest expanded to visualizing the congenital anatomy and highways of conduction, particularly in arrhythmia. Understanding congenital anatomy is the first step to strategic approaches with medical management and interventional procedures.

AS- During general cardiology fellowship the field of complex structural imaging really appealed to me and I enjoyed the clinical management of patients with complex valvular/structural disease. I was fortunate in my third year of general fellowship to work with Ziyad Hijazi, MBBS, MPH, FACC, and Ra-id Abdulla, MD, FACC. This was my first exposure to ACHD as a true specialty, and they made the complex topic enjoyable.

What really inspired me was my time at Ohio State and working with Stephen C. Cook, MD, FACC. He is an expert in cardiac imaging and also has a true passion for ACHD. It was great working with him and seeing how he blended his training in advanced imaging and clinical training in ACHD. 

DP - I was interested in the entire continuum of medical care, developing lifelong patient relationships and making meaningful contributions to patients and their families. The complexity, seriousness, excitement and procedural nature of congenital cardiology allowed and steered me towards the field of interventional and structural ACHD. There are not many fields in medicine where one can round on a newborn with d-TGA in the NICU, perform a BAS and in the same day relieve an SVC baffle limb obstruction in a Mustard who was also born with d-TGA 40 years ago. It continues to be intellectually stimulating and inspiring.   

WB - Prior to starting medical school, I had a fascination with cardiology. I was particularly interested in pediatric cardiology, but not so interested in pediatrics. When I was in medical school at the State University of New York in Syracuse, a quarter of a century ago, doctors were not thinking in terms of CHD survivors in adulthood. Conventional wisdom held that this was primarily a "pediatric" disease. However, the group of pediatric cardiologists that I was working with very accurately predicted the future. There would be a rapidly growing population of adult survivors with congenital heart defects who would need subspecialty care. That group of pediatric cardiologists, Dr. Rae Ellen Kavey in particular, inspired me to pursue a career in caring for the adults with CHD.

During my internal medicine residency training at Indiana University in Indianapolis, I completed my work on the wards prior to 7 AM morning report, in order to allow me spend the morning in the pediatric cardiology clinic. My advisor Dr. Jackie O'Donnell was very supportive and encouraged me to pursue my interests in what was  a very unusual field, at that time. I continued to gain exposure to pediatric cardiology during my cardiovascular disease fellowship training by spending block rotations in the Children Healthcare of Atlanta and the Sibley Heart Center. When I completed my training, I expressed my interest in starting an ACHD center at Emory University. My primary background was in advanced HF and transplantation, and the job that I took at Emory was primarily with the HF and transplant group. They were very supportive of my desire to start an ACHD center.

What type of mentors have you had during your training? What influence did your mentors have on your current practice?

WL – A tremendous amount of what I do from a teaching and administrative standpoint comes from my mentors. Whether it’s encouragement to push the horizons and challenge the guidelines or review the literature or ask poignant research questions, so much of how we practice medicine comes from those who have shown us or supported us.

There has been no lack of mentors to help me grow and adapt to today’s ever-changing world of medicine. It truly takes an academic village! From an ACHD perspective, Wayne J. Franklin, MD, FACC, has been an incredible leader forging a program between institutions and networking ACHD care across the nation and internationally. The late Ali Massumi, MD, FACC, and many of his associates and trainees at the Texas Heart Institute have taught me the fundamentals of clinical EP. In the realm of medical education, Drs. Cynthia Peacock and Dick Hamill have shown me what it means to advocate for trainees to build a program for our patients and for the future. Though each is unique, they all share passion, principle, patience, availability, communication skills, flexibility and malleability, and vision. Those are the qualities we all should seek in our mentors.

AS - I have been very lucky in my medical career to be surrounded by great mentors at all stages of my training and even during my time as an attending at Emory. The common thread in all of them has been the understanding that we should all pursue something in our lives that serves a greater purpose.  

DP - I had excellent mentors during my training including James H. Moller, MD, FACC, at the University of Minnesota, Wayne J. Frankin, MD, FACC, (ACHD) and Frank Ing, MD, FACC, (Interventional) at Texas Children’s. Ultimately, you are constantly absorbing, internalizing and then evolving your professional outlook and patient care. 

WB - I have been very fortunate to have inspiring mentors throughout my career, starting in medical school. These mentors have helped me grow not only as a professional but also as a person and a leader. I'm particularly grateful to Andrew Lee Smith, MD, FACC, at Emory University who believed in my vision and provided the support and guidance needed to get our ACHD center off the ground.

MJ - I don’t think that I had a single mentor, but was fortunate to have been influenced by a large number of faculty, colleagues, and friends. I owe a debt of gratitude to many mentors and teachers including Wendy M. Book, MD, FACC; Michael E. McConnell, MD, FACC; Andrew Lee Smith, MD, FACC; Allen L. Dollar, MD, FACC; Stephen D. Clements Jr., MD, FACC; Douglas C. Morris, MD, FACC; Michael Shane Lloyd, MD, FACC; Vasilis C. Babaliaros, MD, FACC; and Rick Nishimura, MD, MACC. Also, the residents and fellows I trained with, including Pritish Tosh, MD; Monica Drefahl, MD; Rudy Morshed Haddad, MD, FACC; Byron R. Williams, III, MD, FACC; Jacob Green, MD; David Honeycutt, MD; and John Andrew Morrow Jr., MD, FACC, influenced much of what I do today. I continue to learn from many of them and from the residents and fellows that I work with every day.

This article was authored by Jennifer Gerardin, MD, FAAP, an ACHD Fellow in Training (FIT) at Emory University in Atlanta, GA.

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