Small Fish in a Big Pond

March 15, 2017 | Allen Ligon, MD
Career Development

Since 2010, the Centers for Disease Control have published data reporting there are currently more adults (>18 years old) than children living with congenital heart disease (CHD) in the U.S. This speaks to the emphasis that needs to be placed on CHD education for all cardiologists, especially trainees, as the number of these patients is expected to continue to grow.

I was fortunate to attend the ACC's Georgia Chapter's Annual Scientific Meeting in mid-November 2016. A month prior, an email surfaced from my program director about the fellow research abstract presentations. The list demonstrated an abundance of applicants, but none were pediatric fellows. Determined to provide some pediatric representation and CHD updates to this primarily adult cardiology event, I applied and was accepted for the presentation session.

At the start of the weekend, it was easy to feel in the minority as a pediatric FIT. I struck up a conversation with one of the product reps. Upon asking of my interests, which include pursuing interventional, his excitement grew as he was there promoting some new technology for coronary stents. His speech was well-delivered, although admittedly I did not understand most of it. However, his enthusiasm was quickly deflated by my curiosity about whether these had been tested in pediatric patients for ductal arteriosus or systemic-to-pulmonary artery shunt stenting. It was clear we were dealing with what felt like two different specialties of medicine the more we spoke.

I was one of eight FITs presenting data/research in the fellow presentation competition. It was quickly noted that I was the sole pediatric fellow doing so as the title of my research was slowly read when approaching the stage: Transcatheter Ductal Stenting Versus Surgical Systemic-to-Pulmonary Artery Shunts for Pulmonary Blood Flow in Ductal-Dependent Cyanotic Congenital Heart Disease. In knowing my audience ahead of time, I made it my mission to teach a crowd full of adult cardiologists something new and innovative about the field of pediatric cardiology that my research had investigated. The difficulties with conveying this data stemmed from the foreign lexicon and concepts of the pediatric field. After my presentation, I was encouraged by how many people sought me out to express that they enjoyed hearing the information and also the overall presence of the pediatric crowd at the event. The next day at the congenital session reviewing cases of misdiagnosed adult patients, the room was filled with people. Afterwards, many spoke of the educational value of the session and how it is beneficial to all cardiology specialists.

At this statewide meeting, there was a sense of unity among all levels of physicians. This meeting served as a collaboration ground where programs across the state came together for the weekend to just be cardiologists. There was no concern over where the patient referrals were going or who had the latest technology present in their catheterization suites. Instead, it was a fun weekend that highlighted the cardiology specialty as a whole. The conference placed an impressive amount of emphasis on the FITs and early career physicians. I saw the potential it held to not only come together as cardiologist but to also share aspects of our pediatric and adult fields that so often overlap. As a new crop of trainees and early career physicians begin to shape what the next generation of cardiologists will look like, understanding the importance of emphasizing CHD and its lifelong effects starts at grassroots meetings such as this one.

As the congenital heart disease population continues to grow and adult specialists encounter more patients with a history of repaired or palliated conditions, it is crucial that we continue to work together to provide the best care to our patients. I greatly appreciated the opportunity to educate what was largely an adult cardiology-trained crowd on a developing pediatric transcatheter procedure – which has, in many cases, supplanted what was traditionally performed as an open-heart surgery. It was an honor to play a role in the ACC weekend and feel as if a pediatric cardiology fellow was an integral fish in the big pond of our cardiology specialty.

This article was authored by Allen Ligon, MD, a Fellow in Training (FIT) in pediatric cardiology at Children's Healthcare of Atlanta - Emory University.