5th Annual Adult Congenital Heart Symposium

Dr. C. Huie Lin is the Director of the Adult Congenital Heart Program at Houston Methodist Hospital. Dr. Lin earned his Ph.D. and M.D. from the University of Virginia. His residency was done at Beth Israel Deaconess Medical Center in Boston and he completed his fellowship work in Adult Congenital - Adult Interventional Cardiology at Washington University-Barnes-Jewish Hospital.  

Dr. C. Huie Lin specializes in the care of adults with congenital heart defects. He is certified in the care of adults with congenital heart defects -- which is a fairly new specialization. Dr. Lins’s research work is focused on surgical intervention in congenital heart disease and adult congenital heart disease programs. Along with medicine, Dr. Lin also helped to establish the Adult Congenital Heart Symposium, a regional Houston conference which is held every year. 

In this episode of Heart to Heart with Anna, Dr. Lin shares with Anna what to expect at the 5th Annual Adult Congenital Heart Symposium. He talks about why the symposium was created by him and Dr. Ari Cedars. He explained their goals with providing the community with an opportunity for doctors, parents, Heart Warriors and anyone else in their lives to all come together to learn about topics of interest to those living with congenital heart defects.

For the Houston Methodist  YouTube channel go here: https://www.youtube.com/channel/UCb8PGmJ6SILfyOvOWJvHZIg

Use this link for the playlist of last year’s Adult Congenital Heart symposium: https://www.youtube.com/playlist?list=PLZpDzANLjPtWXE2mv8oWSEMuEtteQhElH

To register for this year's Adult Congenital Heart Symposium, use this link: http://events.houstonmethodist.org/events/5th-annual-adult-congenital-heart-symposium/event-summary-da59d4fc2cf04f4cbb6d2828b55fb2d2.aspx

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Transcript

spk_0:   0:04
Well, this is a special episode of heart to

spk_1:   0:06
heart. With Anna. I am so excited. I'm actually at Houston Methodist Hospital here with Dr Q. E. Lynn and I want to welcome

spk_0:   0:14
you to

spk_1:   0:14
the heart to heart with Dani. Share today.

spk_2:   0:16
Thank you. It's a real pleasure and real honor to finally get here.

spk_1:   0:19
I never spent three years that I've been begging

spk_0:   0:21
you to come on the show. I just had to drive to Houston to make it happen. Thank you so much for coming. I'm so glad to have you here. Well, this is really exciting for May. I've been here before

spk_1:   0:32
for some of your fabulous conferences, and that's basically what we're going to talk about today. We have another conference coming up in a couple weeks.

spk_0:   0:41
That's right. Number. Yes.

spk_1:   0:43
And so let's start by having you tell us who some of the the great speakers are that you're flying in because I know you always have people from all over the country come to speak at your conference.

spk_2:   0:53
Yeah, that's great. So one of my favorite people in the world is Ari Cedars, and he's one of the Delta general hard physicians at UT Southwestern Now on Dhe. He and I sort of really came up with this concept to begin with of actually having this type of congenital heart symposium for adults. And as some of you may know, it's slightly different than many of the other meetings that we have in the Dell congenital heart disease. Because what we want to do is we want to really focus on educating people who may not otherwise be educated. So on one hand, what we're interested in is educating people like primary care physicians, nurse practitioners, nurses and primary cardiologists who may not have a very significant background, congenital heart disease. And at the same time, we're also interested in educating patients and their family members and loved ones and friends who also may not know a whole lot about congenital heart disease. And so that way we can actually dubbed till a lot of what we actually do so that we concerned both of those different communities and actually serve the content of our

spk_3:   1:50
community on the whole

spk_1:   1:51
right, and for me, as a parent of a child who is now an adult with a controlled A heart defect, something like this is so important. When Alex was first diagnosed, I thought, How am I supposed to understand all of this? My background is as a teacher of the death, and so we kind of assumed that the heart's okay and we focused on the ears. And when I first found out about my son's heart condition, they didn't really give him much of a chance to survive to adulthood. And so they didn't worry about teaching me too much about him becoming an adult. But there is so much to learn. And now that we have a larger and larger cohort of people who are surviving to adulthood, we're finding out that there are new problems, aren't we?

spk_2:   2:33
Yeah, absolutely. And I think that's probably the most fundamental problem to begin with is we've been playing catch up for many decades at this point, so your experiences just like the many experience of thousands, if not hundreds of thousands of patients out there, which is that doctors never knew exactly after they had their surgery, how long this kid is going to survive for, so they could never tell the families. Oh, you know, you're gonna have X kind of life expectancy. Or you can plan toe have a family or you can plan to get married. You can plan to have kids, et cetera. We never knew that back then. And so the problem is, now we're getting to the point where oh, my goodness. Well, we're actually finding out. Not only can you have a family, you can have grandkids,

spk_0:   3:14
too. I

spk_2:   3:15
mean, I have some patients who are reaching their eighties at this point. Wow. And so we're playing catch up with trying to take care of these patients and helping these patients take care of themselves and helping their families take care of them as well. And so, in a lot of ways, we think of this almost as a public health outreach type of program when we really want to reach out to not just patients, but their friends and their family members, and you know their physicians as well. So that way we can get everybody on board with the idea. Well, guess what? You're gonna live past her childhood. You're gonna live into your adulthood. And guess what? We need to continue taking care of you. And they're very specific things that we need to do to take care of you in the right way. And as part of this, of course we need to educate the physician is also we're gonna be taking care of them as

spk_1:   4:00
well. Yeah, I think that's a really serious issue that maybe has been overlooked for a long time. I know that when I took my son to the pediatrician, I actually had to change pediatricians of a couple of times because not all pediatricians are comfortable dealing with Children who are between open heart surgeries. That could be a really scary thing. But I was able to find a good physician who had had a child with a single ventricle heart. And he was fabulous until my son was about to, and I couldn't understand why he seemed to be getting more and more distant. And then I found out that none of his heart patients had lived past too. And I think he was afraid to get too close to my son for fear that he was just going to die as well. He was still really close to my older son, and I had known him for five years, but I had to switch physicians and find somebody who had more experience and who knew that these kids could make it. I think one of the things that's really interesting, though, is the second physician that I found. I knew that I had written a book and I gave him a copy of my book and he said, You know what? I consider you the expert. I want you to help guide me And at first I felt awkward. But now I think if I were in the same position, I would say, You

spk_0:   5:16
know what? There's this wonderful conference in Houston where you could get some continuing education on

spk_1:   5:23
working with patients with congenital heart disease, where the problems we have as parents is. When do we call? We don't want to be that hovering mother or hovering parent who calls every time your child has a runny nose. On the other hand, you don't want your kid to get R S V and end up in the hospital. Does this conference help with training of physicians to handle parents like us?

spk_2:   5:45
Wow. Well, that's interesting question, because I think we're trying to do specifically is take care of families and patients with war adults with congenital heart disease. So I'm not sure I don't really know how to answer. A question about our is very specific. Um, but I think you know, you bring up a really good point, which is that at the end of the day, what we can't expect is that we're gonna find physicians out in the community or anywhere, really, who don't specialize in Del Control heart disease coming out of the box and know exactly how to take care of adults with congenital heart disease. So that is where we feel our burden is to educate these physicians and these care providers to take care of adults with congenital heart disease because nobody's gonna know, right? I mean, the reality is we can't go around expecting a family care provider or a Nobbs attrition or orthopedists to know how to take care of adults with congenital heart disease. Right? Just doesn't exist. So at the end of day, it is our job as a community of adult virginal heart providers to go out and trying to educate people to understand the basics, to understand the things that they need to know

spk_3:   6:50
about taking care of adults with congenital heart disease

spk_2:   6:53
and so eventually be able to answer some of these questions about Well, you know, if I do have the sniffles or you have a cold or I do have the flu, what do I do? Or should I get the flu shot this year? The

spk_0:   7:02
answer is almost always, yes, So parents do, Yes. Anybody living in the house with that person, everybody around them is right, Right.

spk_2:   7:11
That's right. So So that's what we're hoping. We're hoping that will just be one of the programs. They're gonna be doing this, that in the future, that there will be many, many programs who are doing this as well, because this is really the mission of adult congenital heart disease doctors.

spk_1:   7:28
So will you be recording your sessions and make them available online?

spk_2:   7:31
Absolutely. And actually, we've been doing that every year for the last five years or sorry, last four years. This will be our 5th 1 on DSO, actually, today if you want to go and you want to find some of these programs that we've done in the past, you can actually get on our YouTube site and actually find our programs. Um and so you'll see on those on that site. We have not only the patient family programs is balls, the physician programs, and I find both of them very, very effective. Very powerful for everybody. Irrespective what your health care provider or a patient or family member.

spk_1:   8:04
Right? Last year I got a chance to sneak into the professional one for a little bit, and Dr Amy Bought was presenting. She is amazing. Is she coming back again? Dish.

spk_2:   8:14
No, I think she's already committed to some other things this year. So it's hard, right? Because I think three at the other day, adult congenital heart disease doctors are committed to so many different things

spk_0:   8:24
right now, but you always

spk_1:   8:25
manage to get great people. Dr. Ari Cedars has been on my program before, and he's really good about helping to educate people. Who else do you have coming as a speaker?

spk_2:   8:34
Yeah, So I'm really excited that that we're gonna be inviting a number of different speakers from this territory. So one of things that we're starting to move towards is trying to identify other adult congenital heart disease providers in Texas and their neighboring states like Louisiana on other places in the region. So that way we can start to work together. So one of the secrets that we do is that we have a faculty meeting the day before the symposium, and one of things that we do at this faculty meeting is we actually deep dive into the things that work and don't work with taking care of adults with congenital heart disease so typically had a scientific meeting. Right. Everybody presents their success stories, and everybody presents their research findings. I think it's a little bit harder tohave an environment where people are gonna be candid and honest about areas where things didn't work for their program. I think that's not to say that doesn't happen. But we wanted to create environment where a small group of a C H G physicians and health care providers could get together and actually be very candid about where do things succeed. Word of things not succeed and share their stories and shared their experience that we can all learn from each other. And then, as you know, one of things that we're working towards doing is beginning to create a consortium of research programs because I think the most important thing that we can do for the community in general. It's to start to bring together our experience on dhe. Share our strength. Andi. I think our strength is best when it's actually combined together.

spk_1:   10:09
Absolutely. And one of the things I love about Texas is that we're one of the leaders, especially this

spk_0:   10:16
hospital is really.

spk_1:   10:19
I mean, we're just so lucky we have this great medical center here, but we also have a fabulous medical center in San Antonio and Dallas.

spk_0:   10:26
Me really

spk_1:   10:26
are. State boasts a lot of fabulous medical centers. We all need to be working together because there's power in numbers and congenital heart disease is the number one birth defect. But a lot of people don't know that, and a lot of people don't realize the numbers that we do have out there. I just went to a podcast conference, and so I was talking to people about what their podcast was about, and they were telling me about They were asking me about my podcasts and I met several people who were touched by congenital heart disease. So I ended up getting my portable recorder and doing some on the spot interviews with people who have been touched by congenital heart disease because you just never know where you're going to meet them. And all of these people were adults who had been touched. So I think that you working with the other physicians, that's what's going to be more powerful for the future of our adults with congenital heart disease. So in the last 10 years, I don't even think it's been 10 years. There's the new accreditation for doctors to be specialized in the care of adults with congenital heart disease. How

spk_0:   11:34
many

spk_1:   11:34
of those doctors are here in Texas? Do you know?

spk_2:   11:37
Wow. Actually, I think that's a rapidly shifting number. Yeah, it's actually it's really great because I think there was a time when I think there was less than a handful of us during the first year or during accreditation. But I think now what? I think the number of skyrocketing pretty quickly. So I think we're very fortunate, especially here in the medical center where we have all this different expertise, not only here but at Texas Children's, where they have a phenomenal program as well as that university, Texas,

spk_3:   12:02
where they have also a really fantastic program as well.

spk_2:   12:05
So I think we're very lucky that were very rich in adult control, heart disease providers. And I think that that's again, why it's incumbent upon us as a group to make sure that we helped to educate everyone around us on drily make the lives of our patients and their families better.

spk_0:   12:22
Can you give us an

spk_1:   12:23
idea of some of the topics that will be discussed at the symposium this year?

spk_2:   12:27
Yeah. So Dr Cedars came up with a really great idea. I think most of time people like to hear and learn from specific stories. And so what Dr Cedars came up with was instead of actually having didactic format where we go through lectures on specific congenital heart lesions for the providers were actually going to do is we're gonna focus on three different specific topics and three different specific patient stories. And so what we're going to do is we're going to start with the beginning of the patient story From the beginning of when they presented Andan were actually talk about all the things that happen to the patients. So the imaging that they had done so the echo the CT scan, the M R I. Then move on to the catheterization with those catherization results meant and then move on to whatever the intervention might have been, whether it's surgery, cath intervention or electrophysiology, ablation and et cetera. And we're hoping if we can actually do that, we're gonna actually really help, too. Allow both patients and families as well as health care providers, look into a day in the life of the average adult content heart physician, and understand a little bit more about what actually happens and hopefully have them beam or integrated on how this carrot takes place.

spk_1:   13:38
One thing that I've learned on the show and I've recorded now 240 shows. So I've spoken to a lot of patients and a lot of doctors, but mostly a lot of heart warriors. I'm amazed at how similar the stories are, and I imagine that you doctors air seeing the same kind of cases present or the same kind of symptoms present. My son has a single ventricle heart, and so right now one of the hot topics is liver concerns and other organ concerns as they age, which we didn't know about 30 years ago. So do you think that these the concept that Dr Cedars came up with is to help the physicians to see what a potential I hate to say textbook, because these

spk_0:   14:23
people are textbook,

spk_1:   14:24
but a typical, um, presentation might be for a new patient.

spk_2:   14:29
Yeah, that's exactly right. So we're hoping that if we can take some common findings that we often see in these patients and common issues now we see in these patients that we can sort of help people recognize and understand a little better about the patient that's going to be walking into their office. We're coming into the practice. We're coming there emergency room, for example, on be better, better prepared to deal with some of the issues

spk_3:   14:52
that we're gonna be seen.

spk_0:   14:53
So one

spk_1:   14:54
of the biggest issues that we have dealt with over the last Forever, probably, but definitely over the last 20 years or so is that we'll have patients whose parents are very aggressive at making sure that the Children attend all of their doctor's appointments and they have all their scheduled surgeries. And then the kids grow up, become adults, and they think they're cured So

spk_0:   15:15
what are you

spk_1:   15:16
doctors doing to help future patients know that this is a lifelong condition that requires lifelong education?

spk_2:   15:23
Yeah, that's actually really great point. I think that's where I think you and I had a conversation, that this would be very important for us to have a conversation about two day, which is that we want to invite not just adults with congenital heart disease and their families. But we really want to bring in kids and their families. So we want to bring in parents and their families and loved ones because this is the future, right? So in a lot of ways we learn from patients and their families as well. That's one of the most important things. And that's one of the most important reasons why this is a combined program where we have both healthcare providers as well as patients and their families, because we can learn from each other tremendously about way. But more importantly, I think we want to start to break this cycle way. We wanted to start to break the cycle where nobody knew what to tell the kid when they were growing up. Nobody knew what to tell the parents when they were growing up. And so therefore, everybody's surprised when the kid grows up and becomes an adult that's healthy and having a family and, you know, working a regular life, right? So what we want to do is we want to get everybody prepared. So that way they know how to have the best quality of life in their adulthood. And we want to make sure that they have the right kind of care, whether its primary care, obstetrics care, gynecologic care or cardiology care. Right. And so I think the best way to do that is to get everybody to come together to this type of environment where they can learn some of these basic issues that we're dealing with. And then also we want to really empower people. So the afternoon session is going to be focusing on some very important subjects that again people tend to shy away from talking about All right, so one of the things that we think is most important is learning how to communicate with your health care team.

spk_0:   17:06
Good. So you're

spk_1:   17:07
going to be advocates for themselves?

spk_2:   17:09
Exactly. So you walk into a new doctor's office right and now you need to tell them While I had ex Procedural when I was a new born, then I had my second surgery when I was several months. And then I had my third surgery when I was two or three years old. You know, those are the things that we want to be able to help people, to communicate with, not only to their doctor, but also more importantly, Sometimes they're anesthesiologist surgery.

spk_1:   17:32
Yes, yes, I'm seeing more and more people who or having non cardiac surgeries, and they're having problems with the anesthesia, and that's something that's really concerning. Now. If you're lucky enough to live in Texas in near Houston or Dallas or one of the big cities or Boston or Philadelphia, then you might be lucky enough to get an anesthesiologist who specializes in the care of those with congenital heart disease. But most of the time, people don't. So what kind of advice would you have for somebody like that?

spk_2:   18:04
Yeah, that's a perfect question. And so I think that's in many ways, a $1,000,000 question. But I think from my standpoint or our team, when we talk to our patients, it's so important that we actually arm them with a mystical A stack of paperwork, right? We want to give them their operative report. We want to give them their pacemaker implantation information. We want to give them their last catheterization report. They're echocardiogram, their card, a camera, I et cetera. And we ask each one of them to start a binder, right? And actually keep all of that for themselves. Now, we're fortunate we actually have an electronic medical record, that they can actually download all this data onto their phones, which is great. But I think that the other day, sometimes because electronics is electronics, it's still better to make sure you have two copies, right, One paper copy in one electronic copy. And then So that's the beginning of the advice, right? I think you know, you need to arm yourself with that information so that when you walk into your next doctor's office, you can give them time. Afterwards. They could make a copy of that paperwork, and they can actually sit there, and we're is through it and try to digest it because it's not easy,

spk_1:   19:08
and especially when you have patients like my son who have had three open heart surgeries, and he's actually one of the easier cases.

spk_0:   19:15
There are some people who

spk_1:   19:16
have 10 20 procedures. I don't know how they keep up with it all. It's a lot to keep up with. I do have a binder with all of my son's surgical notes because those surgical notes are golden exactly. And sometimes it's hard to get them exact and costly it either time wise or many wise. Okay, so one of the things that I really enjoy doing at your conference is going to see some of the different vendors and actually let us see the devices. Will you have people like that here this time again?

spk_2:   19:46
Absolutely. So we were really motivated by the fact that we as an institution, really love doing medical education. And we have the center called Mighty, where we actually focus on doing simulation and innovative training. Okay, And so what we typically do is we bring health care providers and physicians actually learn hands on how to do techniques, and we use all kinds of different simulators and models actually teach them. They can actually practice that many, many times before they actually do the procedure on a patient

spk_0:   20:16
makes a lot of sense.

spk_2:   20:17
It could be already have the skills down before they go. So we thought, huh? What if we were to take the average health care provider who actually doesn't do cardiology procedures? And we were to take patients in their family members and bring them to mighty and actually show them, or even let them play with these devices so that they can actually learn how it actually works? So, for example, you know, one of my favorite example is actually showing a trance catheter valve.

spk_1:   20:44
Yes, that was fun. I got to see that last

spk_0:   20:46
year. So I mean, this is

spk_2:   20:48
remarkable, right? I think you know, we, as physicians often take for granted what trains get well, technology is, But it has completely changed the way we can actually look a congenital heart patients at this point in time. So for those of you who don't know, trance, captain valve technology basically allows us to actually implant a new valve. The a small incision in one of the arteries, veins of the body, as opposed to requiring another open heart surgery.

spk_1:   21:10
Right? Right. So that's the interventional cardiology. Quicker time to heal, usually less chance tohave an infection for complications exact. So this is really an awesome

spk_2:   21:23
opportunity, rideable opportunity. And so one of the things that we love about this is we want to be able to actually bring positions of other specialties war, primary care as well as patients, family members and actually show them what this actually means and how it's actually done. Because what we do want to do is we want to take away sort of the myths of Oh, it's easy, It's simple. It's 15 minutes and it's done because that's not what it is, either. And so when we show them how it actually works, I think people will start to really make more concrete in their minds how this actually works on Dhe. So what we're going to do this time around is because we're actually gonna be talking about three specific different lesions on and actually talking about specific cases. What we want to do is we're gonna actually take specific devices that are applicable to those those lesions and so that we have a context of a story in which action learning about these devices, and it makes so much more sense.

spk_1:   22:16
Okay, well, we have a chance to see an l. Bad.

spk_2:   22:18
Yes, absolutely many different types of Albats. Hopefully,

spk_0:   22:21
Okay, that had that. Technology itself has come a long way in the last

spk_1:   22:27
decade, hasn't it?

spk_2:   22:28
Absolutely. So, for those of you who don't know what we're talking about, we're talking about a ventricular assist devices. And so what that basically means is a pump that will sit inside the body to actually help the heart pump on DSO. There are all kinds of different shapes and sizes and concepts for introduces device, but basically, they all share the same concept that you really want to help reduce the work that the heart has to do. So in other words, the ventricular assistance. And so they come in types, word surgeon, implants it directly in the chest, and they come in types where somebody like myself in interventional cardiology will put it in from the small incision in an artery or vein.

spk_0:   23:06
Really? You could do

spk_1:   23:07
an l VAD in an artery or vein.

spk_2:   23:09
Yeah, it's a temporary ventricular assist device, but yeah.

spk_1:   23:12
Oh, my goodness. Okay, because I know about the Berlin hard, and I know about some of the other kind, but I thought they had to wear a backpack or something to carry it with them. I didn't think it was something that actually went inside of their body.

spk_2:   23:25
Yeah, it's pretty fantastic. So I think the reason why this has been such a great boon for us in the community is that we can basically go from a patient on the table to having a vitriol assist device in within about 15 minutes from now. It's not durable, so in other words, you can't leave the hospital with it. But if somebody's in really big trouble in their heart is failing quickly. This is something we can do to save them temporarily while we get everything else ready. So we get the surgical team ready and set etcetera for if they need to go on to have a permanent ventricle assist device implanted.

spk_0:   24:01
So how many

spk_1:   24:02
times does somebody go from having an l've add to transplant? Because that is usually the bridge, right?

spk_2:   24:08
Yeah, that's right. So this is actually really interesting field. And to be perfectly honest, this is not my area of expertise. I'm gonna have to defer to some more Hartfield transplant team members. But I think what we're finding has been really fantastic. Yeah, as unfortunately Don't often talk about is that they're just not that many hearts to give for transplant. And so that becomes one of the major rate limiting factors. So victory to assist devices have come to become a bridge to transplant. So you can have a patient on a ventricular assist device to allow them to continue actually have pretty good quality of life while they're winning for transplant. Well, fast forward a little bit, and it turns out, actually, that a lot of patients are actually doing pretty well on the ventricle assist devices alone. And so it's now evolved into something called destination therapy, which means that you can just live with the ventricle assist device and have a good quality of life. And we just take one day at a time and see how that goes and enjoy that quality of life. And, you know, as we like to talk about when we start talking about thinking about advanced care planning, we like to think about what our Michael's you know what, why, what what are the important parts of what I define his quality of life on dhe when we can actually define those advance. Sometimes these patients who have a destination therapy introduces device that can achieve those goals on dhe. Then we don't need to want to transplant necessarily for some of those patients.

spk_1:   25:34
Well, it's interesting that you say that because one of the people that I met at the Park House conference had a relative who was living within within l've ad and had been for, I think, he said six years. And unfortunately, he was not a transplant candidate any longer. But he was still having a quality life and in fact, was getting ready to take a trip to see his mother. And I was really excited to hear that somebody could live that long on an L that I didn't know that it was designed for a long term placement and, you know, possible substitution for what your heart really

spk_0:   26:10
is supposed to do. I mean, I just think that's amazing that there's a

spk_1:   26:13
little device. While I shouldn't say little because it's actually kind of big, but that there's a device that can help you so that you can walk your kids to school or dance at your daughter's waiting or, you know, do some of those things that would be quality of life issues that maybe you couldn't have done 50 years ago.

spk_2:   26:31
Absolutely, absolutely. I think it's a great area that's expanding very rapidly, and the technology is improving. Remarkably, I think it's just really exciting area to watch. Andi Thinkit's really brought a lot of hope to a lot of patients that part to this, really, we're just waiting for transplant. There were no other options, so I think it's a very

spk_1:   26:50
that can really be a hopeless feeling.

spk_0:   26:52
That's one of the

spk_1:   26:53
things I like about your conference is that we get a chance to go to the different vendors and the vendors can tell us what their devices do, how people can get them. And I think that for the common person, you don't get a chance to ever see something like that. So I appreciate the fact that you make that available to everybody that that comes okay, talk to us about how expensive it is to attend your conference

spk_2:   27:18
well, so it actually turns out that we just have everybody pay a very small fee so that we will help subsidize were actually really just parking. Because one of the things that you know, as you can imagine, we actually get a lot of support from all these different educational grants to the Debate to Bake Education Foundation. And in part, the program is subsidized by the Day Baking Education Foundation. So we're very fortunate that we have that kind of support. And, of course, the other part of it is that all of our speakers donate their time. Wow, that's a pretty fantastic element. So, Dr Cedars and the rest of team, they all donate their time. So we're very fortunate from that standpoint, but yeah, so really, if he is pretty nominal, I think last year was $5. I think I think it's gonna be the same this year as well. Um, and another that registration is pretty, Loki.

spk_1:   28:11
So how can I register for the conference?

spk_2:   28:13
Yeah. So we have a web link right now. You can go ahead and get on that. Um, hopefully we'll be able to supply that you directly to a podcast.

spk_1:   28:20
Yes, and it'll be in the show notes, so don't worry.

spk_0:   28:23
Clicks right into show notes and go straight to it. And actually,

spk_1:   28:27
if you go to our genetic low dot org's, I have the little video that you made to promote the conference. And right below that is the link to register for the conference. So it should be fabulous about how many people do you expect to attend the conference this year?

spk_0:   28:42
Yeah, I think it.

spk_2:   28:43
In the past, we get anywhere between 202 150 people, so it's fine now. That

spk_1:   28:48
is really well attended. Okay, I want to get personal for a moment. I know to become a doctor, it takes a lot of time in education. But

spk_0:   28:57
to become a specialist like you,

spk_1:   28:59
it takes even more. What made you interested in working with adults with congenital heart disease?

spk_2:   29:05
Yeah. You know, it's funny. I always wanted to cardiology part. That's because my father had a heart attack when I was in college. So had a huge impact on me. And in fact, actually, early on before I went to college, I thought I wanted to be an attorney. I wanted to be a prosecuting attorney. I want to be one of the good guys. Um, but you know, when this happened, this complete change my life on dso I had started started thinking about medicine. But when this happened, I definitely solidified my plans that I wanted to go into cardiology. Um, And then when I got to cardiology fellowship, my very first experience with the congenital heart patient was I was in the I c u. I was doing a trans esophageal echo a t on a patient who actually had suddenly arrested while playing softball. And he's a 20 something year old gentleman, and I thought, Oh my gosh, what happens to 20 something year old people that they have a cardiac arrest on dhe. Then when I did the transit echo, I didn't understand it hard at all because everything was criss crossed in my mind. And I thought,

spk_0:   30:05
How does this work? How is

spk_2:   30:06
this even possible? And the

spk_0:   30:08
truth of

spk_2:   30:08
the matter is, I just hadn't action learned a lot about country heart disease prior to this, and I had to open a text books and learn everything that I could. And then, as I learned Maur, I found it to be really fascinating by the way that patient did fantastic on. Dhe left the hospital just a few days later, which was incredible to me. And so that really inspired me that there's this population of patients whose reaching adulthood and actually doing really well, despite all the things that happen to them. Um, and they need specialized care. And as I was going along, learning more about this I was taken under the wing of my mentor, David Ball, sir, who is a pediatric and eventual cardiologists, that seamless troll in this hospital. And I started going in watching him two cases in the pediatric Cath lab. And then after that, he let me start to scrub in, and I started going there once a week. And then once we became every day. And then I end up dedicating a full year to doing pediatric and a veteran cardiology in addition to my other adult cardiology and Vulcan general training. And so

spk_0:   31:08
there's a huge difference

spk_1:   31:10
between paediatrics. Okay, so is that why you decided to stick with just working with adults?

spk_2:   31:18
Yes. So, at the end of the day, as you probably know, trance catheter inventions in adults with congenital heart disease are primarily done right now. Still in Children's hospitals by pediatric interventional cardiologists, because the techniques and the methods that are required to actually do these interventions in the intervention of themselves are still very typical to pee Asher and eventual cardiology armamentarium. And so it's a little bit different from what typically we learned in adult interventional cardiology training. There are similarities, but it's not quite the same. So if one if an individual like myself wants to learn how to do interventional cardiology in adults with cancer heart disease, the best place to learn, at least back then and probably continues now is in a pediatric cath lamb with the really great interventionist like David Balls room. Um, and so he saw my interest in adult congenital heart disease, and he recognized he had this vision that, you know, in the future we're gonna have a lot of adults with heart disease, and we're gonna have a lot of patients who need interventions, trance, Katherine inventions and trance catheter valve in plantations that at the end of day we're going to need people who can actually do adult in general, an interventional cardiology, and said that's why he was interested in training me specifically was feeling. That's why he took me under his wing. And so that's how I really got into this sub sub specialty

spk_3:   32:43
of delicate

spk_1:   32:44
I know. And that's the thing. How many years does it take

spk_0:   32:47
you to get through that kind of

spk_2:   32:51
Yeah. So, um so I did four years of college. I did both an MD and a PhD, so that actually took me a long time on Dhe. Then I did three years of internal medicine residency, and then I did three years of adult cardiology and Duncan General Fellowship. And then I did one year of adult interventional cardiology in one year of pediatric interventional cardiology. So by the time I finished, I was P D Y eight s o postgraduate year eight. So eight years, post medical school training.

spk_1:   33:19
Wow, that is amazing. And you still love what you do.

spk_2:   33:23
I d'oh, I do. I love every day that I come to work. I love thinking about it even when I'm not at work. And But you know what? Honestly. And I think you know the reality is the intellectual part of it is really great in satisfaction that I get from doing a great job and doing right hard case is great, but I think I feel a day being clinic with my patients and seeing them and actually even seeing them outside of clinic at the symposium. Other things. That's the part that's really inspiring to me. That's the thing that I direction really fall in love with ever since I started practice. You know, I love being in the cath lab and I love doing these great cases. But at the other day, I love even more actually interacting with my patients and seeing them do well. I love seeing a patient from, you know, they have an issue. We take care of it and then we see him afterwards after they recovered and they're just things were so much better. I love the You will see that happen.

spk_1:   34:18
Oh, yeah, it's gotta be great to see people when they're up and moving around and not in pain leading at heart

spk_0:   34:24
pillow. Just thio. Just walk

spk_1:   34:28
down the hall or anything like that. So, yeah, you guys do some amazing work. I think what's been interesting is over the last 25 years, I've been watching in eventual cardiology kind of come into the spotlight, and from

spk_0:   34:41
what I understand that was commonly done it much more. And then it

spk_1:   34:47
kind of went out of oak for awhile and open heart open, open heart kind of just really stole the spotlight from you guys. And then they realized

spk_0:   34:56
their eventual

spk_1:   34:56
cardiology. Fewer infectious, faster recovery tie. But, hey, wait a minute. Maybe we should get back in there. Plus what has the three D printer done to help you all?

spk_2:   35:06
That's a great question. I think there's a lot of really cool technology that's coming about. I think one of the funny things about the way to catheterization is for those who you don't know when we actually work in the cath lab. It's in a two dimensional X ray system, right? So basically we take the entire heart, and with X ray it turns into a two dimensional screen image, right? And so what we lose with that is we lose the three dimensional aspect and the heart is very complicated, especially a heart that's been repaired in the past, where palley it in the past and so now we're finding is that we have all these great technologies from all different areas outside of cardiology outside of medicine that we can now import into our arena. So, for example, like you mentioned three d printing. So now what we can do, and we and folks a T c H Folks at UT have also done this, too, because it's just a great technology. You can actually do a CT scan on a patient, and you can actually print their heart out of three D material. And then, if you want to actually try an intervention before you do it in the patient, you could actually do it in this three d printed model and see what happens to it. So we've done this, actually, one of my colleagues here, Steve Little Dr Steven Little Eyes actually doing this specifically looking at valvular interventions, and he's learning how he can actually recreate the textures of the valves. So you better simulate what that invention is going to do and deform the tissues and how it's going to change it. You haven't even better simulation what's going to happen.

spk_1:   36:36
So what material do they use that? Because I know with the three D printing, you can use a variety of material

spk_2:   36:41
that's right, and I think a lot of that very much depends on what your application is. So, for example, if you want to have a crystal clear so you can actually see what's happening inside, that's a completely different material from the very soft material. And there are very wide spectrum of softness of materials. We can mimic different types of tissue, and that's where that's where. Really, the money is at the end of day is trying to mimic the tissue that you're actually simulate. So so you're gonna have the very, very hard, almost hard plastic material to the very soft, almost like a Venus or vain tissue town material.

spk_1:   37:13
Wow. So are you excited about what you're seeing with science and technology and where it might lead you in

spk_2:   37:20
the future? I am. In fact, actually, it's funny because when I was a kid, I loved playing video games, and video game technology is fantastic to this. At this point, you have all these virtual reality techniques. You have these really high resolution, fast puting type of technologies that now we're beginning to be a little lying to healthcare. So, for example, there are people who are using virtual reality to sort of take that same three D model from a CT scan. So you gonna walk through the heart and actually understand how everything is related before you actually do anything to the heart. Wow, Very cool.

spk_1:   37:54
That is really cool. And plus, it would give you a chance to make a mistake without killing somebody,

spk_0:   37:59
which is a good thing, right? And

spk_2:   38:01
to better understand the relationships, right, Because the thing at the end of day is like I said in the cath lab flattens the entire hard right, whereas if you can actually walk around inside the heart or use other technologies like the technology I typically use because it's sitting on my desk is a technology called Eco Picks on and Echo Pixel is basically if you imagine having a three D TV like many people actually have three D TV is at home. But instead of actually looking at TV, you're actually looking at a heart, and then when it allows you to do is actualize. You do exactly the same thing as a virtual reality, which is it allows you to dive through the heart and walk through the heart and see the different chambers of heart. So, for example, if I'm looking at a specific defect, So, for example, eventually septal defect that is risen from a previous patch that was put in and started fall apart 50 years down line. Because that's what success looks like, right? I mean, if you have a patient was operated in their twenties and they're now 70 years of age, things happen right on DSO, for example, in this particular situation, we were actually able to look inside his heart through this three D TV, And it stands out to you because it's like a three D TV and you can actually stereoscopic look at the actual defect that's arisen and how it relates to the different structures in the heart in three dimensions. Which is the Kim that we don't necessarily get when we're actually just looking at regular X ray. That helps us the better plan, how we're actually going to approach this and what kind of the devices we can actually put in there to plug that hole.

spk_1:   39:27
What about robotic arms and Da Vinci? And some of these other robotic techniques that we're hearing about that was commonly being

spk_0:   39:38
glad you're asking you about this because this is something

spk_2:   39:40
that we're really, really excited about. So So we has an institution, especially the heart basket center. Here are very, very interested in how we can actually start to take advantage of robotics, especially robotics. That has really advanced now in the 21st century. So so I specifically have research project in collaboration with our colleagues at Siemens, where we're actually learning how to use a robot to manipulate an intra Kartik echocardiography catheter. So Inter Kartik Echo, which is also called ice. You may have heard that before is basically being will do echo from within the heart. So you're really great pictures, really high resolution pictures because there's nothing in the way or your

spk_1:   40:17
lower. No, I've never heard of this before.

spk_0:   40:20
You can do an echo inside the heart. Yes, how do you do that? How do you introduce it? Yeah,

spk_2:   40:26
so it's pretty cool. So it's about two and 1/2 to 3 millimeters in diameter. So it's a catheter, right? And it has an ultrasound tip on it, just like any other echo. But it's been miniaturized, was about three millimeters in diameter and Then we introduce it through the vein of the leg on Bennett sits inside the heart and because weaken, turn it around and weaken. Tilt it forward backwards, right, Left, et cetera. We can actually look at all the different chambers of the heart. And so what's really cool now is that we're working on a robot that will actually do all this for us. So if we could teach the robot had actually acquire these images, that robot can actually move the catheter for us, and then we can actually tell the rot. Well, actually, I want to see this instead, or I'm going to see that instead. And, of course, because it sits inside the heart, things were moving all the time. Right? So what we're gonna do is we're gonna teach the robot. Well, these are the boundaries of the heart. And we don't want you to touch the batteries of the heart. So we want you to create the safety boundary so that you can make this a safe. It's possible.

spk_0:   41:24
Okay, So if you can

spk_1:   41:25
do that, what about appellations?

spk_2:   41:28
That's a great question. So robotic ablation is actually even further. So so some of My colleagues here in electrophysiology have been actually doing robotic abrasions for quite some time. It's great for them because they can just sit down and share and just actually work with a joystick.

spk_0:   41:43
Yeah, this is that video game training that you were talking about. That's right. That's right. That's fantastic, right?

spk_2:   41:49
I mean, it's so successful and, you know, just really gives you. I think in a lot of ways, I think that they think that it gives them a little bit better control. But really, you know, you don't to stand on your feet anymore. And one of things that's really enabled is the three D technology. Right? So no longer did they necessarily need that X ray. They can create Ah, shell of the heart in the computer that allows them to actually work using the robot so they can actually know where they are in three dimensions.

spk_1:   42:17
Will you be showing us some of those techniques?

spk_0:   42:20
Absolutely. Yeah. We're gonna Everybody has to come. You have to come to the conference this year. This is gonna be amazing. Yeah,

spk_2:   42:27
we're very excited, I think you know, as a CZ. I mentioned the heart ambassador center is very interested in how robotics can make things safer and more efficient in the care of heart disease.

spk_1:   42:37
Okay, so who should attend this conference?

spk_0:   42:40
I think, honestly, everybody, I d'oh, if you're curious at all about the human

spk_1:   42:45
body, you should be here.

spk_0:   42:46
Yeah, absolutely. But I mean, I

spk_2:   42:47
think there's truth to that, right, because I think you mentioned something really important early on, which is that everyone knows somebody with congenital heart to see right? So I think if you think about 1% of population being affected or 1% of the old lifeboats being affected, that means that if you ask anybody in any given room, they know somebody. They may not know that they know somebody, but they definitely know somebody who has a heart defect and may have even had surgery to have a repair or multiple sort of never repaired. And so I think in a lot of ways, there's truth to that that I think this can be important for almost every single person because I think that almost every single person is could potentially be that person that makes a difference in somebody who has a heart defects life whether it's encouraging them to come back to see a cardiologists for their care, whether it's encouraging them, get with the primary care physician, whether it's to just make sure that they get in touch. You know, I think everybody can potentially make a huge difference in one of those hardware's lives.

spk_1:   43:50
Well, I couldn't agree more. I think that there's so much to learn here, and you just never know until you start talking to people. I just got new windows on my house and I was talking to the salesman and I told him I had a podcast and he said, Well, what's your podcast about? And when I told him, he said, Oh my gosh, I had a bicuspid aortic valve and I didn't find out until I was in my forties. He told me he had been playing baseball and soccer and all kinds of sports, and all of a sudden it was hard to walk across the parking lot. And so I, Fred that up to 3% or 3 to 5% of the population can actually have a bicuspid aortic valve. So, really, if a bicuspid aortic valve is a congenital heart defect, which we know it is. Then it affects the great deal. More than 1% of the population

spk_0:   44:37
we're looking

spk_1:   44:37
at. Probably more like four or 5% aren't

spk_2:   44:41
you? That's right. Absolutely.

spk_1:   44:43
Now, do you do any kind of training during the symposium like CPR training? Is that something that you might look at doing in the future?

spk_2:   44:51
Yeah. So that's one of our favorite things is I think we want armed people with as many skills before they leave is possible. And so one of our favorite things is to actually have a team of volunteers coming teaches CPR. One of the other things that we really love having is just providing care. So we're actually gonna have volunteers coming to do health care screening. So they're gonna do blood Pressure's at center. And, you know, maybe somebody will walk away with a little bit more information on DDE in action item that when they go home that they do need to see a physician or they do You need to say their local care provider for something specific. So So we're really hoping that we can give it people as much value as much information as possible. and really send them out with being another one of our ambassadors that they will help us to make sure they pass on this information that they pat pay it for this thes skills that

spk_3:   45:42
were hopefully giving them

spk_1:   45:44
absolutely well. Tell us the name of the conference in the hospital because there are so many

spk_0:   45:50
hospitals used area. Where do people need thio And what date? Yes, so it's

spk_2:   45:55
October 12th and that's actually the fifth annual adult congenital heart symbolism here at Houston Methodist. But even though it's here, we're actually bringing all of our friends from our neighboring programs. That's where we get our strength from is that we team up with all the programs around the area to teach the important things that we're gonna be doing there. So

spk_0:   46:14
well, thank you so much for coming on the show finally, and for

spk_1:   46:18
letting me come to Houston, this beautiful studio. For those of you who are actually seen this, we're in this wonderful studio, and we're having a great time. But we're going to have an even better time on October 12th. I hope everyone will be here.

spk_2:   46:31
Absolute. Thanks, Anna. Thanks.

spk_4:   46:35
We have