Author + information
- Pradeep K. Yadav, MD∗ (, )
- Sharif A. Halim, MD, MHS and
- John P. Vavalle, MD, MHS
- ↵∗Division of Cardiology, University of North Carolina School of Medicine, 6th Floor, Burnett-Womack Building, 160 Dental Circle CB#7075, Chapel Hill, North Carolina 27599-7075
We thank Dr. Daniels and colleagues for reading our paper (1) with interest and highlighting several important points in their letter to the editor. We completely agree that structural heart disease (SHD) and congenital heart disease (CHD) are relatively distinct specialties, and each provide care to patients that have complex anatomy and physiology. However, we would like to acknowledge that there is some degree of overlap between SHD and CHD, and therefore, it would be difficult to draw lines separating the 2. For example, transcatheter aortic valve replacement is emerging as a good treatment option for patients with bicuspid aortic valve stenosis who are at high risk for surgery. This is a congenital abnormality now being treated routinely by structural heart disease interventionalists, often without the assistance of adult congenital heart disease physicians. This is not the only example where structural heat disease interventionalists are now treating congenital heart disease. Other examples include patent foramen ovale, atrial septal defects, patent ductus arteriosus, coronary-cameral fistulas, and others. Hence, the proposed term “non-congenital SHD” may be misleading and not fully justifiable.
Certainly, congenital heart disease represents a full spectrum of disorders, and those mentioned in the preceding text are relatively simple defects that many non–CHD-trained physicians would feel comfortable treating. This is not to minimize the importance of the role for interventional CHD specialists, where their expertise is needed in the treatment of complex defects such as tetralogy of Fallot, transposition of the great arteries, and truncus arteriosus, among many others. Hence, adult congenital heart disease (ACHD) patients are best treated by dedicated specialists who understand these disease processes well and can provide invasive and non-invasive therapies as and when needed. As Daniels et al. pointed-out, ACHD has a dedicated fellowship track with an American Board of Internal Medicine board certification that can be pursued after general cardiology or pediatric cardiology and is its own specialty dedicated to the care of these patients.
It is time to tear down the silos within medicine and not build new ones. These complex patients require a team approach and the expertise of diversely trained specialists. We should capitalize on each other’s skill set and work within each other’s training limitations. We should move away from this sentiment of deciding which patients are “yours” and which are “mine.” They all belong to all of us. This is exactly what SHD has re-emphasized in our medical practice, more than ever before. Like Dr. Holmes and Dr. Mack commented in their response to our original letter, these complex procedures have helped in breaking some of the artificially erected silos between different specialties. Both structural and congenital heart disease could be considered as 2 ends of the spectrum, each with its own unique area of expertise, but with some common shared space; and for this space, working together will give our patients the best possible outcomes.
Please note: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation