Heart Valves and the Future

Heart Valves and the Future

Julie Miller: Hi, I'm Julie Miller, and I'm here as a member of the Family Advisory Council at the Children's Hospital of Philadelphia. I'm here representing families from the Cardiac Center, and it's my privilege to be here with Dr. Mike Quartermain today.

Michael Quartermain, MD: Thanks, Julie. I'm Mike Quartermain. I'm a pediatric cardiologist at CHOP.

I specialize in echocardiography. I direct the Echo Lab at CHOP and it's a pleasure to be here today.

Julie Miller: Great. So in the mid 2000s, we had the privilege of participating in some research that was under your direction. So we wanted to thank you for the service that you provide many of the fellow heart families at the Children's Hospital of Philadelphia.

I got a four year old to do your work. So it was a privilege of ours to participate in that.

Michael Quartermain, MD: Thank you.

Julie Miller: So I wanted to start our conversation today with really your core expertise in the space of echocardiography and every patient or nearly every patient gets an echo while they're at CHOP for their yearly visits or their, whatever frequency they're going.

I wanted to ask you, what are you most excited about that's out there today that you'd like some of our parents to know about?

Michael Quartermain, MD: Sure. Yeah, that's a good question. First. Thank you so much for you and your son participating and a lot of what we do in the echo lab and a lot of the answers to some of these questions about what we're excited about now is because we've had families be involved in these projects to let us kind of learn and grow our skills and through research.

So it's one of the real important things we do. So thank you for that. I'd say there's a number of things that I think we're excited about now, of course, I'm kind of giving you a narrow window from the echo side of things. There's a lot of things going on at CHOP that are interesting, and I think from the echo side, the two big things we've seen, I'd say, over the last three to five years, one is a lot of growth, and that does bring some positive things with it.

So just in the volume of echocardiograms that we do and the sites that we offer the studies at now has grown tremendously and with that our skill sets have grown. The staff we've had, we have really experienced staff. In my mind, probably though, probably the most exciting thing is just the technology that we've seen over the last even 2 to 3 years in pediatrics.

I think in pediatrics for echo and probably a lot of other fields, the adults are sort of way ahead for technology. They sort of have the numbers and it's hard for the vendors for industry to invest a lot in pediatrics, but I think that has happened on the on the echo side of the last 3 to 5 years.

So I think we're seeing now much better product. The echo machines that we use now have capabilities we didn't have 3 and 5 years ago. So we're able to do things in the echo lab that some of your doctors, your son's doctor might ask for certain things that we couldn't do 3 or 5 years ago. And some of the machines we have now have capabilities that are allowing us to look at things and understand things better, just through a surface echocardiogram by putting the probe on the chest. I think that's the most exciting. Seeing just the quality of the imaging continue to get better. A lot of that, again, it's just through the experience we have in our echo lab, you know, the people who have run this echo lab over the last, I'm one of many who have been sort of directors, they're here and they're working and they continue to be a part of the echo lab.

So we're very lucky to have that level of experience. And I think you add that to the image technology we have now and the things we're able to do are really, really impressive. So I'm happy about that. And I think the other part is to comment about how we're able to offer these services a lot of different sites now. Just the quality of the echo machines and stuff we're able to do at satellite sites where a lot of families go. It's always been a high level, but now it's really good level with the new machines we have there.

Julie Miller: That's outstanding.

Michael Quartermain, MD: I think those are some of the things that kind of catch my eye.

Julie Miller: So you talk about innovation in the industry and how certainly, adults are ahead of pediatrics.

If you're looking at a few years from now, what are you most excited about that might be coming in the field of imaging and echocardiography?

Michael Quartermain, MD: I think right now some of the things that we just came out of doing a valve conference and I look at where some of the imaging probes that we use that we couldn't use five years ago, that we can now use the pediatric probes for valve imaging or three dimensional imaging is certainly something that excites me.

We sort of got the first versions of them now. Maybe the second version with some vendors. Usually by the third and fourth iteration, things get really good. So I think we're really close to getting really good with some of these things. And then some of the probes that we use during procedures, which are called transesophageal echocardiograms, that are done when children are asleep, and the echo probe is in the esophagus.

Right now, those are pretty limited in what they can do, because just the size of the probes and the size of the children's esophagus. But we hear in the next year or two, some new probes will be released that we'll be able to use during procedures, that either our surgeons or our cath doctors are doing, that we could give a lot more information to them during the procedure, and those could be released in the next year.

We're hopeful. So I think that would be something I'm personally excited about. All these years, on the smallest of children, not having the ability to do some of the stuff our adult colleagues can do because that equipment doesn't exist anywhere in the United States, but I think we're going to see it very soon.

So I think that'll be a nice boost for us.

Julie Miller: Yeah, that's really encouraging. We've been a CHOP family for 21 years and have seen a lot of growth in this space and there certainly is a lot to be excited about right now. So as we wrap the conversation, is there anything else that you'd like any of our CHD families to know? Something that you'd like them to understand a little bit more about echocardiography?

Michael Quartermain, MD: You know, echo is clearly, you know, probably the central test that they all get. Whether it's a mild form of heart disease or a more severe form of heart disease. Pretty much all of the children who come through the Cardiac Center do come through the echo lab. You know, we've really worked hard on to make children comfortable there.

I think that these can be stressful times.

Julie Miller: Sure.

Michael Quartermain, MD: Some of them are getting new diagnoses, or some of them who are known and followed here with a particular heart defect might have changes and I think a lot, of it the echo often is part of that process so it can be a pretty stressful place. The volume of echoes that we can see some days can be very high. So I think what I would say is give us feedback. We're Just trying to get better.

I'm really thrilled with what we're doing and the support we get from the Cardiac Center, but there's always opportunities to do what we do better. And so I would say to families, if there's things that they can give us feedback, I think these, the family council and what you're part of is really important to us.

I know you've had a role in a lot of things in the Cardiac Center, and I think it's something that we benefit from. Sometimes the feedback we get, it's not always going to be good feedback, but it's helpful feedback. So I would just say to families, we know these are stressful times for you, but let us know if there's things you think we can do differently.

Sometimes we get so focused on the mechanics of the echo machine and the results. And we're, sometimes we need that reminder, you know, that there's a little child there and you know, we need to keep that in mind. So I would say that to the families who come through.

Julie Miller: Excellent. Well, I could tell you that the Miller family is probably the number one fan of the echo lab at CHOP.

So just thank you to you, to your team and to the research that you've done to really make key advancements in this space in cardiology, not just at CHOP, but across the nation. So thank you very, very much.

Michael Quartermain, MD: Thank you very much. And the last thing I'd say is it really does, for our Echolab, it takes a it takes a village.

We have so many key players. And so thank you to all of them for the work they do behind the scenes. And thanks, thanks for speaking with me today.

Julie Miller: Thank you very much.