Guest: Dr. J. Philip Saul - Pediatric Cardiology
Host: Dr. Linda Austin – Psychiatrist
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. Philip Saul and we are going to talk about the Children’s Heart Program of South Carolina, which is housed here at the Medical University of South Carolina. Dr. Saul, what kind of relationship does that heart program have with the pediatricians and heart specialists around South Carolina?
Dr. J. Philip Saul: Well, I think one of the very unique things about the Children’s Heart Program at South Carolina is that all of the pediatric cardiologists in our state actually work together for the best care of the children in South Carolina and actually the program isn’t just at the Medical University. It consist of the 11 cardiologists here at the Medical University, four at the University of South Carolina in Columbia, four in the Greenville Hospital System in Greenville, and one in Florence and the way it works is that if a child is born with congenital heart disease anywhere in the state who was identified to have a problem then most of their care can be done locally, but if they need a procedure like a heart catheterization or a heart surgery or a special MRI of the heart, then they will be sent to the Medical University for the group that I run here to do that procedure and in that way, there is less duplication of services throughout the state and we are able to provide the very best care to all of the children in the state.
Dr. Linda Austin: So, in other words, the centers that are in Greenville, Spartanburg, and Columbia, do they also perform operations and those procedures?
Dr. J. Philip Saul: No, all of the operations and all of the catheterizations are done here, but there is a lot of other care that these children need, so let’s say that a fetus is identify to have a severe heart problem in Greenville prior to delivery, then we would arrange for that mother to deliver the baby here and then the child would get operated at the Medical University in the first week of life, recover from the surgery, and be discharged back to the care of the physicians near their home in Greenville. So, the advantage of that is that we only do about 300 to 350 heart surgeries a year in children in the state of the South Carolina. If we divide those up into three centers, no one would be expert at it and unfortunately that’s the way it works in many states is that all the cases were divided up between the hospitals that all feel they have to do that surgery. In fact, here the cardiologists have decided that it is best for the kids if they are all done in one place that has a little higher level of expertise and the outcome has been that we have the very best results that can be found anywhere in the world for our congenital heart surgery, so it’s good for the kids and it turns out it’s good for the cardiologist.
Dr. Linda Austin: I would imagine that a statewide program like that, a statewide collaboration must take a lot of communication in the building of relationships between doctors, how does that occur?
Dr. J. Philip Saul: Well, that is absolutely critical Linda and what we do is, in a few different ways, we keep those communication channels open. The most important is on an ongoing basis, we are always available. We have the super specialist in pediatric cardiac disease here, so I am an arrhythmia specialist, I deal with heart rhythm problems. Some of my doctors are echocardiographic, they are imaging specialists, some are catheterization specialists, and others are intensive care specialists. So, if there is any problem that one of our colleagues around the state has where they could use some advice, they know that they can pickup the phone and get a hold of us just like we were down the hall. So, we are continuously available on a 365-day 24-hour basis. The other way is we actually get together a couple of times a year and we have meetings, where we go through what are the communication issues, what’s the best way to care for a certain group of children and that way we really use kind of a combined effort. We brainstorm about understanding the literature and figuring out what’s the best way to deal with all the problems that we face and then the last way is through educational opportunities. We run a number of courses here in Charleston and we always make sure that our colleagues around the state are invited and welcomed to those courses, so that we can help provide them with state of the art educational opportunities.
Dr. Linda Austin: It sounds like a fantastic collaboration of pediatric cardiologists.
Dr. J Philip Saul: It really is ? it works better than anywhere I know. We have underwent a downplay any other state, but we have a state next to North Carolina where it turns out that is the exact opposite system. They have five centers that provide care, but they only have twice as many people. So, if five centers are doing surgery and catheterization and it’s just a matter of math if you divide up two times as much work by five, you are going to end up with less expertise at each center and if you could combine those into one center with more expertise.
Dr. Linda Austin: What are the points you have making that I think people may not recognize is that just as with anything else in life, practice makes perfect and for a surgeon to do the same operation over and over and over again is really, really helpful in terms of speed and in terms of activeness and clinical outcome.
Dr. J. Philip Saul: Yeah, that is just critically important in pediatric heart disease and the real reason is that we have very few operations that even you get to do over and over. So, even that 350 or so operations is a mix of a wide variety of procedures and then if you divide it up into three pieces or four pieces, you have got people doing one of this and one of that and it’s just not optimal. We know from the literature that the results are not as good under that sort of a system and that they can be really excellent with our kind of the system, so it is very important and our surgeons are just spectacular Dr. Scott Bradley, Dr. Fred Crawford, and our newer surgeon Dr. T. Y. Shah are all truly stellar surgeons and when you put them together with the team that we have intensive care doctors, cardiac pump specialist, respiratory therapist, and specialized nurses, that’s what you need in order to get these good outcomes and so we are very proud of that here.
Dr. Linda Austin :Tell us about some of the research efforts that the Children Heart Program is pursuing now?
Dr. J. Philip Saul: Another advantage of having a joint program is that we can pool our resources rather than split our resources. So, one way is that in pediatric cardiology, now we are trying to learn a little bit more about how to do what we call evidence-based medicine, so trying to look at all the data and say what was the best way of caring for that group of patients. In our center here at the Medical University as a part of a National Institute of Health either-center network called the Pediatric Heart Research Network and we are able to recruit a relatively large a number of patients into our clinical studies to figure out what’s the best way to care for patients by collaborating with our partners around the state. In addition by having more people in one center and working very closely with the basic scientist here at MUSC, we have an extremely productive Pediatric Cardiac Development Program and what that means is we are trying to understand how does the heart develop and once we understand it, what can you do about it, they can make the heart develop normally or may be even we can fix the holes and other problems with the hearts after birth by telling the cells what to do rather than having the surgeon go in and repair that hole. So, we are really excited about a lot of the works that’s being done here at the Medical University working with Dr. Roger Markwald in cell biology and doctors Tim McQuinn and 07:39, who are in our division and many others in our basic science areas.
Dr. Linda Austin: How thrilling that just sounds like breath-taking research?
Dr. J. Philip Saul: Well, we are hoping that it is and I see kind of the final cure for many of these kinds of heart disease has been coming from stem cells and by that what I am hoping is that we will be able to take in individuals own bone marrow cells some day and tell them how to make a heart either put him on a heart structure or actually tell them and have them form the heart and then when your heart is really bad off, we will just give you a brand new one that’s made from your own cells, so you will never reject it in the last or rest of your life, so it is exciting.
Dr. Linda Austin: Good luck for that work.
Dr. J. Philip Saul: Thank you.
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