Boston Pediatric Cardiology has more than 100 pediatric and adult cardiologists, more than 40 clinical fellows who learn the routines of heart care at a large hospital, and 12 heart chambers dedicated to testing heart function in children. We have an echo lab and five laboratories equipped to perform advanced catheterization procedures. procedure.

Many other numbers may highlight our department’s dedication to treating children and adults with heart disease. But in 1949, he could only consider a single indicator in such an evaluation: one doctor.

That was Dr. Alexander Nadas, the first cardiologist and actually the first employee of the newly established cardiology department. Dr. Nadas began his work following his one instruction from his superior. The idea was to develop pediatric cardiac services comparable to adult cardiac services at what was then known as Peter Bent Brigham Hospital.

Over the years, starting with Dr. Nadas and thousands of clinicians and support staff, the department has become one of the largest in the world. And about this, 75^th Now, one year into its existence, the division is still considered a world leader in improving the lives of people with acquired and congenital heart disease. This is a legacy that Boston pediatric cardiologists today fully appreciate.

“It is an honor and privilege to practice cardiology at Boston Children’s Hospital,” said Dr. Jane Neuberger, who joined the department as a fellow in 1976 and currently serves as vice chair for academic affairs. “It never felt like work to me.”

From bed rest to news-making surgery

Heart care at Boston Children’s Hospital actually began in 1918 with a clinic that diagnosed children with heart disease and conditions that damaged the heart. However, clinicians faced limitations in medical technology that hindered proper diagnosis and management. The only treatment they could offer was rest and encouraging the children to exercise and avoid getting their feet wet.

“In fact, formal pediatric cardiology didn’t exist in this country until the 1930s,” says Boston pediatric cardiologist Dr. Michael Freed. He came to the hospital as a fellow in 1970 and eventually became chief of the cardiology inpatient service, a position he still holds today. .

Boston Children’s Hospital made international news in 1938 when Dr. Robert Gross performed the first surgical repair of congenital heart disease (CHD), which until then often caused premature death. . Yet, even after its pioneering operations, the hospital was not fully focused on researching, diagnosing, and treating cardiovascular disease.

That changed in 1949. Dr. Charles Janeway, chief physician at Boston Children’s Hospital, decided the hospital needed to take a lead in pediatric cardiology, Dr. Freed said. Dr. Janeway was motivated by the advances John Hopkins Hospital had made in diagnosing “blue” babies whose heart malformations prevent them from delivering enough oxygen throughout their bodies. Dr. Janeway selected Dr. Nadas to head a formal cardiology program that would work closely with the cardiac surgery program that began informally in 1938 with Dr. Gross’s surgery. “Boston Children’s Hospital was smart enough to recognize that this was going to be transformative,” Dr. Freed says.

Expanding the limits of heart care

The 75-year history of cardiovascular medicine can be seen as two eras.

From the 1950s to the 1980s, progress was rapid. More doctors, nurses, and researchers joined in and embraced Nadas’ commitment to trying new ways to improve pediatric cardiology. Innovations include adapting cardiac catheterization to safely diagnose and treat children and refining radiology to improve diagnosis and guide procedures such as angioplasty . Programs focused on lung function were also initiated, and exercise studies to measure heart function in children became standard practice.

“I don’t think Dr. Nadas was highly mathematical or technically brilliant, but he had extraordinary emotional intelligence,” says Dr. Neuberger. “He was an excellent judge of people’s abilities and character. It was Dr. Nadas’ skill in building teams with complementary talents that facilitated the growth of this great program.”

The next era, from the 1980s to today, brought even greater advances at a faster pace. Advances in electrophysiology, echocardiography, CT scans, and MRI have given cardiologists different perspectives for identifying heart conditions. The establishment of the Cardiac Registry has provided clinicians with a deeper understanding of congenital heart disease and enhanced education in all anatomy and pathology. Advances in technology and techniques to improve cardiac surgery, including anesthesia and mechanical support, have contributed to an increase in accurate and safe surgeries. And procedures such as the first fetal cardiac intervention in the United States pushed the boundaries of what was possible.

He joined the department as a fellow in 1978 and later became a leader in non-invasive cardiology, where he continues to help cardiologists and cardiac surgeons not only improve basic procedures but also make complex procedures routine. These and many other advances have made it possible, says Dr. Stephen Saunders. He is currently co-director of the Cardiac Registry. “These are all important factors that contribute to the quality outcomes here.”

It’s all about collaboration and self-improvement

The clinical care, research, and training of future cardiologists are only possible through the quality of our cardiology staff. Fried, Neuberger and Sanders said.

“There’s a unique combination of specialization and collaboration between different departments within the department that probably doesn’t exist in many hospitals,” Dr. Saunders says. “Specialism is key to patient care, but it can’t be siloed. So the ability for people here to work together and make sure everything is tailored for the patient, that’s what really makes this place great.” I’m making it a thing.”

Dr. Nadas, who retired in 1982, initiated a collaborative attitude that continues to this day, Dr. Freed said. “As you get bigger, it gets harder to do that, but what still makes it work is patient-centricity. Because you’re patient-centered, department leaders want you to do everything you do.” This encouraged everyone to have their own area of ​​expertise and share that knowledge with others within the department.”

The ability of Dr. Nadas and Dr. Aldo Castaneda, who served as chief of cardiac surgery from 1972 to 1994, to unite cardiologists and heart surgeons is another legacy that continues, doctors say.

“In addition to being a great surgeon, Aldo’s real contribution was to encourage self-criticism,” Dr. Saunders recalls. “I’ve been to a lot of Saturday morning conferences where he would say that the surgery didn’t go the way he wanted and he would take the blame for it. He figured out what he should do and how he could do it differently next time. He instilled that in his trainees and juniors. So when we cardiologists make mistakes, people hold us accountable. People will line up and fight to get it.”

A promising future is built on the past

Doctors. Fried and Neuberger say it’s difficult to name one or a few of the most important advances in cardiology at Boston Children’s Hospital. Rather, each decade after 1949 brought new insights and innovations that worked well at the time but led to further developments, each building on what came before. “The changes were noticeable,” Dr. Freed said.

What’s next? “Advances in heart regeneration and tissue engineering will be remarkable. We may one day grow new heart valves, heart muscle, or even an entirely new heart,” says Dr. Neuberger. “It remains to be seen what great feats these technologies will bring.” Dr. Saunders points out that there are still CHDs that are difficult to treat, such as heterotaxy and hypoplastic left heart syndrome. “There is still room for progress,” he says. “But we will need to look at heart development at the level of molecular biology and try to manage these heart diseases in different ways.”

In the meantime, doctors aren’t afraid to reflect on what motivated them and their colleagues to grow: their patients. “It’s such a joy to care for our patients and their families. They have almost become like family,” says Dr. Neuberger. “It has been a great joy for me to watch children with heart disease grow up and to be able to help guide them through important decisions in their lives. Pediatric Cardiology Not a day goes by that I don’t feel the immense privilege and responsibility of

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