It would be hard for me to make that my entire career. There are so few evidence based treatments for congenital heart disease - most of the treatment is still surgical. I feel that in adult cardiology we have more direct impact on and ownership of our patients, and that's important to me. On the plus side, the anatomy is fascinating.
I agree, I love the anatomy. It is one of the most esoteric fields in medicine and a great challenge. In some sense I would argue that there are plenty of evidence based treatments in congenital cardiology as a whole (spanning a lifetime of CHD) as evidenced by the fact that within the last few decades we've actually turned the numbers on their heads and there are more adults with congenital heart disease than children with CHD. We have kept alive a large portion of patients that were once were destined to die. That said, I agree that surgical treatments have been at the forefront of that being the case. I disagree about the direct impact and ownership part, though. When followed through their lives their (usually pediatric) cardiologists have had a great impact on their quality and quantity of lives. Surgical interventions are very intermittent and are a relatively small (by number, not impact) part of ongoing care of congenital heart patients. If anything, we are often accused (sometimes rightly so) of never letting them go, though the fact is, unfortunately, adult cardiologists usually have little to no interest in this population (when they get to adult years). While the surgeons are important, typically, the peds cardiologist/CTS teams are very collaborative and they (the surgeons) rely on us a great deal. The peds interventionalists do more than the surgeons, and they also collaborate closely with the generalists. I think the level of ownership and direct impact is actually quite high. Now, back to evidence base: I also agree that in ACHD there can be a frustrating lack of evidence, but, like I said, this is a newer population and a smaller number than coronary heart disease. It is truly frontier medicine in a sense.
I thought about doing med-peds and then a cardiology fellowship focusing on congenital heart disease, but am glad I didn't. Many feel that peds and adult cardiology are so different that it's difficult to effectively straddle the two.
I do agree that they (peds and adult cardiology) are very different outside of arrhythmias and cardiomyopathies. I do wish more adult cardiologists developed an interest in ACHD as it is possible that these patients can develop more "typical" adult heart disease (though, interstingly, I never saw much of it, even in our older patients in the cath lab when they got their coronaries shot). I'll add, though, that on top of a new set of plumbing problems to learn, the patients can often present a challenge as anxiety is common (makes sense, doesn't it?) and they can be "needy". They also require imaging expertise and their caths often take forever (a 4-6 hour case is pretty common. No turn and burn coronary cases in the peds cath lab).
I could see doing ACHD if I were primarily interested in imaging, interventional, or perhaps EP (they always have crazy arrhythmias).
Yes, these particular areas might be more interesting for the adult cardiologist.
p diddy
