Transcription:
Structural Cardiology: What Is It And How Has Tech Changed The Game?

Cheryl Martin: Cutting edge technology now offers new choices for heart patients to improve their quality of life. Welcome to FirstHealth and Wellness Podcast, connecting you to the people and medical services that make your life healthier. I'm Cheryl Martin. Joining me to discuss breakthroughs in a unique area of cardiology is Dr. Sun Moon Kim. He's a structural and interventional cardiologist treating patients at FirstHealth of the Carolinas Reid Heart Center. Dr. Kim, so glad to have you on.

Dr. Sun Moon Kim: Thank you for having me.

Cheryl Martin: The specialized area is called structural cardiology. Doctor, please explain what it is and its benefits.

Dr. Sun Moon Kim: So, structural heart disease or structural cardiology mainly pertains to, of course, the heart, but outside our well known area of coronary artery disease, which pertain to the blood vessels that supply the heart and also the muscles in itself. There are multiple structures with the heart, including valves. Some people have congenital defects where they're born with a small hole in their heart. And structural cardiology kind of encapsulates all of the heart in itself, and allows us to provide treatment that were conventionally done with open heart surgery. So, you know, up until about 15, 16 years ago, aortic valve replacements were performed by open heart surgery, and that was actually the only treatment modality. And for mitral regurgitation or leakage of the valve, that was also only treated with open heart surgery. Now with the development of structural cardiology, we are now able to provide non-open heart surgical interventions that have been very successful, and the recoveries have been great. Patients do as well as open heart surgery without the risk associated with open heart surgery.

Cheryl Martin: So, this is a minimally invasive approach then?

Dr. Sun Moon Kim: Yes, ma'am.

Cheryl Martin: Talk more about the technology and it being a game changer in these new procedures.

Dr. Sun Moon Kim: The field in itself was developed because we simply had patients that were too high risk for open heart surgery. And we knew that with a pathological or a mechanical problem, medicines alone won't change their outcome. So in order for us to provide these otherwise high risk patients for open heart surgery, with a real good shot of doing better, preserving their quality of life and, of course, living longer, this field got developed.

And we focused initially on patients who are too high risk for open heart surgery. And that really started off with aortic valve treatment, so patients with a narrow aortic valve, also known as aortic stenosis, which is very common in the general population. We focused on those patients and bright minds got together and developed a transcatheter method of replacing the valve. So, this happens all within your body where the aortic valve or a bioprosthetic valve gets shuttled up to your heart inside a big vessel, and we're able to anchor in a new valve all within inside the body and push your old valve away and achieve the same kind of results as open heart surgery. And we've learned that the patients who couldn't get surgery with this minimally invasive technique were doing much better, obviously compared to medicine only. These patients were living longer. They were feeling better. And they were provided with an alternative treatment where open heart surgery was not available. And that had progressed where we went into high risk prohibitive open heart surgery patients to intermediate risk, and then now low risk.

And essentially, if you are the right type of patient at the right age, now we're able to provide or potentially entertain the idea of doing this minimally invasive aortic valve replacement for you without having to resort to an open heart surgery. And that technique had expanded and opened doors to other valves, and that's how this general field has grown exponentially over the past few years to now incorporate almost all valves of the heart.

Cheryl Martin: This is great. So, you mentioned the right patient. Give a profile of what the right patient looks like.

Dr. Sun Moon Kim: That's a very good question because with this technology now, we have almost all patients coming to us and asking, "Hey, can I get that minimally invasive aortic valve?" Now with that being said, there is still a place for open heart surgery, and there are things that we cannot simply achieve that the surgeons can, because the surgeons have the opportunity to directly look at the valve, touch the valve. They have the potential to clean out any nearby structures or anything that may cause complications long-term.

So, the right patient really means, number one, you can't be too young. Because if you're too young, you're looking at too many procedures in the future, and the first surgery often dictates what is expected to come decades down the road. So if we do a minimally invasive valve surgery too early, when a surgeon actually had an opportunity to go in and clean out that valve and really suture in a nice big valve there, then we are limited on what we can do two, three decades down the road. And therefore, age plays a role.

Number two is anatomy. If there is a very, very heavy burden of calcium or if we think that the anchoring or deployment of these minimally invasive valves are going to hinder nearby structures or potentially cause complications because we do not have the ability to actually clean out that area, those anatomical features often dictate whether this patient's good for a minimally invasive procedure or not.

And last, but nonetheless, is other disease. If the patient has other reasons aside from the primary reason that he's being referred or she's being referred, for instance, let's say the patient is seeing us for an aortic valve problem, but also has severe arterial disease, which the patient needs bypass surgery or if the patient has two valves that are diseased or if there is something wrong with the great vessel of their body called the aorta, sometimes the need for a different surgery also dictates whether this patient should undergo open heart surgery, where the surgeon has the opportunity to fix more than one or two matters at once.

Cheryl Martin: How might a patient end up in your office?

Dr. Sun Moon Kim: So since now our services are becoming more well known, there are patients that actually see us on an ad or a website. They are fully aware of a problem that has been identified by another doctor. So, sometimes patients themselves reach out to us. Number two, often, the vast majority of our patients are referred from our bright-minded nearby cardiologists, who are able to do a lot of the pre-workup, identify the patients who are most suitable for a minimally invasive procedure. So, the cardiologists, nearby cardiologists, definitely refers patients to us. And last, but nonetheless, primary care physicians. They will always be the gatekeepers of our patients. And the most common scenario is where they have a certain patient in their office, they hear a murmur or there is a particular symptom that is concerning that triggers an ultrasound of the heart and that leads to a referral to our office.

Cheryl Martin: When you talk about structural cardiology, summing it up, what does this mean for patients and why should they care either for themselves or their family members?

Dr. Sun Moon Kim: With any kind of procedure that we perform and, personally, I think it starts with whether I can questions answer two questions for the patient. Number one is, "Am I going to make you feel better?" Number two is, "Am I going to make you live longer?" If I can answer these two questions, then, you know, we need to help the patient. And then, the next question is, I think we are past the idea of "Can we do minimally invasive procedures?" I think we've already answered that over the past two decades. We have the technology and expertise to provide some form of therapeutic treatment. The question is, "Is this the best for this patient?" Is the open heart surgery best for this patient or is a minimally invasive catheter based intervention best for this patient? And that is a decision that is made by both the patient and referring physician and the team that is helping and ultimately will perform the procedure. The reason this is so important is because the patient should be aware that now we have an arsenal, a large option of being able to treat heart disease. And structural heart disease has expanded to the point that we are treating stroke risk with atrial fibrillation with a device called Watchman or Amulet. We are replacing valves through a large vessel. If you've had a stroke at a very young age and you're identified to have a small hole in the heart, we're able to close that without open heart surgery.

I think what's most important is that the patients are aware that these options are available to them. And most importantly, available close to them, especially in places like Pinehurst, Sandhills area, or even Moore County with FirstHealth. So, we certainly encourage our patients to be informed through media like this, podcasts and our ads. And we continue to do our best to educate not only our patients, but family members, friends, and also other doctors to keep them aware that these are options and whatever was prevalent 20 years ago is no longer the case. Now, there are other options that may actually be best for the patient.

Cheryl Martin: Dr. Sun Kim, thanks so much for discussing what are exciting advances in technology for heart patients. I love the fact that you said we've got a large arsenal now. Thank you.

Dr. Sun Moon Kim: You're welcome.

Cheryl Martin: To learn more about Reid Heart Center and FirstHealth's world-class heart care team, visit firsthealth.org/heart. That's firsthealth.org/heart. To schedule a cardiology appointment with Dr. Kim, call 910-715-7650. That's 910-715-7650. FirstHealth and Reid Heart Center make world-class heart care available close to home for residents in the Sandhills and beyond. Thank you for listening to the FirstHealth and Wellness Podcast, brought to you by FirstHealth of the Carolinas.