Cardiologist with Great Lakes Cardiovascular discusses adult congenital heart diseases and explains why non-invasive procedures allow doctors to send fewer patients to open heart surgery
Q: What areas of the heart do you specialize in as a cardiologist?
A: I’m a clinical, non-invasive cardiologist, so I don’t do angiograms. My area of specialty is adult congenital heart disease and I also read [echocardiograms] and do ultrasounds of the heart that are done through the throat under anesthesia. I’m mostly office-based, but I’m in the hospital once a week at Millard Fillmore Suburban and helping the team with imaging and stress testing.
Q: When we’re talking about adult congenital issues, we’re talking about structural defects?
A: Inborn, yeah, so congenital structural defects children have usually had surgery for and are transitioning out of the pediatric world to adult cardiology. So I work really closely with our pediatric cardiologists.
Q: How common are these types of congenital defects?
A: It depends what defect we’re talking about. It’s still very rare to have congenital heart defects. But you have to look at the particular patient population with regard to what the risk is for having complications. So the patients with really high-level defects that have had surgery as a child, depending on when they had surgery as well, can put them at risk of heart arrythmias and, in extreme cases, sudden death. But having said that, the population is still very small compared to the general population, so it’s a small group of patients, but it’s just really important that they see someone with a background in congenital heart conditions so it can correctly identify the potential problems they may develop. So it can be anything from a simple hole in the heart that gets closed during childhood that we’re following up on in adulthood or it could be a child that’s born blue and has a complex heart surgery as a child that then manifests later in their life as arrythmias. Those may require a pacemaker, defibrillator or open heart surgery.
Q: How treatable do these conditions tend to be?
A: When you look back at the beginning when they came out with bypass surgery, which really isn’t all that long ago when you think about it, we had very few options for these kids. So we developed techniques to try to limit the amount of cyanosis or blue blood they are exposed to, and circulate more oxygenated blood supply. The pioneers of pediatric cardiac surgeons developed more sophisticated shunts. It’s become advanced enough that these kids are able to grow up with a fairly normal childhood and have the potential to have a pretty normal adulthood, too, depending on the type of lesion they were born with. There are some congenital anomalies that may require a heart transplant at some point in their lifetime, but for the vast majority of people with heart defects, they can go on and have a pretty normal longevity as long as they continue to follow up with somebody watch out for any kinds of bumps along the road, so to speak.
Q: Do you see heart issues in younger adults getting more exposure? We recently had a high-profile case in Damar Hamlin.
A: It’s pretty recent, so it’s hard to know how or if that’s going to translate into more people being assessed. But in general, since COVID, we’ve had a lot more young people come in to get checked out when they’ve had any kind of cardiac symptoms. The sports world is a bit different being a highly competitive environment. I do think a lot of younger people are advocating for getting evaluated if they notice any irregular symptoms.
Q: There’s been more focus on heart inflammation in the context of both the COVID virus and the COVID vaccines. What have you seen in your practice?
A: So I can only speak for my patient population, but I’ve had patients with some complications due to COVID early on, with myocarditis and pericarditis. That’s from the virus itself. Hopefully as time goes on, we’ll see fewer complications. I’ve very rarely seen complications from vaccination, although I have reported some to VAERS to let them know of some myocarditis and pericarditis complications within a week of vaccination. These were young men.
Q: When it comes to recovery in both cases, how able to recover do people seem to be?
A: Speaking generally, before COVID, when we saw myocarditis from general viruses like colds or flu, it could sometimes take a couple months for heart function to return to normal. With covid, it seems like most of the people who have had myocarditis complications have been patients with preexisting conditions cardiac-wise. I haven’t had too many people who have gotten myocarditis from covid who haven’t had any prior cardiac history. There have been a couple, but not many. Most were chronic heart failure patients who got worse after covid. So it’s taken some time for them to improve. But, with the medications we have, we’ve seen a lot of them get better. From the vaccinations, most of the data shows the injury to the heart with regard to myocarditis is very small, and that’s been true of the ones I’ve followed personally. It normalizes pretty quickly, and that probably has a lot to do with their age. Most of these patients are younger than 30.
Q: What kinds of developments in cardiology are you looking forward to? What’s on your radar?
A: I’m looking forward to less and less invasive procedures for structural heart care. We’ve seen great results with TAVRs (trancatheter aortic valve replacement) and as a result we’re sending fewer patients to open heart surgery. So having more conservative treatment options is very exciting. I’m also looking forward to more advances in the congenital heart realm, which is constantly evolving. And a lot of the knowledge that’s advancing in cardiology in general translates over into developing treatments for congenital heart defects.
Name: Laura Ford-Mukkamala, DO
Position: Cardiologist with Great Lakes Cardiovascular
Education: Doctor of Osteopathic Medicine, New York College of Osteopathic Medicine; residency, internal medicine, University of Connecticut; cardiovascular fellowship, University of Connecticut
Affiliations: Kaleida Health System
Organizations: American College of Cardiology; American Society of Nuclear Cardiology; American Society of Echocardiography
Family: Husband, one daughter
Hobbies: Hiking, photography, reading, travel