Raghav A. Murthy1, Abby Zhang2
1Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, USA; 2JTD Editorial Office, AME Publishing Company
Correspondence to: Abby Zhang. JTD Editorial Office, AME Publishing Company. Email: jtd@amepc.org.
Editor’s note
Journal of Thoracic Disease (JTD) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year JTD launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Management of Congenital Heart Disease”(1) led by Dr. Raghav A. Murthy (Figure 1) from Mount Sinai Hospital has attracted many readers since its publication. This special series aimed to provide a very contemporary and practical update to various difficult problems and difficult-to-treat lesions in the management of congenital heart disease. At this moment, we are honored to have an interview with Dr. Murthy to share his scientific career experience and insights on this special series.
Figure 1 Dr. Raghav A. Murthy.
Expert introduction
Dr. Raghav A. Murthy is the assistant Professor of Pediatric Cardiovascular Surgery, Director of Pediatric Heart Transplantation and Surgical Director of Pediatric ECMO at Icahn School of Medicine and Kravis Children’s Heart Center in New York, USA. He has extensive experience treating congenital heart disease in all age groups. He is also very experienced in temporary and durable mechanical circulatory support and heart transplantation. He has special expertise in pediatric airway surgery and complex lung surgery.
Dr. Murthy was born in Bangalore, India. After completing medical school at the prestigious Bangalore Medical College, he pursued his general surgery residency at Henry Ford Hospital in Detroit. He went on to complete his cardiothoracic surgery residency at the University of Texas Southwestern Medical Center, Dallas, Texas. He joined the Pediatric Cardiac Surgery Division at Rady Children’s Hospital and the University of California, San Diego, and under the mentorship of Dr. John Lamberti, he performed extensive and complex cardiac surgery on neonates, infants, children and adults with congenital heart disease. He has been a senior staff surgeon in New York since 2018. During the COVID pandemic, he was at the epicenter of the outbreak in New York and was involved extensively in the management of children with MIS-C.
Dr. Murthy has authored and co-authored more than 55 articles in peer-reviewed journals, 18 book chapters, more than 10 surgical videos and over 110 oral and poster presentations at national and international meetings.
Interview
JTD: As a renowned expert in pediatric cardiac surgery, what prompted you to focus on this?
Dr. Murthy: As a very young first-year medical student, I was introduced to heart specimens with various congenital cardiac malformations by world-renowned cardiac morphologist Dr. Saroja Bharati. I was perplexed and at the same time fascinated by the complexity of the embryology, anatomy, pathophysiology and surgical correction of these complex congenital heart defects. This along with my love for children got me interested very early on in this field.
JTD: What are the current challenges faced with the Fontan population and why are they highlighted? Could you please give a brief description? (2)
Dr. Murthy: Over the past 3 decades, we have become very competent in the management of single ventricle physiology. Not only have the surgical correction for these defects streamlined, but we have also become very good at caring for these patients in the ICU. The detailed understanding of the pathophysiology has led to the greater and more outstanding survival of these patients, now well into their 30-40s and even into their 50s. Thus, we are seeing a huge Fontan population enter adulthood. These are complex patients, they have had multiple previous open-heart surgeries, often have electrophysiological abnormalities and heart failure. They can have low oxygen levels and decreased exercise tolerance, Fontan associated liver disease, protein-losing enteropathy, plastic bronchitis and kidney/lung involvement. We are currently having a Tsunami of adults with corrected congenital heart disease and now exceed the number of children with congenital heart disease in the United States! Heart failure is the number 1 cause of mortality in the Fontan population, placing a huge burden on mechanical circulatory support and organ transplantation.
JTD: In the special series, the development and applications of 3Dp in congenital heart disease during the last decade was stated, then how about the current progress of it? (3)
Dr. Murthy: This is an emerging and very exciting technology in the field. It is still in its infancy but I see a tremendous amount of potential. It is now standard of care to be able to obtain 3D models of complex congenital heart defects, especially double outlet right ventricles, heterotaxy and various forms of borderline left hearts. These can be 3D printed in various materials and also sectioned in different axes making it easier for the cardiologists and surgeons to determine the best surgical options, the feasibility of such septation, and practice runs prior to actually performing such procedures in real-time. There are some centers that have been 3D printing absorbable external and internal airway stents to patient specifications. Such bespoke therapy will revolutionize the field over the next decade. It is a matter of time before we will be able to 3D print valves, vessels and maybe whole organs in the future!
JTD: Though the 3Dp has developed rapidly in treating congenital heart disease, it also has weaknesses. Do you think 3Dp will be more applied along with other methods in the future, for example, interventional therapy? Or is there any other better technology emerging at present?
Dr. Murthy: All technology has its advantages and disadvantages. The key is to exploit the good things that a particular technology has to offer. Often, it has to be integrated into the current technologies that we use and also be able to use it symbiotically with new future emerging technologies. I strongly believe 3D printing has a lot of future potential. In the future, we may also be able to print living structures using stem cells. There are many exciting potential for this technology and we are currently just in its infancy.
JTD: Is the topic of this special series associated with any of your recent research projects? Would you please share some significant researches you are working on?
Dr. Murthy: This special series touched on some of my interests and research projects. Pediatric tracheal surgery is a special interest of mine and in this special issue, I have detailed a variety of techniques for surgical reconstruction and management of such defects in combination with concomitant congenital heart defects. Not featured in this special issue has been some of my research work on the long-term outcomes of the homograft pericardial patch and its utility in congenital cardiac surgery. I am also currently working on a project looking at the national outcomes after pericardiectomy in the pediatric population, which is a rare operation in this population group.
JTD: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more comprehensive series?
Dr. Murthy: There are several new and exciting developments in this field. To name a few: partial heart transplantation, xenotransplantation, management of the borderline left heart and biventricular conversion, mechanical circulatory support and transplantation in the adult congenital heart population, heart vs heart/liver transplantation in the Fontan population, management of peripheral pulmonary stenosis and combined heart-lung transplantation/ PAR plant in this group of patients, tracheal transplantation and what its future holds!
Reference
- Management of Congenital Heart Disease. Available online: https://jtd.amegroups.com/post/view/management-of-congenital-heart-disease
- Murthy RA. Management of congenital heart disease. J Thorac Dis 2020;12(3):1159-1160.
- Hermsen JL, Roldan-Alzate A, Anagnostopoulos PV. Three-dimensional printing in congenital heart disease. J Thorac Dis 2020;12(3):1194-1203.