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Cardiologist poised to care for unique group by Heather Woolwine Public Relations Adults born with congenital heart problems comprise a group of people with unique treatment challenges unlike what most adult cardiologists have seen in their careers. Because of this, cardiologists such as MUSC’s Heart & Vascular Center’s David Gregg, M.D., have decided to sub-specialize in adult congenital heart disease in order to provide these patients with the specific care they need.   Dr. David Gregg Since his arrival in September, Gregg has been busy establishing an outpatient clinic, an inpatient consulting service, and a patient registry that may be used to track congenital heart patients, their outcomes, and treatment follow-up. He also is writing papers and a book chapter on the management of adults with congenital heart disease.   “The pediatric cardiology group here is amazing, and it’s my job to expand on their great success with treating the children of South Carolina by treating those children when they become adults and responsible for their own health,” Gregg said.   Because of advances in the childhood management of congenital heart disease during the last 50 years that led to lengthening life spans, there has been a dramatic increase in now-grown adult patients with congenital heart disease   Gregg is also responsible for caring for those patients who have recently discovered an untreated congenital heart problem. “There are three main categories of patients I see. There are the patients who have had heart disease or a congenital defect their whole life and have had big surgeries or procedures beginning in childhood; patients who only recently found out as an adult that they have congenital heart disease; and patients who have been monitored since childhood but who have had no major issues yet,” he said.   A cardiologist with a subspecialty in adult congenital heart disease not only is necessary for optimal treatment for these patients, but is especially important for continuity of care for those patients who’ve been dealing with a congenital heart issue their whole lives, he said.   “There are unique medical and psychological issues associated with this group of adults now in their 40s. Fifty years ago, the introduction of the heart and lung bypass machine enabled cardiovascular surgeons to begin repairing congenital heart problems, whereas up to that point, these people might have died in infancy or as children,” Gregg said. “They were the first children to receive these pioneering treatments and surgeries, so there is no precedent for how they should be treated and managed as adults. Plus, other adult health issues develop with age, so it becomes very important that these patients not only have cardiologists who can help them with adult heart disease issues, but who also have an understanding of congenital heart disease. Most adult cardiologists are not familiar with congenital heart disease in adults because that population is just coming into existence. Unlike patients with coronary artery disease, no two congenital heart patients are exactly alike.”   As the  point man for treating this new generation of cardiovascular patients, Gregg said the MUSC Heart & Vascular Center was ideally positioned to help those who represent the unknown in congenital heart disease care by combining the resources of adult and pediatric cardiology. “As the only place in South Carolina that has the full resources to treat congenital heart disease for pediatric patients, we have a continued opportunity to serve the entire state when those patients grow up, as well as those adults who are already here,” Gregg said.   One of Gregg’s primary goals is not allowing pediatric patients to slip through the follow-up crack once they reach adulthood. Older teens and young adults often seek their own paths, as many a parent knows, and sometimes those paths lead to other parts of the country or world—and away from the cardiologist who has been monitoring their progress for years. By getting them an appropriate referral to a cardiologist wherever they might be going, and emphasizing the importance of continuing follow-up treatment, Gregg hopes to better the continuity of care from pediatric to adult patient. For those patients who don’t roam too far, he desires a swift and easy transition from pediatric to adult services. Part of that process involves outreach to community physicians to avail them to the services Gregg and the Heart & Vascular Center have to offer while enhancing the group’s heart imaging capabilities.   In addition, Gregg cited the spirit of collaboration on the MUSC campus as an effective tool for promoting the best in cardiovascular patient care. “Adult and pediatric cardiology must work closely together, because there is a lot of overlap in services for these patients. Adult congenital heart patients often need the expertise of pediatric surgeons who are familiar with those defects, because it’s so different from other adult cardiac procedures. MUSC is lucky in that we have an adult surgeon, Dr. [Fred] Crawford, who can perform adult cardiothoracic surgeries and congenital heart surgeries; plus pediatric cardiovascular surgeons Drs. [Scott] Bradley and [T.Y.] Hsia, who have a lot of experience operating on congenital heart defects in children who can then take their expertise to adult patients in need,” Gregg said. “It’s all a very collaborative process, and other disciplines like OB [obstetrics], anesthesia, and dentistry are also instrumental in getting our patients the treatment they need.”   No stranger to moving about the country himself, Gregg came to MUSC after working at the University of California, San Francisco. Not entirely new to the area, Gregg lived here for six years before and during high school. A graduate of Porter-Gaud School in Charleston, Gregg was always interested in science, but his undergraduate years at Middleburry College in Vermont sent him down a different path. There he studied comparative literature and classical Greek. Interested in learning more about classical literature, he attended Yale University for a time before deciding to attend medical school at Columbia University in New York. After graduation, he completed his residency at Duke University in North Carolina, and then a fellowship in at the University of California, San Francisco where he specialized in cardiac imaging and adult congenital heart disease. “I was always interested in science. I just got distracted a bit,” he said with a laugh. “Cardiology was appealing to me, because I find the physiology very interesting, and it’s a field where there is a high rate of success in treating patients.” In addition to his specialty in adult congenital heart disease, Gregg sees general adult cardiology patients, with a special interest in patients who have heart valve disease.   A background in basic science research also seems to have prepared Gregg for his sub-specialty role. “Basic science requires that you think of a new idea or novel approach to work on a problem, and this specialty is like that. There is little information out there about the best way to treat adult congenital heart patients, so you have to be more creative and careful in figuring out what to do for each patient,” he explained.   Living in downtown Charleston, Gregg walks his 3-year-old daughter to her school some mornings before walking to his office and clinic in Rutledge Tower. Gregg, his wife Jessica, and daughter are now closer to family here on the East Coast, and he has been pleasantly surprised to run into many of his Duke-era colleagues and friends since returning to the Holy City. When not working, Gregg enjoys boating and cooking for his family by experimenting with new recipes.     Friday, April 13, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.