Perspectives and Articles

As a senior level physician in the field of pediatric cardiology, I often wonder how life would be if I weren't a pediatric cardiologist or even a doctor...

As part of my profession, I take care of incredibly sick newborns, teens and even adults. Even pregnant women with fetuses with heart defects. I am with the family when they are at their most vulnerable.

My training and experience allow me to enter their space gently and attempt to guide them in the correct direction. Then ofcourse my expert surgical, interventional cardiology, intensive care and anesthesia colleagues take over. Up comes my role again, once the surgery is done and dusted. To take care of the growing young one, to answer vexing questions of the parents (can he be given ghee/butter? Can she go for Karate classes? Can he go for overnight picnic? Can she ever bear a pregnancy? Can he work in the fields...) and to reassure them that I will be by their side for as long as I can. It is a profound privilege to provide this care and to witness the resilience of these young patients and their families.

This is what defines me, a pediatric cardiologist: a calling not only built on skill and training, but also on the unwavering belief that every child deserves a chance-not just to survive, but to thrive. Undoubtedly, the continuation of my work depends on support, collaboration, and a shared commitment amongst a diverse group of professionals, all striving to make a difference.

So would I think myself as any less if I were an engineer or a teacher or housewife or an accountant? The answer is a clear No. As an engineer, I would take pride in my work; I would celebrate when a code runs right, when the bridge is opened up for the public or a satellite is launched into space because I was a cog in that wheel. As a teacher, it would bring tears in my eyes when a pupil moves up from 40 to 80 marks with my guidance; when a former pupil finds me and comes to say thank you Maam; or when the civic sense of a pupil's family improves because of what I taught in class. You see, as a housewife I will be running the family; I would be a multi tasker, a giver, a do-er, a shoulder to cry on. The accountant me would smile to myself looking at the rows of numbers in my excel sheet; would rub my hands in glee when an accounting project finishing before time, when the budget shows a surplus...

So are all professions equal? No, I don't think so. However, the folks in any profession are equally contented if they are in it out of their own free will and passion drives them. Free Will and Passion. There! I said it: Take pride in what you do- Do the best job ever- and sleep in peace at night.

That is what matters to me.

It’s often said that truly fulfilled doctors sacrifice everything at work, even family life. I respectfully disagree.

I feel joyful going to work, eager to apply my skills to help children with congenital heart defects. The friendships with patients and their families, the trust they place in our team to heal their children, are my strength.

Each day brings the fulfillment of revealing the mysteries of the heart through echocardiography, counseling hopeful families, and helping patients recover and live vibrant lives - returning to school, sports, and joyful normal childhoods.

Yet, the job carries its hardships. Seeing a patient's condition worsen, delivering devastating news, and mourning losses are inevitably part of the work. These moments weigh heavily on all of us, yet we push forward, honoring those who didn’t survive by renewing our commitment to care.

Balancing roles - as doctor, mother, wife, daughter, and friend - is a constant juggling act. Still, I find joy and strength in this multifaceted life.

As the year ends, I am grateful for my team and the privilege to serve families with care. To those on similar journeys, may you find kindness, patience, and hope.

Season's greetings and blessings to all.

Dr Swati Garekar
American Board Certified (pediatric cardiology)
Consultant Pediatric Cardiologist, Fortis Hospital Mulund

Congenital heart defects (CHD) are the most common birth defects and can adversely impact quality of life if left untreated. Diagnosis and treatment at the correct time is the right step towards an excellent outcome. Since the first successful open-heart surgery on September 2, 1952, done on a 3-year-old boy with a ventricular septal defect (VSD) at the University of Minnesota, significant advances have been achieved.

However, challenges remain with implantation of valves or conduits for replacing defective or missing parts of the heart. These replacements have several drawbacks such as the need for lifetime anticoagulants, risk of endocarditis, calcification over time, and size mismatch as the child grows.

Another challenge lies with complex heart defects that require staged surgeries; the long-term concern is the pumping ability of the heart’s ventricle. Can regenerative medicine and stem cell therapy help?

Regenerative medicine endeavors include tissue engineering - applying tissue-engineered conduits, valves, and patches, including chemically treated homografts and xenografts. The future hints at scaffolds acting as temporary structures that provide a ‘bed’ for native tissue growth, eventually absorbed by the body.

Stem cell therapy hopes to enable repair and regeneration of heart parts. Stem cells, derived from umbilical cord, bone marrow, or heart biopsy, can be injected into the coronaries or myocardium.

Numerous clinical trials are ongoing internationally, including the TICAP trial (trans coronary infusion of cardiac progenitor cells in single ventricle patients) and the PERSEUS trial for univentricular heart disease. These studies indicate safety, feasibility, and some improvement in ventricular function and growth.

India's regulations via ICMR provide guidelines for ethical stem cell research and evidence-based uses. While stem cell therapy is standard for blood cancers and applying CAR-T therapy for certain lymphomas is recent, usage in CHD remains limited to clinical trials, with none ongoing currently in India.