35 Year Jubilee
Keeping the Image Sharp
Have you heard this one?
The past, the present and the future walked into a bar. It was tense.
David Forst, our witty and affable master of ceremonies, chose to craft his one-liners on the theme of back to the future, and proved he was acutely aware of the historical timeframe as he opened the celebration of the thirty-fifth anniversary of the Michigan Society for Echocardiography on April 8, 2016. Acknowledging the historic setting in the Henry Ford Museum, which commemorates the inspiration and genius behind the birth of the auto industry, David introduced the father of echocardiography, Dr. Harvey Feigenbaum, to a rapt audience of physicians, sonographers and guests. Looking and acting younger than ever, Dr. Feigenbaum led us through a fascinating journey that showed M-mode echo emerge from a combination of good luck, fortuitous timing, and inspired persistence. The pioneers in the field struggled against primitive technology, professional skepticism and arrogance, and publication bias. It was an uplifting story.
Harvey Feigenbaum, MD
A Lesson in the Humanities
Paradoxically, in the midst of the dazzling growth of technological advances and evidence based guidelines, the visionary MSE program planning committee elected to weave a broad view of history, clinical anecdotes, and humanitarian and global perspectives throughout an academic Saturday program fully grounded in scientific rigor.
Dr. William Armstrong began with a nod to the first echocardiographic demonstration of pericardial effusion by Harvey Feigenbaum in 1965, and then pulled the lever on the time machine to take us back nearly two millennia before that, to Pliny in 79 AD. Apparently these “Hairy hearts of hoary heroes” were victims of hemorrhagic pericarditis, a consequence of multiple blows to the precordium, sustained as an occupational hazard of the UFC Unloaded warriors of their time. Bill’s romp through history wove historical 17th century accounts of tamponade and constriction with pearls for contemporary echo diagnosis.
David Adams, RCS, RDCS, etc., provided the most touching and inspirational remarks in his two presentations. First he told of his experiences in humanitarian medical missions centered on cardiac ultrasonography. It is doubtful that any sonographers in the USA can match his experience with rheumatic heart disease. It was a long Saturday program, but very few members of the audience left early, since most hung in to hear about mentorship in “Echoes From my Mother,” a heartfelt amalgam of attributes to his mother, personal reminiscences, and everyday wisdom for the busy sonographer. Gerald Cohen added to the spirit of mentorship by describing novel software to maintain excellence in the echo lab. How does he always make it look so easy?
”My Longest Case” wasn’t so much a venture into humanism as it was a means to expose Felix Rogers as firmly entered into his anecdotage. His rambling tale of an erstwhile football player turned garage-band rocker did blend elements of the evolution of cardiac imaging with a 36-year clinical course of a patient with hypertrophic cardiomyopathy.
David Adams, RCS, RDCS
Keeping the Image Sharp
So much for the perspective of warm and fuzzy. How do we keep the image sharp, as advertised in the title for the symposium of the 35-year jubilee? Answer: by smart programming, tightly coordinated symposia, state of the art lectures and a glimpse to the future with multi modality and 3 dimensional imaging. Of course, it helps to bring in some of the nation's top experts to supplement a strong, Michigan-based panel of speakers.
First on the ice was full-time hockey devotee Allan Klein from the Cleveland Clinic, facing off with the update of the ASE guidelines on diastolic function. To his credit, Dr. Klein seemed sincere as he presented the new algorithms as a “simplification” of the 2009 guidelines. His abundant case examples did provide a realistic way to tread the pathways and emerge with some insight to the process.
A sidebar to the presentations by James Thomas, MD, was how he got to the Motor City. His flight from Cleveland was grounded by a snowstorm, so he commandeered a late vintage Lincoln Town Car to make a white- knuckle journey that morning. If there were any doubts about the past president of the American Society of Echocardiography, and his traits of persistence and endurance, this should have dissipated them, especially since his two presentations were given back-to-back, so he could make it to Chicago that same night for an American Heart Association ball.
It turns out that systology is every bit as complex as diastology, after factoring in strain, 3D volumes and ejection fraction. Meanwhile, Dr. Thomas took us back to the future of cardiac valves with his elegant survey of pathophysiology, Doppler assessment and clinical correlation. His tagline for the surgical treatment of functional mitral regurgitation may have been conceived in the back seat of that town car en route to Dearborn: “A good replacement is better than a bad repair.”
James Thomas, MD
The Work Begins
Please remember that Michigan was the national thought leader when it came to applying guidelines to practice. In that spirit, Karthik Ananth coordinated a fast-paced mini-symposium on cardiac intervention to provide us with up-to-the-minute information about the application of the latest approaches to the imaging perspective on percutaneous mitral valve repair (by Dr. Luis Afonso), closure of the left atrial appendage (by David Langholz, MD) and treatment of paravalvular leaks (by Dr. Ananth).
Luis Afonso again proved himself to be the master of the sophisticated case presentation. During our lunch break, he presented at least 10 cases of unusual, fascinating or illuminating conditions. In the world of art, these would be like etchings- detailed, intricate, personal presentations, as if the patient were a jewel in a case.
The advanced imaging team took the stage for a convincing show in early afternoon. Allan Klein was back up, this time capitalizing on rapidly emerging research on multimodality imaging of the pericardium. Past MSE president Michael Gallagher followed with TAVR imaging, proving once again his mastery of nuance and relevant details. Richard Humes, always the illuminating master of the world of pediatrics, spoke of the use of advanced techniques to add the third dimension to the assessment of patients with congenital heart disease. Rounding out the afternoon session on the practical application of advanced imaging to everyday clinical problems, Dr. Langholz returned to the dais to bolster the role of the cardiologist in the management of cancer patients who are taking a potentially cardio toxic drug.
Make It So
While it only takes a village to raise a child, can you imagine what it takes to build an echo society like the MSE and then to put on an elaborate jubilee celebration and topnotch educational program? The first ingredient is a core group of dedicated sonographers and physicians who could stake out an organization based on a far-field vision, and imbue it with a spirit of inclusion and good humor. The second component is the continuity of this core group with the incorporation of fresh young talent on a regular basis. Fortunately, the collegial spirit that pervades cardiology in Michigan is a statewide phenomenon, which provides a rich talent pool to develop a complex organization.
During the afternoon educational session, the MSE president, Luis Afonso, MD, took a few minutes to present lifetime achievement awards to Karthik Ananth, MD and to Kathleen Shibley Micciche, RDCS. Karthik served as president of the MSE and was program chair on several occasions. Kathy performed as secretary to the society with unprecedented energy and enthusiasm.
The society stands in continuing appreciation to its founding president, Andrew Hauser, MD, whose prophetic vision, organizational savvy and kindness have left permanent marks on the MSE as one of America’s premier local echo societies. David Forst, MD, is in a class of his own, in the best sense of the term. His inexhaustible zeal for this event, his multiple contacts on a national and statewide level, and his relentless attention to detail engendered this remarkable achievement. It is fair to say that he was assisted by the best possible planning committee, who tolerated his exploitation of their meetings as a testing ground for his jokes, not every one of the caliber used in his speech Friday night. And, all of us are in debt to Diane Drago and her team for superb technical and organizational support.
Dr. Allan Klein presented the MSE with a commemorative plaque on behalf of the American Society of Echocardiography. Just as the winners of the Stanley Cup Championship take the trophy with them around town, Dr. David Forst took the plaque on a joy ride. He is shown here in Pleasant Ridge.
David Forst, MD
Submitted by Felix Rogers, DO, FASE
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