The echocardiographers involved in scanning patients with congenital heart disease from foetus to adult make up a relatively small but incredibly important proportion of the national echocardiographers workforce. Dr Saleha Kabir, Physiology Representative for the British Congenital Cardiac Association shares her story and others for Healthcare Science Week.
Due to the nature of the pathologies seen, further training is required to practice to a good level, and specific accreditation in congenital heart disease is now fairly mandated across most centres across the country. Formalised paediatric/congenital training is still not available and those involved in this area have found varied routes in, most starting in adult echocardiography.
The BCCP (British Congenital Cardiac Physiologists) group has been established more formally in recent years to bring together the national expertise within physiologists, to find ways to support one another and also those in smaller units. From the accounts below, you can see that those who work in these areas are incredibly passionate about what they do, and most have had to go through convoluted routes to achieve their aims. Yet it should also highlight that anyone who has an interest in congenital heart disease, need not feel daunted by the prospect of training/working in the area. What should also be heartening is that all of us who work in this field, practice to very high standards and feel incredibly privileged to work with these patients.
My journey towards working as a cardiac physiologist in paediatric cardiology began 35 years ago when I applied for a job as a trainee PMT(physiological measurement technician). What a job title that was! I had no real idea about what the job was, and no Google to check it out, but thankfully have found it to be a varied and rewarding role, particularly since moving to paediatric cardiology.
After seven years in adult cardiology, an opportunity came up to move full time to paediatric cardiology for training in echocardiography. In 1997, I attended a course in congenital echocardiography in Glasgow Sick Kids and gained from the excellent knowledge of Eamon Murtagh, Stuart Lilley and Dr Alan Houston. My time spent in adult cardiology first gave me a good foundation before focusing on congenital heart disease. After a few years, I sat the original BSE congenital echo exam but there was no recertification process available for congenital. A number of years later I transferred that to the EACVI congenital echo certification and have been re-accrediting since then.
I was fortunate to train alongside our fetal cardiology team, mainly with Professor Frank Casey. My involvement in fetal cardiology includes physiologist led clinics.
It is exciting to see the progression within our role as paediatric/congenital cardiac physiologists and the emphasis upon recognised training and standards as we look to the future.
Ms Lorraine Davidson, Paediatric Team Lead Cardiac Physiologist, Belfast Health and Social Care Trust
My journey to congenital accreditation was a bit convoluted and via a long-serving general adult echo role. I gained BSE TTE accreditation in 2012, and worked for a long time at a large level 3 ACHD District General Hospital with a monthly rotational ACHD clinic staffed by ACHD cardiologists from the local level 2 centre in Oxford. I had worked at this centre for a long time, and was the longstanding echo service lead there, but found I was yearning for new clinical challenges. The monthly ACHD echo clinic was always my favourite clinic, I loved the variety of the caseload, and had developed a good relationship with the ACHD cardiologists over the years. I did find that only doing congenital echo once a month really meant I wasn’t able to progress as I wished to, and it was hard to retain the learning from patients with complex pathologies which I didn’t see very regularly. I wanted to train properly in congenital echo, and gain congenital accreditation. I moved to the local Level 2 centre in Oxford in 2021 and have been fortunate enough to have been trained and mentored by the wonderful ACHD cardiologists here, achieving my EACVI accreditation at the end of 2023. I love congenital echo, both the complex clinical scanning and just being involved more generally in service development in this area, and am so excited to see what the future holds!
Ms Catherine Townsend, Cardiac Clinical Scientist in Echocardiography, Oxford University Hospitals NHS Foundation Trust
I began my training in echocardiography whilst completing the STP course at Royal Papworth Hospital. The training here was entirely focused on adults. As part of the STP teaching however we received a one-off lecture about congenital echo. I remember being interested but completely confused and blown away by the upside-down images and pathologies. For my elective, I completed two weeks of the BSE project 'Echo in Africa' and was able to get some exposure to a paediatric screening initiative, with some of my colleagues there picking up some simple congenital lesions. As a result, I started seeking exposure to the ACHD clinics that ran in my Trust, and developed some basic understanding of bicuspid aortic valves, ASDs, VSDs and pulmonary stenosis - nothing too complex but enough to get the ball rolling. After completing my training and obtaining my BSE accreditation, I saw a paediatric echo job opportunity at Great Ormond Street. I was completely intimidated by the possible role and the challenge of becoming a student again, but was willing to drop down a band to learn about complex congenital heart disease. Within this role, I developed my experience and knowledge in dealing with a wide-variety of pathologies and patients to obtain my EACVI CHD accreditation. My move from adult echo to paediatric congenital heart disease felt like a big leap of faith but I've never regretted taking the opportunity - If someone is competent at adult scanning, it's an excellent starting point to start their development in paediatric echo.
Mr Liam Batchelor, Highly specialised Paediatric Cardiac Physiologist, Bristol Royal Hospital for Children
My journey into congenital heart disease started during my degree in Portugal (2007-2011), but it truly unfolded in 2013 during an international placement in Paris, igniting a passion for the field. Relocating to Bristol in 2015 marked a pivotal moment, where I've consistently enhanced my expertise, obtaining the adult BSE and CHD EACVI accreditations and pursuing the HSST in Cardiac Science with specialism in ACHD echo. Now, as the Lead ACHD Echocardiographer at Bristol Heart Institute, I'm dedicated to fostering excellence and strategic development in the amazing ACHD echo landscape. Navigating this field is exceptionally gratifying, especially when contributing to diagnostic insights, educational endeavours, and the privilege of being part of the care journey for patients with incredible life stories.
Mr Gui Rego, Lead Healthcare Scientist in ACHD Echocardiography, University Hospitals Bristol and Weston NHS Foundation Trust
I started working in echocardiography in April 2003 as a British Heart Foundation funded echo trainee at the James Cook University Hospital in Middlesbrough, obtaining my BSE accreditation within 18 months. After 4 years I relocated to London, working at Guy’s and St Thomas’ NHS Foundation Trust working as an Intensive Care Specialist Echocardiographer (50% adult echo/50% intensive care).
My congenital echo journey started in 2012 at the Freeman Hospital (Newcastle upon Tyne Hospitals NHS Foundation Trust) and I have worked in congenital echo full time since 2014. I have EACVI CHD accreditation and am an Associate Lecturer at Newcastle University providing lectures for both the STP and ETP training programmes. I am now Team Lead for the Paediatric and ACHD Echocardiography Team.
Working in a level 1 centre which covers both Paediatrics and ACHD, there is a vast variety of work on a daily basis. I can scan a toddler with a murmur and demonstrate a normal heart, followed by a newborn baby with complex congenital heart disease in the morning paediatric clinic and by the afternoon I could see a 65-year-old with repair congenital heart disease in the ACHD clinic.
I work with a fantastic, supportive team both within the congenital echo team and the wider MDT. All of our consultants are extremely approachable and incredibly supportive of our role and encourage our professional development.
This role can have many challenges however when a child who has been very nervous for their scan walks out of the room saying ‘It is my favourite thing ever!’ gives me great job satisfaction.
Ms Anna Johnson, Lead of Paediatric and ACHD Echocardiography, The Freeman Hospital, Newcastle
My career started fairly late in life, as I obtained my degree in Midwifery at the ripe old age of 33. I thought my career pathway would see me working on the delivery suite or in the community setting, but after a stint in the antenatal clinic I was introduced to the fascinating world of ultrasound. After learning to scan in house, I gained an MSC in Medical ultrasound from the University of the West of England.
As part of my studies I was made aware of the poor antenatal detection rates for fetal congenital heart defects, which led to my interest in improving detection rates within my department and as part of my dissertation I rolled out an in-house cardiac training programme.
I continued working for several years at North Bristol NHS Trust, performing routine antenatal ultrasound screening test such as the 20-week anomaly scan and first trimester combined screening, until I was lucky enough to join the fetal cardiology team at University Hospitals Bristol and Weston NHS Foundation Trust in 2012.
My knowledge and experience as a midwife sonographer has allowed me to embrace fetal echocardiography and the patients. I am currently the lead sonographer for the fetal cardiology service, responsible for the day-to-day delivery of the fetal cardiology service providing tertiary level screening and diagnostic evaluation to maternity/obstetric ultrasound departments across the South West and South Wales region.
I am passionate about training sonographers to improve the antenatal detection of congenital heart defects. I have been actively involved since 2015 in providing specialist fetal cardiac training at local, national and international levels. Firstly, as part of the Public Health England cardiac screening programme and subsequently as a trainer for Tiny Tickers and as part of my fetal cardiology role.
Ms Angela Smith, Lead Fetal Cardiac and Midwife Sonographer, University Hospitals Bristol and Weston NHS Foundation Trust
I graduated in Portugal (Cardiac and Respiratory Physiology BSc) and arrived in England as an adult sonographer, but as there was a huge demand for staff in paediatric echo in Bristol. A good friend of mine worked here so I decided to give it a shot. My first contract was a 3 month maternity leave cover. It was really challenging and very different than I imagined.
I started by doing mostly teenagers and slowly worked towards being independent. I stayed for 1 year to build my skills (in-house training) and I applied for the EACVI paediatric accreditation after a year. After passing the exam I managed to secure a permanent contract and ended up falling in love with it.
It definitely made me a better sonographer and more confident when scanning adults, mainly ACHD. It may sound bad, but I find ‘adult scanning’ boring these days, when compared with paediatrics or ACHD. I have both EACVI paediatric accreditation and BSE adult accreditation.
Currently, I scan paediatric patients exclusively but we do ACHD when we visit peripheral hospitals.
Mr Nuno Duarte, Joint Echocardiography Lead, Bristol Royal Hospital for Children
My career has so far spanned over 20 years, starting as a cardiographer in 2001 in adult cardiology. I soon found a love for paediatric and congenital cardiology. In 2008 I completed my BSc (hons) in Clinical Physiology (cardiology) for which I trained simultaneously in adult and congenital cardiology. After qualification I specialised in paediatric and congenital echocardiography. I worked my way through the grades and I completed my MSc in Advanced Practice (medical ultrasound) during which I was introduced to fetal echocardiography, and gained my EACVI congenital echo accreditation along the way. In 2019 I achieved my STP equivalence in order to start the HSST.
I am now in the final year of my HSST, specialising in fetal and congenital cardiology. In 2022 I was successfully appointed into a Consultant Physiologist post in fetal and congenital. I am now looking forward to what the future holds.
Ms Carla Blunt, Consultant Physiologist in Fetal and Congenital Echocardiography, Leicester Children’s Hospital
I started my career far and away from echocardiography – being a scientist and doing a PhD in molecular biology in cardiac development. But during those four years I did learn lots about cardiac anatomy and development and at the end of it all, I was convinced that bench-side research wasn’t for me and felt that I wanted to work in healthcare. Through happenstance and coincidence, I was able to meet Professor John Chambers for career advice and a short while later found myself as the BHF echo trainee at Guy's and St Thomas' NHS Foundation Trust. I absolutely loved echo and luckily found my years staring at heart sections was not wasted. I earnt my BSE accreditation 15 months after starting my training and have never looked back. My background in cardiac development had always led me towards congenital heart disease so I began to train in ACHD, gaining my EACVI (congenital) accreditation 3 years later. Although ACHD was rewarding in of itself, the occasional unrepaired patients that we saw were the ones that really caught my imagination and I found myself wanting to see more and more of that pathology. A one-year fixed term post came up in the Evelina, so I took the leap from adults to paediatrics. Already having the congenital accreditation under my belt meant that I was familiar in theory with the pathology, but scanning the little ones – that took a little bit more getting used to. However, after only a few months there, I was sure I would never go back to scanning adults full time ever again. Now more than 10 years later with skills such as complex 3D echocardiography and TOE (intraprocedural/operative and diagnostic) as part of my routine work, I am ever grateful for the opportunities that I was given that led me to the very interesting and rewarding role that I now have.
Dr Saleha Kabir, Lead of Paediatrics and Advanced Echocardiography (Paediatrics and ACHD), Evelina London Children’s Hospital
This exciting field provides us with the opportunity to diagnose and follow up both unrepaired and repaired complex congenital heart conditions, often including imaging experience in the catheter labs and cardiac theatres. What I enjoy most is that we get to know many of our patients; being a smaller community and requiring regular close follow up.
My path into congenital echocardiography began in an adult centre with a dedicated ACHD department. This afforded me the opportunity to move to a paediatric role and then return back to what is my true geeky passion: ACHD echo!
A little advice for all adult echocardiographers with even a little interest in congenital echo; contact your local congenital centre or apply for that role you have been considering, even if you don’t think you have enough experience. Our congenital physiology departments throughout the UK are passionate about training and eager to hear from you!
Ms Rebecca Macrae, Clinical Scientist and Lead for ACHD Echocardiography, Bart’s Heart Centre, London
I started out as a physiologist working for Nuffield, doing all sorts of tests for different biological systems, but a large proportion of this involved ECGs and NICE95 ETT treadmill testing. I was encouraged to pursue specialist cardiac physiologist training and came across the STP, for which I was a direct entry applicant. During my time on the programme, alongside meeting peers who are now close friends, who were already working within the field of congenital heart disease, I completed my elective at Great Ormond Street Hospital. It was undertaking this placement that really ignited my interest in pursuing congenital heart disease as a sub-speciality. On completing my training, I joined Bristol Royal Hospital for Children and learnt a great deal whilst in this role, primarily within echocardiography. I am currently based at Liverpool Heart and Chest Hospital in a specialist ACHD echocardiography role which utilizes my background in both adult and paediatric cardiology.
Mr Liam Corbett, Clinical Scientist in ACHD, Liverpool Heart and Chest Hospital NHS Foundation Trust
Having worked in academia and research, I found the scientist training programme as an opportunity to train clinically whilst also furthering my academic qualifications and experience. Following the STP and BSE accreditation, I had the opportunity to join a paediatric and adult congenital team at the Freeman Hospital, Newcastle-Upon-Tyne. Six years later, I've passed further congenital echo accreditation through the EACVI and as an associate lecturer at Newcastle University, offer congenital lectures on the STP programme.
Mr Tom Banks, Clinical Scientist, The Freeman Hospital, Newcastle