Hassan’s heart disease interest leads to European competition

Adil Hassan, MD, second-year Internal Medicine resident, was selected to present at the European Society of Cardiology Congress’s 2021 Best Clinical Case Awards Session on Aug 28, 2021.

After completing medical school at the University of Missouri – Kansas City, Hassan joined Internal Medicine’s residency program in 2019. Under the mentorship of Prashob Porayette, MBBS, Hassan has worked in Adult Congenital Heart Disease (ACHD), a medical subspecialty managing adults born with heart defects. 

“Dr. Hassan is a motivated and quick learner,” Porayette, clinical assistant professor in Pediatrics Cardiology, said. “I am very excited and proud of his achievement at the international stage. I wish him the best for many more accolades in the future.”

Hassan’s interest in congenital heart disease began during his pediatric cardiology rotation as a medical student.

“I was able to witness what extraordinary feats we can now accomplish in the context of congenital heart disease,” Hassan said. “An anatomic abnormality that previously had been a death sentence could now be corrected and allow patients to live well into adulthood, whereas previously survival was limited to weeks or months.”

During his oral presentation, Hassan will discuss the symptoms, diagnosis, and treatment of a 24-year-old ACHD patient. The patient presented with shortness of breath during exercise and a significant drop in oxygen saturation. Suspecting the patient’s heart had developed alternative routes of blood flow, the team performed a heart catheterization in which dye is injected into the heart vessels and X-rays are taken to identify any abnormalities.

“During this procedure, we found that she had complete obstruction of drainage from her coronary veins, as the normal opening that these drain through had not developed,” Hassan said. “This, in addition to the collaterals, were all new findings; the atresia was likely present from birth and the collateral circulation developed over time. As a result, her coronary veins were actually using these collateral vessels to drain the heart.” Due to this, the collaterals were not closed as it was unclear what impact redirecting the blood flow would have on the heart muscle.

Unfortunately, the patient continued to experience exercise-induced shortness of breath and oxygen desaturations; the decision was made to block off the two collateral vessels. This was risky because redirecting the drainage can cause high blood pressure in the heart’s veins and subsequent reduction in blood flow to the heart muscle. Fortunately, the patient handled the procedure well and reported her symptoms of shortness of breath had improved.

“This case highlights that even with known congenital heart disease we still discover new findings in adulthood, in this case, findings that significantly change the way we manage our patients,” Hassan said. “Each patient brings a unique anatomy and therefore requires a unique solution.”

Hassan was originally drawn to adult congenital cardiology because of this uniqueness; however, he soon realized that these patients often get less than ideal care. General cardiologists often do not feel comfortable managing the complex anatomy, Hassan said, and pediatric cardiologists do not feel comfortable managing adult comorbidities in the context of congenital heart disease.

“I aim to help fill this care gap so these patients can continue to get the best care available and have a dedicated provider for their lifetime,” Hassan said.

In addition to the oral presentation, Hassan will receive an award certificate, as well as a prize of either €1,000 or €2,000, depending on his competition placement. If successful, Hassan will not have been the first Iowa resident to take a top prize at the ESC Congress. In 2018, then-resident Chris DeZorzi, MD, and Saket Girotra, MBBS, won a best poster award at the meeting.

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