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Focus on Gautam Singh, MD

Gautam Singh, MD, is a pediatric cardiologist, co-director of the echocardiography laboratory and director of non-invasive imaging research, as well as preventive cardiology. His areas of interest include non-invasive cardiac imaging including echocardiograohy and cardiac MRI, fetal cardiology, congenital heart diseases, preventive cardiology and obesity in children.

Dr. Singh sees patients at St. Louis Children’s Hospital, One Children’s Place.

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What happened in your course of schooling to influence you to choose your specialty?

I went to medical school in India where there were a lot of children suffering from malnutrition and tropical diseases. From time-to-time I would see children born with a heart defect. These children didn’t have access to cardiac care and this resulted in many complications -- 70-80% of them needed heart surgery within the first year or two of life and there was no access for it. At that time we didn’t know much about children born with heart conditions.

I was always interested in adult cardiology, but it was my encounter with sick children with heart defects in the emergency room in India that prompted me to choose pediatric cardiology. I had the opportunity to move to England for my first residency and fellowship in pediatric cardiology at the Hospital for Sick Children in London – a world-class institution.

What brought you to Washington University?

It was a long journey. I came to the United States from England and repeated my fellowship and residency in Philadelphia. I moved to St. Louis and worked at St. Louis University/ Cardinal Glennon Children’s Hospital for about seven years.

In 2003, I was approached by Washington University and offered the opportunity which allowed me to devote some time to clinical research, as well as pursue my passion in non-invasive cardiac imaging. So I made a mid-career move and that is the reason I am here.

Which aspect of your practice is most interesting?

I enjoy interacting with my patients and patients’ families and seeing the child get better. Children have remarkable capacity to recover if the correct treatment is given in time.
Unfortunately, congenital heart defects are such that in most cases they cannot be cured. But we can certainly repair them -- improving heart function and the health of the children.

The first open heart surgery was performed in 1954. At that time there was no heart-lung machine. A parent or another donor was used for cross-circulation and oxygenator for the patient during the surgery. It was never adopted for widespread use because the procedure posed a serious risk to the donor, but it did pave the way for the open heart surgery era.

In 1955, C. Walton Lillehei, MD, MS, PhD, and later John Kirklin, MD, helped introduce the first clinically successful bubble oxygenator that remained the standard for extracorporeal circulation until the late 1970s.

Before these advances, children born with a major heart defect usually had short life spans. Today this is a completely different picture -- the majority of these children now survive and go on to lead healthy and productive lives. This is most rewarding.

What type of research are you involved in?

My area of research interest is cardiac mechanics. I examine how the heart works in different cardiac defects or hemodynamic situations and conditions. I also study cardiac mechanics and cardiac dysfunction in children with cardio-metabolic disorder, as well.

Are you finding as the overall weight of children increases, you are seeing more heart problems?

Yes. We are seeing obese children with adult problems such as high blood pressure, high cholesterol and early stages of diabetes. It’s likely that some of those children may develop heart disease during their adolescence and young adulthood.

We are finding a high level of insulin in most obese children, and this might be a factor in abnormal heart function. We are trying to understand why the heart function is abnormal in obese children. If someone is overweight and has adult-onset heart disease, it didn’t start suddenly when he or she became an adult, it started during childhood. This is alarming.

If we can recognize the mechanism of heart dysfunction, this may help us intervene earlier and prevent adult-onset heart disease in children.

Is there any other research you would like to talk about?

Yes, we are doing research related to cardiac mechanics in children who are born with only one functioning pumping chamber of the heart. The heart has four chambers – two lower pumping chambers and two upper chambers, which are the receiving chambers.

The children that are born with only one pumping chamber go through multi-staged reconstructive cardiac surgeries to make that single pumping chamber behave and work like two pumping chambers.

We are trying to understand the function of that single pumping chamber in these children and how it works. This is a new area of research and hopefully in a few years we will have some answers.

Where are you from?

I’m originally from India, but after finishing medical school and internship, I went to England to do my residency and fellowship. I moved to the United States and repeated my residency and fellowship, because of the requirement for medical practice.

My mother, brothers and sisters and extended family live in India. I miss my family, but we stay in touch all the time.

Is there a particular award or achievement that is most gratifying?

What is most gratifying is the parent’s or patient’s appreciation that we did the best of our ability to take care of the patient. I have a plaque on the wall in my office that was a gift from one of my patients. This child was diagnosed with abnormal rhythm of the heart, which was rather serious. After he was born, we took care of him. I like the line that says “. . . the world may be different because I was important in the life of a CHILD”.

I also enjoy teaching. I received the Angelo M. DiGeorge Outstanding Teacher Award during my fellowship at St. Christopher’s Hospital for Children in Philadelphia, PA.
Wall plaque from one of Dr. Singh's patients



What is the best advice you’ve received?

I can’t recall one specific piece of advice, but one thought has guided me. It’s to do your best work and don’t worry about any return or reward. There are many situations in the practice of medicine where it’s difficult to treat patients, especially children. We do our best for them and if they get better, that’s the reward we cherish most.

My professor of medicine in India said “Just keep working. Be your best and work for your patients.” That’s what I do. It doesn’t matter whether somebody sees it or not, but if my patient gets better, that’s the best reward.

If you weren’t a doctor what would you be doing?

That’s a difficult question. I enjoy understanding the science or physics behind something, so I could have been a physicist.

I also enjoy painting nature’s scenery. I’ve not painted for the last thirty years -- since I’ve been in medicine. If I could, I would love to live in nature and paint – it’s very calming.

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Copyright 2013 Washington University School of Medicine