Expert Voices: Meet the woman leading one of the country’s top congenital heart programs

Dr. Kristine J. Guleserian has devoted her life to healing hearts and has marked her name in the history books while doing so. The board-certified congenital heart surgeon became the first woman in the United States to lead a congenital heart surgery program when she was named Congenital Heart Surgery Program Director at Medical City Children’s Hospital in Dallas in 2019. Dr. Guleserian brings a wealth of knowledge and forward-thinking to the role.

With more than 20 years of experience caring for neonates, infants, children and adults with congenital heart defects, Dr. Guleserian also holds various leadership roles with organizations such as the American Association for Thoracic Surgery, Society of Thoracic Surgeons and Congenital Heart Surgeons Society. She was named a Top Doctor by U.S. News & World Report and made headlines for performing a heart transplant on what was, at the time, the world’s smallest transplant recipient – a five-pound newborn in 2007.

Dr. Guleserian was introduced to the world of hospitals, heart surgeons and cardiologists at an early age when her younger brother was diagnosed with a congenital heart defect (CHD) known as Tetralogy of Fallot, affecting blood flow through his heart and out to the rest of his body. He was one of the so-called “blue babies.” While she was only four years old at the time, her brother’s CHD diagnosis made a significant impact on her destined career path.

“It was at a time when CHD surgery was in its infancy,” Dr. Guleserian said. “Conversations that physicians had with parents at the time were very different in terms of outcomes. The chance of survival was close to 50% for the type of operation my brother went through. Today when I meet with families, whether during their pre or postnatal consultation, I counsel them that survival for babies with that very same CHD is greater than 99%. We can also do the operation through a ‘mini sternotomy’ incision (about ½ the size of the traditional incision).”

Dr. Guleserian’s upbringing not only opened her eyes to the field of medicine but also fueled her passion for increasing gender representation in cardiothoracic and congenital heart surgery, a historically male-dominated field of medicine. Starting in the 7^th grade, she attended The Winsor School of Boston, an all-girls school where she recalls seeing women in all leadership roles from editor of the school newspaper to captains of the sports teams to class president. “I was surrounded by female leaders throughout my education,” Dr. Guleserian said. “For me, there wasn’t anything I thought a woman couldn’t do.”

Dr. Guleserian was inspired to join the more than 45,000 active and affiliated physicians across HCA Healthcare thanks to one simple word: opportunity. Since stepping into the role of director of the congenital heart surgery program, which is part of the Medical City Children’s Hospital Heart Center, Dr. Guleserian was afforded the opportunity to build a “dream team” of surgeons, cardiologists, cardiac intensivists, anesthesiologists and support staff who embody the qualities and skills she looks for in colleagues. As for the many team members she recruited along the way, the majority happen to be women.

“It’s like fantasy football. You just pick people who you would dream to work with,” Dr. Guleserian told D Magazine. “You build a team with all the best people, the most talented and the ones who have the best bedside manner and personality.”

As more women enroll in medical school, Dr. Guleserian hopes she will be able to offer her experiences, knowledge and mentorship to the next generation of female surgeons. “When I was going through my surgical training, it struck me that there were so few women in the most challenging surgical subspecialties,” Dr. Guleserian explained. “It just seemed natural for me – since I didn’t have many female mentors – to become one for the next generation.”

Dr. Guleserian’s advice for the next-gen?

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What are congenital heart defects?

Congenital heart defects (CHD) are malformations in the heart’s structure when a baby is born. They are the most common type of birth defect affecting approximately one in 100 births every year in the United States.

CHDs can vary from mild, such as a small hole in the heart, to complex, requiring surgery shortly after birth. Of the children born with congenital heart defects, about 25% have critical CHD requiring surgery or treatment within the first year of life.

Dr. Guleserian’s team of physicians at the Medical City Children’s Hospital Heart Center, which includes collaboration between congenital heart surgeons and interventional cardiologists in the cardiac catheterization lab, offers hybrid repair or palliation of all forms of congenital heart disease. These conditions include:

• Aortic arch defects
• Atrial septal defect (ASD)
• Coarctation of the aorta (CoA)
• Complete atrioventricular canal defect (CAVC)
• Transposition of the great arteries (dextro-transposition of the great arteries, d-TGA)
• Ebstein’s anomaly
• Hypoplastic left heart syndrome (HLHS)
• Patent ductus arteriosus (PDA)
• Pulmonary atresia
• Pulmonary valve stenosis
• Single ventricle defects
• Tetralogy of Fallot
• Total anomalous pulmonary venous connection (TAPVC)
• Tricuspid atresia
• Truncus arteriosus
• Valve defects
• Ventricular septal defect (VSD)

The Heart Center is supported by the hospital’s 108-bed level IV neonatal intensive care unit (NICU), which is the largest in North Texas. It takes care of premature and low-birthweight babies and those with conditions such as congenital heart disease.

“The good news is that many babies diagnosed with congenital heart disease go on to live long and completely healthy lives,” notes Dr. Guleserian. “The skill of the surgeon correcting the heart defect and the medical team providing care for the patient is incredibly important for a successful recovery.”

How are congenital heart defects diagnosed, treated and managed?

Some CHDs can be diagnosed during pregnancy using a special type of ultrasound, called a fetal echocardiogram, to create pictures of the developing baby’s heart so they can evaluate its structure and function. However, other CHDs are not detected until after birth. The signs and symptoms can vary depending on the type and severity of the particular defect.

The type of treatment depends on which type of congenital heart defect a patient has and how serious it is. Some CHDs will get better over time and do not require treatment, however other CHDs require surgery. If surgery is believed to be the best treatment option, experts like Dr. Guleserian and her multidisciplinary team — consisting of congenital heart surgeons, interventional cardiologists, anesthesiologists, cardiologists, neonatologists, cardiac advanced nurse practitioners and cardiac nurses — work as a unit to:

• Repair common congenital heart defects, such as coarctation of the aorta, ventricular septal defects (VSD), tetralogy of Fallot (TOF) and atrioventricular canal defects (ACDVs)
• Repair complex defects, such as double outlet right ventricle (DORV), transposition of the great arteries (TGA), hypoplastic left heart syndrome (HLHS) and many more unusual defects
• Replace or repair heart valves

The Medical City Children’s Hospital Heart Center has treated patients from more than 125 countries. Connected to Medical City Dallas, it is the only facility in the region that provides care for mothers before and after delivery, as well as for babies with congenital heart defects, all under the same roof. The center also works closely with the hospital’s Maternal Fetal Institute, which provides specialized care for mothers carrying a baby with a congenital anomaly, including those who may require surgery before birth.

When it’s time to go home from the hospital, Dr. Guleserian and her team encourage parents to let their child get back to being a kid. The hospital also provides all patients with important ongoing care information from their cardiologists, and their congenital heart surgeon personally follows up with their pediatrician.

Some babies who are born with more complex heart conditions, such as hypoplastic left heart syndrome or other single ventricle defects, are more fragile when they are discharged from the hospital and require additional surgeries.

The hospital supports these patients through a continuous outpatient monitoring program known as Hearts at Home. This unique program has taken monitoring one step further, including weekly scheduled video visits with the patient and family in their home, daily remote patient monitoring via an iPad, and 24/7-hour access to a cardiac intensive care unit nurse practitioner.

Families are sent home with:

• An iPad for remote monitoring and video visits with the care team
• A pulse oximeter to monitor their baby’s blood-oxygen levels
• A scale to keep track of the child’s weight, which can indicate changes in their condition

In addition to being monitored by your cardiologist, your baby will be followed daily by an advanced nurse practitioner who will be alerted to any changes that may warrant you visiting your pediatrician or cardiologist.

With a focus on ensuring the best outcomes, Dr. Guleserian’s highly skilled team is constantly driven by the progress their patients make – whether it is thriving after only one surgical procedure or achieving milestones through advanced surgical strategies and techniques. 

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What are your hopes for the future of congenital heart defect treatment?

“My hope for the future is that we continue to advance the field by developing less invasive surgical and procedural techniques that would help our patients get back to being kids sooner and eliminate the need for repeat operations,” Dr. Guleserian said. “The field also has the opportunity to advance in-utero (or fetal) procedures, which treat a baby’s condition before they’re born. The final evolution would be advances in genetic interventions so that we may one day prevent CHD from developing at all, eliminating the need for any postnatal intervention.”