Heroes of health care
Dr. Ruben Acherman Pediatric cardiologist
With a big love for little ones, Dr. Acherman created a program to diagnose the valley’s tiniest hearts
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QUOTE FILE •O n teaming up with valley perinatologists at their offices to monitor high-risk pregnancies: “That’s the way it should be done.” •O n how his clients talked him into performing his first prenatal balloon dilatation of an aortic valve: “They said, ‘Listen, we want our baby to be your first baby for that balloon dilatation. We have all of our confidence in you and we want to have it here.’” •O n the satisfactions of his profession: “It’s fantastic. It’s beautiful. This profession is beautiful.”
88 | Desert
r. Ruben Acherman had been the Director of Fetal Cardiology at the Children’s Hospital Los Angeles for eight years when he was asked to join the Children’s Heart Center Nevada. It wasn’t exactly a tough sell. There were a few things that attracted him to this particular group practice. According to Acherman, the doctors at the Children’s Heart Center (childrensheartcenter.com) are more concerned with caring for children with congenital heart disease than they are with their patients’ insurance or ability to pay. In fact, they’re so committed that they reach into their own pockets to fund their clinical research. “That caught my attention. Otherwise, I wouldn’t have even come for a visit,” says Acherman, whose desire to specialize in pediatric cardiology brought him from South America, where the specialty didn’t exist in the mid ’80s, to the United States. Here, he completed a second residency in pediatrics at the University of Southern California Medical Center. Then he completed a cardiology fellowship at the Hospital for Sick Children in Toronto, Canada before heading to Los Angeles. When Acherman made that first visit to Vegas, 11 years ago, only 25 percent of the valley’s serious congenital heart disease cases were being diagnosed prenatally. Now, thanks in part to the unique fetal assessment program he’s instituted through Children’s Heart Center, that number has shot up to nearly 75 percent. It works like this. Seven days a week, Acherman and four other doctors from the Children’s Heart Center travel throughout Las Vegas, meeting patients and performing fetal echocardiographic evaluations (a sort of ultrasound) at their perinatologists’ offices (specialists in high-risk pregnancies). That way, doctors in both specialties can speak simultaneously to the mothers about their babies’ heart conditions. “Because in my view, that’s the way it should be done. But, financially, it’s very inefficient and that’s why not very
Companion | AUGUST 2013
many people do it,” Acherman says. Other programs are apt to require the patients to come to them and may only offer fetal evaluations once a week, since fetal cardiology doesn’t pay particularly well. At the very least, diagnosis of a baby’s heart problems before birth allows a family to be better prepared, often preventing further complications. For instance, a mother from Mesquite will know to deliver in Las Vegas, where her baby can be whisked to a neonatal intensive care unit to be immediately treated. Acherman’s program also has nurses accompany parents to the hospitals, in advance of births, to introduce them to the intensive care unit setting, answering questions and allowing them to be more mentally prepared for the experience. Psychologists are also made available, as are social workers to help families to organize and cope with the logistics of a long hospital stay. Early fetal diagnosis also allows doctors to immediately do what can be done — sometimes while the baby is still in the womb. In the case of a fetus with cardiac arrhythmia, a mother can be prescribed medication to treat her baby’s heart. Also, in Las Vegas, catheters can now be inserted prenatally. “If one of the (aortic) valves is too narrow, you may go in through the mother’s tummy with needles, put (in) a little catheter with a little balloon and open the valve,” Acherman explains. The procedure had never been done in Nevada until two years ago. Acherman remembers the case. Having diagnosed a fetus of 24 weeks gestation with a “very sick aortic valve,” he told the parents that he intended to send them elsewhere to receive treatment because, while the center was preparing to do its first, it hadn’t performed any yet. “They called me and wanted to talk to me a couple of days later. They said, ‘Listen, we want our baby to be your first baby for that balloon dilatation. We have all of our confidence in you and we want to have it here.’” Acherman beams as he recalls the compliment — and the results. Today, his patient is a healthy toddler who the good doctor says you’d never know was once a very sick baby. Children’s Heart Center has since become one of only eight centers in the country to perform a prenatal balloon dilatation of a narrow aortic valve. Furthermore, it’s only been performed eight times on the west coast. “It’s fantastic,” says Acherman. “It’s beautiful. This profession is beautiful.”