Dr. Swaminathan delivering his ASE presidential address at the 30th Annual Scientific Sessions (photo courtesy of ASE).
June 25, 2019 marks a monumental day for the field of anesthesia as Duke Anesthesiology’s Dr. Madhav Swaminathan officially takes his seat as the president of the American Society of Echocardiography (ASE) – the first anesthesiologist elected to serve in this role.
“I’m absolutely honored and privileged. It’s an exciting opportunity and a fantastic feeling to be recognized by your peers,” says Swaminathan, a cardiovascular anesthesiologist, who adds that this leadership role is especially significant because it is outside of his primary specialty. “That is the most heartwarming and gratifying part – that ASE members chose to elect an anesthesiologist to lead the entire organization. This is not only a win for our specialty, but a strong statement on diversity.”
Echocardiography (echo) has traditionally been represented almost exclusively by cardiology since cardiologists are the primary users of echo. According to Swaminathan, anesthesiologists came into the picture much later on, but they have added enough value to echocardiography for cardiologists to feel that this is a good partner to “shake hands with.” He believes that ASE is leading the field in recognizing that diversity has value and is the key to further the growth of the organization.
Dr. Swaminathan (pictured right) with 2018-2019 ASE president, Dr. Jonathan Lindner (photo courtesy of ASE).
“Diversity to ASE means diversity of thought. This society values those who value echocardiography and welcomes those with diverse backgrounds who can think outside of the box like no one else can,” says Swaminathan. The value that he brings to the society is his perspective of perioperative and critical care echo and his ability to attract non-traditional users of echo, whether it’s ER physicians or critical care intensivists, essentially providing the ASE perspective that the field is growing beyond the confines of the echo lab or even the operating room. Cardiovascular anesthesiologists have long regarded their application in advanced intraoperative echo with transesophageal echocardiography (TEE) as a core skill within their subspecialty. “This skill being recognized outside of the domain of cardiac anesthesia, by cardiologists, in the form of selecting a cardiothoracic anesthesiologist as a president, gives us a lot of visibility and speaks volumes to the younger generation of cardiovascular anesthesiologists who have traditionally seen themselves in supporting roles in cardiac surgery. We are not just an opinion in the operating room. We add value to the community of cardiovascular sciences and people are taking notice.”
Joseph P. Mathew, MD, MHSc, MBA, FASE
Jonathan B. Mark, MD
Solomon Aronson, MD
Duke Anesthesiology is a leader in the field of perioperative echocardiography, with early pioneers such as Drs. Solomon Aronson, Jonathan Mark and Joseph Mathew. Aronson is credited for the creation and expansion of the National Board of Echocardiography and was influential in the development of ASE’s Council on Perioperative Echocardiography, which he once led. This month, ASE named him the 2019 Outstanding Achievement in Perioperative Echocardiography Award recipient. “Without him, I would not be here today,” adds Swaminathan. Mark was the 2018 recipient of that prestigious award and was the first chair of the exam committee in perioperative TEE; instrumental in ensuring that there was an exam process for anesthesiologists to be certified in echo by a national board, which helped validate their skills in perioperative echo. Mathew was also one of the early chairs of the Council on Perioperative Echocardiography and is the editor of the leading textbook on perioperative TEE. He, Aronson and Swaminathan have also co-authored several national guidelines on the practice of echo. Swaminathan believes that his ASE presidency represents a golden moment in the recognition of the department’s pioneering efforts and vast contributions. “It puts another feather in the cap.”
Duke University has a rich tradition of institutional history in echocardiography. According to Swaminathan, 2D echo was first developed at Duke in the 1970s by a team of echocardiographers and bioengineers. 3D echo also first came to being here at Duke. Prominent experts like anesthesiologist Dr. Fiona Clements introduced the use of TEE in the operating room at Duke. While Swaminathan is the first ever anesthesiologist to become president of ASE, he is the fourth Duke faculty member to serve in this role, following Drs. Joseph Kisslo, Pamela Douglas and Thomas Ryan. Kisslo helped develop the phased array transducer, is a founding member of ASE, and was largely responsible for the creation of the ASE headquarters in Durham. Douglas was the first woman to serve as an ASE president; she was also the second female to serve as president of the American College of Cardiology.
“The term, ‘first ever anesthesiologist,’ may seem phenomenal, but it comes with a lot of support behind it, so I’m not the only person who should be recognized for this achievement,” says Swaminathan. “I may be the ‘first ever,’ but I did not enable the ‘first ever,’ a lot of other people before me did that. There is absolutely no question that in this election to lead the ASE, there have been a lot of helping hands along the way. I cannot forget that this is the result of that support.”
Swaminathan’s eventual rise to the ASE presidency began back in 1994 when he first touched an echo probe. “It was extremely exciting to see a moving heart in real time. Taking a direct look at the heart through echo was just fascinating. I decided at that time, that this is something that gets my creative juices flowing.” Swaminathan joined Duke Anesthesiology in 2000. His passion for echo, shown through clinical application, teaching, research and writing, was quickly recognized by his mentors, Mathew and Dr. Mark Newman, who encouraged him to follow this path. Swaminathan has dedicated nearly the past 20 years of his career contributing to ASE, serving on its Board of Directors, the Industry Relations Committee, Education Committee, Advocacy Committee and the Scientific Sessions Committee. Notably, he was the first anesthesiologist selected to deliver the prestigious Feigenbaum Lecture at ASE’s Scientific Sessions in 2015. He also served as chairman of both the Membership Committee and the Council on Perioperative Echocardiography – all volunteer efforts.
“It means a great deal to reach the presidency, but it comes after many years of hard work. And, it reflects the fact that contributions are valued in this society regardless of where you come from,” says Swaminathan. “You also have to be given that start. I think my start was given because I demonstrated passion and a willingness to continue learning. You cannot climb this type of ladder unless you really are passionate about the field that you love.”
On June 22, Swaminathan delivered his ASE presidential address. Beginning June 25, Swaminathan’s central theme of his one-year presidency will be the ASE Cares campaign (#ASECares) – creating a caring society among the 17,000 cardiovascular professionals, focusing on the issues of wellness, resilience and burnout. Second, with his platform of diversity, he wants to ensure that the society adapts an outreach program that reaches even the non-traditional echo users throughout the world, including anesthesiologists, critical care physicians, ER doctors, and any other practitioner of cardiovascular ultrasound that isn’t already represented.
Dr. Swaminathan speaking about the first campaign of his presidency, ASE Cares (photo courtesy of ASE).
“Achieving this presidency is a responsibility. It’s not the end, it’s sort of the beginning because just like I have been able to ‘stand on the shoulders of giants,’ I’ve got to make sure to pay it forward. The same effort from my mentors that helped me rise to this position must be carried forward to help someone else. I view my new position as a big responsibility to identify talent and promote that talent as best as possible. It’s good to be the first, but the goal is not to be the last anesthesiologist in this role.”
View the ASE news release announcing Dr. Swaminathan’s presidency.