Patricia A. Pellikka, MD, FASE

It is 5:45 PM in Rochester, MN. If I were home, I would have read my last echo and would be digging into my E-mail. But I am in Beijing, China for the 23 ^rd Great Wall International Congress of Cardiology-Asia Pacific Heart Congress 2012 meeting. It is 6:45 AM and we have taken a taxi from the convention center area, which is near the Olympic Village, to the west side of Beijing. As we depart from the taxi, we notice bright stickers cluttering the sidewalk. These offer a phone number for patients to call to sell unused prescription medications. We follow the throngs of people headed the same way: to the Peking University Third Hospital. Peking University Health Science Center is a famous center, the “Harvard” of China, and many seek help from its physicians. The Third Hospital has 1,400 beds and many outpatient areas, including especially large orthopedics and obstetrics sections. The lobby is jammed with people hoping to get appointments today. A large board is illuminated with names of departments and the numbers of available appointments. Traditional Chinese medicine departments, as well as the standard Western subspecialties, are listed. Some areas have already filled all slots, as people have been waiting a couple hours already.

Our guide, Dr. Dali Fan, an alumnus of this medical school, but now associate professor of medicine at UC Davis, organized this tour for our ASE contingent, which consists of Rebecca Hahn, MD, Columbia University; Rhonda Price, ASE Chief Standards Officer; Andrea Van Hoever, ASE Vice President of Research; and me. We are joined by Dr. Cynthia Taub, Montefiore Einstein Center, New York; she is also an alumnus of this medical school, having graduated a few years after Dr. Fan. Both are very familiar with the setting. Dr. Fan was born in this hospital. The son of Peking University professors, he grew up in a nearby apartment. We visited that apartment, a modest third floor dwelling conveniently located on campus. Immunology and physiology texts belonging to his mother and father and family photographs adorned the shelves, indicating strong values of education and family. Drs. Fan and Taub attended medical school here prior to immigrating to the US, where they now practice cardiology. Both are among the leaders of the Chinese American Heart Association (CnAHA).

We visit the outpatient clinics. Although it is still early, many patients have already claimed seats in the waiting areas. In the pediatrics check-in area, parents stand in line, securing appointments for their children to be seen later in the day. Many people are leaving the cashiers’ area with change in hand after paying for appointments. An ATM-like machine offers lab results. We visit the emergency department, where families and patients fill the large waiting room; many have brought blankets for comfort and rest during their wait. A crowded outpatient observation area is next, with a large room filled with gurneys accommodating patients of all ages and various ailments.

We tour the medical school, a large campus with many students. There are 240 students in each year’s class; the basic training is 5 years, with 7 years for a master’s degree and 8 for a doctorate. Admission is highly competitive and is based solely on the results of a three-day long exam taken the first week of July, after completion of high school. Young men and women are enjoying breakfasts of steamed buns and rice porridge before bustling off to their fall classes. They are an intense, vibrant group, and I am reminded of similar scenes at the US campuses attended by my own kids.

We are met by Dr. Xinheng Feng, the director of the echo lab. He warmly extends our tour, showing us the coronary care unit and cardiac stepdown areas. Like that of many US hospitals, the floor of the stepdown unit is marked for the 6 minute walk test. Members of Dr. Feng’s junior faculty are performing echocardiograms on a couple of inpatients; he assists with additional imaging and interpretation. A system of colorful cards by the head of each bed provides background information about the patients: there are “CHF”, “DM”, and a reclining figure indicating risk of decubitus. Dr. Feng shows us the cath lab, where 300 STEMIs are reperfused each year. A procedure has just been completed and the room is rapidly being prepared for the next patient.

Inviting us into his echo lab, Dr. Feng shows us his fleet of modern echo systems. With bedside and outpatient examinations underway, all four ultrasound systems are highly utilized, and days are long. He explains that his record was 206 studies in one day. He is pulled aside to perform an echocardiogram. A girl, about 4 years of age, chats softly with her mother while Dr. Feng studies her coronary arteries. Her diagnosis is Kawasaki disease. Dr. Feng assesses ventricular function, visualizing all segments, and then zooms on the coronary arteries, carefully inspecting them. The next patient has had a cleft mitral valve repaired. Dr. Feng explores the result, identifying 3 jets of mitral regurgitation which nearly defy quantitation. He views the valve from many windows, intent on understanding the mechanism of regurgitation, verifying adequacy of the septal repair, measuring left atrial size according to ASE guidelines, and quietly but obviously contemplating further steps.

ASE guidelines are available here. Thanks to the dedicated organization of ASE member Dr. Feng Xie at University of Nebraska Medical Center, nine of our documents and five guideline posters have been translated into Mandarin by Chinese physicians too numerous to list in this space. More translations will follow. We distributed CDs with the translated guidelines at the joint session of ASE and GW-ICC. The session was packed and the CDs were enthusiastically received.

Enthusiasm for echocardiography and recognition of its tremendous value in patient care are clearly present in China as evidenced by the attendees at the Congress and Dr. Feng and his colleagues at Peking University Third Hospital. My recent travels to India, Paraguay, and now China, remind me that although there are some superficial differences, our underlying interest in using this remarkable tool to understand disease and improve patient care is widespread, and that ASE’s global community has much in common.