To Create The Clearest Possible Picture
Five Questions With Catherine Teng, MD, Structural Echocardiographer
We spoke with Catherine Teng, MD, about her experience as a faculty member at Columbia—including her role in expanding interventional cardiology imaging services.
What made you choose to become a doctor?
I don't think there's one single point; I never had that moment that called to me, saying , “You should be a doctor.” Back then, I never really had that moment that called to me, saying, “You should be a doctor.” For me, it started in high school; I was weighing my options, and I think my family encouraged me to take this route. In China, you go straight from high school to med school. So even back then, at a young age, it felt like such a good choice, because you get to have a steady job, help people and contribute to society.
I grew up in China and moved to the States with my extended family. I did my internal medicine residency at Greenwich Hospital, a community hospital affiliated with Yale, as my husband was working in the city. When COVID hit, my husband wanted to move to the south. I matched at the University of Texas at San Antonio, where I served as chief fellow. That’s where I found my passion for imaging. As a result, I pursued a structural imaging fellowship at the Houston Methodist DeBakey Heart & Vascular Center.
But I loved the structural valve team in Columbia, where I can be a dedicated imager. So we moved back to the Northeast, which is a full-circle moment. I feel very fortunate to have this job I love, and I like that I'm helping people with my skills.
Can you tell us a little bit about your clinical role here at Columbia?
I am a structural echocardiographer. Here at Columbia, we have an excellent structural heart team; we do the percutaneous valve repair and replacement. So, my role is to help with screening and provide procedural guidance.
Unlike most open-heart surgery, we're doing cases where we put the new devices in a beating heart, so they're not able to see the heart directly like surgeons do.
So it's very important to have good images to show them exactly where they are and guide their trajectory so they can place the device safely.
We also help with screening valvular disease. We perform them through the surface of the skin or through a transesophageal cardiogram, meaning through the esophagus. Because the esophagus is right next to the heart, we can get very good, thorough pictures that help us answer what's going on with the heart valve and decide what options the patient has.
So I think a lot of people know that imaging is going to happen, but they don't necessarily know how that fits into the procedure.
Can You Walk Us Through How Imaging Is Used in a Valve Procedure?
We are involved from the very beginning—even before the patient is seen.
I should stress that Columbia really does have a unique program. We have a dedicated heart team, as well as dedicated structural imagers focused on supporting the structural team. I don’t think many places in the country are doing things the way we do.
Before the patient even arrives, we review their imaging. Additional imaging studies may be ordered to perform a comprehensive evaluation. By the time the patient sees the cardiologist or surgeon, we’ve already reviewed the imaging, formed an opinion, and started helping shape the plan.
Then we assess the patient. Every week, we have large multidisciplinary meetings where imaging is central to the discussion. We review the echo, the CT, and everything else needed to determine the best path forward.
On the day of the procedure, I’m also involved in guiding the intervention through imaging. For example, we have dedicated imaging just for transcatheter aortic valve replacement or TAVR. We will stand right there with the structural folks and scan the patient, ensuring the valve is in the optimal position for deployment.
We can also use ultrasound to check for complications immediately, if needed. Transcatheter procedures have grown so much over the past 15 years, and even more so in the past five, so we're seeing imaging branch out into all these new areas and really add value.
Afterward, we repeat imaging to assess the valve and look for any complications. We also typically follow these patients yearly.
So imaging is present at every stage of valve care. Our voices are valued, and our opinions are central to decision-making. In conferences and clinical discussions, we can weigh in on the anatomy, the severity of valve disease, and which treatment options make the most sense.
For an imager, that is a dream come true—being able to devote my time to what I love while also helping determine what is best for the patient.
That is a unique aspect of Columbia, and I think it makes this one of the most distinctive programs in the country.
Within the current state of imaging, what are some areas that need to improve?
One major unmet need is broader access to dedicated valve imagers.
This is still a relatively new area, and not every center has the infrastructure for it for various reasons. I feel very fortunate at Columbia, we have a comprehensive team and can perform detailed structural and valvular evaluations. But if you look across the country, they may not have specialized imagers dedicated to this work.
Another unmet need is expanding the use of CT and MRI to assess valvular disease as part of a multimodality approach.
Here, during our weekly valve conferences, the entire heart team—interventionalists, surgeons, and imagers—sits together to review patients. We review the echocardiogram, CT, and other imaging studies, and evaluate them together to develop a comprehensive understanding of the patient.
Transcatheter procedures have grown so much over the past 15 years, and even more so in the past five, so we're seeing imaging branch out into all these new areas and really add value. But it’s not available everywhere, and there is definitely a growing national need for structural imagers, cardiac CT expertise, and advanced cardiac imaging more broadly.
Are there any new advances you’re looking forward to in the imaging world?
That’s one of the reasons I love imaging—it’s such a fast-growing field. There’s always something new. For every part of the valve, new technologies and techniques are emerging, and that’s incredibly exciting to me.
For example, in the past, replacing the mitral valve required open-heart surgery. Surgeons had to open the chest, stop the heart, and implant the valve surgically.
Now, we have clinical trial options and commercial options that allow us to avoid surgery altogether. With transcatheter mitral valve replacement, or TMVR, we can often place the valve through the groin, and the procedure itself does not take very long.
There are also many new mitral valve devices in development, and some have recently received FDA approval.
What’s also exciting is that these procedures rely heavily on imaging. We use not only ultrasound and transesophageal echocardiography, but also CT and MRI. Imaging is central to everything we do. That’s a big part of what excites me, and I’m thrilled to contribute to that work here.
I’m especially hopeful about advances that could expand access to TMVR for patients who currently are not good candidates.
One of the major limitations of TMVR is that the anatomy has to be right. Some patients fail screening because of the risk of LVOT obstruction—left ventricular outflow tract obstruction. In other patients, the anatomy is especially challenging because of heavy calcium in the mitral annulus, which we call mitral annular calcification.
For those patients, it can be very difficult to safely place a valve, especially when they also have significant comorbidities or other anatomic issues. I’m hoping we eventually develop valves that can reduce the risk of LVOT obstruction, making the procedure safer and more widely applicable. Ideally, we would also have a valve that behaves more like a native mitral valve—something that supports more physiologic flow and has excellent durability over time.
If technologies such as 3D printing or other design advances can help us get there, that could make a huge difference for patients by improving access, safety, and long-term valve performance.
And of course, everyone is talking about AI right now, so it’s impossible to ignore. There’s a lot of promising research on imaging, and here at Columbia, we are involved in some of it as well. Rebecca Hahn, MD, Director of Interventional Echocardiography at the Structural Heart and Valve Center, has been leading our research work. That said, we haven’t refined it enough to fully trust it on its own. So for now, even when those tools are available, we are still manually reviewing and calculating many things ourselves.
Bonus Question: When you’re not a doctor, what do you like to do?
My life outside of work is probably not as glamorous as some people’s because I have three children, and one of them just turned four months old today. So a lot of my time off revolves around my kids.
I love spending time with them, even in the everyday chaos and just being present in that noisy, busy family life. My husband and I joke that we’re zookeepers right now. At any given moment, someone is either yelling or crying. But it’s a good time, and I really enjoy it.
I also love drawing and painting with them. In some ways, that feels similar to what I do at work—trying to create the clearest possible image. There’s something artistic about that, and I love sharing it with my children.
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