Five Questions with Phanthaphan Sureeyathanaphat, MD, Interventional Echocardiographer
We spoke with Phanthaphan Sureeyathanaphat, MD, about her experience as a faculty member at Columbia—including her role as an interventional echocardiographer.
What Made You Want to Become a Doctor?
I’m from Thailand, and I lived there for almost my whole life. I just arrived here in New York about a year ago. I grew up in a middle-class family. My dad was in accounting, and my mom was a primary school teacher. I have two sisters, and no one in my family is a doctor.
In my culture, there is a strong expectation that if you are a student and perform very well academically, people expect you to become a doctor. Medicine is seen as a stable career, you get respect from other people, and it’s also a career where you get a chance to help people.
I did pretty well in high school, and at that point I was actually interested in computer engineering as well. I had to choose between medicine and computer engineering, and I ended up choosing medicine. My parents were very supportive of me on this journey.
In Thailand, we do six years of medical school. We don’t have to do pre-med first. During those years, I enjoyed it, and that’s why I continued in this career.
The healthcare system here is very different from back in my country. I worked in a government hospital in Thailand, and the majority of the patients we took care of were middle- and low-income patients. We have what is called a universal coverage scheme. You don’t need to pay anything when you visit the doctor or when you are hospitalized.
You also don’t need an appointment. You can come to the urgent clinic or the emergency department and get treated. That’s a big difference.
Before I chose cardiology, I trained in internal medicine for three years. There are a lot of specialties within internal medicine, but I think cardiology matched my personality. I’m a very active person. In cardiology, you have to be very prompt and responsive, especially for emergency conditions. I think cardiology matched both my interests and my personality.
What Does Your Role as a Structural Echocardiographer at Columbia Involve?
I serve as a structural echocardiographer attending, or you can call it an interventional echocardiographer. It’s the same thing.
My main responsibility is to perform and interpret echocardiograms. That includes transthoracic echo, where we scan the patient from outside, and transesophageal echocardiogram, where we put a probe down into the esophagus to get images of the heart.
We do that for patients with structural heart disease, including valvular heart disease, as part of the team here.
I also have clinical service weeks when I see patients who come for procedures with us. We take care of them before and afterward.
We also have structural echo fellows. We have two of them every year, so I get a chance to teach and mentor them as well. Overall, I would say my role combines clinical service, structural imaging, and teaching.
We are also part of the team during the actual procedure, but we are involved in the imaging part. We’re not the ones who put the valve or device into the patient—that’s the interventionist. But we are involved throughout the procedure to take the images and guide them through the whole procedure.
How Does Echocardiography Help Guide a Transcatheter Heart Procedure?
Let’s say we’re talking about transcatheter edge-to-edge repair. Before the actual procedural date, the patient comes in for pre-imaging. Usually, that is going to be a transesophageal echo.
We want to get the images to confirm the diagnosis and see if the procedure is feasible. Then we can plan ahead for what we are going to do on the day of the procedure. So the pre-imaging is there to confirm the diagnosis and help us plan the procedure.
On the day of the procedure, we do the transesophageal echo again.
The procedural part is very important because we can see real-time imaging. For example, when they put the catheter into the heart, we can actually see it move, and we can see its location and whether it’s in a good location or not.
When we advance the device—let’s say it’s a clip—we can see it from the beginning. We can use real-time imaging to see whether it’s in a good location and whether we have a proper grip of the leaflets.
Then, after deployment, we can immediately see the results and also look for complications. So it’s very helpful.
What Is the Biggest Challenge You Face in Your Role?
The biggest frustration is when we don’t have a good image—when you cannot see the anatomy clearly.
With transesophageal echo, we can have limitations in the images depending on the patient’s anatomy. If we don’t get a good image, that means we can’t guide the intervention as well as we would like.
I wish there were new technologies that could help us overcome those limitations.
Another challenge is that everything during the procedure has to happen in real time. You have to catch the little things. Your eyes have to be able to catch everything that is going on, and you have to be very fast.
If a complication occurs—for example, if the patient develops a pericardial effusion after the procedure—you have to know right away. We have to detect complications immediately. It’s high pressure.
How Is Cardiac Imaging Technology Changing?
In the past 10 years or so, I have seen a lot of improvement in echo imaging. Image quality, spatial resolution, and temporal resolution are way better than they were 10 years ago when I was starting in this field. The technology has grown a lot.
But I believe there is still room for improvement.
One area is the equipment we use to get better images. For example, sometimes a patient has a bad imaging window and it is very tough to get good images. If we can develop equipment or tools that help us overcome that, that would be great.
I would also focus on 3D imaging. That has improved a lot. For example, if we want to see a heart valve, we can construct a 3D image and see it in a lot of detail. It can look almost like what you would see during open-heart surgery—very close to the real thing, but maybe not quite yet.
I think that is an area where technology can continue to improve, so we can see the valve or other heart structures in even greater detail and get even closer to the real thing. That would help us both before the procedure and during the procedure.
Bonus Question: What Do You Like to Do When You’re Not Being a Doctor?
I’ve been here in New York for a year, and I consider myself a new New Yorker. I haven’t been to that many places yet, so on weekends, if I’m not working, I like to go explore the city.
I think the city is unlike any city in the world. It’s so dynamic. There are lots of people, a lot of diversity, and a lot of good food and restaurants.
As someone from Thailand, I can tell you that New York City's Thai food is amazing. There are two restaurants I really like: The first one is Chalong.
That’s a good one. The second one I like is Mitr Thai.
I’ve found that the Thai food here is so good—as good as back in Thailand.
I also love Central Park. One day I went there by myself and sat on the lawn doing nothing for two or three hours. It was so relaxing. It was a way to recharge my energy.
Other than that, sometimes I’ll cook something new; I love grocery shopping. After a busy week, sometimes I just don’t go anywhere. I stay in my room and do nothing; just be by myself and relax in my apartment.
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