Spotlight with Dr. Candice Silversides: The New Generation: Adults with Congenital Cardiac Disease
By Chelsea Lowther
Photograph courtesy of Laura Feldcamp
Stepping into the Toronto Congenital Cardiac Centre for Adults (TCCCA) at the Toronto General Hospital, I was acutely aware of how fortunate I was to be meeting with one of Toronto’s leading cardiologists, Dr. Candice Silversides. Dr. Silversides is a successful clinician scientist within the Institute of Medical Science (IMS), Head of the Obstetric Medicine Program at Mount Sinai Hospital, as well as staff cardiologist and Research Director of the TCCCA. She has built her multi-faceted research career around studying adults with congenital cardiac disease, a relatively new field in cardiology, thanks to advances in pediatric cardiac surgery.
Dr. Silversides explains that “60 years ago, in your grandparents’ generation, many of the children born with congenital cardiac defects would not have survived…nowadays, children with congenital heart defects are living in adulthood. However, there is still a lot we do not know about these adults, including one of my specific interests, the impact of pregnancy on the congenitally abnormal heart. This emerging field of cardiology is very exciting for clinicians and researchers who continue to define this new adult cardiac phenotype.” We can thank researchers and clinicians at U of T, who have broadened our understanding of congenital heart disease in the adult population, and who have helped to define standards of care for this group of patients. Dr. Silversides says U of T has been a world leader in this area for over 20 years and continues to be so.
When asked to name her biggest research accomplishment, Dr. Silversides was hesitant to choose just one, which is not surprising, considering her impressive publication record. With over 100 peer-reviewed publications, Silversides has contributed to multiple areas within the field of adult congenital cardiac disease including genetics, clinical outcomes, and management guidelines. Of noteworthy mention is Silversides’ recent publication in PLOS Genetics that aimed to describe the burden of copy number variations (CNVs; microscopic losses and gains of genetic material) in a congenital cardiac disorder called “tetralogy of Fallot” (TOF). TOF is the most common cyanotic heart defect and children born with this heart defect are often called “blue babies.” Silversides discovered that patients with TOF were more likely to have these rare genetic changes when compared to controls. Strikingly, many of the genetic changes are also found in patients with neurodevelopmental disorders, including intellectual disability, autism, and schizophrenia, highlighting the potential links that exist between the heart and the mind.
In true IMS fashion, the vast majority of Dr. Silversides’ research is translational in nature. When developing a new research question, she often asks herself, “If I had the patient right in front of me, what would I need to know?” It’s not hard to see the influence her clinical training has had on her research trajectory—after receiving her MD degree from the University of Manitoba, she went on to complete a residency in internal medicine and a Master’s degree through the Harvard School of Public Health. It wasn’t until she sub-specialized in cardiology and completed two fellowships in adult congenital cardiac disease and echocardiography that her research interests ignited. When asked if she ever envisioned herself ending up in this field she admits, “No, I lucked out by meeting a few key people who got me interested in different aspects of congenital cardiology, and that has taken me in a lot of different directions.”
My interview with Dr. Silversides ended with one of those instances where you find yourself wishing you had just five more minutes to chat. Silversides is as kind and personable as she is smart—certainly a physician I would want standing by my bedside. When asked what advice she would give to someone starting off in her field she replies, “To do medicine and research is very hard work, but it is very rewarding when you get to do a job where you learn something new every day. None of my days are the same, and I guess that is what makes it so much fun.”