From working in a genetics lab to teaching yoga, Melissa Lee Perrotta, M.D., has found a way to blend all of her passions into one career. Her drive to understand and solve complex problems and her interest in integrative healing has led her to caring for patients with adult congenital heart disease (ACHD). She has joined Norton Children’s Heart Institute, affiliated with the University of Louisville, as assistant medical director of the adult congenital heart disease program.
Finding her path to medicine
While an undergraduate student at the University of Georgia, some of Dr. Perrotta’s yoga students would seek her advice on how yoga could help them with physical ailments. She wanted to provide them with solid information, so she began studying anatomy and physiology. She liked helping people find solutions for their issues but wished she could do more.
While she knew many other students preparing for medical school, Dr. Perrotta was instead considering a doctorate in molecular genetics. However, she was still intrigued by her experiences helping others with yoga and her self-taught research. During her senior year, she decided to take the Medical College Admission Test (MCAT) to “see what would happen.”
“I needed a way to integrate these two sides of myself,” Dr. Perrotta said. “This dichotomy of science and the Eastern aspect to healing.”
She enrolled at the Medical College of Georgia, in Augusta, and began her journey to becoming a physician.
Becoming a cardiology ‘super nerd’
At first, Dr. Perrotta didn’t have a clear sense of what kind of medicine she wanted to practice. She enjoyed the coursework but yearned to work with people. That’s when she started volunteering in night clinics run by the hospital’s family medicine group. She worked in a homeless clinic, women’s clinic and a clinic for Spanish-speaking patients, all of which provided free medical care to patients. She learned a lot from that time because the family physicians showed her how to perform examinations, take proper patient histories and create differential diagnoses. She thought she wanted to go into family medicine.
Dr. Perrotta created an elective course at the Medical College of Georgia on integrative medicine. She worked at the Mind-Body Institute in Athens, Georgia, where she created a yoga program for infertility. A fluent Spanish-speaker, Dr. Perrotta also spent time in Honduras, Nicaragua and Belize as a medical volunteer during her training.
Then, during her third year, she began an adult cardiology rotation and became a self-proclaimed cardiology “super-nerd.”
“I had these heart sound cassette tapes for studying,” Dr. Perrotta said. “During long drives on weekends I would listen to the tapes to learn and memorize heart sounds. There is something very Zen about listening to someone’s heart. During a whirlwind morning where I had several patients to see, I needed to be still and quiet, and really pay attention to the sounds I was hearing. There was something about it that I really fell in love with.”
She remembers seeing her first patient with adult congenital heart disease. The patient was in her early 20s and was “blue as a blueberry,” she said. The puzzled adult cardiologist asked for a consultation with a pediatric cardiologist, who drew diagrams of the patient’s heart anatomy.
“I was in awe; listening to that patient’s heart was so different — a cacophony of murmurs I’d never heard before,” she said. “I thought she was fascinating. All of these different teams were working together to help her, but there was no one person who could address all of her needs. I thought, ‘Wouldn’t it be neat to be that person?’”
Making heart patients’ lives better
From there, Dr. Perrotta started making decisions that would lead her to a career in caring for patients with ACHD. She did an internal medicine/pediatrics internship and residency at Case Western Reserve University in Cleveland, Ohio. She completed a pediatric cardiology fellowship at Cincinnati Children’s Hospital Medical Center and an adult congenital heart disease fellowship at Stanford Hospital and Clinics/Lucile Packard Children’s Hospital in Palo Alto, California.
“Adult congenital heart patients are masterpieces of medicine,” Dr. Perrotta said. “No one is like the other. I want to help my patients live productive, meaningful lives.”
Adult congenital heart disease includes several types of congenital heart defects, including:
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- Aortic stenosis
- Aortic valve disease
- Atrial septal defect
- Atrioventricular canal defect
- Coarctation of the aorta
- Double-outlet right ventricle
- Ebstein anomaly
- Hypoplastic left heart syndrome
- Interrupted aortic arch
- Patent ductus arteriosus (PDA)
- Patent foramen ovale
- Pulmonary atresia
- Pulmonary stenosis
- Subaortic stenosis in children
- Tetralogy of Fallot
- Total anomalous pulmonary venous return (TAPVR)
- Single ventricle defects
- Transposition of the great arteries
- Tricuspid atresia
- Truncus arteriosus
- Vascular ring
- Ventricular septal defect
Dr. Perrotta enjoys caring for the unique challenges patients with these conditions experience, such as complex, multisystem organ issues, and social and mental health concerns.
“I like having to delve into their history and piece everything together, almost like an archeological dig,” Dr. Perrotta said. “Depending on what surgeon they had, the type of surgery, the year they had their surgery — all of these things affect what their current anatomy is like. If you just believe their charts, all of the information may not be there. The patient was a child so they may not recall parts of their health history, and some may not have records unless the parents have saved them.”
Her research interests include electrophysiology in adult congenital heart disease as well as the mental and social challenges ACHD patients may have, including learning disabilities, anxiety and depression.
“Feeling isolated can be an issue for patients with ACHD,” Dr. Perrotta said. “If you ask ‘Do you know anyone else with ACHD?’ They often say ‘no.’ Some patients may be connected through social media, but others never think to look.”
She wants to improve quality of life for Norton Children’s ACHD patients by creating community among them through group visits for wellness topics, such as nutrition, self-independence and exercise. Some patients may have been told they shouldn’t exercise when they were younger, but over time research has shown that may not be the case for all. Inactivity can cause issues for people with acquired heart disease, such as high blood pressure and coronary artery disease, as well as for those living with ACHD. Similarly, many women with ACHD are unsure if they can or should have children. With proper care and collaboration between an ACHD cardiologist, a maternal-fetal medicine specialist and the anesthesiology team, many women with ACHD can be managed successfully through pregnancy.
Excitement for joining Norton Children’s Heart Institute
“Everyone, from the physicians to the administration, has a vision and motivation to have expert care in this community and region,” Dr. Perrotta said. “I’m happy to be in Louisville.”