Subspecialized expertise for complex cardiopulmonary disease

Multidisciplinary pulmonary expertise supports diagnostic evaluation, treatment planning and longitudinal care

Advanced lung disease and cardiovascular disease frequently intersect, with overlapping clinical presentations that can complicate diagnosis, risk stratification and treatment planning. Progressive dysfunction in either system can accelerate decline in the other, contributing to increased morbidity and mortality. For physicians managing these complex patients, coordinated evaluation across pulmonology, cardiology, advanced heart failure, advanced lung disease, imaging and interventional specialties is essential to timely diagnosis, appropriate therapy selection and improved outcomes.

Inova Schar Heart and Vascular offers a destination for physicians managing patients with complex pulmonary and cardiovascular disease. High clinical volumes support sub specialization by disease type including rare conditions. This focused expertise combined with a robust clinical trials program affords patients the benefit of leading-edge therapies.

“Our program has evolved over the years into a comprehensive advanced lung disease and transplant program with more than 70 full-time specialists. We’ve earned accreditations from multiple organizations and patient advocacy groups such as the Pulmonary Hypertension Association, the Pulmonary Fibrosis Foundation and the Cystic Fibrosis Foundation,” said Steven D. Nathan, MD, FCCP, Schar Chair, Advanced Lung Disease and Lung Transplant and Medical Director of the Advanced Lung Disease and Lung Transplant Program at Inova Schar Heart and Vascular. “We’ve grown clinically as well as in research and education, with an active clinical research program and our own advanced lung disease fellowship.”

Alpha-1 antitrypsin deficiency

Inova’s advanced lung disease team partners with pulmonologists to manage patients with rarer etiologies such as alpha-1 antitrypsin deficiency. The program provides access to disease-specific therapies, including enzyme replacement therapy, and coordinates care for associated extrapulmonary complications including liver disease. Inova is an Alpha-1 Foundation Clinical Resource Center and a member of the Alpha-1 Foundation Clinical Resource Center Network.

Cystic fibrosis

Accredited by the Cystic Fibrosis Foundation, Inova provides comprehensive cystic fibrosis care for pediatric and adult patients. The adult cystic fibrosis team manages patients across the disease spectrum with multidisciplinary support for disease progression, complications and transition of care.

Lung transplantation

In 1991, Inova pioneered lung transplantation in Northern Virginia serving the entire Washington, DC, metropolitan area. Inova’s lung transplant program remains the only active program in the region performing lung and heart-lung transplants and has performed more than 760 transplants (single and double lung as well as heart-lung) to date. The program routinely exceeds national averages for transplants performed, waiting time and patient survival rates, according to the Scientific Registry for Transplant Recipients.

Pulmonary hypertension and CTEPH

Inova’s Pulmonary Hypertension Program provides comprehensive evaluation for patients across all groups of pulmonary hypertension including those with chronic thromboembolic pulmonary hypertension (CTEPH) – an often underrecognized and potentially curable type of pulmonary hypertension. Our multidisciplinary service incorporates expertise from:

• Pulmonary and critical care medicine
• Interventional pulmonology
• Cardiac surgery
• Invasive and noninvasive cardiology
• Thoracic radiology
• Interventional radiology
• Imaging specialists

For CTEPH patients, Inova is the only program in the metropolitan Washington, DC, area that offers surgical, interventional and medical therapies tailored to disease distribution, symptom burden and operative candidacy including:

• Pulmonary thromboendarterectomy (PTE) – the traditional surgical treatment for proximal CTEPH
• Balloon pulmonary angioplasty (BPA) – a less invasive interventional approach for patients with more distal disease not amenable to surgical intervention

Inova Fairfax Hospital is one of the few institutions in the country offering BPA as a treatment option for a select subset of patients with CTEPH. During BPA, balloon catheters are used to dilate narrowed pulmonary arteries and improve perfusion by displacing organized thromboembolic material.

“The vast majority of patients with CTEPH who are treated with either surgical or interventional therapies will have a very successful outcome,” said Oksana Shlobin, MD, Medical Director for the Pulmonary Hypertension Program and Director of Outreach and Education for the Inova Advanced Lung Disease and Transplant Program at Inova Fairfax Hospital. “In most cases, their pulmonary hypertension is cured. In cases where the procedures are not curative, the severity of the patient’s pulmonary hypertension is decreased dramatically, improving quality of life.”

Sarcoidosis

For more than 20 years, pulmonary sarcoidosis has been part of Inova’s advanced lung disease services. In June 2023, the Inova Sarcoidosis Program was designated a World Association of Sarcoidosis and other Granulomatous Disorders (WASOG) Center of Excellence, recognizing Inova Fairfax Hospital as a leading center for sarcoidosis care.

Sarcoidosis is a complex condition that often affects multiple systems and organs. Because cardiac sarcoidosis can be clinically silent yet associated with significant morbidity, Inova’s sarcoidosis specialists partner with the advanced heart failure team to support evaluation and management. The program offers access to advanced diagnostic capabilities, including cardiac PET CT, to help identify myocardial involvement and guide treatment planning. We also have a robust neurosarcoidosis program, and our rheumatologists are very involved in the care of our sarcoidosis patients.  When indicated, we also partner with dermatology and ophthalmology to ensure comprehensive care for coexisting or isolated non-pulmonary manifestations of sarcoidosis.

Severe COPD

Inova’s severe COPD program focuses on patients with persistent symptoms, advanced disease or inadequate response to standard therapy. Management is designed to slow progression, reduce symptom burden, improve functional status and evaluate appropriate candidates for advanced therapies. The program brings pulmonology, interventional pulmonology, lung transplant, advanced lung disease and pulmonary hypertension specialists together in a single multidisciplinary clinic visit.

“What makes our department unique is the breadth of both evaluation and treatment options that we offer patients,” said advanced lung disease and transplant physician Vikramjit Khangoora, MD. “At the severe COPD clinic, we’re a one-stop shop. We help manage patients’ COPD care along with their general pulmonologist. We can also offer them additional options like an evaluation for endobronchial valves or transplant.”

Learn more about Inova’s Advanced Lung Disease Program and connect with our physicians on Doximity.

Advanced Lung Disease Program Medical Directors:

Steven D. Nathan, MD, FCCP
Christopher King, MD, Associate Medical Director

Sub-specialized care program directors:

Pulmonary Hypertension: Oksana Shlobin, MD, FCCP
Severe COPD: Vikramjit Khangoora, MD
Interstitial Lung Disease: Steven D. Nathan, MD, FCCP
Lung Transplantation: Shambhu Aryal, MD, FCCP
Sarcoidosis: Shambhu Aryal, MD, FCCP
Bronchiectasis/Cystic Fibrosis: Anju Singhal, MD
Advanced Obstructive Lung Disease Program: Jared Wilkinson, MD