Obituary: Dr Stewart Hunter, paediatric cardiology and echocardiography pioneer

Archibald Stewart Hunter MB ChB FRCP. Born: 7 March 1936 in Comrie, Perthshire. Died: 18 February 2021 in Gatehouse of Fleet, aged 84

Away from medicine, Stewart Hunter loved his golf

Stewart Hunter was born in Comrie, the elder of two children born to Archibald, a Church of Scotland minister, and Margaret Swanson.

His father went on to be Professor of New Testament Theology at Aberdeen University and set a high bar for Stewart to follow. His uncle was a GP in Helensburgh. He was educated at Aberdeen Grammar School and read medicine in Aberdeen.

After qualifying in 1960 he decided on a career in paediatrics and during a training post at Great Ormond Street became interested in children with heart disease.

Following further training in Edinburgh he was appointed to a post in Newcastle upon Tyne, where he began to develop what has become one of the UK’s most outstanding Children’s Heart Units.

From 1972-73 Stewart had a research post in Pennsylvania where he helped develop cine angiography in adults, a technique he brought back to the UK and further developed for children.

He was a paediatric cardiologist who championed the use of echocardiography to investigate babies born with congenital heart disease (CHD) – eight in every 1,000 babies are born with a significant heart defect and 30 per cent of these will require intervention in the first year of life. In 1974 a quarter of those with one of the most common defects, Tetralogy of Fallot, died during attempted surgical correction. Now it is most unusual for such an operation not to be successful.

There have been major advances in surgery and anaesthesia but a prerequisite for an optimal outcome is an accurate definition of the nature of the abnormality. The newborn heart is about the size of a walnut. Prior to the 1960s diagnosis depended on the clinical signs, including the heart sounds heard through a stethoscope, and x-rays. The advent of two-dimensional, then 3D ultrasound investigation, which could detect structural abnormalities, and Doppler flow, which could measure the direction and flow of blood through the heart, revolutionised the field

Stewart worked with Ron Pridie, a radiologist at London’s Harefield Hospital, in demonstrating cross sectional echocardiography as the major diagnostic tool in establishing the types of heart malformations.

In 1974 they set up the first UK course in echocardiography, run biannually between Newcastle and Harefield, which continued for 25 years. Hunter was an excellent teacher and most practitioners across the UK attended these courses.

Not everyone can be trained to a high standard of accuracy for a technique which requires excellent psychomotor coordination and abilities of pattern recognition. Pridie instilled in all of his trainees a structured method which had to be followed and which produced excellent results. With colleagues in Newcastle and around the UK his research was pivotal in advancing the understanding of congenital heart disease and paving the way for better outcomes. He wrote 124 scientific papers and co- authored five books.

In the 1990s there were concerns that outcomes for treatment of CHD in Bristol were not as good as they should be and this led to a major enquiry. A few years later similar concerns were raised at Harefield Hospital. Stewart was involved in both of these enquiries and one of the major outcomes was a recognition of the need for reliable data by which units could be compared.

There is now a national mandatory database whereby risk-based assessments can be made and this is slowly being expanded to cover other surgical specialities.

He led the development of Newcastle into one of the leading centres in Europe and set a road map for the development of the care of children with heart disease.

In 1987 the first heart transplant in a baby in the UK was carried out in Newcastle, which remains one of only two centres in the UK authorised for this purpose. Hunter was a good organiser and team builder and set up the Children’s Heart Unit Fund (CHUF) in 1984 which has raised more than £10 million to support the unit

Stewart met his wife Valerie as a neighbour in Aberdeen and they had 60 years of very happy marriage; she and their children, Ruth, Kirsty and Colin, survive him.

The Hunters were very sociable and good entertainers – a convivial evening of Scottish flavour would end with music, dance and Stewart on the penny whistle or mouth organ.

He was warm and enthusiastic and found joy in approaching and finding new things and friends. To many he was an excellent mentor. Dogs were a passion and for 40 years dogs were an integral part of the family.

He loved the countryside and walking in the Scottish hills. Golf was a passion and he also played cricket for the Victorians. He and Val retired to Gatehouse of Fleet in Galloway, where he became a church elder.

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