May 14, 2019

Not too long ago a child with hepatocellular carcinoma – a rare liver cancer – would have few options for treatment and even fewer chances of long term survival.

In most cases, these tumors are discovered so late that surgery and transplant are not viable options to save a young child’s life. Families could hope for recovery, but the odds would not support their optimism.

The good news is that today is a new day.

A multidisciplinary team, led by Dr. Kamlesh Kukreja, expert in Interventional Radiology; is successfully performing the Trans-Arterial Radioembolization procedure – called TARE – on children who have this rare disease.

“There are only three hospitals in the country performing TARE and we are one of them,” Kukreja said. “We are the only one in the state of Texas.”

He added that TARE has the potential to regress tumors and help patients live with their own liver or keep the tumor in control until a liver transplant is available. An additional advantage is that TARE is an outpatient procedure, which allows the child to recover at home.

How it all works

TARE is administered in two steps. Step one involves identifying the angiographic anatomy of the tumor mapping the vascular supply of the cancer to assess how much radiation it can handle, while still keeping the patient safe.

“Two to four weeks after this mapping, the patient returns for the radioactive chemical agent – called Yttrium-90 (Y90) – to be administered directly to the artery supplying the tumor,” Kukreja said. “This administration is targeted and direct, which allows for higher doses of radiation to be administered with minimal side effects; unlike systemic chemotherapy, which has been found to not work well in these cases.”

Record of Success

Kukreja has successfully performed TARE on two patients to date with one patient showing a clear regression in the growth of the tumor allowing complete surgical resection.

Although Texas Children’s is one of the pioneers of TARE in pediatrics, it’s important to note that TARE is a frontline therapy at adult hospitals for patients with the most common type of liver cancer. Accumulating evidence from studies with adult liver cancer suggests that TARE is a promising strategy which may benefit children as well.

The people that make It possible

“We are very proud of what we have been able to accomplish so far and the way we have raised the standard of care for our patient families,” Dr. Kukreja added. “We are also proud that a multidisciplinary team has made this possible.”

The decision to use this approach is first made by a multidisciplinary team involving:

Dr. Prakash Masand, Radiology
Dr. Andras Heczey, Oncology
Dr. Sanjeev Vasudevan, Pediatric Surgery
Dr. John Goss, Transplant surgery

The hands-on clinical teams at Texas Children’s include interventional radiology, nuclear medicine, radiation safety, anesthesia and Dr. Armeen Mahvash, associate professor at M. D. Anderson Cancer Center.

To Learn More

If you know a patient who could benefit from this treatment, please reach out to the department of Interventional Radiology at 832-824-5565 or liver tumor team at https://www.texaschildrens.org/departments/liver-tumor-program. Dr. Kukreja can be reached at kukukrej@texaschildrens.org/kukreja@bcm.edu.

April 29, 2019

On April 26, superheroes of all sizes assembled on The Auxiliary Bridge to celebrate National Pediatric Transplant Week, observed each year during the last full week of National Donate Life Month in April.

The event, hosted by Texas Children’s Transplant Services, marked the end of a week that focuses on the powerful message of ending the pediatric transplant waiting list. There were plenty of fun activities for children, including karaoke, hula-hooping, coloring and crafts, a photo wall, and a visit from Elsa, one of Texas Children’s three therapy dogs. There were also educational materials available on organ donation and transplantation.

The event also honored real-life superheroes – the donor families whose children have saved and healed lives through organ, eye and tissue donation.

The gift of an organ transplant comes to one family as another family is enduring the most difficult time of their lives. The team in Transplant Services works hand in hand with Texas Children’s Spiritual Care Department during these times to provide donor families with compassionate support, to honor the choice to donate an organ, and to honor the legacy of the patient.

There are several ways we recognize the legacies of these children and their families, including:

  • The observance of moments of honor, small ceremonies during which the gift of the organ donation is acknowledged and celebrated through readings and a blessing or prayer
  • Flag ceremonies, at which a Donate Life Flag is displayed and family, Texas Children’s staff and chaplains, and our LifeGift partners gather to tell stories about the patient, let the family touch the flag, share a group reading, and then the flag is then passed around the unit to be signed with messages of support and recognition from Transplant Services staff
  • National Donor Sabbath, an annual three-day observance where members of local faith communities participate in services and programs to honor donor families and to educate the public about the need for lifesaving transplants

In addition to these heartfelt moments of acknowledgement and remembrance, Texas Children’s Hospital has begun a new tradition to honor our donor families.

As the sun went down on April 22, Lester and Sue Smith Legacy Tower was illuminated in green and white. The tower was lit each evening for the rest of the week, both in commemoration of National Donate Life Month and Pediatric Transplant Week, and also as a tribute to our donor families. Going forward, the lighting of the tower will serve as yet another way Texas Children’s acknowledges them.

“Nothing we do would be possible without our donor families, and we wanted to find another way to honor them,” said Dr. John Goss, medical director of Transplant Services. “Now when people see Lester and Sue Smith Legacy Tower lit in green and white, they will know there’s a hero here at Texas Children’s who has just given the gift of life.”

About Transplant Services at Texas Children’s

Transplant Services at Texas Children’s was the nation’s largest pediatric transplant program in 2018, performing a remarkable 107 solid organ transplants including the highest volumes of pediatric liver, lung and kidney transplants.

Transplant Services provides a comprehensive, multidisciplinary approach to care through all aspects of the transplant process, from initial referral to hospitalization and outpatient management. Our team of experts includes physicians and surgical advanced practice providers, transplant coordinators, pediatric ventricular assist device coordinators, perfusionists, child life specialists, dieticians, social workers, financial counselors, pharmacists, inpatient and outpatient nursing and support staff, Perioperative Services, physical and occupational therapists, Radiology, Pathology, our LifeGift partners, and many others.

Our depth of skill and service enables us to offer world-class care for patients, from newborns to young adults, in need of heart, kidney, liver and lung transplants. That expertise has allowed us to successfully treat some cases that other national and international programs might consider untreatable.

Learn more about Transplant Services at Texas Children’s Hospital.

April 22, 2019

Disney Magic has officially arrived at Texas Children’s Hospital.

Invited guests from The Walt Disney Company, media outlets and health care organizations across the country joined Texas Children’s clinical and executive leadership to celebrate the launch of the Disney Team of Heroes pilot. Texas Children’s is the first hospital to work with Disney on this comprehensive new initiative that will enhance the patient and family experience at children’s hospitals across the globe through a unique combination of reimagined spaces, personalized moments and engaging content, all featuring Disney’s beloved characters and themes.

Watch the video to see how all these elements came together over the past three weeks.

“Disney’s commitment to bringing comfort and inspiration to children doesn’t stop at the gates of Disneyland or Walt Disney World, and we are so grateful Disney is bringing those values to us in this way,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “The magic and joy we have all experienced at a Disney park is now apparent as you walk throughout our hospital, and I am looking forward to seeing how this special partnership enhances the patient and family experience.”

Texas Children’s relationship with The Walt Disney Company dates back to 1952 when Walt Disney himself gifted the hospital with an illustration depicting his vision for the hospital’s campus at the time. The partnership was further solidified in 2018 when Texas Children’s was chosen as the pilot hospital for this transformative, five-year commitment to the patient experience from The Walt Disney Company.

The Disney Team of Heroes launch was the culmination of a year of hard work and collaboration between a group of more than 80 Disney team members, including Disney’s famed Imagineers, and a dedicated team of Texas Children’s employees and caregivers.

“As the name itself implies, at Disney we know that if you want something to be timeless, and touch the hearts of millions, it requires a talented team to bring it all to life,” said Elissa Margolis, Senior Vice President of Enterprise Social Responsibility at The Walt Disney Company. “We could not have done this without all the guidance, partnership and collaboration from doctors, nurses, hospital administrators, child life specialists, creative teams, tech leaders and also, importantly, parents.”

Guests at the event got a first look at new Disney Team of Heroes experiences on a tour of Lester and Sue Smith Legacy Tower. These elements included the stunning Magic Mural, which allows patients and families to interact with characters and environments; mesmerizing Magic Windows, where favorite characters pop in for a brief visit before taking off again; captivating Magic Portals, seek-and-find activities that provide distraction while waiting for an appointment to begin; and Disney Products and Hospital Gowns, which help brighten patient rooms and bring familiarity into hospital stays. Additionally, Texas Children’s employees system-wide received themed Disney Team of Heroes Employee Badges featuring Disney characters. The badges will create opportunities to engage patients, and fellow employees, in a fun new way.

Stay tuned for a more in-depth look at the new Disney Team of Heroes elements on our Corporate Communications Instagram, @oneamazingteam. Learn more about Texas Children’s partnership with Disney, and check Connect frequently for more exciting updates.

April 9, 2019

Texas Children’s Heart Center was once again the site of a groundbreaking novel treatment that gives experts in our new catheterization laboratories yet another method at their disposal in the treatment of complex heart conditions.

Dr. Henri Justino, co-director of the center’s cardiac catheterization labs and director of cardiac innovation, recently developed and performed a first-of-its-kind procedure in which a young patient’s lung veins were reached directly through the chest wall.

Hope for Bronx

Three-year-old Bronx Delarosa was born with total anomalous pulmonary venous return, a critical heart defect that causes oxygen-rich blood returning from the lungs to be pumped into the right atrium instead of the left atrium, as it normally should. There, the oxygen-rich blood mixes with oxygen-poor blood, which means the body doesn’t get the oxygen it needs.

At just 8 days old, Bronx underwent a surgery to repair the defect that was initially thought to be a success. However, following a second surgery, doctors told his parents he’d developed a secondary condition – pulmonary vein stenosis, a condition that caused severe narrowing in his surgically repaired veins. The Delarosas were heartbroken when they learned there was nothing else that could be done for Bronx in their hometown.

To give their son a fighting chance, they turned to Texas Children’s Hospital.

Breaking new ground

Justino performed Bronx’s first catheterization procedure in February 2018, during which he placed a metal stent in the blocked upper vein in Bronx’s right lung. However, he was unable to relieve the blockage in the lower vein.

After a personal friend underwent a lung biopsy, where a tissue sample was taken directly through the chest wall, Justino wondered if a similar approach could be applied in cases like Bronx’s – entering the veins of the lungs through the chest.

After thorough research, Justino decided to move forward with the unique approach to relieve the blockage in Bronx’s right lung.

Bronx was taken to the catheterization lab where the team performed a CT scan to identify the exact location where the blocked vein was sufficiently far apart from artery, yet close enough to the chest wall, to allow a needle to enter the vein directly between the ribs. Justino and his team also generated a 3-D computerized model to pinpoint the exact location where the needle would enter Bronx’s chest. To ensure the utmost accuracy, a laser crosshair was beamed on his chest at the entry point.

Justino carefully made his way into Bronx’s lung and placed a tiny catheter, the thickness of a raw spaghetti noodle. He then used a special wire to deliver radiofrequency energy to get across the blocked vein and into the heart. From there, the wire was threaded down through Bronx’s leg. This allowed a stent to be placed in the blocked vein via a catheter in the leg.

Bronx recovered well and a follow-up echocardiogram proved the experimental approach was a success. The first-of-its-kind procedure, which lasted more than eight hours, was performed in one of the Heart Center’s new state-of-the-art, 1,000-square-foot cardiac catheterization labs, which Justino helped design with this type of procedure in mind.

“We are proud that Dr. Justino was able to develop this completely novel procedure for Bronx,” said Texas Children’s Chief of Pediatric Cardiology Dr. Daniel Penny. “Pulmonary vein stenosis in children is an extremely difficult problem to treat and tests the limits of our abilities to innovate. We see this new procedure as another advancement in the treatment of these children, which will be applied more widely in the future and help us improve the care we offer for complex cardiac conditions.”

Learn more about Texas Children’s Heart Center, ranked No. 1 in the nation by U.S. News & World Report.

December 11, 2018

A little over a year ago, Larissa Fletcher took a huge leap of faith and walked into Texas Children’s Family Fertility Center to carry out the plan she and husband made years earlier on the darkest day of their lives.

On that dark day, Larissa and her late husband John Fletcher learned he had stage four esophageal cancer, and would, at best, live another year. Knowing they wanted to give their then 1-year-old daughter, Emma, a sibling, the couple decided to freeze John’s sperm and store it at the Fertility Center’s state-of-the-art in vitro fertilization (IVF) lab until Larissa was ready to try to have another child.

Shortly after that day came, Larissa watched her embryologist zoom her microscope in on what would become the now 4-month-old Elliana “Ellie” Joy Fletcher. Using a leading-edge embryo monitoring system called the EmbryoScope, Larissa also was able to watch a video of Ellie from when she was just a few cells all the way up to the time she was ready to be transferred into her mother’s belly to develop and grow for the next nine months.

“I was in awe of all of it,” Larissa said of the video. “In that moment, everything became very real for me.”

Texas Children’s Family Fertility Center’s three EmbryoScopes bring to life what reproductive endocrinology specialists see under a microscope and then describe to their patients. The technology, which provides continuous time-lapse imaging of embryos as they grow, also enables specialists to identify the healthiest embryo to transfer to the patient, for improved IVF success rates.

Dr. Richard Cochran, the Family Fertility Center’s Laboratory Director, said he and his colleagues in the lab are looking at whether the EmbryoScope can also help improve patient outcomes. The technology, he said, allows clinicians to see how an embryo divides, which in turn gives them the opportunity to see certain abnormalities.

“Sometimes embryos will divide, and then the cells will remerge, and then re-divide,” Cochran said. “That’s very abnormal, and that’s something we would not see in a traditional incubator setting.”

In such a setting, clinicians typically look at an embryo two days after fertilization is attempted, again a day or two later and so on. What happens in-between observations isn’t captured, and could be an important predictor of developmental abnormalities. For similar logistical reasons, the EmbryoScope already has proven to be helpful at enabling specialists to identify the healthiest embryo to transfer to a patient.

“In the vast majority of laboratories, embryos are put in traditional incubators where you have to take them out and expose them to room temperatures to see them,” said Texas Children’s Chief of Reproductive Medicine Dr. William Gibbons. “With the EmbryoScope, handling of the embryos is minimized and visibility is 24/7, enabling us to ensue embryos are growing and reach the appropriate stages at the appropriate times before transplantation.”

Texas Children’s Family Fertility Center is the only location in Texas other than Dallas that is using the EmbryoScope. The center has been using the technology since it opened in 2014 and currently has three. One of the scopes is dedicated to research while the other two are for clinical use.

Larissa, a former Fertility Center patient and a pediatrician with the Texas Children Newborn Center, said her experience at the center was extraordinary from beginning to beautiful end.

“When I was eight weeks pregnant and had to move my pregnancy care from the Family Fertility Center to a traditional OBGYN, it was bittersweet,” she said. “The people there were like my second family.”

To learn more about the EmbryoScope and how clinicians with the Texas Children’s Fertility Center uses the technology, click here.

Texas Children’s Family Fertility Center has earned national and international recognition for advancing the understanding and treatment of reproductive disorders. Our reproductive endocrinology specialists are proud of the impact we have made on the lives of our patients, women and families across the globe. To learn more about our Fertility Center, click here.

November 13, 2018
Early on the morning of November 7, an excited group including Texas Children’s Hospital clinical leadership, executives and members of the Kangaroo Crew and Mission Control teams gathered on the roof of Lester and Sue Smith Legacy Tower for a special ribbon cutting ceremony marking the opening of our new helistop.

Watch the video or view the photo gallery below.

“The Lester and Sue Smith Legacy Tower has always been about improving care for the sickest children we see,” said Surgeon-in-Chief Dr. Larry Hollier. “The helistop is important because it improves access for those children. Whether they’re being transported as part of a scene response for an auto accident or transferred from another hospital, we can now get children and women here in very rapid fashion within a 150-mile radius.”

The helistop is the final element of Smith Legacy Tower to go live and represents the culmination of a major expansion at our Texas Medical Center campus. Months of planning and multidisciplinary cooperation between medical staff, Transport Services and engineering and facilities teams went into preparations for the helistop opening.

“A tremendous amount of work has gone into making sure that the helistop is very safe – safe for the helicopters coming in, safe for those crew that are delivering the patients to us, and safe for our own staff,” said Executive Vice President Mark Mullarkey. “Bert Gumeringer, Gail Parazynski and Deb D’Ambrosio and their teams have been instrumental both in making sure we’re prepared to open the helistop and really in bringing Smith Legacy Tower to full completion.”

Extensive simulation exercises were also held to prepare care and transport teams for potential eventualities they may face, as well as to analyze and improve processes. This included helicopter landings, transferring patients from the helicopter crew to Texas Children’s transport teams, and moving patients from the helistop at Smith Legacy Tower to Trauma and the Emergency Center.

“The helicopter simulation was fantastic,” said Dr. Jeanine Graf, chief medical officer at West Campus and pediatric medical director of the Kangaroo Crew. “We brought together members from our trauma, surgery, ICU and NICU teams, as well as our experts in maternal-fetal medicine, for training and simulations, which were coordinated by our Texas Children’s Simulations Center. Dr. Cara Doughty really did an excellent job demonstrating how more than a hundred folks would be involved in the communication and execution of a helicopter landing at Texas Children’s.”

The helistop at Smith Legacy Tower is the third helistop in the Texas Children’s system, with others in operation at West Campus and Texas Children’s Hospital The Woodlands. The addition of the new helistop will facilitate the rapid transport of patients across all populations, including neonatal and maternal patients. Before the helistop opening, Texas Children’s received roughly 150 helicopter transports a year, which landed at nearby partner institutions. Now with our own helistop, we’ll be able to offer our care to even more patients who need us.

“The helistop really changes things for us,” said Deb D’Ambrosio, RN, director of Transport Services and Mission Control. “We’re certainly expecting high volume, but with the processes we’ve developed with our helicopter vendors and the high level of coordination between Transport Services and Mission Control, this is going to be so much better for our patients.”

October 8, 2018

A world-class, multidisciplinary team at Texas Children’s is making huge strides in the care of children with extremely complex tumors.

The Head and Neck Tumor Program, begun in February 2016 as collaboration with partner institutions within the Texas Medical Center, has performed more than 20 major ablation free-flap multidisciplinary cases – a staggering number, considering the rarity and complexity of the tumors, which can be malignant or benign and can affect any combination of the sinuses, skull, jaw, mouth, neck and face. The ability to handle that volume of complex cases, combined with tremendous outcomes in the first two years, puts Texas Children’s Head and Neck Tumor Program among the best such programs in the country.

“Our institutional expertise is in taking care of these kinds of critically ill children, and Texas Children’s does it better than anyone,” said Dr. Daniel Chelius, attending surgeon in the Division of Otolaryngology and co-head of the program. “We’ve built a collaborative, coordinated program on that foundation of expertise in many different areas to provide the best care possible for the sickest children, while also reviewing and analyzing the care from every angle to see what went well and what processes could improve.”

Treatment of children with head and neck tumors around the country has historically been ad hoc, due to the varying functional issues or oncologic needs present from patient to patient and the extreme rarity of the tumors in any given city. Compound these complex physiological issues with the fact that most children these tumors have been treated in adult hospitals and the result has been a largely disjointed approach to care.

Texas Children’s Head and Neck Tumor Program, spearheaded by Chelius and Dr. Edward Buchanan, chief of Plastic Surgery, has developed a coordinated process around a multidisciplinary team approach that builds crucial experience in the treatment of these rare tumors and provides consistent, personalized care for patients – like 15-year-old Kami Wooten.

Last year, Kami began to notice swelling in her gums. Just months later, a benign tumor had covered half her face and threatened her vision. The team at Texas Children’s developed a specialized care plan that included removing the mass and reconstructing a portion of her face including the roof of her mouth and her orbit (eye socket). Additional procedures will be necessary in the future, but Kami and her family are grateful for the care Texas Children’s gave them.

Learn the rest of Kami’s story here.

The collaborative program comprises more than 10 Texas Children’s specialties and subspecialties, including Otolaryngology, Plastic Surgery, Neurosurgery, Oncology, Interventional Radiology and Anesthesiology, as well as a dedicated operating room team – led by Audra Rushing and Kelly Exezidis – that has been instrumental in building robust perioperative protocols. The additions of pediatric head and neck surgeon Dr. Amy Dimachkieh and microvascular reconstructive surgeons Dr. W. Chris Pederson and Dr. Marco Maricevich have increased the program’s abilities and improved the quality of its recommendations.

“It takes a lot of thought and planning to remove these complex tumors completely, while sparing as many nerves and other important structures as possible, and then to reconstruct those structures to provide both a good functional and cosmetic outcome,” Chelius said. “We tell our patients that the process might not be fast because they need the right surgery the first time. That requires recommendations from a team of experts, not just one surgeon. And that means carefully coordinating to make sure everything is as perfect as possible.”

The care required to treat these tumors, particularly if the patient is also undergoing cancer treatment, can also take a massive emotional and psychological toll. The Head and Neck Tumor Program provides additional care support through the department of Clinical Psychology and Child Life Services.

The team also uses technology to enhance the patient experience, from diagnosis to recovery. The program uses 3-D modeling to reconstruct children’s anatomy to help predict the extent of resection and to develop the surgical plan. The team also developed a data-driven protocol for pediatric tracheostomy removal, in close collaboration with Speech and Language Pathology, which uses a pressure monitoring device to signal when the trach is loose enough in the airway to be removed without adverse effects.

As a result of this innovative approach to care, 100 percent of patients treated have left the hospital breathing, eating and swallowing on their own. And the average stay in the hospital: just 14 days.

The program has been steadily building a referral base, drawing patients from across the region and from as far away as Mexico and the Middle East. In the near term, the team will continue to solidify the program, publish data and findings, and work to increase Texas Children’s reputation as the leading referral center for these complex cases. Long-term goals include building a basic science research infrastructure around understanding the underlying causes of these tumors, as well as collaborating with Texas Children’s Cancer Center and other research partners.

“We know that families are coming to us shocked and scared,” Chelius said. “We want them to know that we’re building our experience, we’ve walked families through this before, and we’re going to get them through this with the absolute best care available.”

Learn more about Texas Children’s Head and Neck Tumor Program.