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.

March 11, 2019

 

Transplant Services at Texas Children’s once again led the way as the nations’ largest pediatric transplant program, performing a remarkable 107 solid organ transplants in 2018. That figure includes the highest volume of pediatric liver, lung and kidney transplants in the United States.

For the year, we performed:

  • 44 pediatric liver transplants
  • 12 lung transplants
  • 31 kidney transplants
  • 20 heart transplants

“I want to congratulate everyone on our outstanding Transplant Services team, which continues to provide excellent care and support for our transplant patients and families,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “I would also like to thank the leaders of our transplant programs – Dr. John Goss, Dr. Jeffrey Heinle, Dr. Jeff Dreyer, Dr. Tina Melicoff, Dr. Daniel Leung, Dr. Christine O’Mahony, Dr. Eileen Brewer and Dr. Ryan Himes – who go above and beyond to uphold high standards.”

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.

“This is another tremendous milestone for our program,” said Dr. John Goss, medical director of Transplant Services. “I couldn’t be prouder of our team for their commitment toward achieving positive outcomes and for the dedication they show our patients every day.”

One of those patients is Jameson Finney.

For the first 12 years of his life, Jameson was an active little boy that always moved at 100 miles an hour, his parents said. There was never the slightest indication that he might have a heart condition. On Christmas Day 2017, while opening presents with his family, Jameson suddenly became ill. Two days later, he was admitted to Texas Children’s heart failure intensive care unit and diagnosed with dilated cardiomyopathy, a condition in which the heart muscle – typically starting in the left ventricle – begins to stretch and become thin. The dilation makes the muscle unable to contract properly, which weakens the heart and can lead to heart failure.

Jameson was experiencing severe heart failure and needed life-saving surgery as soon as possible. Texas Children’s congenital heart surgeon Dr. Iki Adachi implanted a ventricular assist device on December 31, which improved Jameson’s condition so much that we was able to go home after less than a month. But his journey wasn’t over. Jameson’s best chance at survival now was a heart transplant, and he was placed on the list on March 30, 2018 – Good Friday. Less than two months later, Jameson received the miraculous gift of a new heart. Adachi, who also performed the transplant, said Jameson has been doing very well since his surgery.

Jameson’s story is just one example of the amazing work done by Transplant Services in 2018. But none of the work we do would be possible without the selfless decisions that our donor families make during the most difficult time of their lives.

“Our donor families are heroes, said Goss. “They truly give our patients a second chance at life.”

Learn more about Transplant Services at Texas Children’s.

February 25, 2019

An energetic crew of 30 health-conscious Texas Children’s employees, some of their friends and one enthusiastic Heart Center patient mom recently teamed up to put a whole new spin on celebrating Heart Month.

The multidisciplinary group of physicians, nurses, physical and occupational therapists, and nutritionists from our cardiac intensive care unit (CICU), along with several employees from other critical care medicine (CCM)-related departments and services, met at RIDE indoor cycling studio in Houston Heights to sweat for a cause, raising money for Texas Children’s CICU and CCM patients and their families in a charity spin class.

“An event like this shows you the kind of amazing people we have at Texas Children’s,” said Dr. Paul Checchia, medical director of the Cardiac Intensive Care Unit. “Not only does it reflect their dedication to our patients, to give up their personal time – and their sweat – to benefit children with heart disease, but it also shows their dedication to the team, to each other and to their own heart health.”

The idea first came to Dr. Patricia Bastero, Texas Children’s medical director of Simulation for Critical Care Medicine, after the CICU team held two previous spin runs together.

“Lots of us love spin – it gives you strength and cardio, it’s great for you,” she said. “But it’s also a great way to bond with friends. I thought, ‘Why not take it a step further and do it to benefit our families?’ So we started to spread the word through email, on Facebook and with custom-made flyers, and I want to thank Pamela Biggs for all the work she did in helping us to keep people informed about the event.”

Texas Children’s has one of the nation’s largest, busiest and highest-acuity critical care services. Each year more than 6,000 children are admitted to our intensive care units, including approximately 800 children with heart disease admitted to our CICU, the majority of whom have undergone heart surgery. Understandably, because of the complex nature of these cases, critical care treatment can be stressful for patient and family. It can also mean lengthy stays or lots of travel to the hospital, which can add up.

The funds raised through the charity spin class will help defray some of those costs incurred during hospital visits, such as parking or gas.

“An event like this not only raises much-needed funds to support out families, but it’s an incredible team-building event,” said Dr. Lara Shekerdemian, Texas Children’s chief of Critical Care. “We are lucky to have ICU and Heart Center teams whose commitment to our patients extends beyond the doors of the ICU. Excellent teamwork outside leads to even better teamwork and patient care in our ICUs.”

The event was so popular that there are already plans for future charity spin classes. Bastero also hopes it inspires other groups in the hospital to host similar events, both for our patients’ health and their own.

“There are so many groups across the hospital that do similar things for patients and their families, but every little bit helps,” she said. “When many people join together for a common purpose, we can make a bigger difference.”

Learn more about the CICU and critical care services at Texas Children’s Hospital.

February 18, 2019

During Heart Month we celebrate our patients and the miracles our experts perform every day providing heart care that’s the best in the nation. This year, we’re also celebrating a unified commitment to making our Heart Center even better.

Heart Center leadership, faculty and staff recently convened for the inaugural Heart Center Retreat. The event afforded the full, multidisciplinary team of surgeons, clinicians, intensivists, nurses, advanced practice providers, anesthesiologists, administrators and more the opportunity to collectively reflect on past successes, discuss areas of possible improvement, identify transformative goals, and actively plan for the future.

“If you believe some of the external ratings sources, our congenital heart disease program is one of the best in the country. Personally, I do not like to give external ratings much credence” said Dr. Christopher Caldarone, Texas Children’s chief of Congenital Heart Surgery. “A great program will hear such accolades and disregard them while searching for ways to get better. And that was the purpose of the Heart Center Retreat – to help us rise above the day-to-day and intensely focus our attention on ways to improve in terms of patient care, access, teaching, research, innovation, and quality of life for members of the Heart Center team.”

Following an introduction from President and CEO Mark Wallace, attendees heard several talks from Heart Center leadership on a variety of topics. These included reflections on the program’s growth in recent years, how the move into Lester and Sue Smith Legacy Tower has affected processes and outcomes, and what it means to be the No. 1 heart program in the nation. Attention then turned to ways to make the Heart Center even better, with talks outlining opportunities for advancement in innovation and research, plans for improved education and training, challenges posed by competition and strategies for staying ahead, and the need to relentlessly improve patient care, access and experience.

“To be our best we must do our jobs better than anyone, work together and always keep the patient top of mind,” said Dr. Daniel Penny, Texas Children’s chief of Pediatric Cardiology. “We believe that what will separate Texas Children’s Heart Center going forward is a unique combination of exceptional technical abilities coupled with a highly developed collaborative culture that is completely centered on our patients and their families.”

Following the talks, attendees split up into preselected breakout groups. The teams chose their groups based on the topic and were tasked with developing real-world strategies based on key Heart Center objectives. These included:

  • Establishing a comprehensive center for patients and families living with Fontan physiology across the lifespan
  • Developing a unified data platform to increase efficiency and improve quality control and research productivity
  • Creating an innovation fund with a streamlined application process to generate new ideas
  • Design a process that solicits, evaluates and prioritizes innovative projects
  • Improving satisfaction and efficiency in the management of new patients
  • Providing access to professional development for nursing and ancillary services

The breakout groups facilitated lively discussion and engagement. Each team was highly motivated and have since reported back to the Heart Center executive committee with proposals that include target objectives, and tactics and budgetary considerations for meeting those objectives.

Feedback from retreat participants has been positive and there are plans to make it an annual event. It’s yet another way the Heart Center has rallied around its ongoing mission to, as the leadership teams says, “get so far ahead no one can catch us.”

“Even though we’re a large, elite program, we must consistently take a critical and objective look at all aspects of our performance”, said Caldarone. “Our goal is be a large, comprehensive, and collaborative team that is nimble in our ability to mobilize expertise to meet the needs of every patient.”

February 11, 2019

 

It’s Heart Month, which is always a special time at Texas Children’s as we celebrate our patients and families, the care we provide at our No. 1-ranked Heart Center and our many milestones. This year, we’re kicking off Heart Month celebrating yet another momentous first.

A team of experts at Texas Children’s Heart Center®, led by congenital heart surgeon Dr. Iki Adachi, became the first in the United States – and only the second in the world – to implant the Jarvik 2015 ventricular assist device (VAD), a groundbreaking new technology Adachi helped develop.

“Dr. Adachi is truly a pioneer and a world-renowned authority on mechanical heart support,” said Dr. Christopher Caldarone, Texas Children’s chief of Congenital Heart Surgery. “His work in the development of the Jarvik 2015 VAD has been tremendous and is a great example of the power of Texas Children’s in bringing new technologies to benefit our patients.”

Bridge to transplant

For patients with heart failure, a VAD can buy valuable time until they match an organ. In some rare cases, a VAD can be used as a permanent therapy for heart failure or can even improve heart function to such a degree that it makes a transplant unnecessary. VADs can either simulate heart function with pulsing action or allow a continuous stream of blood to flow through the heart. Continuous-flow VADs tend to be smaller and quieter but also more durable, and in recent years have yielded improved results in adult heart failure patients.

The Jarvik 2015 is the first and only implantable continuous-flow VAD designed specifically for small children. Development took more than a decade and was not without setbacks. After the previous prototype failed to gain FDA approval, the team of engineers enlisted Adachi to assist with crucial design modifications to the VAD’s pump while keeping the size of the device small – about the size of a AA battery. Following extensive testing in the Texas Medical Center, the FDA approved the Jarvik 2015 for clinical trial.

A chance at life

One of the most significant benefits of this new technology is that it allows the patient to become stronger, making them a better candidate for transplant. Such was the case with Katlyen Hickman.

You would never know by looking at Katlyen today that the smiling, energetic four-year-old needed multiple surgeries to save her life only a few months ago. She was born with complex congenital heart disease, including ventricular septal defects and small left heart structures, and despite numerous procedures and surgeries during her first years of life, her condition was rapidly deteriorating this past fall.

“It was clear she was moving in the direction of needing heart transplantation,” Adachi said. “She was admitted to the ICU and her heart was just getting worse and worse.”

Though the Jarvik 2015 had been cleared for clinical trials, it hadn’t been approved for commercialization. But because Katlyen’s case was so dire, and because she was too small to receive an adult-size VAD, Adachi and Texas Children’s were able to obtain expanded access from the FDA to implant the device. The fact that the team was already very familiar with the Jarvik 2015, following their extensive laboratory testing, helped facilitate the process with the FDA.

The results couldn’t have been better. Not only did the device keep Katlyen alive, but it also improved her blood flow, which helped her organs recover. This success paved the way for the next critical step in her journey – a heart transplant, which she received on November 23, 2018. It was the day after Thanksgiving. Only a month later she was discharged and spent Christmas at home with her family.

Adachi anticipates the Jarvik 2015 will do well in the upcoming multi-institutional clinical trial and hopes its availability may further accelerate the trend toward the use continuous-flow devices in children.

“Pediatric VAD support will continue to evolve as the pediatric mechanical circulatory support area matures,” he said. “The popularization of continuous-flow devices could be a landmark event that represents a paradigm shift in the field. And Texas Children continues to lead that shift.”

Learn more about Texas Children’s Heart Center and the Jarvik 2015 VAD clinical trial.

January 22, 2019

A group of more than 30 Texas Children’s pediatric cardiac intensive care medicine experts – including intensivists, nurse practitioners, cardiologists, cardiovascular surgeons and nurses – recently attended the 14th International Meeting of the Pediatric Cardiac Intensive Care Society (PCICS) in Miami, Florida. It was the largest conference in the society’s history, with more than 700 participants from across the nation and around the world.

Texas Children’s presence was felt throughout the event. Not only were we an institutional sponsor, but our cardiac critical care expertise was on display, with our specialists leading or participating in 40 programs, meetings, research presentations and pro/con debates, which covered a variety of clinical topics, including:

  • Simulation and quality improvement
  • Managing cardiac arrest
  • Bedside rounds
  • Ethics and social media
  • Approaches to single ventricle neonate management
  • Effective communication and counseling
  • CICU monitoring
  • VAD management
  • Healthy work environments
  • Global perspectives on CICU education

“As an educational opportunity, this event is extremely important for our people, as it highlights important new research, training initiatives and innovations for patients,” said Dr. Paul Checchia, Texas Children’s associate chief of Critical Care Medicine and immediate past president of PCICS. “But it also allows Texas Children’s faculty and staff, who are recognized leaders in this field on an international level, to showcase their thought leadership and to educate others.”

PCICS is an international forum with more than 1,000 members worldwide that promotes excellence in pediatric cardiac intensive care medicine. The annual meeting – the only one of its kind dedicated exclusively to pediatric to pediatric cardiac critical care – plays a large role in the advancement of research and training that has the ability to improve the care of pediatric patients with congenital heart diseases and acquired cardiovascular diseases.

“PCICS is the premier scientific meeting of our field, and Texas Children’s ‘swept the board’ at this year’s meeting,” said Chief of Critical Care Dr. Lara Shekerdemian. “I am particularly proud that all of our clinician groups that included nursing were so strongly represented. This reflects our belief in the importance of collaboration at every level – from clinical care to academic productivity.”

This year’s PCICS conference held additional significance for Texas Children’s as Checchia was honored with the Anthony Chang Lectureship, the only named lecture in the field of pediatric cardiac intensive care medicine. The award is named in honor of Dr. Anthony Chang, who founded PCICS 20 years ago. The Anthony C. Chang Award for Excellence in Pediatric Cardiac Intensive Care recognizes an attending physician who has made exemplary contributions to the field of pediatric cardiac intensive care and to PCICS, and who is making a positive difference in the lives of colleagues, patients and families, as well as in the communities where they live.

About Texas Children’s Cardiac ICU

Texas Children’s 48-bed CICU is one of the largest and most active units in the nation, and a vital part of the complete continuum of care offered by Texas Children’s Heart Center® – No. 1 in Pediatric Cardiology and Congenital Heart Surgery in the country, according to U.S. News & World Report.

Every year, we admit more than 1,000 children with heart disease, the majority of whom have undergone heart surgery. And we provide comprehensive, specialized care for each child’s individual cardiac condition.

Our multidisciplinary team includes cardiac intensivists, cardiologists, cardiac surgeons, cardiac anesthesiologists, perfusionists, advanced practice providers, nurses and respiratory therapists, all working collaboratively to provide the best care and outcomes for patients. State-of-the-art facilities coupled with dynamic decision-making in the CICU allow our team to carefully analyze each child’s case and deliver a customized care experience. Additionally, we are a recognized leader in cardiac critical care education and are dedicated to training the next generation of specialists and nurses on caring for a patient population with complex needs and interventions.

Learn more about Texas Children’s CICU.

December 18, 2018

Experts from across the country recently convened for the fourth Symposium on Coronary Artery Anomalies, hosted by Texas Children’s Heart Center®.

The event was founded by leaders of Texas Children’s groundbreaking Coronary Anomalies Program – the first of its kind in the nation – as a way for caregivers, researchers and others to gather and discuss the diagnosis and management of patients with coronary artery anomalies, such as anomalous aortic origin of coronary artery (AAOCA), which can lead to the phenomenon known as sudden cardiac death (SCD), which usually occurs in young athletes.

“Before we began to really focus on these conditions, there was very little data about the potential risks or causes, which in turn led to controversy surrounding the proper ways to evaluate, treat and monitor children with these conditions,” said Texas Children’s cardiologist Dr. Silvana Molossi. “This event provides an open, dedicated forum for discussion and information sharing, and has become a valuable resource for experts nationwide who are involved in the diagnosis and care of patients with these rare conditions.”

The event featured comprehensive presentations by members of Texas Children’s Coronary Anomalies Program, as well as 11 visiting faculty from some of the country’s preeminent pediatric health care institutions, including Boston Children’s, CHOP, Stanford University, Columbia University, UT Southwestern, and the Heart & Vascular Institute at Hartford Hospital in Connecticut. Major topics included AAOCA, Kawasaki disease and myocardial bridges.

An addition to this year’s conference was a special Patients & Families Symposium.

“We were astounded by the response to the family symposium before it even started,” said Molossi. “We expected between 25 and 30 people to register – we ended up having nearly 80 in attendance.”

During this day-long event, parents and children attended talks that addressed topics such as the impact of coronary anomalies on families and the importance of counseling and shared decision-making when determining a plan of care. And in a session titled, “This is My Story: Patients and Families Living with AAOCA,” visitors had an opportunity to hear from Texas Children’s patients and families who have had similar experiences of unknowingly living with these life-threatening conditions, receiving crucial diagnoses and making the tough decisions that follow, undergoing open-heart surgery, and living a normal life in the aftermath. This emotional and powerful session was followed by discussions about the importance of networking and building a sense of community and collective support for people affected by coronary anomalies.

About the Coronary Anomalies Program at Texas Children’s

Seeing the need for more complete data and a more specialized approach to care, experts at Texas Children’s formed the Coronary Anomalies Program. The multidisciplinary core team of cardiologists, congenital heart surgeons, radiologists and researchers works together to provide the best treatment for patients with congenital coronary anomalies, study outcomes, and educate health care providers and the public about these conditions.

A cornerstone of this team’s approach is the development and use of a clinical algorithm to facilitate the diagnosis and management of these patients. The team presents cases in monthly multidisciplinary meetings to determine the best course of action for each patient, and then tracks the patients’ outcomes over time.