Surgical Milestones in Pe-diatric Cardiology: The

Birth of Open Heart Sur-gery-Dr. John Gibbon’s Dream and the 1st Heart-

Lung Machine

I n the history of pediatric cardiac surgery, there are

no two accomplishments that changed the prognosis for children with congenital heart defects more than the Blalock-Taussig (Thomas) shunt and the development of the heart-lung machine. The Blalock-Taussig shunt made life possible for chil-dren with inadequate blood flow to their lungs by creating a shunt of blood directly from an arterial vessel to the pul-monary artery. Because the

Volume 3 , Issue 2

T H E D I R E C T O R ’ S C U T C H R I S T I N E D O N N E L L Y , M D

Summer 2012

THE HEART BEAT

Children’s Heart Center

Goryeb Children’s Hospital Morristown Medical Center 100 Madison Ave. Morristown, NJ 07962 Goryeb Children’s Center Overlook Medical Center 99 Beauvoir Ave. Summit, NJ 07901 Newton Medical Center 175 High Street Newton, NJ 07860 Physicians Christine Donnelly, MD-Director Stuart Kaufman, MD Donna M. Timchak, MD Suzanne Mone, MD Lauren Rosenthal, MD, MPH Aparna Prasad, MD Leonardo Liberman, MD-EP Consult. Nurses Wanda Kaminski, RN Maria Lawton, RN Elena Cobleigh, RN Technologists Colleen Henderson, RCS, RDCS-Lead Clinician Alexis Harrison, RCS, RDCS- Lead Technologist Bhavisha Pandya, RDCS Alla Greenberg Ashley DeRosa, RCCS Kelli Vranch, RDCS Ginamarie Casale, RCS, RDCS, RVS Medical Assistants Joanne Spiropoulos Caitlynn Caraturo Melissa Citarelli Social Worker Margaret Micchelli, LCSW Administrative Staff Lynn Vanderyajt- Business Coord. Jessica Darcy Diann Vivar Sandy Segreto Phone: (973) 971-5996 Fax: (973) 290-7979 Visit the Children's Heart Center Web Site Edited by:

Margaret Micchelli and Stuart

Kaufman

operation was outside the heart (“closed“), it could be performed on a beating heart with no need to “bypass” the circulation. In this sense, the operation was “palliative”, but it did not fix the problem in-side the heart. To be able to actually correct a defect in-side the heart, it needed to be still and “dry” in order to visualize the problem and repair it. But to do so, the circulation needed to be sup-ported while the operation was performed. Hence, prior to the development of the heart-lung machine, “open” heart surgery was unheard of.

O ne man made it his life’s work to create such a

machine. In 1930, John Gib-bon was a young surgical fellow under the mentorship of Dr. Edward Churchill at Mass. General Hospital when he was deeply affected by the death of his patient after removal of a massive blood clot to the pulmonary artery that had developed when she was recovering from gallbladder surgery. She had been moved to an operating room where Dr. Gibbon sat all night, monitor-

ing her vital signs. When it became apparent there was no hope without surgical removal of the clot, she un-derwent a rapid removal of the clot in which he assisted Dr. Churchill in an operation that lasted only 6 minutes. Despite the short duration, the patient did not survive which was the usual out-come at that time. Dr. Gib-bon subsequently wrote “ if only we could remove the blood from her body by by-passing her lungs and oxy-genate it, then return it to her heart, we could certainly have saved her life.” Creat-ing a means to do this be-came his dream and he spent over 2 decades in me-ticulous research to develop a way to temporarily take over the function of the heart and lungs.

H is work culminated in the 1st heart-lung machine.

In 1935, he published his results about a prototype machine that was able to support the circulation of a cat while the pulmonary ar-tery was closed off. Over the next decade, Dr. Gibbon

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A F O N D ( B U T S A D ) F A R E W E L L !

I n case you’ve heard, it’s really true that Wanda Kaminski, RN will soon be moving on to new adventures. By the end of the summer, she an-

ticipates moving to Georgia to be near family and to continue her career in pediatric nursing.

W anda joined the Morristown Memorial NICU staff 25 years ago and she has cared for countless children and families since then. Fif-

teen years ago, she was the first nurse to work in pediatric cardiology and the rest is history. We thank her for all that she’s given and wish her much happiness in the years to come!

Save The Date: An Afternoon in the Park , September 9, 2012

W hen it came time to decide on a career

direction, I was interested in going to a school for medical office management. The program included a four- week externship and I was assigned to an Ob/Gyn of-fice. I really enjoyed the work and they offered me a position at the end. Over the past 20 years, I have worked for some fantastic doctors in several different Ob/Gyn offices. I had the opportunity to meet a lot of wonderful patients, being a part of their pregnancies and their family experiences.

When the last doctor with whom I worked decided to close her practice and take a position at Morristown Medical Center, I started to think about my future and thought that the hospital might also be a good place for me to work.

I started working at the hospital in 2005 and

came to the pediatric cardi-ology physician practice in 2009. So for the past three years, I have been learning about the ins and outs of pediatric cardiology. Last year I became the business coordinator and it’s given me the chance to come up with ideas to make things run as smoothly as possi-ble. I’m lucky to have a wonderful group of people to learn from and work with every day.

W hen I am not at work, I like to help out in my

community which really comes alive during the sum-mer months. We have three beaches where I’m respon-sible to make sure they’re open and running well. All types of sports begin in May and run through September, so I enjoy participating, or-ganizing, or cheering for a team almost every night during the week. Over the years, I have been able to participate in many different ways with both my own chil-dren and the children in the community and I’ve enjoyed every minute of it. It is al-ways a little sad when Sep-tember rolls around and all the beach equipment gets put away and the children go back to school. If sum-mer could just continue a little longer…..

The Hear t Beat Volume 3, Issue 2

H E A LT H Y H E A R T S U Z A N N E M O N E , M D

S T A F F H I G H L I G H T L Y N N V A N D E R Y A J T - B U S I N E S S C O O R D .

know how hydrated you are. Light colored or colorless urine typically indicates proper hydration. Dark yel-low urine is a common indi-cator of dehydration.

C hildren with cyanotic heart disease (oxygen

saturation in the 80’s or low-er) need to take extra pre-caution with extremes of hot and cold. Adequate hydra-tion is important to avoid increases in red blood cell mass or blood viscosity (thickness of one's blood).

I t’s best to choose water and/or electrolyte- contain-

ing beverages. Be careful to avoid those with a high sug-ar content and artificial col-oring. The sugar content is not good for your teeth or your waistline. The sugar also increases your thirst. Avoid energy drinks as they all contain caffeine or com-pounds with caffeine. Caf-

(Continued on page 3)

duces your coordination and can cause muscle cramps. While working out or playing sports, dehydration compro-mises the body’s ability to cool itself through sweating. This can lead to heat ex-haustion and in extreme cases, heat stroke which is a potentially life-threatening condition.

E xercising inside and outside, especially dur-

ing hot weather, requires more water to stay properly hydrated. Your thirst mech-anism alerts you that you are already becoming dehy-drated. Looking at the color of your urine is one way to

The Importance of Hydration

P roper hydration is im-portant for overall

health. Without enough fluids, you become dehy-drated which means your body does not have enough water to function normally. You lose water every day when you breathe, sweat and go the bathroom. The water content in the foods you eat and the beverages you drink combine to hy-drate your body and replen-ish the losses.

H ydration is essential for peak athletic perfor-

mance. When you don’t consume enough liquid or fresh fruits and vegetables to stay properly hydrated, you end up thirsty and light-headed. Mild dehydration can also lead to headaches and moodiness.

I nsufficient hydration fa-tigues your muscles, re-

N U R S E S ’ N O T E S

Summer Safety Tips by Maria Lawton, RN

Drink plenty of fluids,

preferably electrolyte-

enriched, to prevent

dehydration which can

lead to neurally-

mediated symptoms,

such as fainting,

headaches, lighthead-

edness and fatigue.

Wear protective sun

gear, such as a broad

spectrum sun screen

(SPF 30), sunglasses

and hats to avoid sun-

burn and sun-related

illness.

Avoid being outdoors

during peak sun/heat

hours from 10 am to 3

pm to minimize the

chance of heat ex-

haustion or heat

stroke.

Plan to exercise in air conditioned facilities or during non-peak sun hours.

Wear insect repellent

for outdoor activities and check for ticks to prevent Lyme disease which can lead to heart block.

Remember to pack

medications and all relevant health infor-mation when going on vacation in case of an emergency.

Page 2

The Hear t Beat Volume 3, Issue 2 Page 3

H E A LT H Y H E A R T ( C O N T ’ D )

the Parent Support Group. I was very reluc-tant to go at first, as I am sure many of you are. Once I convinced myself to go, I immedi-ately felt a strong bond with people I had just met! It is a place where I feel I can talk about things regarding Tyler and know that the other parents “get it”. It is also a place where you don’t have to share, but you can feel connect-ed just by listening to other people’s stories.

I have made life-long friends for myself, as well as for my son. I know Tyler doesn’t

understand his heart defect now, but it is com-forting to know that when he does, he will not feel alone either. So, if you are a parent of a young child with a heart defect, I encourage you to think about attending. I hope it will change your life, as it did mine!

Kourtney, mother of a 2 1/2 year old son

M y son, Tyler, was born in February of 2010. My husband and I had no idea

until after he was born, that Tyler had a heart defect which required open-heart surgery to repair. We were sent to Columbia when he was 6 days old, and at 8 days old he had his surgery. Tyler recovered quickly, much quick-er than I did anyway. For months I felt very alone. I was so upset by it and would find myself saying “Why me? Why my kid?”

A s I look back over the past months, I real-ize I have come a very long way. Who

can I attribute that to? For starters, I have a very supportive husband. Next, we go to the best Pediatric Cardiology group. I leave every appointment confident that Dr. Donnelly and her staff are giving Tyler the best care! And lastly, I have met some of the BEST people in

Did you know??

There are now more adults with congenital heart defects (CHD) than children. In the United States, there are about 1 million adults and 800,000 children living with CHD.

The number of adults with CHD increases each year by about 5%.

In the U.S., CHD is now the most common form of heart disease encountered during a woman’s pregnancy.

At least 10% of all congeni-tal heart defects are first found in adulthood.

There are more than 40 different types of congenital heart defects.

The most common congen-ital heart defect is a ventricular septal defect.

It is important for adults living with CHD to see a spe-cialized health care provider for cardiac care regularly throughout their lives.

It is estimated that only 50% of adults with congenital heart defects receive ongoing cardiovascular care.

The Adult Congenital Heart Association (ACHA) is a non-profit organization dedicated to education, outreach and advo-cacy for adults with CHD and their families.

What is the cost of mem-bership in the ACHA?

feine is a diuretic and diuretics make you uri-nate more frequently and can lead to dehy-dration. Another issue regarding hydration is that many children are reluctant to use the bathrooms at school. Therefore, they don’t drink enough fluids in an effort to avoid using

Answer: Membership is free!

F A M I L Y C O N N E C T I O N

worked to solve problems of an artificial circu-lation and developed a machine that could be used in larger animals. Although WWII inter-rupted this research work, he resumed it after the war and continued his intensive experi-ments resolving critical factors in the mainte-nance of circulation outside the body that are now taken for granted: how to drain the blood from the body, how to supply oxygen to it (lung function), how to prevent it from clotting and how to pump it back (heart function). Finally, in 1953, he was ready to apply his decades of work to help a patient. Cecelia Bavolek was an 18 year old with a large atrial septal defect, a hole in the wall between the 2 top chambers of the heart. Massive blood flow through this defect was flooding her lungs, resulting in heart failure and her 3rd hospitalization in 6 months. The only way for Cecelia to be permanently helped was to close this hole. Dr. Gibbon discussed his plan to use his heart-lung machine so he could see the hole directly, even though the machine had only been used successfully in animals at that point. Cecelia agreed to go ahead with the surgery at Jefferson Medical College Hospital in Philadelphia. On May 6, 1953, Dr. Gibbon repaired the atrial defect in

Cecelia Bavolek’s heart using his heart-lung ma-chine. For 26 minutes, his machine completely supported all of her res-piratory and circulatory functions. She recovered uneventfully and 10

years later was named “Heart Queen of the Year” by the American Heart Association. Gib-bon later wrote, his dream “… was born and developed into a reality and finally was em-ployed successfully in an operation on the heart of a human patient twenty-two years later, an event that I hardly dreamed of in 1931.”

S ince the first successful use of Gibbon’s heart-lung machine, which was the size of

a spinet piano, many improvements and re-finements have occurred and today, thou-sands of open-heart procedures are performed every day with use of the heart-lung machine. Thanks to the courage and perseverance of Dr. John Gibbon, May 6, 1953 ushered in a new world of possibility for children born with heart defects who would now benefit from the reality of his dream for generations to come.

T H E D I R E C T O R S C U T ( C O N T ’ D )

the bathroom. School personnel, as well as parents, need to be sensitive to this issue.

R emember to take time out to drink throughout the day. Hydrate to look bet-

ter, feel better and exercise better!!!

L E G I S L A T I V E U P D A T E S

I n February 2012, the Congressional Congenital Heart Caucus was established in the U.S. House of

Representatives. Caucus members function as a group around common concerns; in this case, it’s around issues relevant to congenital heart defects. The Caucus can disseminate information about CHD to other members of the House, as well as promote legislative agendas that affect people with CHD. Congressman Gus Bilirakis (R-FL) is the current chairperson and issues of concern can be directed to him. You may want to encourage your representative to join the Caucus. You can find your representative’s contact information at www.house.gov.

I n June 2012, the Senate’s FY 2013 Appropriations Bill included 3 million dollars for CHD surveillance at the Centers

for Disease Control and Prevention, an increase of 1 million dollars from last year. This will enable improved data collection to better understand the prevalence and the public health impact of CHD.

The Hear t Beat Volume 3, Issue 2 Page 4

5 T H A N N U A L C O N G E N I T A L H E A R T D E F E C T A W A R E N E S S W A L K

Who: The CHD Coalition is a NJ non-profit organization whose mission is to raise awareness, fund research and provide support for those with congenital heart defects.

What: Fund raising walk, children’s activities, music, refreshments

When: Sunday, September 30, 2012 at 10 AM

Where: Duck Pond in Ridgewood, NJ

Why: Staff members of the division of pediatric cardiology will be participating and we invite you to join us for a fun and worthwhile event.

For details please contact: Kim Shadek (973) 291-4676 or www.chdcoalition.org

S O C I A L W O R K C O R N E R M A R G A R E T M I C C H E L L I , L C S W

F or the third year in a row, the divi-sion of pediatric cardiology cele-

brated National Congenital Cardiac Defect Awareness Day with a Valen-tine’s party for children and families. On February 12th, the hospital auditori-um was filled with food, fun and lots of

activities. Ferris the Magician performed a mesmerizing show, even pulling a live dove out of his hat. The balloon art-istry of Hug-A-Me the clown was in great demand, while the therapy pets from St. Hubert’s are always a big hit. Free raffle prizes, arts and crafts, as well as a bean bag toss were all part of the festivities. It’s gratifying to see more new faces each year, building our community of “heart” families. And many thanks to the parent volunteers who were indispensable in making the afternoon a great success!

O ne of the most important functions of our family events is to provide an opportunity for parents and children to meet

others who understand what they are experiencing. Please put this annual event on your calendar. Next year it will be on February 10, 2013.

3 R D A N N UA L N AT I O N A L CH D A WA R E N E S S D AY

W E L C O M E D R . P R A S A D

W e are pleased to announce that Dr. Aparna Prasad will be joining the division of pediatric cardiology as another

full-time physician to care for families at both Morristown Medi-cal Center and Overlook Medical Center. She has recently completed her fellowship in pediatric cardiology at the Chil-dren’s National Medical Center in Washington, D.C. Following medical school at SUNY Buffalo, Dr. Prasad did her pediatric residency at the Children’s Hospital at Montefiore in the Bronx. Among her many skills, she also speaks Hindi and Spanish. We are very happy to welcome Dr. Prasad to our team in July.

C O N G R A T S T O T E C H N O L O G I S T S

W ell deserved congratulations to three of our cardiovascu-lar technologists who recently received national certifi-

cation in pediatric echocardiography: Kelli Vranch, Ashley DeRosa and Bhavisha Pandya. After meeting education and experience requirements, the qualifying examination involves many months of study preparation. The two 3 hour tests cover areas such as anatomy, hemodynamics, congenital & acquired pathology, instrumentation and surgical repair. We’re very proud of your accomplishment!