Pediatric Cardiology - UT Southwestern
Pediatric Cardiology - UT Southwestern
Pediatric Cardiology - UT Southwestern
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<strong>Pediatric</strong> <strong>Cardiology</strong><br />
2011 Academic Review<br />
The Division of <strong>Pediatric</strong> <strong>Cardiology</strong> is committed to:<br />
• advancing scientific discovery through clinical and basic research,<br />
• the provision of outstanding pediatric cardiac care,<br />
• and the education of new physicians as well as the ongoing support of<br />
practicing physicians throughout the region.<br />
Research is strongly supported by <strong>UT</strong> <strong>Southwestern</strong>’s main campus resources,<br />
including extensive core facilities for genetic evaluation and both surgical and<br />
catheterization suites for large animal studies. Clinical research is further<br />
augmented by the Department of Clinical Sciences, with support services for<br />
study design, grant preparation and statistical analysis.<br />
The clinical service benefits from a large referral base, including those from<br />
regional, national and international sources in addition to the local metroplex<br />
population. In collaboration with Children’s Medical Center, construction of<br />
a new Heart Center is under way to bring all cardiac services together on one<br />
floor of the hospital. A dedicated outreach program facilitates patient care.<br />
The division actively participates in the training of students, residents and subspecialty fellows, which is provided by a<br />
diverse and talented cardiology faculty, who themselves represent all of the major training programs in the United States.<br />
Faculty<br />
William Scott, M.D.<br />
Professor,<br />
Director, <strong>Pediatric</strong> <strong>Cardiology</strong><br />
The Division has 22 board-certified pediatric cardiologists, each with a special area of expertise,<br />
including critical care medicine, inteventional catheterization, electrophysiology, advance<br />
imaging, fetal cardiology, cardiac transplantation, heart failure, prevention and adults with<br />
congenital heart disease.<br />
In 2011, Dr. Bibhuti Das joined us from the University of Louisville where he directed the heart<br />
transplant program. He will be providing expertise in the management of patients with heart<br />
failure and with the heart transplantation program.<br />
Dr. Tejas Shah moved to the University of Wisconsin to pursue his interests in transplantation<br />
and adults with congenital heart disease.<br />
Bibhuti Das, M.D.<br />
Aliessa Barnes, M.D.<br />
Assistant Professor<br />
Shannon Blalock, M.D.<br />
Assistant Professor<br />
Sarah Blumenschein, M.D.<br />
Clinical Associate Professor<br />
Mark A. Clay, M.D.<br />
Assistant Professor<br />
Michael Day, M.D.<br />
Assistant Professor<br />
Bibhuti B. Das, M.D.<br />
Associate Professor<br />
Vivian Dimas, M.D.<br />
Assistant Professor<br />
David Fixler, M.D.<br />
Professor<br />
Candace Gibbin, M.D.<br />
Assistant Professor<br />
Lisa Heistein, M.D.<br />
Assistant Professor<br />
Catherine Ikemba, M.D.<br />
Assistant Professor<br />
Amy Juraszek, M.D.<br />
Associate Professor, <strong>Pediatric</strong>s and<br />
Pathology<br />
Colin E. Kane, M.D.<br />
Assistant Professor<br />
Matthew Lemler, M.D.<br />
Professor<br />
Lynn Mahony, M.D.<br />
Professor<br />
Alan Nugent, M.D.<br />
Associate Professor<br />
Claudio Ramaciotti, M.D.<br />
Professor<br />
William Scott, M.D.<br />
Professor, Division Director<br />
Poonam Punjwani Thankavel, M.D.<br />
Assistant Professor<br />
Surendranath Veeram Reddy, M.D.<br />
Assistant Professor<br />
Shawyntee M. Vertilus, M.D., M.P.H.<br />
Assistant Professor<br />
Thomas Zellers, M.D.<br />
Professor, Chief Medical Officer, CMC<br />
Ilana Zeltser, M.D.<br />
Assistant Professor<br />
Additional faculty recruitments to support expansion in the areas of cardiac transplantation, heart failure, critical care,<br />
prevention and advanced noninvasive imaging are ongoing.<br />
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Research Activities<br />
Basic Science<br />
An exciting ongoing area of investigation is the development of biodegradable stents for use in the cardiovascular system.<br />
Current research is directed at an evaluation of the tissue response to these materials in animals Another new area of<br />
investigation is to optimize cardiovascular support therapy for pediatric patients with end stage heart failure. Currently the<br />
only ventricular assist devices available require surgical placement. We are investigating an animal model for the feasibility<br />
of a pediatric sized catheter delivered device. Animal research is also ongoing to optimize catheter-based interventions in<br />
the fetus.<br />
Clinical Sciences<br />
The cardiology division participates in multiple multicenter trials. In interventional catheterization, current trials are<br />
assessing various devices, including the Amplatzer and Helex occluders, and management of coarctation, including the<br />
placement of stents. A multicenter effort is also underway to evaluate the use of ventricular assist devices in the pediatric<br />
population.<br />
In cardiac transplant medicine there are both multi-institutional trials and local investigative efforts to evaluate ABO<br />
incompatibility, drug therapies, markers for cardiac transplant rejection and the role of pulmonary hypertension.<br />
It is anticipated that a recently completed multicenter trial of athletic screening processes will be used for a broader national<br />
evaluation. We are contributing to a quality initiative to assess the care of patients with hypoplastic left heart syndrome.<br />
Other clinical investigations are underway to study coronary artery imaging, tricuspid valve disorders, racial and ethnic<br />
differences in mortality for children with congenital heart disease, natural history studies of patent ductus arteriosus<br />
in preterm neonates, evaluation of renal function following heart catheterization, innovations in noninvasive cardiac<br />
monitoring and the psychological impact of prenatal diagnosis of congenital heart disease.<br />
Collaborative studies within the department of <strong>Pediatric</strong>s include protocols to evaluate stroke, migraine, muscular<br />
dystrophy, neonatal asphyxia, and complications of sickle cell disease and childhood cancer.<br />
Clinical Activities<br />
<strong>Pediatric</strong> <strong>Cardiology</strong> faculty provided more than 8,000 inpatient, outpatient and diagnostic services in 2011. Inpatients with<br />
cardiac disease received care in the 20-bed CVICU and a 22-bed telemetry/step-down unit. Last year, care was provided for<br />
523 surgical patients, including 336 open cases and nine cardiac transplants. The average length of stay is 12.05 days in the<br />
CVICU and 7.03 days on the cardiology inpatient unit.<br />
Nearly 10,734 patients were evaluated in the outpatient clinics at Children’s main campus, Legacy and Southlake facilities.<br />
In addition to overall cardiac evaluation, specialty clinics provided focused care for patients with implanted devices,<br />
arrhythmia, obesity, cholesterol and lipid disorders, heart transplantation, Marfan syndrome and adults with congenital<br />
heart disease.<br />
Diagnostic services included 856 cardiac catheterizations, most involving interventional procedures. Eighty-six of those<br />
were electrophysiologic procedures including catheter ablation. Noninvasive studies are comprised of imaging and<br />
electrocardiographic (ECHO) studies. The division performed:<br />
• 6,616 transthoracic ECHOs,<br />
• 632 transesophageal studies,<br />
• and 279 fetal ECHOs.<br />
Additional studies included:<br />
• 14,058 electrocardiograms (ECGs),<br />
• 797 Holter monitors,<br />
• 155 pacemaker analyses,<br />
• 164 exercise tests,<br />
2<br />
• and 87 cardiac MRIs.<br />
Additionally, telemedicine capabilities for transmission and review of echocardiographic (ECHO) and electrocardiographic<br />
(ECG) studies are available to multiple institutions across the state, from Amarillo to Tyler. Approximately 549 ECHOs and<br />
100 ECGs were interpreted from these institutions.<br />
Education and Training<br />
The Division provided educational opportunities for medical<br />
students and pediatric residents, including third-year pediatric<br />
rotations and fourth-year electives in pediatric cardiology.<br />
The fully-accredited fellowship program offers comprehensive<br />
training in all aspects of pediatric cardiology. Two fellows are<br />
accepted each year. Advanced fellowships are available in critical care,<br />
interventional catheterization, cardiac imaging, transplantation and<br />
electrophysiology. Currently there are six fellows in the categorical<br />
program and two receiving advanced training.<br />
Two fellows graduated in 2011:<br />
• Adrian Dyer, M.D., stayed at <strong>UT</strong> <strong>Southwestern</strong> to complete a<br />
fourth-year fellowship in cardiac imaging.<br />
• Jason Imundo, M.D., went to Children’s Hospital of Philadelphia<br />
to complete a fourth-year fellowship in electrophysiology.<br />
Presentations<br />
Dr. Adrian Dyer<br />
Poster presentation at the 2 nd Annual<br />
<strong>Pediatric</strong> Senior Fellow Research Day<br />
Aliessa Barnes, M.D.<br />
• “Donors’ Characteristics and Impact on Outcomes in <strong>Pediatric</strong> Heart Transplant Recipients” and “Use of Bortezomib<br />
in Management of Humoral Rejection in a Non-Compliant Teenage Heart Transplant,” International Society for Heart<br />
and Lung Transplantation’s 31 st Annual Meeting and Scientific Sessions, San Diego, CA, April 2011<br />
• “Management of Single Ventricle Patients with Berlin Heart EXCOR Ventricular Assist Device: Single Center<br />
Experience,” International Society for <strong>Pediatric</strong> Mechanical Cardiopulmonary Support, Philadelphia, PA, May 2011<br />
Shannon Blalock, M.D.<br />
• “MRI and Pulmonary Hypertension,” ACC.11 Session: Beyond Eisenmenger - Pulmonary Hypertension in <strong>Pediatric</strong>s,”<br />
Invited Lecture, American College of <strong>Cardiology</strong> Annual Meeting, New Orleans, LA, April 2011<br />
• Blalock SE, Ogawa M, Chan F, Maxey D, Rosenthal DN, Feinstein JA. “MRI Evaluation of the Right Ventricle in<br />
<strong>Pediatric</strong> Pulmonary Hypertension,” International Society of Heart Lung Transplantation Annual Conference, San<br />
Diego, CA, April 2011 (Oral abstract presentation)<br />
Sarah Blumenschein, M.D.<br />
• “Hypercholesterolemia in Children,” National Association of <strong>Pediatric</strong> Nurse Associates and Practitioners, Arlington,<br />
TX, October 2011<br />
Bibhuti Das, M.D.<br />
• “Outcome of Fetal Listing for Heart Transplantation,” American Heart Association Annual Conference, Orlando FL,<br />
November 2011<br />
Amy Juraszek, M.D.<br />
• “The Surgical Pathology of Transposition,” Annual <strong>Pediatric</strong> Cardiac Care Conference, Austin, TX, February 2011<br />
• “Small Group Demonstrations of Congenital Heart Disease Pathology,” 17 th Annual <strong>Pediatric</strong> Echocardiography<br />
Conference, Atlanta, GA, April 2011<br />
• “Pre-sports Participation Evaluation,” 43 rd Annual Kenneth C. Haltalin Conference <strong>Pediatric</strong> for the Practitioner,<br />
Dallas, TX, April 2011<br />
• “Introduction to Cardiac Anatomy and Nomenclature,” “ASD, VSD, CAVC,” “Left Heart Obstructions,” “Conotruncal<br />
Malformations” and “Heterotaxy and Anatomically Single Ventricles,” The Heart Center at Nationwide Columbus<br />
Children’s Hospital, Columbus, OH, October 2011<br />
William Scott, M.D.<br />
• “Duchenne Muscular Dystrophy: Optimizing Cardiac Care,” DMD, and <strong>Pediatric</strong> Neuromuscular Diseases, Texas<br />
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Scottish Rite Hospital for Children, Dallas, February 2011<br />
• “Risk Stratification for Sudden Cardiac Death in Children: What Do We Really Know and When Do We Know It?,”<br />
<strong>Pediatric</strong> Electrophysiology Symposium, Boston, MA, October 2011<br />
Poonam Punjwani Thankavel, M.D.<br />
• “Echocardiographic Prediction of Spontaneous Closure of the Ductus Arteriosus in Neonates Less Than 30 Weeks of<br />
Gestation,” <strong>Pediatric</strong> Academic Societies, Denver, CO, February 2011<br />
• “Double Switch with LVOT Resection and Mitral Valve Repair,” Congenital Heart Surgeons’ Society’s Annual<br />
Meeting, Chicago, IL, October 2011<br />
• “Repair of DORV with Subpulmonary VSD, D-TGA and Type B Aortic Arch Interruption,” Southern Thoracic<br />
Surgical Association’s 58 th Annual Meeting, San Antonio, TX, November 2011<br />
Awards and Honors<br />
Sarah Blumenschein, M.D.<br />
• Texas Super Doctor , Texas Montly<br />
Michael Day, M.D.<br />
• Best <strong>Pediatric</strong> Specialists in Dallas, D Magazine<br />
David Fixler, M.D.<br />
• Best <strong>Pediatric</strong> Specialists in Dallas, D Magazine<br />
Matthew Lemler, M.D.<br />
• Top US Doctors, US News & World Report<br />
Lynn Mahony, M.D.<br />
• Texas Super Doctor , Texas Montly<br />
• Top US Doctors, US News & World Report<br />
• National Heart, Lung, and Blood Institute (NHLBI) Leadership<br />
Appreciation Award<br />
Alan Nugent, M.D.<br />
• Best <strong>Pediatric</strong> Specialists in Dallas, D Magazine<br />
Claudio Ramaciotti, M.D.<br />
• Texas Super Doctor, Texas Montly<br />
William Scott, M.D.<br />
• Best Doctors in America<br />
• Best <strong>Pediatric</strong> Specialists in Dallas, D Magazine<br />
• Texas Super Doctor, Texas Montly<br />
Thomas Zellers, M.D.<br />
• Best <strong>Pediatric</strong> Specialists in Dallas, D Magazine<br />
• Texas Super Doctor, Texas Montly<br />
Publications<br />
Dr. Jason Imundo<br />
Oral presentation at the 2 nd Annual<br />
<strong>Pediatric</strong> Senior Fellow Research Day<br />
1. Artman M, Mahony L, Teitel D. Neonatal <strong>Cardiology</strong>, McGraw Hill Inc., New York, NY, 2nd edition, 2011<br />
2. Atz AM, Travison TG, McCrindle BW, Mahony L, et al. Late status of Fontan patients with persistent surgical<br />
fenestration. J Am Coll Cardiol;57:2437-43.<br />
3. Atz AM, Zak V, Breitbart RE, Colan SD, Pasquali SK, Lu M, Mahony L, et al. Factors associated with serum brain<br />
natriuretic peptide levels after the Fontan procedure. Congenit Heart Dis;6:313-21.<br />
4. Balakrishnan PL, Guleserian KJ, Schuster J, Blalock SE. Congenital arteriovenous malformation between the<br />
subclavian artery and superior vena cava presenting in neonatal heart failure. Pediatr Cardiol;32:1204-6.<br />
5. Bergersen L, Gauvreau K, Justino H, Nugent A, et al. Randomized trial of cutting balloon compared with highpressure<br />
angioplasty for the treatment of resistant pulmonary artery stenosis. Circulation;124:2388-96.<br />
6. Conway J, Chin C, Kemna M, Birch M, Barnes A, et al. Donors characteristics and impact on outcomes in pediatric<br />
heart transplant recipients. J Heart & Lung Transplantation 2011;30:S133.<br />
7. Crary SE, Ramaciotti C, Buchanan GR. Prevalence of pulmonary hypertension in hereditary spherocytosis. Am J<br />
Hematol;86:E73-6.<br />
8. Das BB, Shoemaker L, Kim E, Mascio CE, Austin EH. Severe calcification of the aorta (porcelain aorta) associated with<br />
4<br />
sarcoidosis in a pediatric heart transplant recipient. Pediatr Transplant.<br />
9. Dowling MM, Ikemba CM. Intracardiac shunting and stroke in children: a systematic review. J Child Neurol;26:72-82.<br />
10. Hubail Z, Lemler M, Ramaciotti C, Moore J, Ikemba C. Diagnosing a patent foramen ovale in children: is<br />
transesophageal echocardiography necessary? Stroke;42:98-101.<br />
11. Kane C, Kogon B, Pernetz M, et al. Left ventricular function improves after pulmonary valve replacement in patients<br />
with previous right ventricular outflow tract reconstruction and biventricular dysfunction. Tex Heart Inst J;38:234-7.<br />
12. Marino BS, Drotar D, Cassedy A, Davis R, Tomlinson RS, Mellion K, Mussatto K, Mahony L, et al. External validity of<br />
the pediatric cardiac quality of life inventory. Qual Life Res;20:205-14.<br />
13. Massimiliano C, Simona S, Bruno M, Aldo C, Das BB. Clinical relevance of different B-type natriuretic peptide decisional<br />
cutoff values for the diagnosis of congenital heart disease in the first weeks of life. Pediatr Cardiol;32:537; author reply -8.<br />
14. Mir A, Lemler M, Ramaciotti C, Blalock S, Ikemba C. Hypertrophic Cardiomyopathy in a Neonate Associated with<br />
Nemaline Myopathy. Congenit Heart Dis; Nov 2011[Epub ahead of print]<br />
15. Mir A, Obafemi A, Young A, Kane C. Myocardial infarction associated with use of the synthetic cannabinoid K2.<br />
<strong>Pediatric</strong>s;128:e1622-7.<br />
16. Nembhard WN, Salemi JL, Ethen MK, Fixler DE, Dimaggio A, Canfield MA. Racial/Ethnic disparities in risk of early<br />
childhood mortality among children with congenital heart defects. <strong>Pediatric</strong>s;127:e1128-38.<br />
17. Ravishankar C, Tabbutt S, Allen K, Cooper DS, Frank DU, Frommelt P, Ghanayem N, Goldberg C, Graham EM, Kirsh<br />
JA, Krawczeski CD, Lai WW, Lewis A, Lodge AJ, Mahony L, et al. Risk Factors for Mortality in the Single Ventricle<br />
Reconstruction Trial: Beyond Shunt Type. Circulation 2011;124:A9867.<br />
18. Rehman M, Jenkins KJ, Juraszek AL, et al. A prospective phase II trial of vinblastine and methotrexate in multivessel<br />
intraluminal pulmonary vein stenosis in infants and children. Congenit Heart Dis;6:608-23.<br />
19. Shah T, Fixler D, Barnes A. Use of Bortezomoib in management of humoral rejection in a non-compliant teenage<br />
heart transplant. . J Heart & Lung Transplantation 2011;26:S179-S80.<br />
20. Thankavel PP, Ramaciotti C, Lemler MS. A neonate with left congenital diaphragmatic hernia and transient<br />
retrograde flow in the aortic arch. Pediatr Cardiol;32:1207-8.<br />
21. Veeram Reddy SR, Welch T, Wang J, Bernstein F, Richardson J, Eberhrt R, Forbess J, Nugent A, et al. A Novel<br />
Biodegradable Stent Design Applicable for <strong>Pediatric</strong> Use in Congenital Heart Disease : Bench Testing and Initial<br />
Results in a Rabbit Model. Circulation 2011;124:A16010.<br />
22. Vogel M, McElhinney DB, Wilkins-Haug LE, Marshall AC, Benson CB, Juraszek AL, et al. Aortic stenosis and severe<br />
mitral regurgitation in the fetus resulting in giant left atrium and hydrops: pathophysiology, outcomes, and preliminary<br />
experience with pre-natal cardiac intervention. J Am Coll Cardiol;57:348-55.<br />
23. Weintraub RG, Nugent AW, Davis A, King I, Barucha T, Daubeney PEF. Presentation, echocardiographic findings and<br />
long term outcomes in children with familial dilated cardiomyopathy. Prog Pedatr Cardiol 2011;31:119-22.<br />
24. Young AC, Schwarz E, Medina G, Obafemi A, Feng SY, Kane C, et al. Cardiotoxicity associated with the synthetic<br />
cannabinoid, K9, with laboratory confirmation. Am J Emerg Med.<br />
Grants<br />
NIH and Other Government Subcontracts<br />
Lynn Mahony, M.D.<br />
“<strong>Pediatric</strong> Heart Disease Clinical Research Network”<br />
New England Research Inst./National Heart, Lung and Blood Institute, 5 U01 HL068270-11<br />
09/01/11 - 06/30/12<br />
Ilana Zeltser, M.D.<br />
“Early Cardiovascular Screening Pilot (CVSP)”<br />
Championship Hearts Foundation<br />
01/15/08 – 08/31/11<br />
Sponsored Clinical Trials<br />
Aliessa Barnes, M.D.<br />
Pharmacokinetics and Safety of Valganciclovir in <strong>Pediatric</strong> Heart Transplant Recipients < 4 Months of Age<br />
Hoffmann-La Roche, Inc., NP22523<br />
03/16/09 - 08/31/12<br />
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Vivian Dimas, M.D.<br />
Amplatzer Duct Occuluder II Clinical Study<br />
AGA Medical Corporation, ADO II<br />
01/27/09 – 08/31/12<br />
Lynn Mahony, M.D.<br />
“Quality of Life Assessment in <strong>Pediatric</strong> Cardiac Population: Testing the <strong>Pediatric</strong> Quality of Life Inventory”<br />
Cincinnati Children’s Hospital, 22504-01-05<br />
04/26/05 – 06/30/13<br />
Thomas Zellers, M.D.<br />
Post Market Surveillance Plan for the Amplatzer Duct Occluder<br />
AGA Medical Corporation, IDE G980103<br />
05/15/07 - Present<br />
Closure of Muscular Ventricular Septal Defects with the AMPLATZER Muscular VSD Occluder -- Post Approval<br />
Study<br />
AGA Medical Corporation, AGA016<br />
02/17/06 - Present<br />
Comparison Between Surgical vs. Balloon Angioplasty vs. Intravascular Stent Placement for Recurrent or Native<br />
Coarctataion of the Aorta<br />
Children’s Hospital of Michigan, CCISC<br />
04/16/07 - 08/31/11<br />
GORE HELEX Septal Occluder: Post Approval Study<br />
W. L. Gore & Associates Inc., HLX06-04<br />
12/12/07 – Present<br />
Multicenter Continued Access Study of the Helex Septal Occluder<br />
W.L. Gore & Associates Inc., HLX0301<br />
01/01/04 - Present<br />
Coarctation of the Aorta Stent Trial (COAST)<br />
Johns Hopkins University<br />
05/01/08 - 08/31/12<br />
Melody Transcatheter Pulmonary Valve Post Approval Study<br />
Medtronic, Inc., Melody<br />
01/05/11 - 12/31/12<br />
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