Meet Ellie Whelan, Heart Patient

In November 2013, young actress Ellie Whelan was performing in front of a packed auditorium at Appomattox Regional Governor’s School for the Arts and Technology when she collapsed onstage. Audience members thought it was part of the act; then she didn’t get up. At the age of 16, she had suffered a cardiac arrest.

The school nurse performed chest compressions while a teacher gave her mouth-to-mouth resuscitation. Despite their interventions, she still lost her pulse. Paramedics, then her father, arrived.

Story-3_Ellie_Whelan“I stepped through the door as they’re beginning to shock her,” recalls her father, Jim Whelan. “They shocked her three times in front of me.” Her mother, meanwhile, was unaware of the situation unfolding.

An ambulance took her to Southside Regional Medical Center, where, because of the direness of the situation, she was packed in ice as part of the ARCTIC protocol. The treatment involves cooling the body to prevent further cell death. Then she was airlifted to VCU Medical Center.

“I spent two days in an induced coma,” says Ellie Whelan. “I didn’t have any brain waves. My parents were pretty certain that it was the end for me, but my doctors really stayed calm and collected, and they were really comforting to my parents. I really don’t think that they would have been able to get through it without people like Dr. [Mary Ann] Peberdy,” the director of the ARCTIC program.

Once she emerged from her coma, she underwent extensive physical and genetic testing. The tests determined that her erratic heartbeat was caused by a gene mutation in the cells around her heart. VCU Director of Cardiology Dr. Kenneth Ellenbogen worked with a Mayo Clinic geneticist to determine the best pharmaceutical course for her condition. She also received an implantable cardiac defibrillator (ICD).

A year and a half after her traumatic experience, Whelan is now a junior at Appomattox, still involved in musical theater. She also teaches cotillion at the Richmond Women’s Club. “I was really worried that I wasn’t going to be able to do stuff like that again, and that’s really scary because that’s what I’ve been doing forever, that’s my passion,” she says.

Her brush with death “has really put a lot of things into perspective. I think that probably for the first time since I was really little, I’m comfortable in my own skin. I’m really happy with who I am. And when I’m not happy, I’m not scared to change it anymore,” she says, noting that she even has a new short haircut, something she has always wanted to try.

Encouraged by her friends, she now shares her story with others. She spoke at the American Heart Association’s “Bollywood Goes Red” gala at the Virginia Museum of Fine Arts in February and is also part of an ad campaign for VCU Medical Center.

Audiences connect with her “because she’s smart, she’s warm, she’s funny, she has a lot of insight into people and the human condition, and she says what she feels,” says Dr. Ellenbogen. “She’s just an amazing human being.”
Whelan, who had some warning signs before her arrest, says that a previous doctor didn’t take her concerns seriously enough because she is a teenager. “I think it’s really important to get the word out, that heart problems aren’t just for people who are older; they can happen to anybody,” she says.


VCU Pauley Heart Center Renowned for Care of Afib Patients

Although every case of atrial fibrillation is different, many begin the same way.

“My patients will tell me, `I feel washed out. I don’t have any energy,’” said Dr. Jay Koneru, assistant professor of medicine, Division of Cardiology and Electrophysiology at the VCU Pauley Heart Center.

In addition to fatigue, patients may feel a fluttering or pounding in the chest, dizziness, lightheadedness, or shortness of breath.

According to the American Heart Association, about 2.7 million people in the U.S. suffer from atrial fibrillation. The condition can lead to heart failure and is one of the leading causes of stroke. It’s marked by an irregular and rapid heartbeat in the atria, the upper chambers of the heart. The condition affects the organ’s ability to pump blood efficiently, leading to pooling in the atria. At the root of the problem are abnormal electrical signals in the heart.

Dr. Kenneth Ellenbogen and Dr. Jay Koneru

Up to 10% of individuals over the age of 75 will develop the condition. In addition to age, the following are considered risk factors: previous heart attack; congestive heart failure; leaky valves; coronary artery disease, or inflammation near the heart; high blood pressure or diabetes; thyroid, lung or other illnesses; high levels of caffeine or alcohol use; sleep apnea. Afib may occur sporadically or be a chronic condition.

VCU Pauley Heart Center’s Atrial Fibrillation Program offers innovative treatments and cutting-edge research to patients under the direction of renowned physicians Dr. Kenneth Ellenbogen, Chair of Cardiology and Dr. Vigneshwar Kasirajan, Interim Chair of the Department of Surgery and Chair of Cardiothoracic Surgery.

Following appropriate treatment, afib rarely causes serious or life-threatening problems. The comprehensive, interdisciplinary program at VCU begins with diagnosis and extends to a full range of treatments, including medication management; implantation of cardiac assist devices such as pacemakers; cardioversions to shock the heart back into a normal rhythm; catheter-based ablations to disable the areas causing the fibrillation; and surgery, including minimally invasive options.

“We probably have one of the largest centers in the U.S. in terms of both the EP [electrophysiology] component and the surgical treatment of afib. The departments have a unique collaborative relationship,” said Dr. Kasirajan.

VCU’s afib program has gained widespread recognition for its expertise and innovation with ablative techniques. “We are one of the preeminent institutions in the world for atrial fibrillation ablation,” said Dr. Ellenbogen. “We have a track record of over 15 years in ablation and have pioneered—and continue to pioneer—the use of new tools and techniques.”

Dr. Jay KoneruThe center has, for instance, performed over 8,000 radiofrequency catheter-based ablations, which involves applying a burst of heat to destroy the tissues that cause the abnormal electrical signals. Pauley’s specialists can also freeze the problematic tissue areas through a newer procedure, cryoablation. They are also exploring cryoballoon ablation in clinical trials.

Other new advances at Pauley include the LARIAT procedure (see sidebar) and, soon, Topera’s FIRMap™ 3D, multipolar catheter which places an expandable wire “basket” over the heart. The structure conforms to the shape of the heart’s contours and contains 64 evenly spaced electrodes that record its electrical activity. The images are analyzed through Topera’s RhythmView™ 3D Electrophysiological Mapping System. Pauley will also be one of the few centers to begin using the WATCHMAN®, a device that is implanted in the opening of the left atrial appendage to help prevent strokes.

According to Dr. Koneru, “While there is currently no cure for atrial fibrillation, there are effective treatments.”


About the Cover

Dr. Kenneth Ellenbogen and John Britton

The cover photo of Dr. Kenneth Ellenbogen and his patient, John Britton, was taken by Mark Mitchell, a Richmond photographer who is also a patient of Dr. Ellenbogen’s. Mitchell’s bout with atrial fibrillation began eight years ago. “Being a photographer who travels around the country, it was very important that I be able to work, to be comfortable, and not have an afib attack,” he said. Following a cardioversion, ablations, and medication, he no longer suffers from the condition. “I’m able to work now and that’s the most important thing to me.” He included a photograph of Dr. Ellenbogen on his website for his “Richmond Personalities” project. “He’s one of the `real celebrities’ that exist, both to me and the whole electrophysiological community.” For more information, please visit www.markmitchellphotography.com.


Dr. Szentpetery Retires; VCU Professor Helped Start VA Transplant Program

Dr. Szabolcs SzentpeteryThe staff of the Hunter Holmes McGuire VA Medical Center held a retirement reception last year for cardiac surgeon and VCU professor Dr. Szabolcs Szentpetery.

He was joined by his family, including his daughter, Dr. Eva Smith, a resident in the anesthesiology department at the VCU Medical Center. Dr. Szentpetery was the Chief of Cardiothoracic Surgery at McGuire, which has a collaborative program with VCU.

He graduated from the Medical University of Budapest in 1963. After moving to the U.S. to continue his medical training, he served two tours in Vietnam with the U.S. Army and received a medical Bronze Star. He completed an internship, a general surgical residency, a research fellow in cardiac surgery, and a cardiothoracic fellowship at VCU, where he was later appointed the Richard R. Lower Professor of Surgery.

“Dr. Szentpetery was responsible for building the cardiothoracic surgical program at the Hunter Holmes McGuire VA and led the creation of the first independent heart transplant program for the VA Health System,” says Dr. Vigneshwar Kasirajan, Chair of Cardiothoracic Surgery at VCU. “He is a master surgeon and an outstanding clinician. Above all he is a true gentleman and a colleague who is always ready to lend a hand.”

 


VCU Raises $35,000 for Heart Walk

VCU Heart Walk participantsOn September 28, 346 patients, staff, and students from VCU’s medical and academic campuses took part in the 3.4-mile American Heart Association’s Heart Walk on Brown’s Island in Richmond.

The VCU teams brought in over $35,000 in donations for the organization, with almost $15,900 raised by the Pauley Heart Center alone. The “Pauley Heart Center Pumpers” team, which collected over $4,900, included a number of heart transplant patients and those with mechanical assist devices.

VCU Heart Walk participants“VCU has participated in the Heart Walk for over 20 years. It’s really a passion for us. The funds that we raise are directed locally and go toward research that helps in the fight against heart disease and stroke,” says Laura Savage, RN, Heart Transplant Coordinator and team leader for the Pauley Heart Center Pumpers. “Our patients directly benefit from the funds raised.”


VCU Artificial Heart Patient Included in “Bionic” Documentary

It may have seemed a flight of fancy in the 1970s, when Lee Majors fascinated TV viewers with his portrayal of astronaut Steve Austin in The Six Million Dollar Man.


But science has advanced to the point where almost all human body parts can be simulated and replaced, according to the makers of The Incredible Bionic Man, a documentary that debuted on October 20 on the Smithsonian Channel.

The film, produced by British Darlow Smithson Productions, follows leading roboticists as they assemble a fully functioning bionic man from the most advanced materials available today. While some of the body parts are still prototypes, the documentary shows how a number of the manufactured parts—such as artificial hearts—are already being implanted in humans to help improve their quality of life.

In July 2012, the film crew arrived at the VCU Pauley Heart Center, where they filmed cardiothoracic surgeon Dr. Daniel Tang implanting a SynCardia Total Artificial Heart in patient David Henderson, who at the time was 46 and suffering from advanced heart failure.

“We selected VCU as it is a major center for artificial heart replacement and [the doctors] were implanting an artificial heart during our filming period, said James Pope, researcher for Darlow Smithson. At perhaps the most dramatic point in the film, Dr. Tang surgically removes Henderson’s own organ from the surrounding arteries, in preparation for the implantation of the artificial heart.

In speaking to Dr. Tang about the movie, he said Henderson’s surgery went “extremely well.” The patient remained in the hospital while he awaited a donor heart. One became available, and Dr. Vigneshwar Kasirajan performed the successful transplant.

Throughout the lengthy stay, “Dr. Tang kept me going, kept my spirits up,” said Henderson. “He always explained things if I needed it.”

Henderson returned home to Fredericksburg in April 2013. Now, he said, “It’s the best I’ve felt in ages.” Before the surgeries, “I couldn’t walk maybe five feet.” Now, he says, “I can go up and down the stairs. I can walk to the mall.” He celebrated the debut of The Incredible Bionic Man with friends. “We went to a big sports bar and watched it on a big-screen t.v.”

Filmmaker Pope explained that “this documentary aims to celebrate the incredible benefits prosthetic technologies are bringing to people’s lives, but also explore the ethical implications of their development and what this revolution might mean for society as a whole.”

Dovetailing with the film’s debut, the bionic man constructed in the film was displayed at the Comic Con convention and then at the Smithsonian National Air and Space Museum.

For more information about the exhibit, and to view the film online, please visit SmithsonianChannel.com.


Symplicity Trial Brings Hope for Patients with Severe Hypertension

Symplicity toolFor years, Dr. George Vetrovec has been frustrated by the lack of options for patients with severe high blood pressure that does not respond to medication. Now, he’s hoping his work on a clinical trial will give these patients a new course for treatment.

The Symplicity HTN-3 study involves an investigation of the safety and effectiveness of using the Symplicity Catheter to help patients with “really severe hypertension that’s not well-managed. It’s intractable, despite maximal medical treatment,” says Dr. Vetrovec, Director of the VCU Pauley Heart Center’s Adult Cardiac Catheterization Laboratory.

Dr. George Vetrovec and Dr. Dominic Sica

Dr. Vetrovec and Dr. Dominic Sica, a VCU nephrologist, are the co-principal investigators for the VCU component of the trial, which began its third phase in September 2011. The Pauley Heart Center is one of 90 centers nationwide participating in the study.

Using the special catheter, Dr. Vetrovec delivers radiofrequency energy through the luminal surface of the renal artery. He explained how this procedure, known as renal denervation, works: “You have nerves that run from the kidneys to the brain that contribute to high blood pressure. When you burn this part of the renal artery, you are burning the nerves that normally would stimulate the kidney, often leading to hypertension.” The procedure is completed 
in one short session.

Patients who qualify for the study have uncontrolled high blood pressure despite 
being on a regimen of three or more anti-hypertensive medications, including a diuretic. If the Symplicity Catheter proves to be effective in trials, it may one day be approved by the FDA as a new therapy.

Kidney and renal arterySo far, says Dr. Vetrovec, “Data from previous trials suggests blood pressure drops with the ablations and continues to drop even two to three years later.” He is excited about the possibility of a new therapy for these patients. “There really isn’t anything else out there,” he says.


Gift Establishes Chair in Cardiology

The Pauley Heart Center gratefully acknowledges a significant gift from the late John R. Congdon, Sr. Shortly before his death in October, Mr. Congdon donated a $500,000 gift to establish the Natalie N. and John R. Congdon Chair in Cardiology. His gift will be matched by the VCU Glasgow Endowment, creating a total 
endowment of $1 million.

“Mr. Congdon was a great friend of the Pauley Heart Center. His gift will have a lasting impact, as it will support the recruitment of a world-class clinical cardiologist to the VCU Medical Center,” said Dr. Kenneth Ellenbogen, Chair of the Cardiology Division, Pauley Heart Center.

A previous gift from Mr. Congdon, given in memory of his late wife, Natalie, created the Congdon Visiting Scholar Program. “The program supports worldwide cardiovascular education by providing the opportunity to bring visiting experts to our campus to help us expand our education and training in various areas of cardiology,” said Dr. Ellenbogen.

 


New Electrophysiology Room Debuts; Part of $24 Million GE Lab Project

New Electrophysiology Room

As Dr. William Moskowitz viewed the CT angiogram of his patient’s chest on a monitor, he touched the screen to rotate the image. With another touch, the rib cage disappeared, enabling him to focus on the patient’s arterial structure.

“This blue thing that we’re looking at, this blood vessel, is not supposed to be here,” he said. “It’s causing excessive volume load on her left ventricle.”

Dr. Moskowitz, Chief of Pediatric Cardiology and an interventional cardiologist who specializes in congenital heart disease, appreciates the improved visualization made possible by the GE Innova IGS 6201—a big, white machine with smooth-rounded corners that he calls “the Starship Enterprise.” The advanced x-ray system is among the state-of-the-art equipment and technology found in “EP3,” VCU Pauley Heart Center’s new electrophysiology/catheterization room that opened in September 2013.

“We often get adults and kids with complex physiology who have developed extra blood vessels,” he said. The new system “takes brilliant pictures. You get a three-dimensional picture that you can rotate so that you know exactly where the structure is so, for instance, you can plan precisely where to place a stent or device….You have the roadmap for the procedure before you even walk into the lab.”

The Innova IGS’s “biplane” system includes both a floor-mounted and a ceiling-suspended C-arm that allows for flexible, 3D rotational angiography as well as real-time fluoroscopy. The enhanced visualization makes for easier imaging, resulting in lower doses of radiation for patients. The system’s flexibility means that diagnostic imaging and interventional procedures can take place in the same room.

EP3 is the first of seven state-of-the-art GE labs that VCU Pauley Heart Center plans to roll out by 2015 to meet the increasing demands of its patients and those of VCU Children’s Hospital of Richmond. The $24 million project will include three electrophysiology labs and four cardiac catheterization labs. The planning of the project involved the extensive participation and feedback of Pauley Heart Center physicians and staff, said Kathryn Perkinson, RN, Pauley’s Nursing Director and the project’s manager.

Perkinson said the labs will be connected to each other through a consistent platform, but “there will be components to each of these labs that will be unique to each discipline, whether it’s pediatrics, electrophysiology, general catheterization, or structural heart disease.” Each lab will be self-sufficient, she said. “We won’t have to roll individual pieces of equipment around from room to room.”

The project will include a hybrid cardiac catheterization/operating room that will be the first of its kind on the East Coast. The room’s Discovery IGS 730 system will include a gantry with flexible positioning that will enhance the heart center’s ability to perform innovative procedures, such as transcatheter aortic valve replacement (TAVR), in a cath lab setting.


VCU Receives Gold Award from American College of Cardiology

In October, the American College of Cardiology Foundation selected the VCU Medical Center as one of only 32 hospitals nationwide to receive its NCDR ACTION Registry–GWTG Gold Performance Achievement Award in 2013 for care of patients with acute coronary syndrome.


The award recognizes the hospital’s success and consistency in implementing the highest standards of care for heart attack patients. VCU follows the rigorous American College of Cardiology/American Heart Association’s clinical guidelines and recommendations. The ACTION Registry-GWTG is a data registry and outcomes-based, quality-improvement program that focuses on the care of high-risk STEMI/NSTEMI patients.

“This award confirms the outstanding clinical care that patients receive at VCU Medical Center and puts us among an elite group of medical centers,” said Dr. Kenneth Ellenbogen, Chair of the Division of Cardiology at the Pauley Heart Center. “The VCU Pauley Heart Center provides world-class cardiovascular services, and this significant designation affirms our role as leaders in cardiac care.”