Letter from the Chairman

Friends and Supporters,

It’s an exciting time at Pauley. In this month’s issue, you will read about amazing research, new facilities, state-of-the-art technologies, grateful patients and our first-ever director, Dr. Greg Hundley.

Hundley is well-respected—not just in Virginia or the U.S., but all over the world—for his groundbreaking research in cardiac imaging. Like many of our faculty members, he is not satisfied with the status quo but is continually thinking about ways to improve patient outcomes and prevent heart disease. He’s a thoughtful, brilliant and very warm human being. We are so delighted to have him here and hope you will enjoy reading about him in the cover story.

Our new Cardiovascular Imaging Suite will support Hundley’s research, including his collaborative work with VCU Massey Cancer Center. The venture was made possible through the support of our great friends, Stan and Dorothy Pauley.

One of my favorite stories is about our bright cardiology fellows, who recently placed second in the national Fellows-in-Training Jeopardy contest at the American College of Cardiology’s Annual Scientific Session. I could not be more pleased. It’s a testament to the outstanding education they have received.

Finally, in this issue, you’ll also read about the plans for a new Surgical Innovation Suite, unveiled at our Consortium dinner in May. In gratitude for the care he received at VCU Health, David Cottrell, along with his wife, Christine, provided a generous lead gift for the new suite. “When I arrived, I was your patient,” he wrote in an open letter to the Richmond Times-Dispatch. “Today, you are my family.”

We would not be where we are today without the support of people like the Cottrells, the Pauleys and other members of our family. Thank you!

Sincerely,

Dr. Kenneth A. Ellenbogen
Chair, Division of Cardiology
Martha M. and Harold W. Kimmerling, M.D. Chair in Cardiology


Stony Point Clinic Offers Heart, Vascular Care

Stony Point reception area

Joseph Chodkiewicz, the first echocardiogram patient at Pauley’s new Stony Point outpatient clinic, had the honor of cutting a ceremonial ribbon to a patient room on January 9, 2018.

“I was very much impressed with the professionalism of the clinic,” said Chodkiewicz, a health care worker for numerous hospitals over the years and a heart patient since 2008. “The new location is much more convenient—we live in Bon Air—and you don’t have to fight the downtown traffic.”

The clinic is on the second floor of VCU Health’s Stony Point 9000 building, which is conveniently located off the Chippenham Parkway, near the Stony Point Fashion Park, and offers free parking. About 25-30 Pauley physicians and surgeons see patients at Stony Point each week.

“We now have a strong footprint in this community for all heart services and providers,” said nurse manager Karen Stewart. “You can come for women’s heart health, heart failure, for electrophysiology and device, and consultation with thoracic surgery, vascular surgery, cardiac surgery and transaortic valve replacement. We also have a provider who does a special clinic for lipid management.”

Drawing so many specialists to one location, the clinic creates a collaborative environment that benefits patients.

“When we are all in the same space, we can consult with each other in real time. This is particularly helpful when treating patients with complex needs,” said Dr. Zachary Gertz, medical director of Pauley’s Stony Point clinic and the Hermes A. Kontos, M.D. Professorship of Cardiology.

Services include Holter monitor placements, lab work, echocardiograms, vascular testing and pre-operative assessment appointments, which are required before surgeries. The clinic plans to offer stress testing within the year.

“You can come for women’s heart health, heart failure, for electrophysiology and device, and consultation with thoracic surgery, vascular surgery, cardiac surgery and transaortic valve replacement,” said Karen Stewart.

“We’re very patient-centric,” said clinical coordinator Ann McRae. “A patient can come here for a vascular test prior to seeing their vascular surgeon. If it turns out they need surgery, they can get a pre-operative appointment on the same day. All other pre-operative testing, including electrocardiograms, labs, and radiology, can be done in the same building.”

The vascular clinic offers a full range of ultrasound and other arterial testing. “We offer pretty much the gamut, from checking the circulation in the legs to testing for deep vein thrombosis, blocked carotid arteries, and fistulas,” said Gary Travis, a registered vascular technologist. “While the vascular lab at Stony Point has daily scheduled appointments, patients can be seen the same day for emergent needs.”

The clinic space underwent a complete renovation before its opening. The 15 exam rooms are decorated in warm colors and designed with patient comfort in mind.

“We have equipment in every room, which makes it very convenient. We also have scales in each room, for patient privacy,” said McRae. Examination tables can accommodate patients up to 500 pounds, and a wheelchair scale provides easy access for patients with disabilities.

First patient at Stony Point

Patients often note the friendliness of the staff, said Stewart. “Our nurses here are exceptional in managing patient calls, concerns and questions,” she added.

Ronda Boyd, a patient access representative, said the new Stony Point clinic has proven popular with the patients she sees at checkout. “They like it because it’s not the hustle and bustle of downtown,” she said. “It’s more relaxing because everything they need is in one central spot.”

To schedule an appointment at the new Stony Point clinic, please call (804) 628-4327.

 

Joseph Chodkiewicz cutting a ceremonial ribbon as echo technician Kim Murphy looks on.

 
 


New Cardiovascular Imaging Suite Debuts

“The new Cardiovascular Imaging Suite was designed with multidisciplinary collaboration in mind,” said Dr. Greg Hundley.

Filled with numerous monitors and screens displaying MRI and cardiopulmonary exercise test (CPET) findings, the suite’s 435-square-foot control room provides space for Hundley to work with a wide array of experts in cardiovascular medicine and radiology as well as biomedical engineering, medical informatics, physical medicine and rehabilitation, and behavioral medicine. The group is exploring heart failure in cancer and cardiac patients.

“The new suite is a cutting-edge diagnostic unit offering a combination of equipment, procedures and expertise only available at a few top-tier institutions,” said exercise physiologist Justin Canada, Ph.D.

A $4 million donation by Stan and Dorothy Pauley and family made the suite and Hundley’s recruitment and research possible, and enabled Pauley to receive an additional $5 million gift for the project from the Glasgow Endowment. Stan Pauley and his daughter, Kathy Pauley Hickok, attended the official ribbon-cutting held July 17.

“Our visit to the new suite was most gratifying. We are very excited by Dr. Hundley’s vision and are pleased to have been able to support this unique endeavor,” said Stan Pauley. “We think the work that will be conducted here will have a major impact on the lives of many heart and cancer patients.”

Located on the ground floor of the North Hospital, the 7,200-square-foot suite is decorated in warm earth tones. Blue-accented entrances guide patients from waiting to changing rooms, then on to rooms for procedures and recovery. A plexiglass wall with rows of 2-inch holes allows for improved communication between the patient recovery and control rooms.

A sign indicates “Magnet Always On” at the doorway to the room that holds a new Siemens Magnetom Vida 3T MRI system, which just received FDA approval last fall.

“MRI CPET imaging is done by only a few centers in the world,” said exercise physiologist Justin Canada, Ph.D.

The term “3T” refers to a 3 Tesla magnet, indicating the strength of the magnetic field. The new Siemens wide bore MRI is the first 3T system of its kind at VCU Health and generates a field twice as strong as the existing 1.5T machines. The 3T runs faster, is less vulnerable to background noise, and produces higher resolution images as a result. The new Biomatrix Sensors of the Siemens’ model help anticipate a patient’s breath-holding capability, to reduce the percentage of poor quality scans.

“It’s the Cadillac of the 3 Tesla systems,” said Brent Metts, MRI modality manager at VCU’s Massey Cancer Center.

Heart studies involve more than 1,000 images and can take 45 minutes to an hour to complete at many facilities. “With the new equipment, for some patients, we can complete the studies in as little as 15 minutes,” said Hundley, who explored the effectiveness of these shorter MRI sessions as principal investigator of a multi-center, NIH-funded study of patients undergoing the imaging for the treatment of cancer.

The new suite offers electrocardiogram (ECG) stress testing, stress echocardiography, exercise MRI, and MRI CPET testing for patients. Normally, patients who undergo CPET have a catheter placed in their wrist, to draw blood samples during the test; breathe into a tube to measure ventilation, oxygen consumption and carbon dioxide production; and are hooked up to a blood pressure cuff, pulse oximeter and ECG leads. The new testing will include all these measurements coupled with magnetic resonance imaging. A bicycle attachment will allow patients to pedal to get their heart rates up while lying inside the MRI. 

“MRI CPET imaging is done by only a few centers in the world,” said Canada. “It will refine our ability to detect early signs of cardiopulmonary disease and more accurately determine the causes of exercise intolerance in symptomatic patients.”

According to Dr. Ann Fulcher, chair of the Department of Radiology, “the lab will enhance collaboration between radiologists and cardiologists as exercise/stress testing followed by magnetic resonance imaging will be performed in the same area.” She added, “this will promote a close working relationship as these physicians strive to provide optimal diagnostic examinations for their patients which can then be used to guide therapy.”

The suite provides technologies and opportunities not available at any other academic institution in Virginia, North Carolina or Maryland and will draw other VCU Health experts and students as well as from VCU’s School of Engineering and other academic programs, said Hundley.

“This is going to be a training facility for the next generation,” he said.

From L to R: Dr. Vigneshwar Kasirajan, Dr. Kenneth Ellenbogen, Dr. Peter Buckley, Dr. Greg Hundley, Stan Pauley, Kathy Pauley Hickok, Dr. Marsha Rappley, Deborah Davis, and Dr. Gordon Ginder celebrate the ribbon-cutting of the new cardiovascular imaging suite.
 
 


Save the Date: Heart Failure Symposium

Pauley doctors will present “Heart Failure Symposium: Caring for our Community” on Saturday, October 13. Targeted to health care professionals, the event provides an in-depth look at current practices, emerging technologies and medical advances in this rapidly growing and evolving field.

Dr. Keyur Shah, section chief of heart failure, will speak in the morning on “Identifying Patients for Advanced Heart Failure Therapies” and moderate the event along with Dr. Richard Cooke, medical director of heart transplantation who will present opening remarks.

Other morning topics will include heart failure, cardiac transplantation, mechanical circulatory devices, pulmonary hypertension and structural heart disease. Drs. Melissa Smallfield, Antonio Abbate, Ben Van Tassell, Zachary Gertz and Inna Tchoukina will be some of the featured speakers.

In the afternoon, guests will rotate to three rooms for short sessions on “LVADs” presented by Drs. Daniel Tang, Mohammad Quader and Vigneshwar Kasirajan; “Pacing Case Studies” presented by Drs. Gautham Kalahasty, Jay Koneru and Kristyn Gentry, P.A.; and “Genetic Heart Disease: MRI Imaging Potpourri” presented by Drs. Greg Hundley, John Grizzard and Krishnasree Rao.

Attendees will receive continuing medical education credit for the symposium, which will run from 8 a.m. to 2 p.m. and include breakfast and lunch. The event will be held at VCU McGlothlin Medical Education Center, 1201 E. Marshall Street, Richmond, Virginia 23219. Call (804) 628-0719 for more information or visit vcu.cloud-cme.com

 


Conference Focuses on Women’s Heart Health

Electrophysiology nurse Eileen Tangley never misses VCU Health’s Women’s Heart Health Symposium. “I have attended all of the symposiums so far and look forward to it each February now,” she said. “It has really opened up my eyes to the subtle, yet sometimes significant, circumstances that are unique to women’s heart health.”    

About 100 health care providers attended the annual conference in February at the Virginia Historical Society. Participants arrived from all over the state and even outside Virginia for the symposium, sponsored by Pauley and VCU Health Continuing Medical Education.

“The conference was fantastic,” said Dr. Jordana Kron, who organized the event with fellow Pauley cardiologist Dr. Phoebe Ashley. “As in previous years, the feedback was very positive. Attendees really enjoyed the day, both the lectures and catching up with old friends, and had suggestions for topics to include next year.”

Highlights of the day included a talk on hypertension in women, led by Dr. Benjamin Van Tassell. “It was very thought-provoking,” said Kron. “He challenged the audience to think about the ways research answers and sometimes doesn’t answer the critical questions of how diseases and treatments affect women differently than men.”

In addition to traditional risk factors for cardiac disease—such as hypertension, smoking, diabetes, and obesity—there are nontraditional risk factors that play an important role in women, she said. “These emerging, nontraditional risk factors include hypertensive disorders of pregnancy, gestational diabetes, autoimmune disease and breast cancer treatment.”

Tangley, a cardiology nurse at Pauley for more than 35 years, described the talks as “enlightening.” For instance, in Dr. John Reavey-Cantwell’s talk on carotid artery disease, “he promoted the simple act of listening for a bruit to help when screening.” A bruit is the sound heard over a blood vessel reflecting turbulent blood flow.

Dr. Huzaefah Syed spoke on cardiac risk in women with rheumatologic disease—an important topic, said Kron, “because many inflammatory diseases predominantly affect women.” 

Following breakfast, Dr. Kenneth Ellenbogen gave opening remarks. Other speakers included Dr. Stephanie Mayer (diabetes), Dr. Barbara Lawson (valvular heart disease), Dr. Jose Exaire (peripheral vascular disease), genetic counselor Allison Goodwin (genetics) and Dr. Erica Mason (obstructive sleep apnea).

“Throughout the conference, we highlighted that heart disease is the number one cause of death in U.S. women, killing more than all types of cancer combined,” said Kron. “Women hear and worry a lot about breast cancer, but they should be aware that cardiac disease is their number one threat.”

Save-the-date! The Fourth Annual Heart Health in Women Symposium will be on Saturday, February 2, 2019. Visit vcuhealth.org/pauley for more information.

From L to r: Dr. Erika Mason, Dr. Stephanie Mayer, Dr. Barbara Lawson, Dr. Phoebe Ashley, Dr. John Reavey-Cantwell, Dr. Jordana Kron, Dr. Huzaefah Shah, and Allison Goodwin, M.S.

 

 


Sharing a Piece of History

Drs. Daniel Tang, Szabolcs Szentpetery and Timothy Wolfgang

On May 24, a group of current and retired physicians gave a historical grand rounds presentation on the 50 years of heart transplantation at VCU Health. The program focused on the work of Dr. Richard Lower and how the heart transplant program began at the Medical College of Virginia, now VCU Medical Center. About 250 guests attended the event.

“It was standing room only in the Egyptian Building auditorium,” said Dr. Michael Hess, one of the guests, who also appeared in a video interview with Dr. George Vetrovec. “The event was designed to inspire our students and demonstrate the high quality of our cardiac transplant program.”

Drs. Szabolcs Szentpetery and Tim Wolfgang also shared their memories of working with Dr. Lower in the program’s early days. Dr. Keyur Shah, one of the hosts along with Drs. Daniel Tang and Richard Cooke, gave opening and closing remarks. He observed how many of the clinical discoveries made 50 years ago had led to further developments in the field, and presented a chart showing that cardiac transplantation one year survival rates have improved from 41% in the early era to 97% in recent years.

Guests included faculty, fellows, residents and alumni. “It was a multi-generational event. The room was filled with people who over many years had built and sustained the heart program at VCU Health,” said Shah. “There was a real sense of pride about our continuation of the program’s advanced heart failure and transplant research.”

To see the videotaped interview, please visit MCVFoundation.org

From L to R: Drs. Daniel Tang, Szabolcs Szentpetery and Timothy Wolfgang

 
 


Campaign Kicks Off for Surgical Suite

Dr. Kasirajan and the Cottrells

Pauley recently unveiled plans for the new Christine B. and David E. Cottrell Surgical Innovation Suite, which will support innovation in cardiac surgery and other interventions. Through a new $5 million fundraising campaign, Pauley is now reaching out to its supporters to make the state-of-the-art lab a reality.

In fall 2017, the Cottrells generously donated $1 million to launch the initiative. VCU hopes to raise an additional $4 million for the 6,000-square-foot lab. The lab will be built on the ninth floor in Sanger Hall in the same lab space of Dr. Richard Lower. He helped develop the techniques for transplanting a human heart and performed the ninth transplant in the United States.

“The new Cottrell Surgical Innovation Suite will offer the space and advanced technologies necessary to usher in preeminent cardiovascular and other surgical research at VCU Health,” said Dr. Vigneshwar Kasirajan. “One of the focus areas for research will be to understand organ preservation further and to improve the number of organs available for transplants. Also, this space will help us train future generations of surgeons.”

One faculty member who will use the new lab is cardiothoracic surgeon Dr. Mohammed Quader, who is studying how to improve the viability of hearts procured from donors after circulatory death. The lab will be available to the faculty of all surgical specialties and VCU’s schools of Pharmacy and Engineering for preclinical, translational and other research studies. The site will also provide additional space for students and continuing medical education.

All donations to the campaign are appreciated, and naming opportunities are available for extraordinary levels of support:

$10K – $75K: Donor recognition

$75K – $500K: Named research spaces

$500K – $700K: Surgical space recognition

“We are grateful to Christy and David Cottrell for providing the lead gift for this new venture and invite others to be a part of this exciting campaign,” said Kasirajan.

For more information, contact Carrie Mills at (804) 828-0423.

Dr. Vigneshwar Kasirajan (left) and David and Christine Cottrell discuss plans for the new Cottrell Surgical Innovation Suite, to be located in Sanger Hall.

 


Proud of Its Past. Poised for the Future.

By Janet Showalter
Jeni Simonitis

Jeni Simonitis was 8-years-old as she lay in a hospital bed at MCV Hospitals, now VCU Medical Center, in December 1992.

With her parents by her side, she anxiously awaited news that a donor heart had been found to save her life.

Twice she went into cardiac arrest.

“It was scary,” she said. “We weren’t sure they would find a match in time. But they did. I remember the doctor coming in and telling us we had a heart. It was a Christmas miracle.”

Twenty-five years later, in December 2017, Simonitis underwent her second successful heart transplant at VCU Medical Center.

“It never crossed my mind to go anywhere else,” said Simonitis, 34. “The team there is just amazing. They are passionate about what they do, and they are the best in the field.”

The world’s first successful human-to-human heart transplant took place in December 1967 in South Africa. Five months later, the first heart transplant in Virginia — ninth in the country and 16th in the world — took place at MCV Hospitals.

Since that historic moment 50 years ago, the team has completed more than 590 heart transplants, including the first heart-lung transplant in Virginia and the first total artificial heart transplant on the East Coast. It is the second-oldest heart transplantation program in the U.S.

“It’s an amazing thing we do here,” said Dr. Daniel Tang, the Richard R. Lower, M.D. Professorship in Cardiovascular Surgery and director of heart transplantation, heart-lung transplantation and mechanical circulatory support. “It may not be uncommon anymore, but it is hardly routine. The very notion that we are taking a heart that was someone else’s and giving it to a patient so that they may have life is truly amazing. It is very emotional and never gets old.”

Since that historic moment 50 years ago, the team has completed more than 590 heart transplants, including the first heart-lung transplant in Virginia and the first total artificial heart transplant on the East Coast. It is the second-oldest heart transplantation program in the U.S.

The race to perform the first human-to-human heart transplant was a competitive one.

“It was similar to the race to get a man on the moon,” said Dr. Keyur Shah, section chief of heart failure. “Anytime you accomplished anything to get you closer to your goal, you were on the cover of Time magazine.”

The breakthrough was one of the most significant in the field of medicine in the 20th century, with the late MCV surgeon Dr. Richard Lower leading the way. Lower, along with Dr. Norman Shumway, began extensive research in California in the late 1950s and later successfully completed the first heart transplant in an animal model.

Their work grabbed media attention, as well as the eye of renowned transplant surgeon Dr. David Hume, chief of surgery at MCV Hospitals at that time. In 1965, Lower accepted Hume’s invitation to join him in Richmond to lead the cardiac surgery program.

As the team inched closer to its ultimate goal, Dr. Christiaan Barnard, a young South African surgeon, visited Richmond for three months to observe the team’s work. He became obsessed with becoming the first surgeon to perform
a human heart transplant.

A few weeks after Barnard returned to South Africa, Lower and Hume nearly performed the first transplant but decided against it because the donor and recipient blood types did not match.

Jeni Simonitis at 8.

That opened the door for Barnard, who found a donor for a patient under his care. On Dec. 3, 1967, Barnard successfully performed the world’s first human-to-human heart transplant. Lower performed his first in May 1968. In all, he took part in 393 heart transplants before he retired in 1989.

“Lower was cautious, as he should have been,” said Dr. Michael Hess, who worked with Lower for 10 years and started the heart failure program. “He did groundbreaking work that led to incredible growth in the field.”

Soon after Hess became medical director of cardiac transplantation in 1979, the team was well on its way to performing more than 50 heart transplants a year.

“We were demystifying cardiac transplantation,” said Hess, who retired in 2017. “People back then thought we were crazy as hell. Or they thought it was a piece of cake. Today, it is standard heart patient care.”

But when Lower retired, the program took a hit. Several other surgeons and physicians also left, and three other transplant programs opened in Virginia. The number of heart transplants completed at MCV Hospitals plummeted to fewer than 10 annually.

“When I interviewed for a job here in 1999, they had done only one transplant that year,” said Dr. Vigneshwar Kasirajan, the Stuart McGuire Chair of Surgery. “But we were able to rebuild it. I am most proud of the team we have assembled here.”

“We were demystifying cardiac transplantation,” said Hess, who retired in 2011. “People back then thought we were crazy as hell. Or they thought it was a piece of cake. Today, it is standard heart patient care.”

Over the past 15 years, the number of heart failure and transplantation cardiologists at VCU Medical Center has grown from two to six while the number of surgeons has doubled to four.

Today, the medical center averages 25 transplants a year, including several multi-organ transplants.

“This has been a second coming,” Shah said. “Our staff takes a lot of pride in that, and our patients can see the passion we have in serving our community.”

Each year, thousands of patients turn to the center for inpatient and outpatient care, ranging from noninvasive cardiology procedures to heart transplantation. Pauley’s transplant and heart failure experts speak at national conferences, lead clinical trials, take part in funded research and have published hundreds of abstracts and manuscripts.

The center has become known worldwide for its groundbreaking work, and Pauley leads the way in device-based treatments for advanced heart failure. In 2006, Kasirajan led the team that completed the first total artificial heart implant on the East Coast.

Since then, VCU Medical Center has performed more than 100 artificial heart transplants, and its program is the third largest in the country. Pauley also implants about 40 ventricular assist devices a year. A VAD is a mechanical pump that helps the heart push blood to the body. Artificial hearts and VADs can allow a heart transplant candidate to safely survive until a donor heart becomes available.

“This work has become mainstream,” Kasirajan said. “It’s incredible how far we’ve come.”

For some, it might sound like science fiction. For others, research in the areas of stem cell and gene therapy, genetic coding and xenotransplantation offers a promising future.

“People looked at what Lower was doing 50 years ago and thought those guys were absolute cowboys because they were doing something that was so unusual,” said Tang, who performs about half of the heart transplants at VCU Medical Center. “Their work evolved into what we are doing today. People may think that the days of the cowboy are over. I would argue it is not.”

Stem cell therapy, now in the trial stage, is showing great promise in repairing tissue damaged by heart attacks. If successful, this would save patients who otherwise need a heart transplant.

Another national study underway is for the Carmat heart, which has been called the world’s first self-regulating, total artificial heart. It uses embedded sensors to regulate the rate of blood flow to a patient based on his or her individual needs.

Tang is also excited about research that could lead to an increase in donor hearts. Currently, about 2,500 heart transplants are performed in the U.S. each year. But about 4,000 people nationwide are waiting.

“The need is great,” Tang said. “We need to do all we can to meet it.”

The prime window to successfully use a donor heart is four to six hours after death. That time frame is not always plausible because of distance to the recipient, and sometimes the heart goes unused. But new ways to expand protection times are being studied, including a pump system that would keep the heart viable until it arrives at its destination.

Another area of study by Dr. Mohammed Quader, assistant professor of surgery, is exploring ways to recover a heart from a person who has suffered a cardiac death. Currently, donor hearts are used only if the person suffers brain death because blood continues to flow to the heart. In a cardiac death, blood ceases to flow and the heart sustains cellular damage. But research is uncovering ways to protect the donor heart from cellular damage, making it viable for transplantation.

In addition, the ongoing study of modifying genetic signatures could one day open the door to cross-species heart transplantation.

“It’s very exciting to think what the future can bring,” Tang said.

Tang, who performed Jeni Simonitis’ surgery in December, said that while the procedure is becoming more common, he will never get used to the miracle it is.

“When you call the patient and tell them we have found a donor heart for them, they jump for joy,” he said. “Even though they know it is a daunting surgery, they look forward to it.”

Simonitis can remember the fear she felt as a young girl, clutching her stuffed tiger, Stripes, in her hospital bed. Born with a heart defect, a transplant was her only option.

“As they were wheeling me to surgery, I got scared and wanted to back out,” she said. “But I knew I had to do it. A few months later, I was back on the playground with my friends. I got my life back.”

For more than 20 years, her donor heart served her well. The average life expectancy of a donor heart is 12 years, with some lasting three decades. When Simonitis began experiencing chest pains three years ago, she hoped it was heartburn. It turned out to be a form of chronic rejection.

In August 2017, Simonitis was placed back on the transplant list. Four months later, she got the call that a donor heart had been found. She and her husband, Jason, grabbed her bag, already packed with clothes and Stripes, and drove to VCU Medical Center. A few hours later, she was in surgery. This time around, her hospital stay was two weeks instead of three. She missed nine weeks of work.

“It’s amazing how much more advanced they are now,” Simonitis said. “Technology is better, the medications are better and the surgeons, I think, are more skilled. The team is right there with you through it all. I trusted them every step of the way.”

As she did after her first surgery, Simonitis will send a letter to the donor family, offering her gratitude.

“Words can’t possibly express how thankful I am,” she said. “I know my heart came at a cost. It means someone else’s family suffered great tragedy. I never lose sight of that. Every year on the anniversary of my surgery, I celebrate that family. They gave me the greatest gift possible. They gave me life.”

Janet Showalter is a contributing writer for the alumni magazine.

This article was originally published in the spring 2018 VCU Alumni magazine. Alumni can read the whole magazine online at vcualumni.org

Now on her second heart transplant, Jeni Simonitis still has the same stuffed animal from her first transplant at age 8.

 

VCU Medical Center’s heart transplant program was established in 1968, making it the longest-running transplant program on the East Coast and the second oldest in the U.S.

• MCV Hospitals celebrated the first long-distance heart transplant in the world in 1977 when Dr. Szabolcs Szentpetery made the 600-mile flight from Richmond to Indianapolis to bring back a donor heart.

• In 1981, Dr. Michael Hess created the International Society of Heart and Lung Transplantation.

• The first heart-lung transplant in Virginia took place at MCV Hospitals in 1986.

• In 1994, the first left ventricular assist device was implanted at MCV Hospitals.

• The first total artificial heart on the East Coast, and the third in the country, was implanted at VCU Medical Center in 2006.

• VCU Heart Center was renamed VCU Pauley Heart Center in 2006 to recognize a $5 million gift from the Pauley Family Foundation.

• The center has 14 endowed professorships and chairs.

• Since 1972, the American Heart Association has funded 138 VCU Health researchers with $12.8 million.

 


Consortium Celebrates Heart Transplantation

Dr. Mohammad Quader

This year’s Pauley Consortium dinner highlighted the 50th anniversary of Virginia’s first heart transplant, performed at MCV by Dr. Richard Lower on May 25, 1968.  

The dinner, held in May at the Dominion Arts Center’s Dorothy Pauley Square, included many Pauley friends and supporters. The guests included three heart transplant patients and several retired cardiac surgeons who had worked with Lower, including Dr. Joe Deignan, a member of the team that performed the first transplant.

“As a cardiothoracic surgeon myself, I came to VCU Medical Center from the Cleveland Clinic in 2000 because of the incredible program Dr. Dick Lower built,” said Dr. Vigneshwar Kasirajan, one of the evening’s speakers. Since the first transplant, “we have performed 590 heart transplants at VCU Medical Center as well as more than 300 at the Hunter Holmes McGuire VA Medical Center.”

Kasirajan and Dr. Mohammed Quader spoke about innovations in heart transplantation and advanced heart failure, and what to expect in the next decades. Dr. Daniel Tang was unable to join the celebration as he was finishing a heart and liver transplant that evening. The combined heart-liver transplant is a rare, lifesaving procedure that treats complex and often fatal diseases including familial amyloidosis polyneuropathy.

Other speakers included Dr. Kenneth Ellenbogen, who gave opening remarks and spoke about the new research pilot grants funded by donations to the Consortium’s annual fund. Michael Rao, Ph.D., president of VCU and VCU Health, introduced a video featuring transplant survivor and VCU alumna Jeni Simonitis. Dr. Peter Buckley, dean of VCU School of Medicine, and Deborah Davis, CEO of VCU Hospitals and Clinics, announced the leadership gift to establish the Christine B. and David E. Cottrell Surgical Innovation Suite, a new facility designed to foster cutting-edge surgical research and education.

Ellenbogen recognized the importance of the donors and others gathered. “We appreciate your support and investment in the research, clinical and educational mission place just blocks away from where we are now,” he said. “We are able to be extraordinary thanks to your support.”

Dr. Mohammed Quader discusses innovations in heart transplantation at the Consortium dinner.


Interventions for Lower Extremity PAD

Dr Mark Levy

Dr. Luis Guzman

Peripheral artery disease (PAD) is often called a “silent killer.” Often, individuals are not aware they have the condition until it has significantly progressed.

“People are walking around all the time with blockages in their legs,” said Dr. Mark Levy, chair of the Division of Vascular Surgery and the H. M. Lee Professorship in Vascular Surgery. “When it’s symptomatic, it’s usually leg cramping or gripping when walking. If the blockage is more severe, then it can cause pain in the feet at rest, which is known as ischemic rest pain. Sometimes the condition can be asymptomatic until the patient develops gangrene, due to lack of circulation.”

The blockages are caused by atherosclerosis, or the buildup of plaque in arteries. Risk factors for developing PAD include smoking, diabetes, hypertension and high cholesterol.

In addition, “the vast majority of patients with PAD will have coronary artery disease,” said Dr. Luis Guzman, medical director of Pauley’s Cardiac Catheterization Laboratory. “There is a significant interaction between the two processes. When a coronary artery disease patient has both conditions, their risk of mortality increases sevenfold. That’s why the prevention and the treatment of this is very important.”

Pauley’s vascular and cardiology teams often collaborate on the treatment of patients. Early treatments can include diet and other lifestyle changes or medications. The first step is a 3D cardiovascular evaluation using state-of-the-art ultrasound imaging and noninvasive imaging tests like magnetic resonance angiograms or computed tomography, or CT, scans. The exams are available at Pauley’s downtown Richmond, Stony Point, Prince George and Colonial Heights locations. 

“There is a significant interaction between the two processes. When a coronary artery disease patient has both conditions, their risk of mortality increases sevenfold. That’s why the prevention and the treatment of this is very important.”

For more advanced cases of PAD, Pauley’s vascular surgeons and interventional cardiologists offer various procedures:

Minimally invasive, catheter-based treatment. Angioplasty and stent: A catheter is inserted into the patient’s femoral artery in the groin. The doctor then directs the catheter through the body to the location of the blockage. A small balloon is then inflated to open the artery, which is followed by the placement of a mesh stent.

During an atherectomy, the physician uses a catheter with a blade on one end to shave off plaque that is hardened to the artery walls. Like angioplasty, this procedure is generally performed under local anesthesia, with patients leaving the hospital the same day or the next morning.

Lower extremity bypass surgery is recommended when patients have large blockages or are not good candidates for the minimally invasive, catheter-based procedures. In the procedure, the surgeon bypasses the blockage by creating a new path for blood flow by using a graft from one of the patient’s veins. The surgery requires general anesthesia and a hospital stay.

Pauley’s teams take care of some of the area’s most complex lower extremity PAD patients.

“We’ve been able to offer people limb-saving procedures in situations where other institutions can only offer amputations,” said Levy. Additionally, “we’ve had patients with severe blockages that require both open surgical bypass and angioplasty on two different areas of their leg. Since we have the region’s most modern hybrid suites, we’re able to take advantage of our facilities for the patient’s benefit, performing both the bypass and the angioplasty in one setting.”

About 80% of the surgical procedures for lower extremity PAD are scheduled, with the remaining 20% performed under emergency circumstances. The interventions have led to significantly improved mobility and quality of life for patients.

“Drs. Levy and Guzman are expert clinicians with decades of experience in treating patients with peripheral arterial disease. Combining a collaborative approach with state-of-the-art technologies, they and their colleagues offer some of the most advanced interventions in the region,” said Dr. Kenneth Ellenbogen.

The Pauley teams stay current on research that can benefit patients with PAD and have taken part in trials for new therapies aimed at increasing lower extremity circulation.

Whatever the necessary treatment, “we are patient-centered and safety-focused,” said Levy.

To set up a consultation, please contact the Pauley Heart Center at 1-800-762-6161.

The following Pauley physicians have expertise in treating lower extremity PAD:

Dr. Francisco Albuquerque, Jr. • Vascular Surgery

Dr. Jose Exaire • Interventional Cardiology

Dr. Luis Guzman • Interventional Cardiology

Dr. Robert Larson • Vascular Surgery

Dr. Mark Levy • Vascular Surgery

 

Top: Dr. Mark Levy and Dr. Luis Guzman

 

Stroke Prevention via the Carotid Artery

Pauley’s vascular surgeons have extensive experience with the minimally invasive stenting of the carotid artery, which is found in the neck. The interventions are performed via catheter.

“Most are not emergency procedures but are performed promptly when patients are discovered to have a severe blockage in the carotid artery to their brain,” said Dr. Mark Levy. “Some of those patients have had ministroke or stroke symptoms; other patients are occasionally identified before they develop these life-threatening symptoms.”

Signs and symptoms for a stroke may include face drooping, blurred vision, difficulty with speech or a sudden weakness, often on one side of the body. Always call 911 in the event of a suspected stroke.

Did you know…

About 8.5 million people in the U.S. suffer from peripheral artery disease, according to the American Heart Association.