VCU #1 in TAVR Procedures

In a few short months, the Pauley Heart Center has become Central Virginia’s leader for performing Transcatheter Aortic Valve Replacements, a procedure in which aortic valves are replaced via catheter instead of open heart surgery. 

“We did the first one on November 1. Since then, we have performed about 13 or 14,” said Dr. Zachary Gertz, Pauley’s director of structural heart disease, who participated in the first study of TAVR during his cardiology fellowship at the Hospital of the University of Pennsylvania and is nationally recognized for his expertise in aortic stenosis and valvular heart disease.

TAVR holds special appeal for elderly and high-risk patients who suffer from severe aortic stenosis, a condition which, if left untreated, can lead to heart failure or even death.

“It is important to offer this therapy because many patients are not candidates for surgery, so this is their only hope. And for some patients who are high risk for surgery, this offers them an alternative with equally good outcomes but a much easier recovery,” said Dr. Gertz.


Letter From the Chairman

It’s springtime, and the spirit of renewal and growth is ever present at the Pauley Heart Center. I hope you will enjoy learning about some of our latest news and achievements in this issue of The Beat. 

In January, we embarked upon a joint agreement with HCA Virginia Levinson Heart Hospital at Chippenham that will allow our physicians to provide a continuum of care for patients with advanced and end-stage heart failure. In some cases, VCU physicians will provide donor heart transplantation and total artificial heart implantation for Levinson patients. We look forward to taking part in this partnership in advanced cardiac care.

Our center also recently received Chest Pain Accreditation from the Society of Cardiovascular Patient Care (formerly the Society of Chest Pain Centers). This accreditation recognizes that VCU has achieved a high level of expertise in emergency preparedness and in caring for patients with heart attack symptoms. Important research in cardioprotection is taking place in our newly renovated basic science laboratories.

Finally, our cover story this month spotlights an exciting gift that has propelled a new Pauley Heart Center campaign. We are grateful to the Pauley Family for their continued commitment to the heart health of those in the Commonwealth and beyond. I hope you will enjoy reading more about this campaign, which will allow us to expand our research in a number of key areas in the years to come. Thank you for supporting the Pauley Heart Center.


Diamond Jubilee Medal Awarded to Children‘s Hospital of Richmond

Children's Hospital of RichmondOn March 20, the Caribbean nation of St. Vincent awarded the Queen Elizabeth II Diamond Jubilee Medal to Children’s Hospital of Richmond at VCU for public service to its citizens. Children’s Hospital of Richmond at VCU has provided medical care to nearly 70 St. Vincent children since 2002, and over 75 percent of the cases were for treatment of pediatric heart conditions. Beyond these cases, medical teams have traveled to St. Vincent to provide thousands of medical and surgical screenings.

Children’s Hospital of Richmond at VCU provides care to St. Vincent children through a partnership with World Pediatric Project, a nonprofit organization founded and based in Richmond, Va., that provides surgical and diagnostic care to Central American and Caribbean children. Dr. William Moskowitz, professor and chief of the Division of Pediatric Cardiology at CHoR and vice chairman of the VCU Department of Pediatrics, was one of the first World Pediatric Project volunteers, and he continues to screen hundreds of children in St. Vincent every year.

“Many public health concerns Americans consider rare are common in other countries,” said Dr. Moskowitz. “Our rheumatic fever and rheumatic heart disease prevention program has a dramatic effect on public health in St. Vincent, and our clinical teams gain invaluable experience when they provide care to children who would otherwise go untreated.”

The medal, presented by His Excellency Sir Frederick Ballantyne, Governor General of St. Vincent and the Grenadines, and an official representative of Queen Elizabeth II, acknowledges exceptional public service and is the only medal the country has awarded to a non-citizen.

“It’s amazing to treat a child here in Richmond, knowing it will change their life in St. Vincent,” said Dr. Scott Gullquist, with the division of Pediatric Cardiology at Children’s Hospital of Richmond at VCU. “In fact, some of our patients in St. Vincent are not only doing well, they’re all grown up.”


Welcome, New Faculty!

Dr. Melissa SmallfieldMelissa C. Smallfield, M.D. joined Pauley Heart Center in September as assistant professor of Internal Medicine. In addition to her work at the MCV campus, she also plans to attend to patients at VCU’s outreach clinics in Stony Point and Williamsburg.

Dr. Smallfield’s clinical specialties include advanced heart failure, heart transplantation, mechanical circulatory support (LVADs) and pulmonary hypertension. She performs procedures including right heart catheterizations and heart biopsies.

A native of Newport News, Dr. Smallfield received her B.A. in East Asian Studies from the College of William and Mary and then attended Eastern Virginia Medical School, where she received an M.S. in Biomedical Sciences and her M.D. At the University of Alabama at Birmingham, she completed her residency in Internal Medicine as well as her fellowships in Cardiology and Advanced Heart Failure, Transplant and Pulmonary Vascular Disease. She is board certified in Cardiovascular Disease, Internal Medicine, Nuclear Cardiology and Advanced Heart Failure/Transplant Cardiology.


Dr. Ranjith Shetty

Ranjith Shetty, M.D. joined the Pauley Heart Center in October as assistant professor of Internal Medicine, specializing in Interventional Cardiology.

A native of the Washington, D.C. area, Dr. Shetty received his B.S. in Biology from Washington University in St. Louis and his M.D. from Eastern Virginia Medical School. He served his residency at Georgetown University, and undertook a research fellowship in venous thromboembolism at Brigham and Women’s Hospital in Boston. Dr. Shetty completed fellowships in Cardiovascular Diseases and Interventional Cardiology at VCU and is board certified in both, and received additional training in structural heart disease and peripheral vascular interventions at Swedish Medical Center in Seattle.

Dr. Shetty’s clinical expertise includes coronary artery disease, peripheral vascular disease and structural heart disease. His procedural skills include percutaneous coronary interventions, percutaneous carotid artery interventions, percutaneous aortoiliac, renal, and lower extremity interventions, transcatheter aortic valve replacement, valvuloplasty, left atrial appendage occlusion/ligation, and closure of atrial septal defects and patent foramen ovale.

He has published several articles in peer-reviewed journals and has presented his research at national meetings such as the American Heart Association and the American College of Chest Physicians.


National Institutes of Health Supports New Lab for Cardiovascular Research

Dr. Chang YinDr. Rakesh Kukreja excitedly leads visitors around the VCU Pauley Heart Center’s renovated Basic Science research lab in Sanger Hall, where he directs a renowned program in molecular cardiology.

Recognizing the important work being performed there, the National Institutes of Health provided $5 million in funding to renovate the lab, provide some new equipment and add an additional 3,000 square feet to the facility.

The highly organized state-of-the-art lab, completed in November, includes an instrument room, a cold room for experiments requiring frigid conditions, a dark room to track fluorescent proteins and separate rooms for imaging, echocardiography, catheterization, cell preparation and tissue culture.

The new space will help him and his colleagues continue to carry out cutting- edge research in cardiovascular research and attract talented young investigators to VCU. “We have to have state-of-the-art facilities in place to remain competitive in our research,” he said.

Over the years, Dr. Kukreja’s research projects have secured close to $18 million in NIH funding. In 2006, he received the organization’s prestigious MERIT Award. Also, the governor of Virginia, Bob McDonnell, honored him with the Outstanding Scientist of Virginia Award in 2010.

“We are lucky to be in the presence of a world-class researcher like Dr. Kukreja and his colleagues who every day make important discoveries that translate into better care and longer lives for our patients,” said Dr. Kenneth Ellenbogen, the Pauley Heart Center’s chairman of cardiology.

Born and raised in India, Dr. Kukreja received his Ph.D. in biochemistry from Kurukshetra University in 1982. He completed a fellowship in endocrinology in France, but always dreamed of working in the cardiovascular field. He learned of an opening at VCU in October 1984. Although he wasn’t impressed by what was then a tiny, overcrowded lab, he was excited by the research going on there and the opportunity “to work with two renowned physician-scientists—Dr. Hermes Kontos and Dr. Michael Hess.”

Dr. Kukreja made an important discovery in 2002—that male erectile dysfunction drugs like Viagra can protect the heart from damage caused by a heart attack. The widely prescribed drugs are powerful inhibitors of phosphodiesterase-5 (PDE-5), an enzyme that can cause injury to the heart following a heart attack.

The finding came by accident; some Viagra pills left in the department by a Pfizer representative led to some productive noodling (“a Sunday afternoon experiment”) by Dr. Kukreja and his colleagues. In a later breakthrough, he demonstrated that the medication can also sustain the heart against injuries caused by the chemotherapy drug doxorubicin. The Viagra discoveries he made in his animal lab received international attention and are now being studied in several human clinical trials, including one in the VCU Massey Cancer Center.

He said VCU encourages experimentation. “When I was working in France, I did not have the freedom to do whatever I wanted…If I deviated, I knew they would not like it.” But his VCU mentors, Drs. Kontos and Hess, “were so open to creativity. I think that was very good for me because I knew the only way you can succeed in science in this country is to be creative.”

For VCU’s cardiovascular research team, innovation has led to success—and now, a brand-new lab.

“I’ve been waiting for this for most of my life,” said Dr. Kukreja, with a smile.


LVAD Patient Impresses His Doctors: “They called me ‘The Rock’”

Francis Joseph “Joe” Pratt III, a former executive chef, suffered from advanced heart failure. 

His health had deteriorated so much in the years following his heart attack in 1997 that he and his wife, Marsha, had to retire, leave their home in Ohio, and move closer to a son in Fredericksburg, Va., who could give them extra help.

Joe Pratt, Dr. Daniel Tang and Regina Volman

By 2011, “his activity level really went down. He was just limping along,” said Mrs. Pratt.

One day his cardiologist gave it to him straight. “He said, ‘Joe, I can’t do anything else,’” recalled Pratt.

His doctor referred him to Dr. Keyur Shah, medical director of the Mechanical Circulatory Support program at the VCU Pauley Heart Center. Dr. Shah believed Pratt could improve with an LVAD (left ventricular assist device), a device that aids the heart in pumping.

Pratt met with VCU cardiothoracic surgeon Dr. Daniel Tang, who told him about the risks and potential benefits of the surgery, as well as the lifestyle changes he would need to make—such as not being able to take showers for a while and being tethered to a battery-charging machine at night.

Dr. Tang “was very likable, just the way he talks to you—the way he explains everything,” said Pratt. “And he wasn’t in a hurry.”

After overcoming some reservations, Pratt underwent a 10½- hour surgery to implant the LVAD on June 30, 2011. Although he experienced some complications during the surgery, his recovery went better than expected. He didn’t have to go on dialysis, and got out of the hospital in three weeks instead of six—an amazing feat, considering his medical history of not only heart disease but diabetes and prostate cancer as well.

“They called me ‘The Rock,’” said Pratt, with a laugh.

But at age 75, “Mr. Pratt nicely demonstrates that age is truly just a number,” said Dr. Tang. “Despite being one of our oldest LVAD patients, he has done extremely well.”

Pratt is now able to walk in grocery stores instead of relying upon a motorized cart. He goes fishing with his wife, and even drives them to Ohio several times a year to visit family. They have 15 grandchildren and six great-grandchildren.

He pointed out the driveline that leads from his body to a portable battery pack. “I get asked a lot, ‘what is that?’ I say, ‘it’s a left ventricular device.’ And they just stare at you. So I say, ‘this is my heart, if I don’t have this, I don’t have a heart.’”


Dr. George Vetrovec Honored with Endowed Chair

Dr. George VetrovecA $500,000 gift from an anonymous donor will help create an endowed chair named for Dr. George Vetrovec, professor of medicine and director of the Adult Catheterization Laboratory at the VCU Pauley Heart Center. The VCU Glasgow Endowment will match the gift, making it a $1 million endowed chair.

“This will serve as a wonderful tribute to Dr. Vetrovec and ensure his legacy at the VCU Pauley Heart Center on the MCV campus,” said Dr. Kenneth Ellenbogen, chair of the Cardiology Division, Pauley Heart Center.

Dr. Vetrovec is internationally known for his research on coronary artery disease. He has authored or co-authored more than 200 papers, eight book chapters and has edited two texts on interventional cardiology. He has also served on numerous cardiovascular journal editorial boards and has served as a consultant to the FDA New Cardiovascular Devices Panel. He has received several honors, including the National Award of Merit in 1991 and the Richmond Golden Heart Award in 1997.


Dr. Minisi Leads Cardiology Fellows

Dr. Anthony MinisiLast year, 450 applicants applied for just six openings in VCU’s Cardiology Fellows program.

“I think our program attracts top applicants because we have a well-established reputation for being a busy medical center that offers excellent clinical training,” said Dr. Anthony Minisi, an interventional cardiologist and the program’s director for 18 years. “There are not many cardiology fellowship programs that offer such a breadth of experience as VCU.”

Fellows selected for the three-year training program in Cardiovascular Diseases can learn about cutting-edge care in all areas of cardiology—from noninvasive imaging and testing to electrophysiology, invasive/interventional cardiology and heart failure/transplant cardiology. They can take part in research and even rotate through Cardiac Surgery and Pediatric cardiology.

“Having a cardiology fellowship is what makes a place like this an academic medical center–training new minds, new doctors. As director of the program, Dr. Minisi has done a phenomenal job. It’s a first-rank fellowship,” said Dr. Kenneth Ellenbogen, chairman of Pauley’s division of Cardiology.

Before they can start cardiology training, fellows must already hold an M.D. and have completed three years of training in internal medicine. They divide their time between VCU and the Hunter Holmes McGuire Veterans Hospital. Fellows are given significant autonomy to grow and learn.

Dr. Minisi ensures the program remains in compliance with guidelines set up by the Accreditation Council for Graduate Medical Education (ACME) as well as the American College of Cardiology and the American Heart Association. He also reviews applications, takes part in the interviews, oversees the fellows once they are selected and participates in their training.

“Dr. Minisi is a tremendous advocate for the fellows and a fantastic mentor. He has provided me invaluable advice and direction through the course of my fellowship,” said senior fellow Dr. Stephen Rennyson.

As director, Dr. Minisi has overseen the training of nearly 100 cardiology fellows since his tenure with the program began. Over the years, he has received eight Best Faculty Teaching Awards and nine Mentorship Awards from the fellows.

“In the cath lab, he is deliberate, purposeful and uses every moment as a teaching opportunity,” said senior fellow Dr. David Cotoni. “However, what truly makes Dr. Minisi a great physician is that he truly cares about his patients. The love that he has for his work shines in everything he does.”

Dr. Minisi would like to thank Karla Conway, who retired this year after 18 years as program coordinator for the Fellows program.


Glasgow Trusts to Provide Matching Funds for Pauley Gift, New Campaign

The $5 million Pauley Family Foundation gift to VCU’s Pauley Heart Center will double in value thanks to a matching gift from the VCU Glasgow Endowment.

The Glasgow Trusts will also provide up to $5 million in matching funds to support a new fundraising campaign. The campaign is seeking new donations to help expand recruitment and research opportunities at the heart center. Donations of $500,000 and over may be eligible for the matching funds.

Funds will help support recruiting a scientific director and five new research faculty members, along with start-up funds for lab research staff and lab and equipment costs. The funds will also create new research programs in cardiovascular disease prevention, women’s cardiovascular health and congenital heart disease while expanding and accelerating VCU’s existing and nationally acclaimed programs in artificial devices (such as LVADs and Total Artificial Hearts), ARCTIC resuscitation for cardiac arrest and cardio-protection research.

The Glasgow Trusts were established in the 1950s, shortly before the deaths of Arthur Glasgow and his wife, Margaret. The funds, which over the years had grown to $125 million, were disbursed in 2011, following the death of the couple’s last heir. The portion of their estate bequeathed to VCU totaled $45 million, to be directed for research into cancer and other degenerative diseases.


VCU Pauley Heart Center Receives $5 Million Gift from Pauley Family

Mrs_Pauley_award

The Pauley Heart Center at the Virginia Commonwealth University Medical Center recently received a $5 million gift from the Pauley Family Foundation to support research and recruitment for its worldclass Cardiology program.

“VCU’s progress as one of the nation’s Top 50 public research universities has been accelerated by a series of game-changers, and the Pauley Family Foundation’s latest generous gift is another example,” said Michael Rao, Ph.D., president of VCU and the VCU Health System.

According to Dr. Jerome F. Strauss III, dean of the School of Medicine, “we are very fortunate to have philanthropists in our community like Stanley and Dorothy Pauley, who are instrumental in helping us bring innovation and excellence to the care of patients with cardiovascular disease.”

The Pauley Heart Center ConsortiumThe Pauley gift, announced February 26 at the Pauley Heart Center Consortium dinner, will be paid out over four years. VCU received the first installment of $1.25 million in December 2012.

“This is a project that is near and dear to my heart,” said Stanley Pauley, who oversees the Pauley Family Foundation along with his wife, Dorothy, and daughters, Katharine Pauley Hickok and Lorna Pauley Jordan. Pauley, a former heart center patient, was so impressed with the staff that, in 2006, his foundation gave its first $5 million gift to the VCU heart center, which was later renamed the Pauley Heart Center. “The care these health care professionals provide is so genuine and moving that it is an honor to contribute to research that will enable them to learn even more about heart disease.”

The Pauley Heart Center ConsortiumAt the Consortium, guests learned that the Pauleys’ $5 million gift will be matched by the Glasgow Endowment— resulting in a total of $10 million for the heart program. The Pauley donation is also the lead gift in a new campaign that will provide additional opportunities for matching funds (see sidebar).

Dr. Rao presented Stan and Dorothy Pauley with white coats with their names embroidered in appreciation for their longtime commitment to the heart center.

“The Pauleys’ generosity through the years will have a lasting impact on the region and nation for the remarkable breakthroughs made possible for their support,” said Dr. Sheldon M. Retchin, senior vice president for VCU Health Sciences and CEO of the VCU Health System. “Thanks to their marvelous gift, we will be able to recruit even more talented faculty to the Pauley Heart Center.”

The Pauley Heart Center Consortium

The Pauleys’ first gift has already brought about significant improvements to the center, said Dr. Kenneth Ellenbogen, chairman of Pauley’s division of cardiology. “The Pauleys’ gift has transformed our facility into a first-tier heart center by allowing us to devote resources towards renovating and improving our research laboratories. It has also resulted in our attracting some new faculty in cardiology and particularly in structural heart disease and heart failure that has been substantial in improving our ability to take care of the sickest and most complex patients from all over the region.”

Originally from Canada, the Pauleys were married in 1949 and moved to the U.S. in 1954. Mr. Pauley is an engineer and the owner, chairman, and CEO of Carpenter Company in Richmond, the largest manufacturer of comfort cushioning in the world.