Fixing broken hearts

 

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With a nationally renowned Congenital Heart Center and experts dedicated to adult cardiovascular care, UF Health has become a leader in caring for the heart and the supporting blood vessels around it that help it thrive. This month, we stitched together a few stories about the myriad ways UF Health experts are helping to fix broken hearts (and blood vessels).

Mikayla Trantham and Wyatt Thomas

Mikayla Trantham and Wyatt Thomas

The neighbors

On his sixth day of being alive, Wyatt Thomas underwent open-heart surgery at UF Health Shands Children’s Hospital to repair one of his five congenital heart defects.

Nine days after his parents took him home in 2009, he was back in the hospital again. He did not leave for 276 days.

“He was in complete heart failure,” remembers Wyatt’s mom, Ann Thomas. “The initial surgery did not do what they had hoped it would do.”

As the infant’s condition continued to deteriorate, physicians with the UF Health Congenital Heart Center told Ann and her husband, Johnny, that their son’s only option was to be placed on the Berlin Heart, a ventricular assist device that keeps a child’s heart pumping while they wait for a transplant. The problem was they had never used the Berlin Heart on a child as young as Wyatt, and he was growing sicker by the day. His chances of survival seemed slim.

Scared and confused, Thomas sought support from another mom whose daughter had been on the Berlin Heart and received a transplant the year before. She didn’t have to turn far.

Although the UF Health Congenital Heart Center had only begun using the technology in 2006 and only 21 children have ever been on it to date, the Thomas family happened to live across the street from Mikayla Trantham, who had been on the Berlin Heart and received a heart transplant in 2008, when she was 5.

The families, who live in rural Gilchrist County, knew each other because their sons played football together, but Wyatt’s stay in the hospital brought them even closer, Thomas says.

“Tammy (Trantham) was my rock,” Thomas says. “Having her shoot me an email or knowing I could pick up the phone and call her and talk to someone for five minutes who knew what I was going through … there is nothing like being able to talk to someone who is in your shoes.”

Like Wyatt, Tammy’s daughter, Mikayla, had undergone surgery as a baby at UF Health Shands Children’s Hospital to address a complete heart block, meaning her tiny heart was not able to properly send signals from the top of the heart to the bottom. Surgeons had implanted a pacemaker and thought she should be OK until she was at least 2. She made it to 4 before doctors needed to implant a new pacemaker. A few months later, she developed what seemed like the flu.

“I figured they would give us antibiotics and send us home,” Trantham says. “Instead, they sent her to a hospital in an ambulance. At the hospital, when we got there, they were saying they had to intubate her and she might not make it.”

Eventually, doctors placed Mikayla on the Berlin Heart and the wait for a heart began.

“We had great nurses. She had friends in the hospital,” Trantham says. “She was 4 and had her 5th birthday there. They threw her a little birthday party. That’s the stuff she remembers, all the good stuff.”

Finally, on Sept. 4, 2008, Mikayla received her new heart. Wyatt’s day came May 24, 2010, when he was 9½ months old. Both children are thriving now, their moms say.

“The (people with the Congenital Heart Center and the hospital) are amazing. I don’t know any other word to use,” Thomas says. “Completely amazing. They treat my child like he is theirs. I could never fathom anyone else treating my child but them.” — April Frawley

Answers in a heartbeat

For families with children facing complicated congenital heart conditions, waiting for answers can prove torturous. But physicians with the UF Health Congenital Heart Center are helping to shorten that wait, using technology to treat and diagnose patients even if they are hundreds of miles away.

An echocardiogram, or ECHO, is an ultrasound test that uses sound waves to create a picture of the heart. This test is crucial for cardiologists making decisions about a patient’s care, but requires an expert to read and analyze it. Under the direction of Curt DeGroff, M.D., director of noninvasive imaging for the Congenital Heart Center, UF Health developed an electronic system to receive and review these images. This allows them to give instant feedback to physicians and patients all across the state.

“Patients need instant referral … and questions can be addressed almost immediately,” he says. “It’s even helped in the non-urgent cases.”

DeGroff modeled the system after ones housed in other hospitals across the country. UF Health adopted the practice a few years ago. In the old days, tapes of imaging tests would show up at the hospital in taxis, he says.

Now, DeGroff, who specializes in pediatric and congenital echocardiography, and his team receive a phone call and can quickly look at the images and make a decision.

“Most of the time we can get them immediate feedback of our opinion in terms of what they’re looking at and whether it requires immediate intervention,” he says.

It’s often so quick that patients and their families don’t even have to go home and wait for feedback. Rather, they can sit in the office and wait for the doctor to come back with the diagnosis. For places like Pensacola, where there’s a large group of doctors but no surgeons on staff, it’s a fantastic time saver, DeGroff says. It also gives a “second eye” to physicians in private practice who may not have the luxury of bouncing ideas off another doctor.

“In this day and age, no one should be practicing alone,” he says.

With the help of Peggy Carney, manager of ancillary applications for UF Health, DeGroff’s team is moving to a “cloud-based” system, which will require less hardware and installation and will be a much quicker, secure way to get feedback from doctors. — Kelsey Meany

 

The heart’s little helper

Diagnosed with congestive heart failure in 1998, John Olsen had been through a number of different treatment options — medication, an implanted defibrillator and a stent.

Luckily, Olsen’s condition had remained relatively stable through the years, but his cardiologist, Mark Hepp, M.D., of Clearwater, knew eventually they would have to treat his heart failure more aggressively. Heart failure occurs when the heart stops pumping blood as well as it should, and treatments vary depending on how severe the case is.

After learning about ventricular assist devices at a conference, Hepp referred Olsen to Juan Aranda, M.D., a cardiologist with UF Health Heart and Vascular Care, one of the only centers in the region that offers ventricular assist device surgery. Although ventricular assist devices are often used in patients who are waiting for a heart transplant, they can also be used in cases like Olsen’s to help improve quality of life.

Olsen began seeing Aranda every six months for monitoring, although he still felt fine. That changed in December 2012. Olsen and his wife, Harriett, were on a cruise when the 78-year-old began to feel ill.

“I started to feel bad all of a sudden,” he recalls. “I lost my appetite and my energy and was having shortness of breath.”

His heart failure was accelerating, so in May 2013, he underwent surgery to have a ventricular assist device placed in the left ventricle of his heart. Nine months later, Olsen reported that he was feeling “normal again.”

Ventricular assist devices are just one of the technological advances UF Health surgeons are using to help hearts and the vessels that lead to and from it.

For example. UF Health surgeons were the first in Florida to use the AngioVac to vacuum out a blood clot from a patient’s blood vessel. UF Health is also one of only eight sites in the country participating in a trial of the Cook P-branch, a new stent graft used to treat abdominal aortic aneurysms. — Katrina Ciccarelli

 

 A new life

Patricia Dickinson/Photo by Jesse S. Jones

Patricia Dickinson/Photo by Jesse S. Jones

The pain started in her back. At first, Patricia Dickinson of Ponte Vedra Beach thought it had something to do with a broken back she’d had years ago. But then the pain traveled to her stomach. She was starving, but she couldn’t eat. She lost more than 30 pounds.

But an MRI revealed an unexpected problem — an aneurysm on her aorta. Because the aorta is the largest artery, transporting blood from the heart to the rest of the body, if the aneurysm were to burst, she could quickly die.

“I started crying because my grandmother died from that,” she says.

Her doctor referred her to Adam Beck, M.D., with the UF Health Aorta Center. Beck and his team quickly assessed Dickinson’s case and decided to take a two-pronged approach to her care. In addition to her aneurysm, she had blockages in the blood vessels leading to her intestines. The surgeons addressed the blockages first by placing a stent in one of the vessels. After giving Dickinson a month to recover from that procedure, they repaired her aortic aneurysm.

“She immediately felt better,” Beck says. “Since then she has done very well.”

Beck and his team at the UF Health Aorta Center treat a variety of conditions related to the aorta. Because these conditions are so complex, the team includes physicians from a variety of disciplines, including vascular surgery, cardiovascular surgery, cardiovascular anesthesiology and radiology. The teamwork between these experts is what allows the center to offer advanced, collaborative care, Beck says.

Now feeling better and back to pursuing things she enjoys, like carving pumpkins at Halloween, Dickinson says she appreciates every second she gets.

“They gave me my life back.” — April Frawley

 

 Treating chest pain emergencies

The UF Health Shands Chest Pain E.R. has received full accreditation from the Society of Cardiovascular Patient Care, an international nonprofit organization focused on transforming cardiovascular care.

The eight-bed facility, located on Archer Road, opened in August 2011. Emergency medicine specialists, cardiologists and specially trained practitioners treat patients who have low-to-moderate chest pain and/or symptoms of a heart attack. The accreditation acknowledges that the facility can quickly and effectively help patients who arrive with heart attack symptoms.

“These patients benefit the most from an accredited chest pain center where protocols are in place to rapidly detect underlying coronary artery disease that may not be immediately evident, literally saving lives,” said Joseph A. Tyndall, M.D., M.P.H., chair of emergency medicine in the UF College of Medicine and chief of emergency services for UF Health Shands Hospital. — Mina Radman

 

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February 2014

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