Innovate: Issue 9, Fall 2010

Fall 2010

™

Rapid Response: b a r n e s - j e w i s h l e a d s E m e r g e n c y C a r e i n H o s p i ta l a n d i n t h e F i e l d

Als o in th is is s ue:

■ Excellence in Spine Surgery ■ Siteman Cancer Center: New South County Location ■ First Kidney-Heart Transplant in St. Louis

Innovate

a l e t t e r f r o m RICHARD LIE K WEG

News

BY THE N U MBERS

BARNES - J EWISH HOSPITA L,

a nonprofit academic institution, is the largest hospital in Missouri and is consistently ranked among the Honor Roll of America’s best hospitals by U.S. News & World Report. The adult teaching hospital of Washington University School of Medicine, Barnes-Jewish was the first adult hospital in Missouri to be certified as a Magnet hospital for its nursing excellence.

Barnes-Jewish Hospital is a member of BJC HealthCare, one of the largest nonprofit health care organizations in the United States.

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is the only cancer center within a 240-mile radius of St. Louis to hold the Comprehensive Cancer Center designation from the National Cancer Institute and membership in the National Comprehensive Cancer Network.

WASHINGTON UNIVERSITY PHYSICIANS

are the medical staff of Barnes-Jewish Hospital and the Siteman Cancer Center.

For more information or to make an appointment, call 314-TOP-DOCS (314-867-3627) or toll-free 866-867-3627.

Photo by Tim Mudrovic

P HYSICIANS AT BAR NE S- J E WISH HOSP ITA L

Dear Friends,

B

arnes-Jewish Hospital is home to one of the busiest emergency and trauma centers in the nation, exceeding 90,000 patient visits each year. What many people aren’t aware of is the coordinated, high-level care that is provided before patients ever reach our doors, performed by emergency medical service (EMS) professionals.

Once the patient arrives at the hospital, our team of emergency medical experts and nurses ensure a rapid and safe hand-off with EMS.

In a program unique in our region, Washington University emergency medicine physicians at Barnes-Jewish Hospital provide extraordinary oversight over the some of the largest ambulance companies serving our community. Our physicians not only ensure the care offered by our EMS is safe and of the highest quality, but assist by going on ambulance runs and caring for patients at the scene of accidents.

As national leaders in medicine, we are always striving for new ways to provide innovative care to our community, and partnerships with our EMS professionals help keep everyone safer.

Sincere regards,

Managing Editor: Laura Thomson Contributing Editors: Bob Bokerman, Mary Lee, Juli Leistner and Jackie Stack

Richard Liekweg President, Barnes-Jewish Hospital and Barnes-Jewish West County Hospital

Address Changes:

Want to send a message to Richard Liekweg?

Have questions or comments? E-mail: innovate@bjc.org

If you no longer wish to receive Innovate or received multiple copies, please call 314-TOP-DOCS (314-867-3627) or toll-free 866-867-3627, or e-mail innovate@bjc.org.

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8th

b est h osp ita l in Am er ica , according to U.S. News & World Report, making the Honor Roll for 18

hospital and washington university physicians

performed a record

358

transplants in 2009,

consecutive years.

the hi g hest in the re g ion .

J an u ary thro u g h A u g u st 2 0 1 0 ,

I N I T s f irst year ,

the Barnes-Jewish Hospital Pheresis Center collected

Innovate is published quarterly by Barnes-Jewish Hospital.

Innovate circulation | Mailstop 90-94-204 600 S. Taylor Ave. | Suite 202 St. Louis, MO 63110

B A R N E S - J E W I S H I S ran k e d

4,187 p l at e l e t d o n at i o n s.

For more information visit: http://bjhne.ws/platelets

12,729,318 orders were entered online into

COMPASS,

the new computerized medication system at Barnes-Jewish Hospital.

And medication was delivered on average 57 minutes faster since moving online.

Thank you to everyone who completed the readership survey from the summer issue! The winners of our four gift cards have been notified. If you have more suggestions or would like to let us know how we’re doing, please e-mail innovate@bjc.org. www.BarnesJewish.org

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News

atest The L ical d in Me s and urce Reso ology n Tech

New Siteman South County Location

The 16.28-acre building site is located immediately south and east of the intersection of I-55 and Butler Hill Road.

Currently, more than 4,500 cancer patients in the surrounding area come to Siteman for evaluation and treatment. This includes approximately 850 newly diagnosed cancer patients each year.

A 40,000-square-foot, one-story outpatient facility is planned for the site, designed to provide the most advanced cancer care in a convenient and comfortable setting closer to home. The facility will include a linear accelerator for leading-edge radiation

therapy and a chemotherapy infusion center. Washington University medical oncologists and radiation oncologists will treat patients at the new facility, and surgical oncologists will provide consults there. Clinical studies will be available to patients for whom standard therapy is not the best option.

Building the $17-million facility will generate nearly 300 construction jobs. Once open, the facility will create approximately 50 new permanent staff positions.

at Barnes-Jewish Hospital and Washington University School of Medicine

There is no one test that identifies TN, also called tic douloureux; it is diagnosed through patient history and examination. “There are other causes of facial pain that must be ruled out because treatments effective for TN won’t work for them,” says Joshua Dowling, MD, Washington University neurosurgeon. “It is important people be seen early in the condition. The quality of the pain changes over time and becomes less clearly defined as TN.” MRI or CT scans of the brain can identify some causes of TN, such as tumors (usually benign), vascular

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Patients have more treatment options than ever before. When pain cannot be kept under control with medications, the neurosurgeon has a variety of tools with which to personalize treatment.

Microvascular decompression (MVD), a form of brain surgery, can be higher risk but is the only approach that doesn’t involve injuring the nerve.

Three different needle procedures,

barnes-jewish hospital and washington university physicians

performed through the skin in the cheek, are performed with good success and all involve deliberately damaging part of the nerve to relieve pain while limiting the degree of numbness.

The most recent treatment option is stereotactic radiosurgery using the Gamma Knife.® This radiation-delivery device focuses about 200 separate beams of radiation on a tiny area of the nerve root. It allows a high dose of radiation to be delivered without affecting the surrounding structures.

“The treatment is effective in most patients, but it can take up to two months to take effect,” says Dowling.

“It is very safe.”

Barnes-Jewish and Washington University were the first in Missouri to have the Gamma Knife.® Find out more about trigeminal neuralgia and

Cu s t o m T o t a l K n e e

Navigation System

LEG

B O DY

Images © Masterfile

Trigeminal Neuralgia: Facial Pain with Treatment Options malformations and multiple People who have trigeminal neuralgia sclerosis (MS).

(TN) facial pain describe it as intermittent electrical shocks to a “The majority of cases, which typically specific area. It can be triggered by occur in people over 50 and more eating, drinking, touching the face, or often in women than men, are caused even a breeze wafting by. The length by compression of the nerve by a of the jolts can be very brief or become blood vessel bundle,” Dowling says. chronic with longer severe durations.

BREAKTHROUGHS

right image courtesy of Veran Medical

Barnes-Jewish Hospital and Washington University School of Medicine plan to build a new Siteman Cancer Center location in south St. Louis County, serving the I-55 corridor and southern Illinois.

Construction is expected to begin in spring 2011 and last two years.

Patients sometimes experience more pain and

A new electromagnetic navigation system is

stiffness than they would like following total

improving the safety and efficiency of interventional

knee replacement. Everyone’s knee alignment is

radiology procedures such as ablations, drainages

slightly different, and a small degree of misalignment may

and biopsies. The system captures and displays

be one of the causes of persistent symptoms and

three-dimensional images gathered in real time along

dissatisfaction. To further refine the surgery and improve

natural organ cycles such as breathing. This ability

outcomes, Robert Barrack, MD, is studying custom

allows clinicians to target lesions within a moving

incision guides. “Three-dimensional models are

organ without continuously stopping for new CT scans,

developed from MRI scans,” he says, “and the guides

greatly reducing the patient’s radiation exposure,

are customized for each patient’s anatomy.”

tissue damage and treatment time.

For more information and a video, visit: http://bjhne.ws/kneereplacement

your treatment options at http://bjhne.ws/tn

www.BarnesJewish.org

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In the crucial minutes

after a devastating auto accident, the victim often remembers very little.

The impact and ensuing sirens of ambulances, police and fire trucks become background noise as emergency medical service (EMS) personnel rush to the scene.

Pre-hospital physicians are fellowship-trained to provide care before patients arrive at the hospital and supervise the care and training of EMS providers and paramedics.

EMS:

Composed of subspecialists within emergency medicine, Washington University EMS is the first and only physician-based emergency medical response agency (EMRA) licensed in the state of Missouri. When area fire and police departments or ambulance services call the hospital emergency department for help, physicians head to the scene in specialized emergency response utility vehicles. Each is equipped with sirens and lights, defibrillators, advanced airway instrumentation, medications—everything needed to save a life in the first few minutes of a critical emergency.

RAPID RESPONSE BARNES - JEWISH l e a d S e m e r g e n cy ca r e i n t h e h o s p i ta l a n d i n t h e f i e l d

David Tan, MD, (left) practices forcible entry techniques with Jacob Keeperman, MD, 2010-2012 EMS/ critical care fellow during Missouri Basic Firefighter School.

Photo by Tim Parker

First responders

Missouri law requires that paramedics who perform advanced life support do so under the authority of a licensed physician. Washington University EMS physicians have been chosen to oversee the three largest EMS agencies in the St. Louis area: Abbott Ambulance, the St. Louis Fire Department and the Christian Northeast Hospital EMS. The physicians also work with smaller agencies and pre-hospital operations. Barnes-Jewish Hospital, through its emergency and trauma communication center, serves as the medical control hospital for these ambulance companies, managing the flow of patients and helping to assign physicians to serious cases.

In addition to providing care themselves, Washington University EMS physicians also train paramedic staff members.

“Our modern EMS approach aims to develop our prehospital colleagues: EMTs, who give basic life support; paramedics, who can do invasive airways and other advanced procedures; and to some degree the first responders such as police or firefighters, who typically are individuals who can offer basic first aid,” Tan says.

While all EMS programs must have the oversight of a supervising physician and hospital, this is the only program in the region that routinely sends physicians along with ambulances for certain patients and also performs periodic ride-alongs to make sure quality and patient safety are at the highest levels. A typical week might include a physician going on a dozen or more ambulance calls.

Tan and his EMS colleagues provide medical oversight both indirectly, through written standard procedures, and directly, by responding to paramedics’ calls for permission to administer medications.

Oversight also includes clinical quality assurance and continuous quality improvement. www.BarnesJewish.org

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Brian Froelke, MD, demonstrates respiration equipment to paramedics Derek Mollett and Jessica Reed of Christian Hospital EMS. Froelke, a 2007 graduate of the EMS Fellowship, is active in EMS administration, disaster response and emergency legislation implementation.

EMS work in the field can be dangerous. Washington University EMS physicians frequently provide care in chaotic settings. They have climbed down a steep, muddy ravine to reach a wrecked car at the bottom, helped fire victims and the firefighters themselves while nearby structures were in flames and entered hostile settings where even doctors are viewed with suspicion. “Providing the injured, the ill and those who might die with the very best medical care

2007, is the medical director for the state-affiliated disaster medical team, MO-1 DMAT, Inc (the Missouri-1 Disaster Medical Assistance Team).

Together with its federal counterpart, MO-1 DMAT provides everything from a small strike team that furnishes medical staffing wherever needed to a fully equipped 50-bed hospital tent with attendings adjacent to an incapacitated facility. During the ice storms that paralyzed much of the St. Louis area in 2006, Froelke’s medical experts stepped in.

they maintain a safety net for citizens with unmet health, social or mental health needs. More than 40 percent of patients who visit the emergency department have little or no health insurance, no primary care physician and may be indigent or homeless. Emergency physicians are often their sole providers of medical care. They hear life stories and problems and try to help make these patients’ lives better by connecting them with resources that may exist in their area.

A year-long EMS fellowship program at Washington University and BarnesJewish Hospital prepares emergency medicine physicians to specialize in the clinical and operational aspects of pre-hospital care. One to two fellowships are awarded each year.

The future field physicians engage in fire rescue, urban and rural search and rescue, air and ground ambulance transport and mass-gathering and events medicine. They also receive SWAT, hazardous-materials and National Incident Management System training.

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Such extensive preparation equips them to become future medical directors and chief EMS physicians.

“Our job is to make sure that medical care provided in the community under our oversight is scientifically sound and compassionately delivered.”

To help nurses and EMS staff collaborate in the care of patients, Tan also created a nurseto-paramedic bridge fellowship.

barnes-jewish hospital and washington university physicians

Alex Stringer, RN, a nurse in the Charles F. Knight Emergency and Trauma Department at Barnes-Jewish Hospital, will be one of the first graduates. It is not something he is required to do, but Stringer thinks it will ultimately make a big difference to patients.

“It helps me understand what patients go through out there before they get to the hospital,” Stringer says. “Once a patient comes to see us in the emergency department, we say they are ‘in our house’ but as an EMS provider you are out there in the patient’s house, dealing with their families and providing care.”

possible, under difficult circumstances, “We want to be sure we are prepared is what our physicians do,” says Tan. to handle anything for our community when the need arises,” Washington University EMS physicians says Robert Poirier, MD, chief of and many of their colleagues in clinical operations in the emergency the division have rushed to assist department. communities when disasters occurred, lending medical assistance after 9/11, Whatever the special situations, Hurricane Katrina, and the Haiti Washington University EMS earthquake of 2010, and rushing to physicians adapt, resolving problems regional and local disasters such as from deluges of patients during the 2008 floods in southern Missouri, flu outbreaks to on-sight trauma where Tan oversaw medical support emergencies. operations for search and rescue.

Emergency medicine physicians not Brian Froelke, MD, emergency only serve as a safety network for the medicine physician and the EMS general public in the St. Louis area Fellowship Program’s first graduate in through EMS and in-hospital services,

Photo by Steve Frazier

Photo by Tim Parker

“Our job is to make sure that medical care provided in the community under our oversight is scientifically sound and compassionately delivered,” Stringer says.

Training for the future

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Getting your hands dirty

Alex Stringer, RN, (right) is one of the first nurses to enter a specialized nurse-to-paramedic fellowship, under the supervision of the program’s medical director, David Tan, MD.

www.BarnesJewish.org

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Spinal cord injury is a major lifechanging event. Whether spinal cord injury is caused by trauma, infection, degenerative disorder, vertebrae dislocations or tumors, it can result in a drastic change in the life of patients and their families. At Barnes-Jewish Hospital and Washington University, surgeons from the Department of Neurosurgery and the Department of Orthopedic Surgery work in unison to preserve spinal function and alleviate pain.

Combined, the two have one of the largest clinical practices in the United States for the surgical management of adult and pediatric spinal deformities and complex reconstructions. Each year, the spine division sees approximately 3,000 new patients in consultation and performs

approximately 1,400 spinal surgeries.

The clinical care and research is among the most advanced available, and these physicians have published more scientific peer-reviewed articles about research or treatment for spinal conditions than any other center.

The expertise of the Washington University spine surgeons extends well beyond local reach. “Over half of new patients come from outside Missouri and Illinois,” says Keith H. Bridwell, MD, chief of orthopedic spine surgery. “They come from all 50 states and other countries.”

“We’ve even operated on spine surgeons and physicians from many of the other major medical centers around the country,” adds Bridwell’s partner Daniel Riew, MD, chief of cervical

spine surgery in the department of orthopedics and director of the Orthopedic and Rehabilitation Institute for Cervical Spine at Washington University Orthopedics.

Comprehensive and specific

Spine surgeons at Barnes-Jewish are able to coordinate care with other neurologic and orthopedic specialties, as well as oncology, radiology, internal medicine and physical medicine and rehabilitation. In fact, when patients first have symptoms, they most often go to a rehabilitation/physiatry doctor, who specializes in conservative management of orthopedic conditions.

These specialists then determine whether the patient needs surgery or can be treated with medication or physical therapy.

NE U ROS U RGEONS

Paul Santiago, MD specialist in the surgical treatment of cervical disorders and tumors

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Todd J. Stewart, MD clinical focus in the surgical treatment of cervical disorders and spondylolisthesis

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These relationships mean treatment is based on the specific disorder and not on which department first examined the patient.

“From the nurses to the technicians and medical assistants, we have one of the most complete and structured systems specifically for the care of spine conditions,” says Neill Wright, MD, Washington University neurosurgeon specializing in the care of cervical spine conditions.

If spinal surgery is needed, patients are referred to one of eight surgeons specializing in specific spinal disorders and conditions. For example, Riew is the only physician in the country whose practice is entirely dedicated to cervical cases. Bridwell and his partner, Lawrence Lenke, MD, co-chief of pediatric and adult spinal, scoliosis and reconstructive surgery, are two of the top physicians in thoracic and lumbar

Photo by Robert Boston

Excellence in SPINE Surgery:

“At Washington University we are fortunate to work with highly qualified neurosurgeons who also specialize in spinal care. We wouldn’t be able to do our jobs without the expertise of neurosurgery. Drs. Paul Santiago, Todd Stewart and Neill Wright at BarnesJewish are all fabulous, talented spinal neurosurgeons,” Bridwell says.

spine deformities (scoliosis, kyphosis, spondylolisthesis) and are among the most prolific researchers. In addition to their active involvement in spine research, Washington University spine specialists serve as national leaders in their field, with Bridwell serving as president of the Scoliosis Research Society from 2002 to 2003, and Lenke currently in that role.

Above: Orthopedic spine surgeon Jacob Buchowski, MD, specializes in minimally invasive surgery and metastic spinal tumors.

spinal neurosurgeons at Barnes-Jewish offer a “one phone call” service to the community. Patients with both spinal and spinal-cord abnormalities can be rapidly triaged with a cooperative effort.

Jacob Buchowski, MD, MS, director of the Orthopedic Center for Spinal Tumors, in conjunction with neurologival surgery provides comprehensive care of oncologic and degenerative disorders. By collaborating, Buchowski, Santiago and the other

Complex cases may be co-managed by both an orthopedic surgeon and a neurosurgeon. Buchowski and the neurosurgical spine surgeons have an unparalleled interest and experience in dealing with tumors of the spine. and spinal cord.

ORTHOPEDIC S U RGEONS

Neill Wright, MD neurosurgeon dedicated to the management of complex cervical spinal disorders

barnes-jewish hospital and washington university physicians

Keith Bridwell, MD chief of orthopedic spine surgery, co-director and founder of the pediatric and adult spinal deformity service

Jacob Buchowski, MD, MS chief of degenerative and minimally invasive surgery, director of the center for spinal tumors

Lawrence Lenke, MD co-chief of pediatric and adult spinal, scoliosis & reconstructive surgery

K. Daniel Riew, MD chief of cervical spine surgery and director of the orthopedic and rehabilitation institute for cervical spine

Lukas Zebala, MD minimally invasive surgeon for degenerative spine conditions

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Stewart also has an interest in lumbar degenerative spondylolisthesis (slipping forward of one vertebrae on another). He treats this with both the standard technique of decompression and fusion as well as some of the new minimally invasive techniques of interspinous stabilization.

“Regardless of the spinal problem you have, we have a specialist with high expertise who can help you,” Bridwell says. “We may all take care of the spine, but in completely separate ways.

When I began my career here in 1984, there was no spine specialization. My goal was to build the kind of team we now have. We have trained almost 50 orthopedic spinal surgeons, including Drs. Lenke, Buchowski and our newest member Lukas Zebala.”

“What people fear most about spinal care is paralysis,” Riew says. “Many don’t get care because they are afraid of having a surgeon make a small slip and losing function of their limbs.

Because of our specialized expertise,

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patients of Barnes-Jewish can have confidence in a doctor who has performed the procedure 3,000 times with no paralyzed outcomes.”

Bridwell was recently awarded a 5-year $2.5 million National Institutes of Health grant to study treatment of advanced adult spinal deformity.

St. Louis’ only heart transplant program reached a milestone in 2010 by celebrating the 25th anniversary of its first transplant. One of the program’s first patients, Nick Belfiglio, received his new heart in December 1985.

Today, Belfiglio credits his longevity to the care of the entire Barnes-Jewish Hospital team, his wife’s support, and being proactive about his health.

Leadership and Innovations

“In order for any surgical technique to become useful, results must be uniform and the technique should While Washington University spine be easy to teach. All of our spinal surgeons develop the latest procedures, surgeons are frequent lecturers at they also make traditional procedures national and international meetings better and more reliable. and physician training courses,” notes Santiago.

“We perform the most advanced surgeries, but our main innovations Through the latest research have to do with experience and and advanced clinical care, reliability,” Bridwell says. in the field

the entire spine service is

For example, a few spine surgeons preserving patients’ mobility perform complicated vertebral and ways of life. column resections (VCRs) to realign and stabilize severely deformed spines.

“I think we are a unique group in But Lenke employs a novel technique, that we all truly love what we are pioneering an approach through doing, and that passion can be seen a single incision in the back of the in the dedicated care we provide to spine to perform the entire correction our patients,” Wright says. “We in a single operation versus two follow a patient’s progress through operations through both the patient’s their entire treatment, from the back and side. detailed initial evaluations to the rehabilitation process.

In 2004, Wright developed a procedure known as translaminar fixation of the axis. The technique, now used around the world to stabilize vertebrae in the upper cervical spine, reduced risks and made it possible for more surgeons to perform atlantoaxial stabilization surgeries more safely.

Instead of relying on restrictive spinal fusions to correct neck deformities, both departments are advancing the use of artificial disc replacements.

Riew, Santiago, Stewart and Wright have been actively engaged in clinical trials to study the efficacy of artificial cervical disc surgery.

barnes-jewish hospital and washington university physicians

Lukas Zebala, MD, an orthopedic specialist in minimally invasive surgery and degenerative conditions of the spine, is the newest physician to join the team. “He will expand the horizons of what we do here to include and advance minimally invasive surgeries,” Bridwell says. Buchowski and Zebala are working closely with Heidi Prather, DO, to open and manage the Washington University Spine Center in Chesterfield. This will be a collaborative approach for the treatment of acute back pain and related spinal pathologies.

Photo by Laura Thomson

Santiago, Stewart and Wright are all specialists in treatment of disorders of the cervical spine from straightforward discectomies to the resection of complex tumors involving the spine and base of the skull. As neurosurgeons, they also treat conditions within the spinal canal such as spinal cord tumors and build up of fluid within the spinal cord (syrinx). “When Drs. Santiago, Wright and I discuss complex cases, it is interesting to see the different ways in which we think about and approach the same problem,” says Stewart. “This process leads to unique insights and ultimately better patient care.”

Heart-felt Milestone

NIC K BEL F IGLIO , 8 0

GREG EWALD , MD , 4 7

Heart Transplant Patient, Chesterfield, Mo.

Washington University Cardiologist Medical Director, Cardiac Transplant Program

the exceptional team

My surgeon was a fine doctor, as is Dr. Ewald.

He is very pleasant and extremely knowledgeable. I’ve also been fortunate to have a wonderful transplant coordinator, Cindy Pasque, who has been with me since the very beginning. It’s important to have someone you can relate with and trust, like Cindy.

the past 25 years

The surgical techniques we use now are similar to what we used in the past, but the drugs used to prevent rejection and infections have improved over time. We now use mechanical-assist devices that stabilize heart failure and allow patients to wait for longer transplant surgery.

the past 25 years

the next 25 years

I got to see five more grandchildren and 2 more greatgrandchildren. I traveled and went on cruises with my wife.

I helped start a transplant support group and met some amazing people I’d never have connected with otherwise.

I’ve had a good life.

I think one of the issues is that there aren’t enough donor patients. Whether we’ll get to a place where we can use cells or grow our own organs in the next 25 years, it’s possible.

Mechanical devices are getting smaller and more durable so they last longer, and there may come a time where we aren’t so dependent on a donor.

what to expect

Anyone with a transplant has to be aggressive in seeking out care. You have to take care of yourself. Keep track of your own medications and test results. If something changes make, your support team is aware of it.

Watch an interview with Ewald and find out more about the heart

transplant team at http://bjhne.ws/hearttransplant

what to expect

For anybody surviving 25 years after any transplant sets them apart. I’ve been Nick’s physician for the past decade or so and he is a great example of someone who has benefited greatly. He takes care of himself; he stays in touch with us and gets his follow-up care.

He’s a big part of his own success.

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FYI

at a g lance

Photo by Tim Parker

Sealing a Hole in the Heart

First KidneyHeart Transplant in St. Louis Washington University surgeons performed the first combined heart-kidney transplant at BarnesJewish Hospital June 2 and 3 on Jonathan Sadowski, 20, of O’Fallon, Mo. The success of the procedure opens the door for other patients with both heart and kidney failure to have transplants, according to Gene Ridolfi, RN, Barnes-Jewish Transplant Center director. BarnesJewish is currently the only hospital in the St. Louis region performing heart transplants.

The heart transplant was Sadowski’s second. He was born with left hypoplastic heart syndrome and received his first transplant when he was less than two months old. About a year ago, doctors found that he had developed transplant coronary artery disease, and anti-rejection medication plus his failing heart had caused irreversible damage to his kidneys.

While the failure of two organs might have automatically ruled him out as a candidate for transplant a couple years ago, physicians now look at multi-organ transplants as an option for patients such as Sadowski—who is young, otherwise healthy and likely to benefit long term from the procedure.

The transplant was performed in two “We’re lucky here at Washington stages, with Washington University University and Barnes-Jewish to heart transplant surgeon I-wen Wang, have the resources and the multiMD, PhD, performing the five-hour disciplinary teams to be able to do heart transplant. Sadowski was then procedures such as this and then taken to the cardiothoracic surgery provide the long-term transplant intensive care unit to be stabilized care that results in outstanding and his new heart monitored before outcomes,” Wang says. being wheeled back to the operating room where Washington University Find out more about Sadowski and the procedure at http://bjhne.ws/kidneyheart transplant surgeon Jason Wellen, MD, implanted the donor kidney in a three-hour operation.

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When a person is born, there’s a naturally occurring hole between the two upper chambers of the heart. In about 25 percent of the population, that hole stays open to some degree. The condition is known as patent foramen ovale (PFO) and is the most likely cause of stroke in patients under age 55. Most patients have no symptoms and never know they have the condition until something serious occurs.

“PFO is one of the simpler defects that affect the heart,” says John Lasala, MD, PhD, Washington University interventional cardiologist. “With PFO, when you exercise or exert yourself, a change in pressure pushes blood from the right venous side to the oxygen-rich left arterial side.”

If there is a clot or other material caught in that blood, it can lead to serious consequences and possibly travel to the brain, where it causes a stroke.

“We have the technology to close these PFOs without the need for major surgery,” Lasala says. Physicians are also participating in trials to determine the best treatments for the condition, such as a new minimally invasive surgery. In the procedure, a catheter is inserted through the inner right leg and directed to the heart where a small device is placed to seal the hole. The procedure only takes around 20 minutes.

“In over 90 percent of patients, the seal will be complete,” Lasala says. “In the rest, there’s enough of a correction to prevent another event.”

Listen to a podcast on PFO with Lasala at: http://bjhne.ws/pfopodcast.

Medical Peace of Mind A reflecting pool and a 2.2-acre plaza with Missouri’s lush

The year-round pool is an “infinity pool” with a disappearing

native landscape now welcome visitors to the BJC Institute

edge and fiber-optic lighting made to look like twinkling

of Health at Washington University School of Medicine

stars when lit at night.

and create an expansive and welcoming green space in the middle of Washington University Medical Center.

World-renowned artist Maya Lin, best known for designing the Vietnam Veterans Memorial in Washington, D.C.,

Many of the 40,000 plants in the plaza are species

designed the plaza’s landscape and water feature, in

found at the Missouri Botanical Garden’s Shaw Nature

partnership with Michael Van Valkenburgh Associates Inc.

Preserve. The focal point of the plaza is a water feature

of Boston. The project was funded by private donors,

nearly 80 feet in diameter.

including Robert Clark and his wife, the late Ellen Hope Clark.

One Barnes-Jewish Hospital Plaza Mailstop 90-94-204 St. Louis, Missouri 63110

Nonprofit Organization U.S. Postage

PAID Pewaukee, Wisconsin Permit No. 543

Bringing the News to You To receive e-newsletters from Barnes-Jewish Hospital and the Siteman Cancer Center about the latest in medical news and breakthroughs, visit our web site at barnesjewish.org/newsletters.

You can also join in the conversation through Twitter at www.twitter.com/barnesjewish, become a fan of Barnes-Jewish Hospital on Facebook, or visit our blog at newsblog.barnesjewish.org.

Dr. Matthew Ellis, MD, PhD Washington University breast cancer expert

This publication in no way seeks to serve as a substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.