A S U P P L E M E N T T O W E S T C H E S T E R H E A LT H & L I F E M A G A Z I N E F R O M WESTCHESTER MEDICAL CENTER
heartcare ADVANCES IN
‘I WANT TO BREATHE OUTSIDE AIR’
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GOOD DEVICES FOR BAD HEARTS
FETAL CARDIOLOGY SAVES LIVES
CAN STEM CELLS REPAIR A DAMAGED ORGAN?
1/18/11 1:49 PM
contents 12
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14 4
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welcome 8
letter
i n T h i s s p e c i a l s upp l e m e n t t o W e s t c h e s t e r
advances in
heart care W e lco m e
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w h at ’ s n e w i n d i ag n o s i s
and top 10 percent in the nation for cardiac surgery care, and as
You will read about the amazing, life-changing procedures performed by our surgeons on patients young and old—as well as the innovative use of devices such as the Centrimag® and HeartMate® that significantly improve our patients’ health and quality of life.
g o o d d e v i c e s
for bad hearts
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Westchester Medical Center, ranking us in the top 10 in New York
Award from the American Heart Association.
and treatment
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of the breadth and depth of the heart services available at
one of a handful of hospitals in the nation to earn the Triple Gold
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H e a lt h & L i f e m a g a z i n e , you will get a solid overview
‘ I wa n t to b r e at h E
Get a glimpse into the future by reading how our new hybrid operating room—opening later this year—will allow interventional cardiologists, cardiac surgeons, neurosurgeons and vascular surgeons
the outside air’
to work together.
RE PAIRING
Department of Medicine and Physiology will contribute to the
tiny hearts
discovery of groundbreaking therapeutic alternatives for patients
And learn how research at Westchester Medical Center’s
with coronary artery disease and cardiomyopathy.
10 THE POWER o f
We hope you enjoy reading about all that
sharing
Westchester Medical Center has to offer for children
12 CAN
and adults in need of advanced cardiac care and STEM CELLS r e pa i r
a damaged heart?
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invite you to visit us at www.thewestchesterheart. com to learn more about our cardiac services.
Y O U C A N RED U CE YO U R r i s k
of heart disease Advances in Heart Care is published by Wainscot Media, Montvale, N.J. © 2011. All rights reserved.
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advances in heart
WMC_Cardiac_0211final.indd 2
Michael D. Israel President and CEO Westchester Medical Center
care 1/18/11 12:08 PM
what’s new in
diagnosis & treatment one of the nation’s leading medical centers offers comprehensive services for heart disease
There’s good news for the more than 80 million Americans who suffer
angina and heart attacks • Heart attack, which occurs when
minimally invasive mitral valve repairs to repair of complex thoracic aortic
from heart disease: Dramatic strides have
your heart is damaged by extended
aneurysms.
been made in prevention, diagnosis and
oxygen deprivation
treatment, leading to a reduction in deaths from this national number-one killer. That progress is much in evidence at Westchester Heart at Westchester
• Heart defects present at birth, also called congenital heart disease • Irregular heartbeats, which are also termed arrhythmias.
Vascular Diagnostic Services Westchester Heart also offers several vascular diagnostic services to assist in early diagnosis and prevention of serious
When blocked or narrowed coronary
vascular conditions, including diseases of
percent in the nation for overall cardiac
arteries are the cause of congestive heart
the arteries, veins and lymph vessels and
care and best in the region for cardiology
failure, angioplasty—with or without
blood disorders that affect circulation.
services. It’s home to a specialized
stenting—may improve overall heart
coronary care unit, a dedicated cardiology
function and reduce or resolve heart-
New York State for cardiac surgery and
unit, a state-of-the-art cardiac diagnostic
failure symptoms. High-risk interventions
cardiac catheterization, Westchester
center and one of the region’s leading
can now be performed safely with a
Heart at Westchester Medical Center
cardiac catheterization labs. In addition,
new state-of-the-art catheter offering
offers services to patients of all ages,
Westchester Medical Center’s Aortic
hemodynamic (blood-flow) stability while
from diagnostic services and minimally
Aneurysm Program is a lifesaving
the patient’s arteries are worked on.
invasive surgeries to highly technical
Medical Center, ranked among the top 10
resource for patients and referring
The Cardiothoracic Surgery
As one of the top 10 hospitals in
invasive cardiothoracic procedures such
Program at Westchester Heart, ranked
as mitral valve repair, coronary bypass,
among the top 10 percent of such
ventricular assistive devices and heart
ization Lab, one of the busiest on the
programs nationally, offers patients the
transplant surgery. And post-procedure
East Coast, performs more than 5,000
latest surgical techniques. The medical
recovery and rehabilitation are also
diagnostic cardiac catheterizations and
team has expertise across the spectrum
provided without requiring a long trip.
more than 1,600 angioplasty and coronary
of cardiothoracic procedures—from
stent procedures annually. It is available
coronary bypass grafting (CABG) to
physicians throughout the Hudson Valley. Westchester Heart’s Cardiac Catheter-
Visit thewestchesterheart.com to learn more.
24/7 for emergency lifesaving procedures. Cardiac catheterization is used to diagnose abnormalities of the coronary blood vessels that supply blood to the heart. It can also be used to observe heart chambers and heart valves, and may be advised for people who have or are suspected to have one of these conditions: • Abnormal enlargement of the heart • Angina, chest pain that results when too little oxygen reaches the heart for a short period • Coronary artery disease, which is a blockage in the arteries that supply blood to your heart, and is often the cause of
to FIND A
physician WMC_Cardiac_0211final.indd 3
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GOOD devices FOr
f o r t Y- s i X-Y e a r old Bill Dehnert owes his life to the good doctors at Westchester Medical Center and the devices they deploy.
neW technologY
The Cortlandt Manor auto appraiser went into cardiac arrest while
helPs in the
being transferred from Hudson Valley
fight against
for emergency angioplasty. While
advanced cardiovascUlar disease
Hospital to Westchester Medical Center healthcare personnel Tyrone Fuller and Pablo Quinones performed CPr, Craig Monsen, M.D., Associate Chief of Cardiology, went to work. Within minutes, Dr. Monsen performed an angiogram—an imaging study of Dehnert’s heart—that showed that three of his coronary arteries were blocked. Starved of oxygen-rich blood, Dehnert’s heart—particularly his left ventricle—suffered major damage and then stopped. “Our first priority was to get oxygen into Mr. Dehnert’s blood and then get the blood circulating to restore oxygen to his brain and other major organs,” says Dr. Monsen, an interventional cardiologist and Associate Professor of Clinical Medicine at New York Medical College. While Fuller and Quinones continued to perform chest compressions, Dr. Monsen threaded two
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advances in heart
WMC_Cardiac_0211final.indd 4
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Westchester is among a very few facilities that combine the new centrimag® with an oxygenator to give damaged hearts a chance to rest and recover. spaghetti-thin tubes called
minimize any brain damage
catheters into an incision made
that might have occurred during
craig monsen, m.d.
for Mr. Dehnert,” says Howard Tarkin, M.D., an attending physician at the
in Dehnert’s groin up to an artery and
the 30 minutes that his brain was without
medical center and an Assistant Clinical
a vein in his heart. The catheters were
oxygen while his heart was stopped,”
Professor of Medicine at New York
attached to two machines outside his
says Dr. Monsen.
Medical College—and Mr. Dehnert’s
body: the CentriMag® ventricular assist
For two days, Dehnert was sedated
device (VAD) that took over the pumping
and his body cooled to about 92 degrees
action of his heart, and an oxygenator,
Fahrenheit. While this “hypothermic
which took over for his lungs, supplying
protocol” protected his brain, the
oxygen to his blood and expelling
CentriMag® gave his heart a chance to
carbon dioxide from it. While Dehnert’s
recover. By day three, his heart function
own heart and lungs rested, Dr. Monsen
and his body temperature were back to
opened up the three blocked arteries and
normal. And by day five, the CentriMag®
put in tiny scaffolds called stents to keep
was removed. Once he was awake,
them open and allow the restoration of
neurological tests showed that his brain,
blood flow to the heart.
remarkably, did not suffer any damage.
“Within 20 minutes we were
Two weeks later, he was home with his
able to install the CentriMag® and get
fiancée, Paula, and their dog, Hershey.
it working, which is about half the
“I’m just happy to wake up every
time it would have taken to put in a TandemHeart®, another type of assist
day,” says Dehnert. “According to state statistics,
device we’re using here,” explains Dr.
only about 5 percent of New Yorkers
Monsen. The TandemHeart® is a good
survive the type of heart attack and
choice when physicians have more
cardiac arrest that Mr. Dehnert had,”
time to insert a device, and it can keep
says Dr. Monsen. “The fact that we
working for up to 14 days.
were able to bring him back, and that
Although other major medical
he did not sustain any permanent
centers throughout the United States
damage to the rest of his body, is a
are using the CentriMag® to take over
testament to the team effort of our
a damaged heart’s pumping action,
cardiologists, cardiothoracic surgeons
only Westchester Medical Center and
and perfusionists, who over the
a few other facilities are combining the
months leading up to this event fine-
technology with an oxygenator so that
tuned the CentriMag ® procedure so
a patient’s heart can completely rest
that we were ready to utilize it with a
and recover.
moment’s notice.”
more Work to do
and Westchester Medical Center’s
But Dehnert wasn’t out of the woods
24-hour cardiac catheterization
just yet.
and intervention services were the
“Innovative treatment techniques
“Our next objective was to try and
to MAke AN
appointment WMC_Cardiac_0211final.indd 5
primary cardiologist. “His prognosis is excellent for a full and active life.”
techNOlOGy THAT MAKES A
DiffereNce centrimag® is the latest generation of mechanical assist devices to be employed at Westchester medical center. these devices act as either a short-term “bridge to recovery” (as in bill dehnert’s case, at left) or a “bridge to transplant,” or as a long-term “destination therapy” for patients who are too old or too ill to undergo a heart transplant or who decline the surgery for religious reasons. other mechanical assist devices in use at the facility are the short-term percutaneous tandemheart®, which is installed through the groin and does not require a chest incision, and the long-term heartmate® ii, a secondgeneration left ventricular heart-assist device (lvad) that, so far, has kept 70 percent of all patients who have received it alive for up to five years.
difference between life and death
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‘I WANT TO BREATHE THE
outside air’
TWO HEART-ASSIST DEVICES GIVE A MAN’S HEART TIME TO HEAL
IT’S THE SIMPLE THINGS
one hour was amazing. Even more
routinely perform diagnostic testing and
that sometimes mean the most. After
amazing was that he did not require
interventional procedures in the Cardiac
“living” at Westchester Medical Center for
a heart transplant, says Linda Cuomo,
Catheterization Lab. Using thin tubes
nearly three months following his transfer
M.D., an interventional cardiologist at
called catheters, balloons and stents are
from another facility for an emergency
Westchester Medical Center.
introduced into an artery in the groin
angioplasty, John Kenney, a 60-year-old
or wrist and then threaded into the
auto mechanic from Holmes, N.Y., had only
Catheterization Laboratory, Dr. Cuomo,
arteries leading to and from the heart.
two requests: “I wanted to walk out of the
with assistance from cardiac surgeon
Patients who undergo these procedures
hospital without an IV pole and to breathe
Ramin Malekan, M.D., partners, fellows
can usually go home the following day
the outside air,” he says.
and the Cath Lab nursing and technician
and are spared surgery.
Kenney did both when he left the medical center on November 16, 2010. That Kenney survived cardiac arrest that left him with no pulse or heartbeat for almost
BELOW: DURING A CARDIAC CATHETERIZATION PROCEDURE, A DYE IS INJECTED INTO THE CORONARY ARTERIES TO GIVE THE CARDIOLOGIST A BETTER VIEW OF THE ARTERIES VIA FLUOROSCOPY. INSET: A CARDIAC CATHETER IS INSERTED INTO A PATIENT.
6
In the facility’s advanced Cardiac
advances in heart
WMC_Cardiac_0211REV3.indd 6
staff, brought Kenney back to life. Interventional
A DANGEROUS BLOCKAGE
cardiologists at
An angiogram—a diagnostic imaging
Westchester Medical Center
test of the heart’s blood vessels— revealed that Kenney’s left main
BOUNCING BACK FROM
A HEART DEFECT
Baby Donovan McCracken won’t remember, but he gave his parents quite a scare when he was just seven days old. That’s when he underwent an interventional heart procedure at Westchester Medical Center. Donovan was born with pulmonary valve stenosis, narrowing of the heart valve that opens to allow blood to flow from the heart to the lungs. By inflating and then deflating a special balloon atop a catheter threaded into Donovan’s tiny pulmonary valve, Markus Erb, M.D., Director of Pediatric Cardiac Intervention at Maria Fareri Children’s Hospital at Westchester Medical Center, opened up the valve and restored blood flow in the area. That evening, Donovan was home sleeping in his own crib. “My husband Andrew and I were so devastated when we learned that our newborn had to undergo a heart procedure,” says Donovan’s mother, Rebecca. “But when we met Dr. Erb and the wonderful nurses and technicians who took care of Donovan, we were comforted knowing that they had performed this procedure many times. We’re so lucky that the medical center is so close to our home in Ossining.” Thanks to the expert treatment Donovan, now nine months old, received at Maria Fareri Children’s Hospital at Westchester Medical Center, he is expected to develop normally, with no restrictions on his activities.
care 1/19/11 11:54 AM
linda cuomo, m.d.
artery was completely blocked. “Most
protect his heart from potentially life-
patients do not survive the massive
threatening arrythmias. It was then that
heart damage Mr. Kenney experienced,”
he was able to walk out of Westchester
says Dr. Cuomo. “A total blockage robs
Medical Center, sans IV pole, to breathe
the heart tissue of oxygen-rich blood,
the crisp autumn air.
causing it to die.”
anthony Pucillo, m.d.
Says Kenney, who continues to see
Using a balloon-tipped catheter
Dr. Gass periodically for his ongoing
threaded through blood vessels from
cardiac care: “It was divine intervention
Kenney’s groin all the way to his heart,
that got me here.”
Dr. Cuomo opened up the artery and inserted a metal stent into the vessel to keep it open. Then she installed a
UPGrADING SErVICES:
What’s NeXt
mechanical heart-assist device called an intra-aortic balloon pump into Kenney’s aorta to help his heart resume pumping blood. Still, Kenney’s heart was functioning at less than 10 percent capacity. As a result, Dr. Malekan implanted a shortterm TandemHeart® device to pull oxygenated blood from Kenney’s heart to his body. A TandemHeart® can be a “bridge to recovery” or a “bridge to transplantation” if the patient has endstage heart failure. Kenney’s doctors expected that he’d need a new heart and a long-term left ventricular assist device (LVAD) to keep him alive while he waited for a donor. His care was then assumed by Alan Gass, M.D., the medical center’s Medical Director of Heart Failure, Heart Transplantation and Mechanical Circulatory Support. Instead, over the next two months, Kenney’s heart rallied, and he was weaned off the intravenous medication helping his heart to pump blood. An implantable cardioverter defibrillator
the cardiac catheterization laboratorY at Westchester medical center is one of the most Patients of all ages—from premature soPhisticated Units of its kind in the region. babies to seniors—have been diagnosed and treated in Westchester medical center’s cardiac catheterization laboratory. later this year, the suite will undergo a complete renovation and upgrade in technology. also, a new “hybrid” operating room will open for patients with heart, vascular and neurological conditions. here interventional cardiologists, cardiac surgeons, neurosurgeons and vascular surgeons will work together. it’s likely that the medical center’s first nonsurgical percutaneous aortic valve replacement procedure will be accomplished in the “hybrid room,” predicts anthony Pucillo, m.d., director of the cardiac catheterization laboratory. “this will bring together interventional cardiologists and cardiothoracic surgeons to treat patients with severe narrowing of the aortic valve,” says dr. Pucillo, an associate Professor of medicine at new York medical college. “it will open up a whole new treatment option for patients who are poor candidates for surgery.” the hybrid room will be used for three main diagnostic and treatment specialties: (1) coronary interventions for patients with acute and chronic heart conditions, including emergency angioplasty/stenting and the placement of short-term and long-term mechanical heart-assist devices; (2) non-coronary interventions to treat narrowing and blockages of blood vessels other than those of the heart, including arteries and veins leading to and from the brain, neck, legs, kidneys, intestines, hands and other areas; and (3) electrophysiology testing and treatment for heart arrhythmias in conjunction with the medical center’s expanded electrophysiology laboratory.
was inserted by Martin Cohen, M.D., to
to MAke AN
appointment WMC_Cardiac_0211final.indd 7
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repAiriNG Prenatal diagnosis and treatment enhance Positive oUtcomes
all the parts of the heart are in place, to
surgeon and pediatric intensivists to
identify any defects or nonfunctioning
prepare for the birth. This helps achieve
blood vessels or valves and to calculate
the best outcome for the baby.”
heart rhythms,” says Frank Manning, M.D.,
must wait until birth to be addressed,
internationally recognized for creating the
dangerous heart arrhythmias can be
the trUe measUre of the
fetal biophysical profile to evaluate fetal
treated by giving the mother medication
success of the Pediatric Cardiology
anatomy and health. He and his associate,
to regulate the fetus’ heart rate. A
Program at Maria Fareri Children’s Hospital
Geetha rajendran, M.D., provide prenatal
permanent pacemaker can be placed in
at Westchester Medical Center is seeing
care for women with acute or chronic
tiny newborn babies if necessary.
the men and women who have survived
diseases that put them at risk for carrying
childhood heart conditions and are now
a fetus with a heart abnormality, as well as
breakthroUgh sUrgeries
having babies of their own.
healthy women whose fetuses have been
Most fetuses identified as having heart
diagnosed with a congenital heart defect.
abnormalities are delivered by maternal-
More than 100,000 young people have been diagnosed, treated and
If a sonogram shows a fetal heart
fetal medicine specialists and then
monitored for heart ailments ranging from
problem, the mother is referred to Maria
transferred to the Isaac and Naomi
congenital defects to rhythm irregularities
Fareri Children’s Hospital’s fetal cardiology
Kaplan Family Foundation regional
since the program was founded in 1983
services, led by pediatric cardiologist
Neonatal Intensive Care Unit at Maria
by Michael Gewitz, M.D, Physician-in-
Bernard Fish, M.D. Using state-of-the-
Fareri Children’s Hospital. Some of these
Chief of Maria Fareri Children’s Hospital at
art multi-dimensional echocardiography
newborns require surgery within hours
Westchester Medical Center and its Chief
technology, Dr. Fish and his colleagues,
or days. For others, waiting until they
of Pediatric Cardiology.
Henry Issenberg, M.D., Director of the
are bigger and stronger is best.
“There is almost no heart
Pediatric Echocardiography Lab, and
From 2006 through 2009, nearly
abnormality that we can’t diagnose
pediatric cardiologist Deborah Friedman,
300 infants and children underwent
here and then treat,” says Dr. Gewitz.
M.D., further evaluate fetal heart defects.
heart surgery at Maria Fareri Children’s
Each day, the hospital’s 35-person team
(The three physicians also use advanced
Hospital at Westchester Medical Center,
of highly trained professionals and
three-dimensional echocardiography to
most of whom had congenital defects
specialized support staff focuses on
evaluate the heart valves and chambers of
repaired. Pediatric cardiac surgeon Suvro
keeping little hearts beating and growing.
newborns and older children.)
S. Sett, M.D., physician assistants David
“With 95 percent of the fetal cardiologY saves lives
fetuses who are at potential
When a mother-to-be undergoes her
risk for a heart problem,
first routine sonogram at 12 weeks of
we can reassure
pregnancy, her baby’s heart is beating
the parents that
about 140 to 170 times per minute. By 18
nothing is wrong,”
weeks, 90 percent of all heart defects can
says Dr. Fish. “If
be detected in the acorn-sized organ.
there is a defect,
“Our three-dimensional ultrason-
8
Although most fetal heart problems
a maternal-fetal medicine specialist who is
we consult with
ography units examine the four chambers
our neonatologists,
and the large blood vessels to ensure
a pediatric cardiac
advances in heart
WMC_Cardiac_0211final.indd 8
Volpe and Anna riccio and their team achieved a 97.4 percent
With 95% of the fetuses who are at potential risk for heart problems, parents can be reassured that nothing is wrong.
survival rate. No other hospital in the region has an equal record for pediatric cardiac care. “We are saving the lives of children who would not have lived just 20 years ago,” says Dr. Sett.
care 1/18/11 12:08 PM
michael gewitz, m.d.
bernard fish, m.d.
markus erb, m.d.
testing for YoUng Patients
as little as 1.5 pounds,” says Markus
Noninvasive cardiac tests—including
Erb, M.D., Director of Pediatric Cardiac
electrocardiograms (ECGs), stress tests
Intervention. “Eighty percent of all holes
and echocardiograms—are most often
in the heart can be repaired with an
the first line of diagnostic testing for
interventional procedure.”
children with suspected heart problems. These tests do not usually require
maPPing heartbeats
anesthesia and are easily tolerated by
When a disturbance in the electrical
babies and young children.
system that regulates a child’s heartbeat
Westchester Medical Center’s
is suspected, pediatric electrophysiologists
256-slice computed tomography (CT)
use advanced technology to pinpoint the
scanner—the only one in the lower
exact area of the heart that is affected.
Hudson Valley—uses ultra-high-resolution
Treatment may include medications,
3-D imaging to capture visual “slices”
radiofrequency ablations, pacemakers
of the heart and blood vessels. This
or implantable cardioverter defibrillators
technology can produce a detailed
(ICDs). Irfan Warsy, M.D., a pediatric
image of a child’s heart in less than two
electrophysiologist at Maria Fareri
heartbeats, reducing the amount of
Children’s Hospital and Assistant
radiation needed to assess congenital
Professor at New York Medical College,
heart defects or abnormalities in blood
recently joined the staff after advanced
flow to the heart. The medical center’s 3
training at Duke University. With catheter-
Tesla Mr imaging system, twice as strong
based technology, he is able to effectively
as conventional magnetic resonance
cure many arrhythmias in children and help
machines, helps to assess a heart problem
them avoid years of daily machines and
without exposing the child to radiation.
lifestyle restrictions.
PictUres tell a storY
move into the hospital’s Adult Congenital
Even after noninvasive testing is
Heart Disease Center, where adult and
completed, a diagnostic imaging study
pediatric cardiologists collaborate on their
called an angiogram may be needed to
continuing care for the rest of their lives. If
assess how blood flows to and from the
female patients want to have children, they
heart in complex congenital defects.
are referred to Drs. Manning and rajendran
Once patients are about 18, they
Many heart defects can be
for their prenatal care as well as to fetal
repaired without open-heart surgery
cardiology services and genetic counseling
in an interventional procedure during
to evaluate the risk of a congenital heart
catheterization that may involve placing
problem in the developing fetus.
balloons, stents or devices to open up
of my patients who have grown up into
or unnecessary vessels in the heart or lungs.
successful young adults,” says Dr. Gewitz.
to MAke AN
appointment WMC_Cardiac_0211final.indd 9
suvro s. sett, m.d.
CUrBING
chilDhOOD OBesity
Pediatric cardiologist karen seligman, m.d., is on a mission to stem the rising tide of childhood obesity. a risk factor for heart disease, obesity also contributes to high blood pressure, type ii diabetes, sleep apnea and endocrine and orthopaedic problems. dr. seligman’s Preventive cardiology Program takes a nonjudgmental approach to helping kids make healthy lifestyle decisions. services include physical evaluations, body mass index (bmi) assessments, nutrition counseling and exercise advice. dr. seligman works closely with other pediatric subspecialists such as endocrinologists and nephrologists to provide comprehensive care. she notes that the best way to get atrisk kids moving and eating healthfully is to slip exercise and wise food choices into their everyday activities. “Put the treadmill near the tv, serve breakfast every day, don’t use food as a reward, and keep the junk food out of the house,” she says. “dad can’t have soda if the kids are banned from drinking it.” dr. seligman says it’s rare for a teenager to have a heart attack. “We want to keep it that way and also help our patients prevent the onset of heart disease in adulthood,” she adds.
“It’s gratifying to meet the children
blocked valves or vessels, and to plug holes “We’ve treated newborns weighing
frank manning, m.d.
“They are like my grandchildren.”
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the power of
sharing
A special s upport group helps patients deal with life before and after trans plant
“ Yo u c a n n e v e r k n ow a
So once a month they meet to
are invited to speak at meetings. But
man until you walk around in his shoes,”
support each other and their loved ones.
mostly it’s the recipients themselves
said Atticus Finch in Harper Lee’s Pulitzer-
And they visit patients in Westchester
who educate and encourage.
prize winning novel To Kill a Mockingbird.
Medical Center’s heart transplantation
Members of a heart-transplant recipient
unit, who are either awaiting a donor
an outlet to discuss your concerns
support group at Westchester Medical
heart or learning to live with a long-term
after your transplant, and that’s with
Center have, in effect, walked in one
mechanical left ventricular assist device
us,’” says realtor Paul Brand, 66, of
another’s shoes. Only they know what
(LVAD) that performs the circulatory
Tuckahoe, who received his donor
it’s like to worry about every unexplained
work of one’s own damaged heart.
heart and kidney on June 26, 2007—the
twinge they feel, or to live with the effects
Occasionally, physicians, nurses and
“I tell each member, ‘You have
first patient at Westchester Medical
of immunosuppressant medications. Only
other members of the medical center’s
Center to receive such a two-organ
they can say that someone else’s heart is
Heart Failure, Heart Transplantation and
transplant—and helped found the group.
beating within their chests.
Mechanical Circulatory Support Team
“We visit patients before and after their transplants, because no one should be afraid of their new life with a new heart.” “This group is a great launching pad,” says Warren D. Rosenblum, M.D., Associate Medical Director, Heart Failure, Heart Transplant and Mechanical Circulatory Support and an Associate Professor of Medicine at New York Medical College. “Meeting others who have the same medical concerns helps to build camaraderie among patients and confidence that they will lead normal lives after transplantation.” In addition to general discussion about their medical conditions, members share information about practical issues, such as navigating the health-insurance landscape and temporary living arrangements. Turning Fear Into Action John Newton, 55, of Wantage, N.J., says pre-transplant visits from Paul Brand and two other members of the support group helped allay fears he and his wife, Maria, experienced after he was admitted to Westchester Medical Center
used with permission from thoratec
10
advances in heart
WMC_Cardiac_0211final.indd 10
care 1/18/11 12:08 PM
Warren D. Rosenblum, M.D.
Alan Gass, M.D.
the day after Father’s Day 2008 to be
meeting since my transplant, even though
placed on the waiting list for a new
Westchester Medical Center is about an
heart. Two weeks earlier, he had suffered
hour-and-a-half drive from my job,” he
guitar, writing music and producing
his eighth heart attack in two decades
says. “When I go for my biopsies, I visit
music videos,” says Maffei, whose song
and had a stent inserted near his heart
other transplant patients. This is my Band
and video “Mama” talks about outliving
to stabilize the organ. His heart was
of Brothers. We’re a diverse group, but we
his mother, Jane, and two brothers,
damaged beyond repair.
all share the experience of having been
Doug and Frank, who all died of heart
saved at Westchester Medical Center.”
disease at 57, 32 and 38, respectively.
my dogs, not knowing whether I would
embracing the new
received his donor heart July 18, 2008,
see them again,” recalls Newton, a vice
Nicholas Baker Maffei of Hopewell
says he’s developed his sense of humor.
president at Fujinon, an optical systems
Junction, who received a new heart on
“I’m retired from teaching high school
company. “Then Maria and I met Paul,
August 23, 2009, says support-group
math in the South Bronx, so I have good
Vinny and David, who wore their heart
members taught him to focus on the
stories to tell,” he says with a laugh.
“I had just said goodbye to my children, my grandson, my house and
positive and to try new things. “I am concentrating on playing my
And Tom Ryan, 62, of Mahopac, who
hats from the support group. They were having their routine heart biopsies to check if their donor hearts were showing any signs of rejection. I saw how healthy
Does spirituality
help heal?
they looked, and I turned to Maria and said, ‘If they can do it, so can I.’” Newton’s journey toward a heart transplant took a detour when his ailing heart stopped on July 3. A mechanical heart-assist device called a TandemHeart®, inserted through his skin, provided shortterm pumping support for his heart. A week later, a long-term LVAD called HeartMate® replaced the TandemHeart®. Although Newton’s LVAD might have kept him alive indefinitely, he was put back on the donor heart waiting list. “Throughout the fall, I attended the support group meetings with my wife and niece,” says Newton. “We knew we were not alone.” Finally, on January 25, 2009, Newton received his new heart. The next day, cardiothoracic surgeons removed the LVAD that had kept him alive for six months.
Alan Gass, M.D., Medical Director of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, says both research studies and his personal observations over the past 20 years suggest that mental imagery, positive thinking—and even prayer—may explain why some patients’ bodies do not reject donor hearts while others do. “I have one patient who places a little figure of an Indian deity over the area of his heart that is to be biopsied, and he has never had any signs of rejection,” says Dr. Gass, an Associate Professor of Medicine at New York Medical College. “Another patient swears that by picturing images of a clear biopsy, he has been able to avoid rejection. A third patient had a fungal infection stop 1 millimeter short of his carotid artery after he focused on a positive outcome.” Although Dr. Gass says these examples are hard to explain objectively, there is reason to believe that a successful recovery from heart transplantation depends on more than surgery and medical intervention. “When patients embrace their transplant and make it part of their lives, they are more likely to make healthy lifestyle changes and take their immunosuppressants and other medications regularly and properly,” says Dr. Gass. “Noncompliance is the leading cause of death after heart transplantation.”
“I have never missed a support group
to make An
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Westcheste r Medical C enter 1-877-WMC-DOCS | www.worldclassmedicine.com
1/18/11 12:08 PM
CAN steM CeLLs repAir A
damaged heart?
stUdies on heart regeneration shoW that a Whole organ transPlant isn’t the onlY WaY to combat advanced cardiovascUlar disease researchers on the campus of Westchester Medical Center and New York Medical College are working hard to debunk the old notion that hearts, once they are damaged, forever lose their ability to heal. And their discoveries suggest that exciting new treatments for heart disease may be just around the corner. In studies funded by the National Institutes of Health, investigators in the Departments of Medicine and Physiology, directed by William Frishman, M.D., and Thomas Hintze, Ph.D., have discovered that stem cells found in the heart can be removed by a simple biopsy procedure, cultured in a laboratory to grow more heart stem cells, and then placed back into a subject’s heart. The new cells then grow new tissue in a process called cardiomyogenesis. While it may take at least six months to assess whether the procedure has been successful—clinical trials are currently under way at several research centers in the United States—scientists already have succeeded in growing new heart
12
advances in heart
WMC_Cardiac_0211final.indd 12
care 1/18/11 12:09 PM
tissue in laboratory rodents and dogs
Unlike the controversial embryonic stem cells that require the destruction of a daysold embryo, heart stem cells are found within the heart itself.
William frishman, m.d.
the patient is awake. A catheter, or thin tube, containing small pincers
using stem cells.
is threaded into a neck vein.
This research may
Once heart tissue is secured, stem
soon provide additional
melvin Weiss, m.d.
“As these studies progress into multicenter clinical trials involving hundreds of patients, Westchester Medical Center is ready to test this promising new therapy.”
treatment options for patients
cells are then isolated from the rest of
with coronary artery disease,
the specimen. Over the next six weeks,
research that sets the medical
cardiomyopathy (enlarged heart) or
using cell culture techniques, millions
center apart in the fight against
congestive heart failure—many of
of new heart cells can be grown.
cardiovascular disease. Physicians
whom die each year from acute cardiac
Because these new cells originate
there are responsible for many of
events while waiting for a donor heart.
directly from the patient’s heart, there
today’s lifesaving treatments; for
Every year, more than 1,000 patients
is no worry that his or her immune
example, the groundbreaking trials
with end-stage heart failure in the
system will reject the new cells, as
that assessed the effects of using
United States receive a new heart.
could happen with donor stem cells.
tissue plasminogen activator (TPA) to
Unlike the controversial embryonic
“We’re not sure yet about the
It’s just this type of innovative
dissolve blood clots. The first patient
stem cells that require the destruction
best way to reintroduce these new
to receive treatment just turned 70
of a days-old embryo, heart stem cells
heart stem cells into the patient,
years old. Other trials assess the
are found within the heart itself, and
whether by putting them back
following therapies for patients with
there is no issue of rejection when they
through a catheter or injecting them
both Type 2 diabetes and coronary
are used in the same person.
directly into the heart via an open
artery disease: the safety of using
procedure or through the skin,” says
angioplasty and stenting to open
heart stem cells originate—whether
Dr. Frishman, whose Cardiovascular
narrowed carotid arteries and screen
they begin in the heart or begin in the
Regeneration and Stem Cell Therapy,
patients for other types of vascular
bone marrow, as do blood cells, and
edited with colleagues Piero Anversa,
disease; and the effects of combining
then migrate to the heart,” explains Dr.
M.D., and Annarosa Leri, M.D., is the
antiplatelet drugs for the prevention of
Frishman, who is also Chairman and
definitive research textbook in this
blood clots.
rosenthal Professor of Medicine at New
area. However, once the new cells are
York Medical College. “researchers in
introduced, a synthetic hormone given
signs of a bright fUtUre
North Carolina have already succeeded
to the patient could accelerate the
The dramatic progress already made
in using stem cells to grow an entirely
regrowth of heart tissue.
in treating heart disease is surely
“We’re not yet sure where the
new bladder in a lab for a child born
With congestive heart failure
a good omen for these promising
with a damaged one. A heart is more
ranking as the number-one reason
developments. After all, says Melvin
complicated than a bladder, but we are
for hospital admissions in the United
Weiss, M.D, Chief of Cardiology at
very excited that soon we may be able
States, heart stem-cell therapy holds
Westchester Medical Center and a
to save patients with this technology
great potential for patients who are
Professor of Medicine at New York
who otherwise might not survive.”
not candidates for a heart transplant.
Medical College, “already patients who
“Long-term clinical trials are
once spent weeks recuperating from a
groWing neW heart cells
needed to refine the process until it
major heart procedure now routinely
The process involves obtaining a piece
can be used on a widespread basis in
go home just days after undergoing
of heart tissue from a biopsy while
the United States,” adds Dr. Frishman.
emergency heart care and treatment.”
to MAke AN
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WESTCHESTEr MEDICAL CENTEr 1-877-Wmc-docs | WWW.Worldclassmedicine.com
1/18/11 12:09 PM
YOU CAN REDUCE YOUR RISK OF
heart disease
be done to treat and stabilize patients with it. For example, atherosclerosis, the narrowing and hardening of arteries, is known to cause cardiovascular disease. The process starts slowly when high blood pressure and cholesterol damage cells; it’s then that plaque—consisting of cholesterol, fatty substances, cellular waste products, calcium and fibrin (clotting material)—begins to form. Elevated levels of triglycerides in the blood and damage caused by cigarette smoking further injure arteries by harming the endothelium, the innermost layer of the blood vessel. “We have learned that chronic coronary artery disease is a systemic
6 HEART-SMART TIPS KEEPIN G INFLAMMATION IN CHECK IS ONE OF THE BEST STRATEGIES HOW IS AMERICA DOING IN
■ 1 Eat a healthy diet made up of fresh, not processed foods.
its fight against heart disease? Very
modern miracles of cardiac surgery, heart
■ 2 Exercise every day for at least
well—and not so well, according to the
transplants, angioplasty and mechanical
30 minutes.
American Heart Association’s “Heart
heart-assist devices have helped reduce
■ 3 Lose weight if necessary.
Disease and Stroke Statistics 2011
heart-disease deaths. But cardiologists at
Update.” The good news, reported in the
Westchester Medical Center say we need
December 15, 2010, issue of Circulation,
to do more to prevent the disease from
■ 5 Manage your blood pressure.
includes the fact that deaths from heart
developing in the first place.
■ 6 Ask your physician about
disease fell 28 percent from 1997 to 2007. On the flip side, the update reveals
14
period rose 27 percent. Of course, the
Arthur Fass, M.D., and Franklin Zimmerman, M.D., cardiologists at the North State Division of Westchester Heart at Westchester Medical Center, suggest:
Research conducted over the past decade by Arthur Fass, M.D., and other
that the number of heart procedures
scientists has revealed new insight into
performed during the same 10-year
what causes heart disease and what can
advances in heart
WMC_Cardiac_0211REV3.indd 14
■ 4 Control your cholesterol.
taking a low-dose (81 mg.) aspirin once a day to prevent the formation of blood clots.
care 1/19/11 11:44 AM
“There is no reason why heart disease must always be the scourge it is.”
Arthur Fass, M.D.
disease throughout the circulatory
blood pressure-lowering medications are
system and that it starts at a young age,
the real “aggressive therapies” that are
sometimes in childhood or in the teen-
reducing deaths from heart disease, not
age years,” explains Dr. Fass, an Assistant
angioplasty and cardiac surgery.
Clinical Professor of Medicine at New York
“Taking care of your heart by treating
Medical College. “But is coronary artery
elevated cholesterol and high blood
disease inevitable? The answer is no.”
pressure is much like changing the oil in your car to prevent engine trouble,” he
PREVENTION, THE KEY
says. “It won’t make the car run any better
Plaque alone does not cause a heart
that day, but if you don’t, the engine will
attack. Instead, inflammation in the
be harmed over time.”
body causes a disruption of the plaque,
Dr. Zimmerman uses this analogy
creating a blood clot. The clot, or
to encourage patients to take their
thrombus, wedges itself atop the resident
medications. The stumbling block, he
plaque in the artery, where, if it breaks
says, is that high blood pressure and
off, it may block the flow of blood to the
high cholesterol cannot be felt. “If these
heart. Robbed of oxygen-rich blood, the
conditions caused pain as arthritis does,
heart tissue dies. Disruption of plaque can
we’d never have to remind our patients,”
also lead to disturbances in the heart’s
says Dr. Zimmerman, an Assistant Clinical
electrical system, resulting in a potentially
Professor of Medicine at Columbia University
lethal arrhythmia.
College of Physicians and Surgeons.
The key, then, writes Dr. Fass in
Statin drugs have revolutionized
“Chronic Coronary Disease in the Post-
cardiology practice, he says, by lowering
COURAGE Era: A New Paradigm,”
“bad” LDL cholesterol in the blood.
published in the November/December
Scientists are learning there may be
2010 issue of Cardiology in Review, is to
hundreds of chemical reactions in the
stop the buildup of plaque or to stabilize
body that lead to atherosclerosis, most
plaque that is already lurking in our
of which are still a mystery, but what
bodies, thus preventing a heart attack
is certain is that statins modify the
or other acute coronary event. Research
sequence of events. Long-acting, once-
suggests that cigarette smoking and
a-day medications that lower blood
elevated levels of “bad” LDL cholesterol
pressure have virtually no side effects as
increase the likelihood that unstable
their predecessors did years ago. “Heart disease did not become
plaque will rupture. Westchester Medical Center
the leading killer of Americans until the
cardiologist Franklin Zimmerman, M.D.,
1940s,” Dr. Fass points out. “And there
points out that lifestyle modifications—
is no reason why it must always be the
including a healthy diet, no tobacco use,
scourge it is. Our goal in the next 25 years
and at least 30 minutes of daily exercise—
is to see heart disease lose its number-
combined with cholesterol- and high
one ranking.”
TO MAKE AN
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Franklin Zimmerman, M.D.
Dina R. Katz, M.D.
WOMEN AND
HEART DISEASE Heart disease kills more women than all cancers combined. Yet many women don’t have their cholesterol level or blood pressure checked regularly. And they don’t realize that symptoms of heart attack in women are often different from those in men. “Because women do not always exhibit the classic signs of heart attack—crushing chest pain, clammy skin, and numbness in the left shoulder or arm—they may not recognize that extreme weakness, shortness of breath, right-sided pain or even flu-like symptoms may indicate a heart attack,” says Dina R. Katz, M.D., a cardiologist at Westchester Medical Center. “Women tend to ignore their own healthcare. If something ‘doesn’t feel right,’ see your doctor!” Dr. Katz recommends that women have a yearly physical exam to check their blood pressure, cholesterol levels, blood glucose level and vitamin D level, since this vitamin regulates the body’s inflammatory process. Walk at least 10,000 steps a day, and try a “women-friendly” gym. Most important, stop smoking. “Two cigarettes a day are as bad as two packs a day,” she adds. “Women who smoke lose all of the protection of estrogen, and they have heart attacks, on average, 10 years before nonsmokers.”
WESTCHESTER MEDICAL CENTER 1-877-WMC-DOCS | WWW.WORLDCLASSMEDICINE.COM
1/19/11 11:45 AM
175,000 people didn’t plan on having cardiac procedures.
Fortunately, we did. Since 1977, over 175,000 people have come to Westchester Medical Center for the treatment of some of the most severe and complex heart conditions. The talent and dedication of our doctors, nurses and staff, and our exceptional outcomes, are the reasons Westchester Heart is the premier provider of cardiac care in the region. • In the last 10 years alone, we have performed: 45,000 diagnostic cardiac procedures 15,000 cardiac interventions 7,000 electrophysiology procedures 5,000 pacemaker & related device implants • Five full-service catheterization labs; the largest number of sophisticated labs in the Hudson Valley including a new state-of-the-art electrophysiology lab • The only cardiac surgery program in Westchester • The only Medicare-approved heart transplant center and Joint Commission certified VAD program in the Hudson Valley
• Awarded the 2010 HealthGrades® Cardiac Surgery Excellence Award • Awarded HealthGrades® five-star rating for treatment of heart failure and for carotid surgery in 2010 • One of only a handful of hospitals in the nation to earn the Triple Gold Award from the American Heart Association • One of only three hospitals in NY to earn a designation of low-risk for valve or valve/bypass surgery* * NYSDOH report – April, 2010
• Ranked in the top 10 in New York and the top 10% in the nation for cardiac surgery care by HealthGrades®
Westchester Heart. One hospital, changing countless lives. thewestchesterheart.com Maria Fareri Children’s Hospital • Westchester Heart • Cancer Center • Transplant Center • Neuroscience Center Joel A. Halpern Regional Trauma Center • Burn Center • Behavioral Health Center • Advanced Imaging Center • Advanced OB/GYN Associates
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