Heart History: Pioneers in
Pediatric Cardiology-William
Rashkind, his ―magnificent‖
catheter and the birth of inter-
ventional cardiology.
I n 1929, Werner Forssmann
inserted a catheter into his
own arm vein and threaded
this catheter into his heart
under X-ray guidance. With
this historic event, cardiac
catheterization was born and
shortly thereafter, became the
definitive test for the diagno-
sis of heart disease.
W illiam Rashkind, a bril-
liant pediatric cardiolo-
gist at Children’s Hospital of
Philadelphia, had different
ideas for the role of this pro-
cedure, however. He wanted
to use the cardiac catheter as
a non-surgical instrument to
actually treat children with
congenital heart defects. He
first demonstrated this possi-
bility by helping babies born
with transposition of the great
vessels (TGV). Unlike the
―blue babies‖ who had little
blood flow to the lungs and
were helped by the Blalock-
Taussig shunt you read about
in the last issue of The Heart
Beat, babies with TGV were
Volume 1, I ssue 2
TH E D IR E CT O R ’S C U T C H R I S T I N E D O N N E L L Y , M D
Winter 2010 -11
THE HEART BEAT
MAG I CA L MA S QU E RA D E BE N E F IT ! The fabulous five—our team of pediatric cardiology physicians—made an appearance at the masquer-
ade benefit on October 29, 2010 at the Bernards Inn. They donned their bat masks and showed their
―heart‖ at the event which
was a tribute to the memory
of Mrs. Marge Goryeb, as well
as a fundraiser for The Chil-
dren’s Heart Center. Pro-
ceeds will be used to pur-
chase a new, state of the art,
echocardiography machine.
Children’s Heart Center
T H E P A S S I O N T O L E A D
Goryeb Children’s Hospital
Morristown Memorial Hospital
100 Madison Ave.
Morristown, NJ 07960
Goryeb Children’s Center
Overlook Hospital
99 Beauvoir Ave.
Summit, NJ 07901
Newton Memorial Hospital
175 High Street
Newton, NJ 07860
Physicians
Christine Donnelly, MD-Director
Stuart Kaufman, MD
Donna M. Timchak, MD
Suzanne Mone, MD
Lauren Rosenthal, MD, MPH
Nurses
Wanda Kaminski, RN
Maria Lawton, RN
Victoria Kratsch, RN
Technologists
Colleen Henderson, RCS, RDCS-Lead tech
Alexis Harrison, RCS, RDCS
Bhavisha Pandya
Alla Greenberg
Ashley DeRosa
Anthony Brown, RDCS
Kelli Vranch, RDCS
Medical Assistants
Jennifer Bailey
Joanne Spiropoulos
Social Worker
Margaret Micchelli, LCSW
Administrative Assistants
Dawn Smith
Diann Vivar
Lynn Vanderyajt
Sandy Segreto
Phone: (973) 971-5996
Fax: (973) 290-7979
Visit the Children's Heart Center Web Site
Edited by:
Margaret Micchelli and Stuart Kaufman
blue because of the
―switching‖ of the large arter-
ies that emerge from the
heart, resulting in oxygen-poor
blood going throughout the
body, while oxygen-rich blood
went to the lungs. These
babies had plenty of blood to
the lungs; it was just not get-
ting to where it needed to be.
I n 1964, William Mustard
reported a surgical proce-
dure for TGV patients that
redirected blood to the proper
chambers, but it couldn’t be
done in young infants. Unless
there was a way for the blood
to ―mix‖ within the heart, the-
se babies were starved for
oxygen and rarely survived
past 6 months of age, not old
enough for Mustard’s surgery.
The only option was a surgical
procedure to ―create‖ a hole
in the top chambers of the
heart, an atrial septal defect
(ASD), but it was extremely
hazardous and associated
with high mortality. A less
risky, non-surgical way of cre-
ating this ASD was needed so
these babies could survive
until 6 months of age and
undergo the Mustard proce-
dure.
S o thought Dr. Rashkind.
He was working on just
such a project using a balloon
-tipped catheter that he had
developed. At the 1964 Se-
cond National Congress of
Cardiology, he met Helen
Taussig and described his
initial animal work to her. The
perceptive Dr. Taussig wrote a
letter of thanks to Dr. Rash-
kind: ―It would be wonderful if
we can do some …operations
without opening the chest…I
think that is a real advance
and a real look into the fu-
ture.‖ With such encourage-
ment from the ―mother‖ of
pediatric cardiology, the fu-
ture arrived for infants born
with TGV in 1966 when Dr.
(Continued on page 3)
C an you
tell from
the picture
that I always
wanted to be
a nurse? I
realized my
c h i l d h o o d
dream when
I graduated
f r o m
Muhlenberg Hospital School
of Nursing. For my first job, I
travelled west and worked in
a Chicago hospital in the new-
born nursery. Two years later,
ready for another adventure, I
went to Zaire in central Africa
(now called the Congo) to
work in an 80-bed mission
hospital. It was a new culture,
new language and third world
medicine. My heart was
touched, my faith strength-
ened and my nursing skills
challenged. One special mo-
ment was when the father of
a child very sick with malaria
knocked at my door bearing a
most generous gift - a chick-
en. It was his way of saying
thank you. The witch doctor
was not able to help the
young boy, but we had the
medicine to make him well.
A fter 2 years in Africa, my
next challenge was ad-
justing to life back in the
States with extravagant sup-
plies, like oxygen, IV’s and a
cafeteria. Shortly before my
30th birthday, I started at Mor-
ristown Memorial, the place
where I was born. I loved my
job in the NICU, caring for
preemies and their families.
After 10 years, I moved to
pediatric cardiology where I
learn something new every
day. It has been such a joy to
work with our families, watch-
ing the children grow and
thrive. In my leisure time, I
take walks with my miniature
poodles, Ben and Lacey. Or
I’m likely to be found at a
fabric store or craft fair, pur-
suing my creative side, from
beading to quilting to baking.
The hum of my sewing ma-
chine brings great solace.
The Heart Beat Volume 1 , Issue 2
HE A LTH Y HE A RT S U Z A N N E M O N E , M D
STA FF H I GH L I GH T W A N D A K A M I N S K I , R N
any food containing cholester-
ol, your body would still make
enough cholesterol to run
smoothly. In fact, the liver
produces about 1,000 mg. of
cholesterol a day. The rest
comes from the foods we eat.
C holesterol has to combine
with proteins to travel
through the blood stream.
Cholesterol and protein travel-
ing together are called lipo-
proteins: low density lipopro-
teins (LDL), or ―bad cholester-
ol‖ and high density lipopro-
teins (HDL), or ―good choles-
terol.‖
L DL (bad) lipoproteins are
the primary cholesterol
carriers: too much can build
up on the artery walls leading
to the heart and brain. This
buildup forms plaque – a
thick, hard substance that
can make blood vessels stiff
a n d n a r r o w e d . T h i s
―hardening of the arteries‖ is
called atherosclerosis. If a
blood clot forms and totally
blocks a narrowed artery, the
result can be a heart attack.
(Continued on page 4)
food choices are always es-
sential for a healthy heart.
H igh levels of cholesterol
are a major factor in
heart disease and stroke.
Current medical research
shows that cardiovascular
disease has its roots in child-
hood. Early abnormal changes
in the blood vessel walls of
children, infants and even
fetuses have been demon-
strated. So, it’s never too
early to be aware of cholester-
ol in your child’s diet.
C holesterol is a waxy sub-
stance produced by the
liver. It’s one of the lipids, or
fats, the body makes to form
cell membranes and some
hormones. If you never ate
Cholesterol and Healthy
Eating
Y ou may be used to hear-
ing about cholesterol
levels in adults, but did you
know that this is an important
screening measure for chil-
dren, too? Since 1994, the
American Academy of Pediat-
rics has recommended cho-
lesterol screening in selected
groups of children, some as
young as age 2. It’s im-
portant to be aware of choles-
terol in a plan for healthy
eating for all children. Howev-
er, cholesterol levels are par-
ticularly important for children
with heart disease.
S ome parents of children
with congenital heart
disease may have struggled
with difficulties in getting their
child to gain weight early on.
For instance, some infants
with heart disease may have
temporarily needed a feeding
tube. Following early eating
difficulties, parents may be
inclined to let their child eat
whatever they want, just to
see them eat heartily. We all
need to be aware that healthy
N U R S E S ’ N O T E S
Tips for a smooth
office visit
Schedule your child’s
appointment at a time
that avoids unnecessary
stress. For example,
avoid naptime or when
your child gets hungry.
Avoid coming immedi-
ately after another doc-
tor’s appointment.
Don’t use lotions or oils
on the skin on the day of
the appointment.
Bring familiar items that
will be comforting to
your child, such as a
pacifier, bottle, favorite
toys, video/DVD or blan-
ket.
Contact the nursing
staff before the appoint-
ment to express your
concerns and to develop
a plan to get through
the examination, EKG
and echocardiogram.
Avoid negative com-
ments, such as “You
may not like this”.
Reassure your child that
we do not “give shots”
and we try not to do
anything that will hurt.
As a parent, take a deep
breath. We know that
there are difficult ages
and we will do all that
we can to get the testing
done in a timely manner.
We are not critical of
your child or of your
parenting if your child
finds the appointments
stressful. We all know
that it will pass as your
child grows and ma-
tures.
Page 2
The Heart Beat Volume 1 , Issue 2 Page 3
FA M I LY CON N E C T I ON
D I R E C TO R ’S C U T ( C O N T ’ D )
W ith the stress and pres-
sure of life and death
decisions behind me, I was
looking forward to feeling
normal again. Unfortunately,
this didn’t happen. I chas-
tised myself for not being able
to adjust to the new circum-
stances of my life. Finally, my
husband and I decided to go
to a professional counselor. I
explained our situation and
the counselor asked if we had
mourned. I was shocked by
this question and explained
that our son was alive and
doing great. She explained
that we needed to mourn the
loss of our life with a healthy
child. We both said ―no‖. We
had never consciously
thought about it. She told us
that it was okay to mourn that
loss. It didn’t diminish the
love we felt for our son. Once
I acknowledged this, things
got better. I was able to relax
and feel happy again. I felt
very humbled by this. No
matter how hard I tried, I
couldn’t pretend that every-
thing was fine, especially
when my life had been turned
upside down and was totally
different than what I expected
it would be.
M y advice to new parents
is to acknowledge the
changes that have happened
and how you feel about them.
It will help you adjust and
embrace being the parent of a
child with a heart defect.
Ann, mother of a 7 year old
son.
I found out when I was 37
weeks pregnant that my son
had a heart defect. In a mo-
ment, my life would never be
the same. Immediately, it
was a whirlwind of tests, doc-
tor appointments and surger-
ies. The first years of my
son’s life left little time to
reflect. We were always plan-
ning and moving forward with
surgeries and dealing with the
normal complications and
developmental delays that
accompany his defect. My
son had his last heart proce-
dure at 5 ½ years old. He had
made it through the ―worst of
it‖. Overall, he was doing pret-
ty well. I was very relieved
and knew how fortunate we
were.
Did you know??
During the course of a lifetime, the heart does the most physical work of any muscle in the body. Even when resting, your heart muscle works twice as hard as your leg muscles when you’re run-ning. Try this: hold out one hand and make a fist. If you’re a kid, your heart is about the same size as your fist. If you’re an adult, it’s about the size of two fists. The heart muscle (or myocardium) is unique to the heart. It’s not found anywhere else in the body. A newborn baby has about one cup of blood while an adult has 16 to 20 cups of blood (4 to 5 quarts) that circulate throughout the body. Try this: Get a tennis ball and squeeze it very hard. That’s how much force the heart uses when it pumps the blood out into the body. The sound of the heart beating (“lub-dub”) is made when the four valves in the heart are clos-ing. The heart pumps blood to almost all of the 75 trillion cells of the body. What is the only part of the body that does not receive blood?
Rashkind reported a non-
surgical means of creating an
ASD with a balloon-tipped
catheter in three severely
cyanotic TGV infants with
wonderful success. A cathe-
ter with a deflated balloon at
the end was inserted into the
leg vein of the cyanotic baby
and passed into the heart and
left atrium. The balloon was
then inflated and the catheter
rapidly withdrawn across the
atrial wall, ―creating‖ a hole,
or ASD, which allowed the
blood to mix. The technique
became known as the Rash-
kind balloon atrial septostomy
(BAS) and following publica-
tion of his technique, the pro-
cedure was adopted by pedi-
atric cardiology centers
WALK-IN HEART MODEL
Valentine’s Day Event
W e will once again cele-
brate National Congeni-
tal Cardiac Defect Awareness
Day. The goal of this national
campaign is to raise commu-
nity awareness about the
prevalence of congenital car-
diac defects and the need for
more funding and research.
O ur family social event will
be at the Goryeb Chil-
dren’s Hospital on Sunday
afternoon, February 13th
2011. There will be a huge
walk-through model of the
heart to explore, as well as a
magician, clowns, balloons
and more. Please mark your
calendar and join us.
Answer: The cornea is a trans-
parent film over the front of the
eye. If there were blood vessels, it
wouldn’t be transparent anymore. throughout the world, saving
the lives of thousands of TGV
infants.
I n the original article de-
scribing the BAS technique,
a typographical error oc-
curred. Instead of the word
―magnified‖ to describe the
enlarged picture of the cathe-
ter, the text said
―magnificent‖. How appropri-
ate an error this was – for not
only was this catheter and the
physician who developed it
responsible for changing the
prognosis of children born
with TGV from a 90% mortality
rate by 1 year of age to a 90%
survival rate, but it also her-
alded the birth of interven-
tional pediatric cardiology-
―magnificent‖ indeed!
F E B . 1 3 , 2011
T here is ample research
evidence that social sup-
port has a mediating or
―buffering‖ effect on stress.
Also, according to the psy-
chologist Abraham Maslow,
the need for a sense of be-
longing is vital. Social support
and a sense of belonging
come from many sources -
family, friends, work, even the
people you see every morning
when you stop for coffee.
O ur monthly parent sup-
port group is an oppor-
tunity to experience a sense
of community with others who
understand in a unique way;
they’ve been there, too. It’s a
chance to share ideas and
feelings; to both give and get
guidance and information;
and to have company on the
journey through early child-
hood.
J oin us on the first Wednes-
day of each month from 7
to 8 pm. Jan. 5, Feb. 2,
March 2, 2011.
For details, please call (973)
971-8689 or email:
H DL (good) lipoproteins
carry cholesterol away
from the arteries and back to
the liver, where it’s processed
and sent out of the body. The-
se lipoproteins may even help
remove cholesterol from al-
ready-formed plaques.
C hildren who are physically
active, eat healthy foods,
don’t have a family history,
and aren’t overweight proba-
bly aren’t at risk for high cho-
lesterol. Your pediatrician will
decide whether your child’s
cholesterol needs to be
checked.
C urrent guidelines recom-
mend screening in chil-
dren at risk for high cholester-
ol starting at age 2, but no
later than age 10. It’s recom-
mended for those who have:
A parent with total cho-
lesterol higher than 240
mg/dL
A family history of cardio-
vascular disease earlier
than age 55 in men and
age 65 in women
An unknown family histo-
ry of cardiovascular dis-
ease
Obesity or overweight
Additional risk factors,
such as diabetes, high
blood pressure or ciga-
rette smoking.
C hildren with behavioral
issues, such as ADHD, or
children infected with the
human immunodeficiency
virus may have to take medi-
cation(s) for their condition.
Some of these medications
are known to elevate choles-
terol levels. These children
should also have their choles-
terol levels checked regularly.
H ealth complications asso-
ciated with high choles-
terol develop gradually. How-
ever, it’s important to focus
on healthy diet and exercise
early on. These measures can
have a significant positive
impact on the health of your
child and that of your entire
family.
NEXT ISSUE: Ways to Lower
Cholesterol
The Heart Beat Volume 1 , Issue 2
noon was capped off by a
raffle of donated gift baskets
and the promise of a good
time again next year.
T he children tested their
skills on a rock climbing
wall and a giant inflatable
slide to the tunes of a live DJ.
They decorated pumpkins,
roamed around on a scaven-
ger hunt, and made a variety
of craft projects. While enjoy-
ing hot dogs, hamburgers and
homemade desserts, families
had the chance to meet and
share experiences. The after-
Park, where 175 families,
staff, and volunteers enjoyed
food, games and crafts. Upon
arrival, families were greeted
by a menagerie of large ani-
mals, including an alpaca
named Frankie and a pot-
bellied pig named Giggles.
Many thanks to Wanda Ka-
minski, RN, who arranged for
the petting zoo and a bouquet
of thanks to the parents and
volunteers for all their dona-
tions.
Page 4
O n September 19th, the
division of pediatric cardi-
ology hosted its first annual
family picnic. It was a beauti-
ful, sunny day at Lewis Morris
SUM M E R P IC N I C - GOO D T IM E FO R AL L
The Human Bond and the
Importance of Social Support
W e have all known the
experience of feeling
better after talking over our
concerns with someone who
understands. This is especial-
ly true under conditions of
stress, which is the body’s
response to a challenge that
requires some type of change
or adjustment. Defined this
way, stress is not always neg-
ative or bad. For instance,
many developmental transi-
tions involve this kind of
―positive‖ stress – the birth of
a baby or a child’s entry into
kindergarten.
H owever, there are inevita-
bly life events that are
stressful and challenge our
coping abilities. This is cer-
tainly true for parents when
they hear the diagnosis of a
congenital heart defect. It’s a
new world of doctor appoint-
ments, tests and often sur-
gery that presents challenges
as their child grows and pass-
es through life’s various stag-
es.
SO C IA L WOR K COR N ER M A R G A R E T M I C C H E L L I , L C S W
HE A LTH Y HE A RT ( C O N T ’ D )