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:

Margaret.micchelli@ahsys.org

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 )