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Three Eras of Cardiac Surgery, One Grateful Heart

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Three Eras of Cardiac Surgery, One Grateful Heart HopkinsNEWS FOR FRIENDS OF THE JOHNS HOPKINS HEARTPulse AND VASCULAR INSTITUTE SPRING 2015 Roger Girson is a strong supporter of the Johns Hopkins Heart and Vascular Institute as well as Habitat for Humanity. Three Eras of Cardiac Surgery, One Grateful Heart t 10 years old, Roger Girson struggled to breathe and quickly became weak when he exerted himself. “My fingernails and lips Awould turn blue,” he says. “We lived in a two-story home, and my mother had to carry me up and down the stairs because I couldn’t climb them.” When none of the various doctors near his hometown in Pennsylvania could address the “the research Johns Hopkins does has helped A lot of people over problem, Girson’s aunt, who lived in Maryland at the Years. I want that to continue.” the time—it was 1949—recommended he visit The Johns Hopkins Hospital. —roger girson There, he was examined by renowned pediatric cardiologist Helen Taussig, who found that his pulmonary valve was not allowing proper blood story, come back to the studio, run up the stairs, take For more flow from the heart to the lungs. Despite the my film and put it on the processor, and then run than two seriousness of his diagnosis, Girson could not have downstairs.” decades, Girson been in a better place at a better time. Only five years Even so, Girson returned to The Johns Hopkins has made earlier, Taussig had worked with Johns Hopkins Hospital periodically for checkups. In 1962, with annual financial Surgeon-in-Chief Alfred Blalock and surgical the advent of open-heart surgery, he was referred contributions technician Vivien Thomas to devise the “blue baby” for complete correction of his complex congenital to the Johns operation for tetralogy of Fallot. heart defect. David Sabiston at The Johns Hopkins Hopkins Heart The congenital defect includes a ventricular Hospital performed surgery on Girson that year, and and Vascular septal defect, an enlarged right ventricle, a defective in just three months, Girson was fully recovered. Institute in pulmonary valve that prevents full flow of blood to Six months later, he landed a job at a TV station, recognition of the lungs and blueness caused by a lack of oxygen to and nine months after that, he was married. He had the care he has the blood. two children and became a longtime volunteer with received over the In 1949, Girson had a pulmonary valvotomy to Habitat for Humanity. years and the open his valve, also known as the Brock operation, Years later, at an annual checkup with Johns care he continues by surgeon Russell Brock at The Johns Hopkins Hopkins cardiologist Thomas Traill, Girson to receive from Hospital. Portrait of Helen Taussig by learned that he needed another open-heart surgery, Traill. “The Yousuf Karsh. “Afterward, there was a huge difference,” says but this time for an aneurysm. In 2008, Duke work they do Girson. “My parents taught me how to ride a bicycle. Cameron, director of the Division of Cardiac is wonderful,” I had a normal childhood, and I played outside with Surgery at The Johns Hopkins Hospital, performed says Girson. “Besides the fact that they saved my life friends.” the operation. All went well, and after a successful several times, the research Johns Hopkins does has When Girson got to college, he continued to recovery, Girson went back to supporting not only helped a lot of people over the years. I want that to be active as a broadcasting major. “I would shoot a Habitat for Humanity, but also Johns Hopkins. continue.” n Explore our new online resource to improve your heart health. Visit bit.ly/jh_heart or scan the QR code. NEW THERAPY APPRoach minimally invasive SURGERY A Less Invasive Cardioverter An Ideal Defibrillator or people who have a dangerous Candidate for irregular heartbeat and are at high risk of sudden cardiac arrest, an Robotic- implanted cardioverter defibrillator Fcan be lifesaving. Even so, the device has an Achilles’ heel: the possibility Assisted Mitral of infection or a break in the wire or electrodes going to the heart. But Johns Hopkins electrophysiologist Valve Repair Alan Cheng is now providing another option to selected patients: a defibrillator whose wires are placed just under the n 2000, Jim Watkins’ cardiologist told him not to skin instead of into cardiac vessels or the worry about his heart murmur but to have a follow-up heart itself. “The device senses off the lead every three years or so. By 2013, tests showed a related placed under the surface of the chest,” Irupture in his heart’s mitral valve that would require says Cheng. “The main advantage is that surgery to repair. patients will not face the risk of difficult Exploring alternatives to open-heart surgery, lead extractions in the future, but there Watkins learned that minimally invasive robotic repair are some drawbacks.” offered faster recovery and minimal scarring. After The battery needs to be replaced Early repair is vital, says Kaushik Mandal, because valve doing his research, he found Johns Hopkins cardiac leakage can go from mild to severe in a short period of time. after about four years. The device is surgeon Kaushik Mandal, a valve disease specialist also about twice as large as a traditional with expertise in minimally invasive repairs. implanted cardioverter defibrillator, so Mandal informed Watkins that the robotic-assisted not all patients—especially those who mitral valve repair is an option for about 80 percent To further minimize risks during the operation, the are very thin—are eligible. In addition, because the detection algorithm uses an of people but that thorough presurgery tests were Johns Hopkins team monitors oxygen saturation in the electrocardiogram sensed through the essential. “The first priority is having a safe and durable legs and brain during the procedure. wire under the skin, certain patients may repair, which is why we carefully screen every patient to Another critical variable is early referral, Mandal says, not qualify for the device due to their determine the best approach,” he says. because “once a patient develops symptoms, the valve may particular condition. Besides being in be salvageable, but the outcomes While it can be used for rapid good overall health, the are not as great.” heartbeat conditions like ventricular ideal candidate has no “i think of the robot as A Robotic surgery can be used to tachycardia or ventricular fibrillation, it lung disease, Mandal million-dollar scissors.” repair leaky or narrowing valves, does not have standard pacing support explains, because the —kaushik mandal close a defect between the upper for patients with slower-than-normal right lung is collapsed chambers of the heart, remove heart rates. Nevertheless, it is a good repeatedly for several cardiac tumors or treat an irregular option for some people with limited vascular access or other issues placing minutes at a time during heartbeat that is resistant to them at high risk for bloodborne the procedure. treatment by ablation. infections. In addition, the arteries in the arms, hands, legs and “I think of the robot as a million-dollar scissors,” The implantation requires the patient feet must be free of plaque and calcification, because the Mandal says. “The decision to use it and whom to use it to have general anesthesia but not lung-and-heart bypass machine used during the procedure on is mine. Safety is paramount.” fluoroscopy imaging. The device’s pulse can destabilize plaque, increasing risk for a stroke or heart In the end, Watkins was the ideal candidate for the generator is placed right below the attack. This is why, in addition to a stress echocardiogram operation. One week afterward, he was discharged, and armpit. Then, an electrode on the device and a physical, Watkins underwent a CT angiogram to within a couple of months, he was able to travel across is tunneled across the heart above the rib identify calcium deposits. Europe with his wife. n cage and is attached to the connective “Patients with notable calcium deposits on their valve tissue beneath the skin. leaflets should have a traditional open-chest operation,” Watch a video of Jim Watkins telling his story at Cheng says time will tell how effective bit.ly/JimWat or scan the QR code. the new device will be. “We have 30 Mandal says. And since echocardiography is notorious for years of experience with the traditional missing calcifications, a cardiac CT scan is essential, he implantable cardioverter defibrillator adds. versus about one year with the new one,” says Cheng. But, he adds, it does PERFORMANCE matteRS hold promise for patients who are good candidates. n The Johns Hopkins Hospital has been recognized by The Joint Johns Hopkins Commission as a Top Performer on Key Quality Measures for: benchmark • Heart Attack • Pneumonia 66 min • Heart Failure • Surgical Care national benchmark 10 min 20 min 30 min 40 min 50 min 60 min 70 min 80 min 90 min Electrophysiologist Alan Cheng [Time between arrival and treatment for heart attack patients] 2 • HOPKINS PULSE • SPRING 2015 showinG SUPPORT Honorable Hosts with the Most Thad Shelly, chairman of the Johns Hopkins Cardiovascular Advisory Board, and his wife, Totty, What Will Your hosted more than 40 guests plus Johns Hopkins leadership and faculty for dinner at the Brazilian Legacy Be? Court Hotel in Palm Beach, Florida. The event took A single gift in 1873 from our founding place in January 2015 and included research and benefactor, Johns Hopkins, inspired a program updates. revolution in American medicine. The Johns Hopkins Legacy Society honors Mr. Hopkins and welcomes those who make their own legacy gifts to secure the financial future of Johns Hopkins Medicine.
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