Cardiovascular Newsletter

Heart & Cardiovascular News from Georgia Regents Heart and Cardiovascular Services

Welcome Dear Colleagues, Welcome to the winter edition of CV News, which includes a discussion of bicuspid aortic valve and aortic stenosis in children as well as notes about our Pediatric Cardiology Fellowship Program.

As you peruse our many accomplishments on the following pages, I’d like to draw your attention to even more: • We are extremely pleased to announce the start of our cardiac stem cell therapy trial for patients with advanced congestive heart failure. Dr. Adam Berman serves as principal investigator of the therapy trial for patients with CHF. Please contact Carol Smith, nurse study coordinator for more information at 706-721-0193.

• Our cardiology fellows have once again excelled in rigorous testing, surpassing the national average on the first attempt of their American College of Cardiology in training exams.

These scores show the true caliber of our trainees as well as our teaching faculty, led by Drs. Sheldon Litwin, Vincent Robinson, and Pascha Schafer.

• Thanks to the effort of Drs. Preston Conger and Laurie Matthews, our cardiac rehab program has been accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation. Such timely accreditation required monumental effort and close coordination.

• Please join me in welcoming Dr. Anastasios Polimenakos as Associate Professor for congenital heart surgery. He comes to us from the University of Michigan and the Geisinger Health System in Pennsylvania. He will begin seeing patients on May 1.

• Mark your calendars for the GRU 2014 Alumni Weekend April 25-27. Dr. Neena Tandon, a Professor at Columbia University working to create a beating heart out of stem cells, will deliver the 2014 Robert and Lois Ellison Lecture on Stem Cell Engineering.

As always, your suggestions and comments are welcome.

M. Vinayak Kamath, MD Director, Heart and Cardiovascular Services and Chief, Cardiothoracic Surgery

Winter 2014 In This Issue • Welcome • Pediatric Cardiology Fellowship Program • Introducing Dr. Anastasios Polimenakos • Bicuspid Aortic Valve and Aortic Stenosis in Children • CME Lecture Calendar • Cardiovascular Conference May 29-31, 2014

M. Vinayak Kamath, MD

Director, Heart and Cardiovascular Services and Chief, Cardiothoracic Surgery Georgia Regents University 1120 15th Street, BA-4300 Augusta, GA 30912 706-721-3226 kamath@gru.edu

Dr. Zahid Amin

Dr. Rod E. Pellenberg

Professor and Chief of Pediatric Cardiology, Children’s Hospital of Georgia

Pediatric Cardiology Third-year Fellow Children’s Hospital of Georgia

Pediatric Cardiology Fellowship Training

The Pediatric Cardiology Fellowship Program at the Children’s Hospital of Georgia is well-balanced, providing comprehensive training to fellows. Weekly didactic lectures are supplemented with oneon-one training. This close learning environment allows exceptional training in general pediatric cardiology. These pediatric cardiology fellows are exposed to all facets of pediatric cardiology, including research; cardiac catheterizations; complex interventions; trans-thoracic, fetal, and transesophageal echocardiography; inpatient and outpatient care; and management of post-operative cardiac patients.

New Physician

Fellow Notes: A pediatric cardiology fellowship experience at the Children’s Hospital of Georgia has certainly provided me with the knowledge and skills necessary to become a well-rounded pediatric cardiologist. I have truly loved my time here. The program exposes fellows to a wide variety of cases as we look to serve a diverse patient population. In this way, we are ultimately prepared to provide the best possible care for our patients and their families.

It goes without saying that I am part of a great team of fellows, Drs. Stefani Samples and Mac Vining. Our faculty serve as passionate and personable role models while demonstrating

top-notch knowledge and skills.

Each member of the program plays vital roles in making the workday enjoyable. Fellows here encounter multiple learning opportunities through the cardiac catheterization laboratory, echocardiogram laboratory, neonatal intensive care unit, pediatric intensive care unit, operating room, emergency room, and the outpatient center. We also work alongside support staff and faculty in areas including sonography, nursing, and cardiac catheterization, creating a great learning environment. Rewarding opportunities for both clinical and basic research are abundant.

For referrals and more information, please call 706-721-8522.

Dr. Anastasios Polimenakos

Director of Congenital Heart Surgery, Children’s Hospital of Georgia

We are pleased to announce the appointment of Dr. Anastasios Polimenakos, coming to us from Danville, Pa. He will serve as Director of Congenital Heart Surgery and Associate Professor of Surgery at the Children’s Hospital of Georgia beginning

May 1, 2014. He currently serves as the Director of Congenital & Pediatric Cardiothoracic Surgery at Geisinger Medical Center, Danville, Pa. He will perform major congenital heart surgeries for newborns, infants, and children at CHOG. He has published extensively and specializes in pediatric cardiac and thoracic surgery.

Polimenakos, who evaluates and treats all types of congenital heart defects, is working on several initiatives related to heart failure in animal research models and has completed numerous clinical presentations.

–2–

Polimenakos, a graduate of the University of Athens Medical School in Greece, completed his general surgery residency at Case Western Reserve University in Cleveland and Saint Vincent’s of New York Medical College and a thoracic surgery fellowship at St. Louis University School of Medicine in 2006. He completed a clinical fellowship at the Children’s Hospital at the University of Southern California Keck School of Medicine in Los Angeles.

Bicuspid Aortic Valve and Aortic Stenosis in Children Dr. Henry Wiles

Pediatric Cardiologist Children’s Hospital of Georgia Georgia Regents University

In the last winter issue of the Heart & Cardiovascular Newsletter, Drs. Sheldon Litwin and Paul Poommipanit reviewed issues with a bicuspid aortic valve (BAV) and balloon valvuloplasty in adults. A fetus develops BAV in the womb, a condition present at birth. Ventricular septal defect is cited as the most common form of congenital heart disease, but BAV is clearly under-represented because it is often asymptomatic and undiagnosed. The rate of this diagnosis in children has increased due to early physician awareness by hearing a systolic ejection click on auscultation through echocardiography.

Children with BAV and/ or aortic stenosis are treated differently than adults Children with BAV and/ or aortic stenosis are treated

differently than adults. Often, children lack the associated calcification of an abnormal aortic valve that develops over time in adulthood. An asymptomatic child with no hemodynamic effects from a BAV, or a valve that works normally, is followed periodically throughout childhood to watch for changes in valve function and for changes in the ascending aorta, such as dilatation. This treatment is similar to that of adults. On the other hand, children may have a wide range of hemodynamic embarrassment from mild to severe stenosis, or insufficiency from birth and at any time during childhood. This condition requires careful evaluation by a pediatric cardiologist.

Clinical evaluations for children with BAV are often shortened through times of rapid somatic growth. Rapid growth periods in the first year of life and during the adolescent growth spurt coincide with BAV function and growth.

Aortic stenosis is also treated differently in children than adults.

Aortic balloon valvuloplasty is a mainstay of therapy in children.

This technique is used much less commonly in adults because the calcification of the valve makes the procedure less beneficial.

At CHOG’s dedicated pediatric hybrid catheterization laboratory, children have been treated sucessfully with this technique.

Therapy for this condition is critcally important in children due to the fact that aortic valve replacement at that age carries many risks and is avoided or delayed as long as possible.

These risks include repeat open heart surgery and valve replacement due to outgrowing a valve and the necessary use of anticoagulation such as warfarin.

Risks of anticoagulation therapy include head trauma in active children, poorly regulated anticoagulation in growing children, and fetal impairment during pregnancy.

Operative view shows congenital bicuspid aortic valvar stenosis in an infant.

Hurst, J. Willis, et. al. Atlas of the Heart. McGraw-Hill Book Company, New York, New York, 1988.

–3–

Bicuspid Aortic Valve and Aortic Stenosis in Children Continued

Exercise is important for children with aortic valve disease.

The 36th Bethesda Conference on athletic participation for patients with aortic stenosis states that children with mild AS can compete in all sports. However, children with moderate AS are limited to low-intensity sports (class

IA), see table 1, or higher-level sports in Classes IB and IIA if they have appropriate exercise stress testing that shows no dangerous symptoms or signs. Children with severe AS or symptomatic children with moderate AS should not participate in any competitive sport. Appropriate levels of

–4–

sports participation should be discussed at first diagnosis. These dialogues enable patients and families to discuss and understand the condition.

Hurst, J. Willis, et. al. Atlas of the Heart. McGraw-Hill Book Company, New York, New York, 1988.

CME Lectures

Please contact us for more information 706-721-2736

Feb. 7

April 25

Speaker: Dr. Bob Applegate Topic: Transcatheter Aortic Valve Implantation

Speaker: Dr. Simi Kumar Topic: Cardiac Oncology

Feb. 14 Speaker: Dr. Simi Kumar Topic: Cocaine and the Heart

May 2 Speaker: Dr. William Maddox Topic: Atrial Fibrillation

May 9

Feb. 21 Speaker: Dr. Jacob Misenheimer Topic: Taking Advantage of Hibernating Myocardium: Potential Strategies to Mitigate Ischemic Insults

Feb. 28 Speaker: Dr. Justin Resley Topic: Blood Conversion

Speaker: Dr. Amudhan Jyothidasan Topic: Newer Advances in Heart Failure Therapy

May 16 Speaker: Dr. Pratik Choksy Topic: Current Use of Intra-Aortic Balloon Counter Pulsation Pump

May 23

March 7 Speaker: Dr. Sheldon Litwin Topic: Heart Failure with Normal Ejection Fraction: Separating Fact From Fiction

Speaker: Dr. Loren Morgan Topic: Advanced Cardiac Imaging: Current and Future Usage

May 30

March 14 Speaker: Dr. Michael Luc Topic: Diet and Heart Disease

Speaker: Dr. Zahid Amin Topic: Meledy Valve

Cardiovascular Conference

March 21 Speaker: Dr. Loren Morgan Topic: Therapies for Refractory Angina

International Multidisciplinary Forum on Cardiac and Respiratory Care

April 4

May 29-31 at the Westin Savannah Harbor Golf Resort & Spa in Savannah, Ga.

Speaker: Dr. Paul Poommipanit Topic: Atrial Septal Defect and Patent Foramen Ovale

Please contact us for more information 706-721-6679, or check out the website, gru.edu/cardiac-conf

April 18 Speaker: Dr. Shvetank Agrawal Topic: Anesthesia During Cardiac Surgery

Hearts:

The official sponsor of life.

–5–

Non-Profit Org. U.S. POSTAGE

PAID Augusta, Georgia Permit No. 210

Georgia Regents University 1120 15th Street, BBR-6518 Augusta, Ga. 30912

Physician List Director of Heart and Cardiovascular Services M. Vinayak Kamath, MD

Chief, Cardiovascular Medicine Sheldon Litwin, MD

Chief, Pediatric Cardiology Zahid Amin, MD

Cardiovascular Electrophysiology

Adam Berman, MD William Maddox, MD Robert Sorrentino, MD

Cardiovascular Imaging (Echo, MRI, CT, and Nuclear Imaging) Preston Conger, MD Sheldon Litwin, MD Vincent Robinson, MBBS Pascha Schafer, MD Gyanendra Sharma, MD

Cardiothoracic Surgery M. Vinayak Kamath, MD Vijay Patel, MD

Rehabilitation and Prevention Preston Conger, MD Vascular Surgery

Gautam Agarwal, MD, RPVI

No-hassle referrals

Cardiac Anesthesiology

Shvetank Agarwal, MBBS Mary Arthur, MD Mafdy Basta, MD Manuel Castresana, MD, FCCM Sanjay Dwarkanath, MBBS Tao Hong, MD Vikas Kumar, MBBS

General Cardiology (Inpatient and Outpatient) Preston Conger, MD Mahendra Mandawat, MD Chris Pallas, MD Vincent Robinson, MBBS Pascha Schafer, MD Gyanendra Sharma, MD John Thornton, MD Neal Weintraub, MD

Interventional Cardiology (Coronary and Vascular) Vishal Arora, MD Deepak Kapoor, MD, MBBS Paul Poommipanit, MD

Pediatric Cardiothoracic Surgery Anastasios Polimenakos, MD

Pediatric Cardiology Zahid Amin, MD William Lutin, MD Kenneth Murdison, MD Henry Wiles, MD

Your time is valuable. To make an appointment for your patient, please call: Cardiology 706-721-BEAT (2328) Cardiac Surgery 706-721-3226 Pediatric Cardiology 706-721-8522 Pediatric Cardiac Surgery 706-721-5621

Convenient Locations Pediatric Augusta CHOG 706-721-8522 Thomasville Archbold Hospital 229-228-8006 Valdosta Children’s Medical Services South Georgia Medical Center

229-245-4310 Albany Phoebe Putney Memorial Hospital Pediatric Specialty Clinic 229-312-5480

Adult Augusta GRMC Trinity Hospital (Summerville Bldg.)

Washington Wills Memorial Greensboro Lake Oconee

706-721-CARE 706-481-7070 706-678-9334 706-453-9803