Stories from the Heart

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stories from the

Heart 84

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Sheila Flanagan

A New Approach to AFib at CVA Sheila Flanagan was born with an atrial septal heart defect and at the age of six had open heart surgery to repair it. Over time, scar tissue from her open heart surgery caused atrial fibrillation, an irregular heart beat caused by abnormal electrical activity in the heart that over time can lead to blood clots, stroke and heart failure.

In 2012, Sheila started experiencing AFib on a frequent basis. She was unaware of what was occurring in her body.

“My heart would race. It felt so strange and I didn’t know what was happening,” she says. “At one point, I was walking to class at the local community college and by the time I got from the parking lot to my classroom I felt like I had run a marathon.” Her heart rate would increase to 140 to 150 beats per minute during her AFib episodes.

Sheila went to see a cardiologist in Nashville, Tennessee and was told she needed to have a heart ablation procedure. This involves inserting small tubes, or catheters into the groin that are advanced through veins into the heart.

Energy is then delivered by an ablation catheter which electrically deactivates the abnormal heart tissue.

Her first ablation at the Mayo Clinic was not successful and her cardiologist referred her to a pediatric cardiologist at Vanderbilt Children’s Hospital.

In November 2012, the second ablation was performed and was also unsuccess-

ful. During the long surgery, she received large doses of radiation emitted from an x-ray camera used to help visualize the heart. This resulted in a significant second degree burn on her back, all while her AFib persisted. After several trips to the ER and a short hospital stay, her AFib was treated through medication. Between 2012 and 2015, her episodes with AFib became less frequent.

Sheila started a new job in the beginning of 2015. Around the same time her AFIb was starting to occur again and it was getting harder to control with medication. “I had been texting with a new friend from work about my first day and the possibility that I might need to stay home because of my heart,” says Sheila. “She told me about her brother, Dr. Macy Smith, who was an electrophysiologist in Alabama that specialized in the treatment of AFib.” Sheila traveled from Nashville to Birmingham to meet with Macy Smith, M.D., cardiac electrophysiologistt. “Dr. Smith told me that he thought he could fix me and that he was passionate to do so because of what I had been through,” she says. “Before meeting him, I had no idea there were doctors that specialized in atrial fibrillation.”

In preparation for her procedure, Dr. Smith considered ways to improve and streamline the process of a heart ablation to limit the procedure time and radiation given her prior experiences of receiving excessive radiation. She had her third ablation surgery in April of last year at Brookwood Medical Center.

“I’m doing great and I haven’t had problems with my AFib since surgery,” says Sheila. “Dr. Smith is so passionate about his profession and treating people with AFib problems. He and his staff took such good care of me. I’m so appreciative of them all.” Heart health has become important to Sheila and her family.

“My daughter is wearing a heart monitor because of some recent problems and if she has the same AFib problem, I’m taking her straight to Birmingham to see Dr. Smith.” With this in mind, Dr. Smith has since further enhanced heart ablations now performing Zero Fluoro heart ablations without the use of radiation to improve the safety for all of his patients.

The Shape of a Heart at Children’s Four days before a scheduled Caesarean-section, Ashley Neil of Vestavia Hills, Alabama, learned her baby girl, Parker, would have only minutes to live.

An ultrasound showed Parker had a severe heart defect that is virtually always fatal. But through fastidious planning and an unprecedented approach to treatment, Parker survived.

Parker’s heart has only three chambers instead of the normal four. In addition, she had an intact atrial septum which blocked the flow of oxygenated blood to the rest of her body. “It’s universally fatal within the first minutes of life,” pediatric cardiovascular intensivist Jeffrey Alten, M.D. said. “You have to open that septum. Nothing else works.”

The only way to save Parker was to place her on extracorporeal membrane oxygenation seconds after birth. ECMO is a heart-lung bypass machine which oxParker Neil

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Only one health system in the

NATION can say it has three heart

ACCREDITATIONS at the highest level.

US. By meeting the highest level of qualifications, St. Vincent’s* has received all three accreditations from the Society of Cardiovascular Patient Care. That means our standard of care is nationally recognized and that our doctors, technology, and techniques are high quality. And that’s why we are The Heart Experts.

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Between St. Vincent’s Birmingham and East, our cardiologists draw on a wide breadth of experience in 40 cardiac subspecialties. That way, you have access to a range of expert care. Whether it’s detecting heart disease, replacing heart valves, or performing the latest procedures, our doctors are The Heart Experts.

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ygenates the blood and pumps it through the body. Then she would immediately need surgery to unblock the septum – all within minutes of delivery.

The challenge in most hospitals is that all of the components necessary to provide this life-saving care are located in different areas – often different floors – of the facility. But when the Russell Building at Children’s of Alabama was built in 2012, the plans included a 40-foot hallway connection from the Joseph S. Bruno Pediatric Heart Center on the fourth floor to the Women and Infants Center at the University of Alabama at Birmingham where so many high-risk babies are born.

With labor and delivery, critical care and cardiac care in close proximity to one another, precious time is saved when newborns are fighting for their lives.

Once Parker’s medical condition was identified, a team of intensivists, perfusionists, surgeons, nurses and anesthesiologists met with specialists in maternal/ fetal medicine and staff of the UAB Regional Neonatal Intensive Care Unit to make a plan for Parker’s birth and surgical care. To give Parker the best chance of survival, the team decided to set up a cardiovascular operating room in the hallway outside the birthing suite. There, the baby would be placed on ECMO and immediately wheeled over to one of Children’s heart catheterization labs. “There were 20 doctors and nurses in the room,” Alten said. “All had a very defined role.”

On November 9, 2015, Parker was born by C-section and the team sprang into action. “She cried once and went completely blue so we inserted a breathing tube, started IVs to resuscitate her and performed an ultrasound of her heart to confirm the diagnosis,” Alten said. “Within five minutes she was on ECMO and within 10 minutes, she was stable.”

As planned, the baby was transferred directly to the cath lab, where the planned procedure was successfully performed. Doctors were able to wean her off the ECMO machine after a couple of days. Over the next several weeks and months, Parker underwent two more heart surgeries and experienced multiple complications. But after five months in the hospital, Parker was healthy enough 88

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to be discharged. “We brought her home on oxygen and a feeding pump. She’s on 12 kinds of medicines that she has to take three times a day. We have to watch her color, her breathing,” Neil said. “There are a lot of little factors you have to be aware of.”

Because of the detailed collaboration of the medical team, the availability of advanced technology and the single platform of care provided by the design of the Children’s facility, Parker has already beaten the odds. “None of us expected her to survive her hospital stay,” Alten said. “And she’s still not out of the woods. In fact, only about 30 percent of these children make it to age 1 because of the associated severe lung disease that is associated with the heart defect. But she’s learning to eat, she’s gaining weight, smiling and interacting.”

Her mom said she’s a fighter who has already made an impact on friends and family. “I’ll never look at the shape of a heart the same way again,” Ashley said.

Top Accreditation Serving the community for more than 117 years, St. Vincent’s Health System, which is a part of Ascension, has a longstanding reputation of caring for hearts as the heart experts. As part of this dedication to patients, St. Vincent’s Health System is now the first and only health system in the nation to hold the highest Society of Cardiovascular Patient Care accreditations in all three of its areas. The accreditation is based on meeting and exceeding stringent quality and outcome cardiovascular measures on an ongoing basis. By combining this accreditation with the experience of our physicians and the latest in cutting-edge technology, patients are offered cardiovascular expertise with the care and compassion that is uniquely St. Vincent’s.

Through the teamwork and determination of numerous associates and physicians across the Health System, St. Vincent’s earned the prestigious accreditations in only seven months. Among the many criteria evaluated were how the hospitals worked internally to care for cardiac patients, its outreach efforts to educate the community on heart disease, and its

process to help ensure patients continued to thrive even after they left the hospital.

Two of its facilities – St. Vincent’s Birmingham and East – achieved the highest level available in Atrial Fibrillation (AFib) with EPS, Heart Failure, and Chest Pain Center with Primary PCI and Resuscitation. Its St. Vincent’s Blount and St. Clair facilities received Chest Pain Center accreditation.

AFib is a particularly troublesome cardiovascular ailment that affects 4.5 to 5 million patients a year, according to Dr. Michael Bailey. “ It causes a tremendous amount of symptoms and is big driver to the ER. The accreditation process is important because it educates the hospital staff in the most current AFib research available. This allows patients to get the right treatment, right up front leading to much better outcomes,” Dr. Bailey says.

“There is a tidal wave of information but sometimes all the info is not able to be synthesized quickly enough. This accreditation process educates personnel and insures that our patients get the best possible care,” he says.

SCPC-accredited hospitals demonstrate the ability to employ a system of handling patients in a manner that allows a shorter time between diagnosis and treatment, while also reducing patients’ length of stay both in the emergency department and when receiving inpatient care. By implementing this system, the accredited facilities are able to offer patients the highest level of coordinated care in a concise time frame.

St. Vincent’s Health System, which is a part of Ascension, includes five hospitals, a health and wellness facility, outpatient surgery and diagnostic centers, home health and hospice, home medical equipment services, behavioral health, wellness services, corporate health services and specialized care. To learn more about its full range of cardiovascular services, visit stvhs.com/heart. For a physician referral, call the St. Vincent’s Heart and Vascular Line at 205-939-7886.

The TAVR Procedure at UAB Pastor, professional baseball player, heart attack survivor. Gil Barrow has experienced many things in his life, but he

Do you suffer from leg pain, swelling, varicose veins, or a heavy feeling in the legs?

Dr. Duane Randleman is a cardiovascular surgeon who is board certified in General and Thoracic Surgery as well as Certified by the American Board of Venous and Lymphatic Medicine. Dr. Randleman and the Varicosity Team believe in providing the highest quality, personalized healthcare to achieve proven results using the most advanced technologies and procedures, including sclerotherapy, endovenous laser and radiofrequency ablation and vascular surgery.

Most procedures are covered by Medicare and other insurance.

Dr. Duane Randleman, Jr., medical director of Varicosity Vein Center

(Homewo od/Birmingham) 2704 20th Stre et South Suite 100. Birmingham, AL 35209 // 205.592.1800 (Montgomery) 445 Cotton Gin Road Montgomery AL 36117 // 334-647-1811 COMING SO ON: St. Vincent’s One Ninete en

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never thought the latter would be a part of his story. Barrow, now retired, played two years for the Brooklyn Dodgers organization in the minor leagues before hanging up his cleats to attend New Orleans Baptist Theological Seminary and spend a career as a pastor.

In October 2016, the Montgomery resident experienced shortness of breath and a rapid heartbeat while lounging in his chair at home. Barrow and his wife, Barbara, went to their local physician and determined he was in the middle of a heart attack.

A Southern Baptist preacher for more than 40 years, Barrow, 79, says he never was afraid.

After treating him in Montgomery, staff there determined Barrow should consider having a TAVR procedure. Barrow reached out to John Porterfield, M.D., a gastrointestinal surgeon at the University of Alabama at Birmingham Hospital, for whom Barrow had been a father-figure since Porterfield was a child.

“Dr. Porterfield told me that he knew the doctor who did the TAVR procedure,” Barrow said, “and that there was nobody better than Dr. Davies.” James E. Davies, Jr., M.D., chief of the UAB Section of Adult Cardiac Surgery, met with the Barrows and explained the TAVR procedure.

The technology available at UAB for surgeons to perform a TAVR procedure is among the most advanced in the Southeast. In a hybrid operating room with both surgical and X-ray capabilities, a multidisciplinary team places a guidewire through the malfunctioning valve, either from the groin or through a small inci90

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sion between the ribs in the chest.

The new valve is compressed on a flexible catheter. With imaging guidance, it is positioned inside the malfunctioning valve, then expanded to replace the Gil Barrow malfunctioning valve.

In only four years of performing the procedure, UAB is the only hospital in Alabama that has been able to do 500 TAVR cases. Davies credits his staff and the resources UAB is able to provide in changing so many lives.

TAVR provides a low-risk alternative to open-heart surgery with a much shorter recovery time. Many patients return home in less than a week. As a pastor, Barrow had seen many of his church members in the hospital and knew the toll that heart surgery can take on a person. After the TAVR device was successfully placed, Barrow says he could not believe how much better he felt immediately after the procedure. “I felt so good,” he said. “I wanted to get up and walk around.”

Barrow has since retired from preaching full time; but because of his new opportunities in both health and retirement, he has spread the word about TAVR and the doctors at UAB who helped him get back on the right track.

“I’ve spoken to prayer groups, churches, anybody I can, and I tell them ‘Go to Birmingham. Go see Dr. Davies,’” Barrow said.

While the science may be difficult to understand, the outcome is not.

“I cannot understand how the doctors do it, but it is making a tremendous difference in people’s lives,” Bar-

bara Barrow said.

Changing the Face of Vein Surgery Varicosity Vein Center, under the direction of Dr. Duane Randleman, has changed the face of vein surgery not only in Birmingham but throughout the country. Varicosity Vein Center is solely dedicated to the treatment of venous disorders and lymphedema.

Dr. Randleman, having grown up in Birmingham, attended the University Of Alabama Medical School. Subsequently, he spent five years as a general surgical resident at the Mayo Clinic in Rochester, Minnesota and three years at Emory University completing his fellowship and cardiac and thoracic surgery. It was his surgical training at the Mayo Clinic that he developed his compassionate care and dedication to delivering the highest quality care. It was where he learned that the patient always comes first.

Dr. Randleman began his surgical career in Birmingham performing cardiac, thoracic and vascular procedures. After 20 years, he further sub-specialized exclusively dedicating his career to the treatment of venous disease and lymphedema. Hence, Varicosity Vein Center emerged as an advanced state-of-the art medical facility. In addition to his vein centers in Homewood, St. Vincent’s 119 and Montgomery, Dr. Randleman has developed and managed over 57 vein centers as hospital departments in 11 different hospital systems in over 24 states.

“We have trained hundreds of physicians, nurses and ultrasound sonographers”, Dr. Varicosity Vein Center

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Randleman stated. “We are especially proud that they have all adopted our policies and procedures as well as the quality guidelines developed at Varicosity Vein Center.”

Dr. Randleman was certified by the American Board of Surgery, the American Board of Thoracic Surgery and the American Board of Venous and Lymphatic Medicine. He has been a guest lecturer at both national and international vein conferences. He has performed over 15,000 venous surgical procedures.

Dr. Randleman stated, “We are so proud to have changed the lives and the quality of living for so many people.”

Cardiac Electrophysiology at Grandview Medical Center Grandview Medical Center received a three-year accreditation in Cardiac Electrophysiology in the areas of Device Implementation, Chronic Lead Extraction, and Testing & Ablation by the Intersocietal Accreditation Commission (IAC).

Grandview is the only hospital in the state of Alabama to obtain this accredi-

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tation and one of only four hospitals in the country.

Dr Jose Osorio of Alabama Cardiovascular Group, an affiliate of Grandview Health, describes the accreditation as a seal of approval that insures the highest standards of patient care. “We make sure everyone in the room knows exactly what they should be doing when treating a patient with a very specific set of protocols and procedures,” Dr. Osorio says.

“We have been educating nurses, patients, doctors in a system-wide program.

Physicians from all over the country come to visit to see what we have developed here, to see how we structure our services.”

There has been an explosion in the prevalence of AFib with the number of patients diagnosed with the disorder continuing to grow very quickly. Risk factors that play into other cardiac disorders—obesity, diabetes—are also at play in AFib. There can also be a genetic predisposition to the disease.

The earlier the diagnosis and treatment the more success patients experi-

ence, Dr. Osorio says.

Each year, more than one million cardiac device and ablation procedures are performed for the treatment of heart rhythm disorders worldwide. The practice of cardiac electrophysiology is comprised of specialized diagnostic testing and therapeutic procedures performed by highly skilled healthcare professionals.

The training and experience of the cardiac electrophysiology specialist performing the procedure, the type of equipment used and the quality assessment metrics each facility is required to measure, all contribute to a positive patient outcome. IAC accreditation is a seal of approval that patients can rely on as an indicator of consistent quality care and a dedication to continuous improvement.

Accreditation by IAC indicates Grandview has undergone an intensive application and review process.

Nearly 4 million people in the United States have Atrial Fibrillation (AF). This heart rhythm abnormality can increase the chance of having a stroke and may lead to heart failure.