R E P O R T
A N N U A L
S U R G E R Y
O F
2011
2012
T E X A S C H I L D R E N ’ S H O S P I TA L D E PA R T M E N T O F S U R G E R Y A N N U A L R E P O R T 2 0 11 - 2 0 12
D E P A R T M E N T
B
Thank you for your interest in the Department of Surgery Annual Report.
This year’s publication highlights our leading surgical program, provides updated data for
each division and showcases the treatments, innovations and expertise taking place at
Texas Children’s Hospital.
The Department of Surgery is on track to complete approximately 25,000 operating
room cases and more than 100,000 outpatient visits in 2012. In addition, we became
the first hospital in the southwestern United States to perform an in utero procedure to
treat congenital diaphragmatic hernia. We established a comprehensive Sports Medicine
Program to treat patients with all types of sports-related injuries and disorders. We were
the lead site for a groundbreaking trial of the Berlin Heart EXCORВ® Pediatric Ventricular
Assist Device, the only pediatric mechanical circulatory support device designed
specifically for infants and small children that received approval from the United States
Food and Drug Administration, and so much more.
Our surgical capabilities continued to expand with the opening of surgical suites at Texas
Children’s Hospital West Campus, the first pediatric community hospital in Houston, and
Texas Children’s Pavilion for Women, a comprehensive obstetrics and gynecological care
facility that provides some of the most advanced technologies and treatments available
for women, mothers and babies.
Texas Children’s Hospital was recently ranked #4 among top children’s hospitals in the
nation and was also ranked in all ten subspecialties in the 2012 U.S.News & World Report’s
list of America’s Best Children’s Hospitals. While we are pleased our hospital ranks among
the best in the nation, we consistently strive to improve our patient outcomes, satisfaction
levels and medical advancements.
This report is part of our ongoing effort to examine our programs, be transparent with
our activities and to improve the quality of care we provide to our patients. I hope you
find it valuable and informative.
Sincerely,
Mark A. Wallace
President and Chief Executive Officer, Texas Children’s Hospital
1
D E P A R T M E N T
O F
S U R G E R Y A N N U A L
R E P O R T
2 011-2 012
Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Texas Children’s Hospital and
Baylor College of Medicine . . . . . . . . . . . . . . . . . . . . . 3
Department of Surgery .
. . . . . . . . . . . . . . . . . . . . .
5
Berlin Heart EXCOR Pediatric. . . . . . . . . . . . . . . . . . 13
В®
Department of Surgery Research Seed Grants.
. . . .
16
Department of Anesthesiology . . . . . . . . . . . . . . 19
Surgical Divisions
Congenital Heart Surgery . . . . . . . . . . . . . . . . . . . . . . . 25
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Ophthalmology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Orthopaedics .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
45
Otolaryngology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Pediatric and Adolescent Gynecology. . . . . . . . . . . . . 55
Pediatric General Surgery . . . . . . . . . . . . . . . . . . . . . . . 63
Plastic Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Transplant Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Urology .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
81
Department of Surgery Services
Inpatient Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Operating Room and Perioperative Services . . . . . . . 90
Trauma Services and
the Center for Childhood Injury Prevention. . . . . . . . 92
Medical Staff Directory .
. . . . . . . . . . . . . . . . . . . . . . . .
98
2
Dear colleagues, parents and friends,
I am pleased to share with you the second edition of the Department of Surgery Annual
Report from Texas Children’s Hospital. The Department of Surgery had a busy and
productive year pursuing our vision to set the standard for quality in pediatric surgical care,
educate tomorrow’s surgical leaders and conduct pioneering research.
We have launched several new initiatives to meet the needs of children in the community,
including the area’s first pediatric Sports Medicine Program, a dedicated Voice and
Swallowing Clinic, comprehensive aerodigestive care, and a continued focus on craniofacial
anomalies and transplant services. Additionally, as Texas Children’s Hospital West Campus
has grown, we have continued to grow our presence to meet the needs of the west
Houston community during the day and after hours.
The opening of Texas Children’s Pavilion for Women has enabled us to expand our fetal
surgical capabilities and treatment of neonates needing surgical care as well as allowed
us to continue to grow into supporting select adult surgical needs. Moreover, our focus
on patient outcomes led us to establish the Surgical Outcomes Center. This center
enables us to track, analyze and report the outcomes of procedures and identify areas for
improvement and research within Texas Children’s Hospital.
As part of our ongoing commitment to provide the very best possible surgical care, we
have added several new faculty to our already outstanding team. We plan to continue
to add faculty during the next year in order to further expand our programs to meet the
needs of our patients and their families.
I hope you enjoy reading about our outstanding surgical team here at Texas Children’s
Hospital. I am privileged to work with these dedicated surgeons. With deepest respect,
I remain,
Sincerely yours,
Charles D. Fraser, Jr., M.D.
Surgeon-in-Chief, Texas Children’s Hospital
Donovan Chair and Chief of Congenital Heart Surgery, Texas Children’s Hospital
Susan V. Clayton Chair in Surgery, Baylor College of Medicine
Professor of Surgery and Pediatrics, Baylor College of Medicine
3
Texas Children’s Hospital and Baylor College of Medicine
Texas Children’s Hospital, located in the Texas Medical Center, is committed
to a community of healthy children by providing the finest pediatric patient
care, education and research. Renowned worldwide for its expertise and
breakthrough developments in clinical care and research, Texas Children’s
Hospital is nationally ranked in all of the ten subspecialties in U.S.News & World
Report’s list of America’s Best Children’s Hospitals and was one of
only twelve hospitals in the nation to make its Honor Roll in
2012. Texas Children’s also operates Texas Children’s Pediatrics,
the nation’s largest primary pediatric care network, with more
than 45 offices throughout the greater Houston community and
Texas Children’s Health Plan, the nation’s first health maintenance
organization (HMO) created just for children.
Texas Children’s Hospital is affiliated with Baylor College of Medicine
(BCM), ranked by U.S.News & World Report as one of the nation’s top 25
medical schools for research. Texas Children’s Hospital serves as BCM’s
primary pediatric training site, and BCM faculty are the division chiefs and staff
physicians of Texas Children’s patient care centers. The collaboration between
Texas Children’s Hospital and BCM is one of the top 10 such partnerships for
pediatric research funding from the National Institutes of Health. The hospital’s
medical staff includes more than 1,500 board-certified, primary-care physicians,
pediatric subspecialists, pediatric surgical subspecialists and dentists, offering
the highest level of pediatric care in more than 40 subspecialties, programs and
services and a support staff in excess of 8,500.В 4
Mission
D epartment of S ur g er y M i ss i on S tatement
The Department of Surgery at Texas Children’s Hospital
strives to provide the highest quality surgical care in a
collaborative and family-centered environment while being
the national leader in surgical education and research.
Vision
D epartment of S ur g er y V i s i on S tatement
The surgeons of Texas Children’s Hospital are committed
to setting the standard for quality surgical care, to inspiring
and educating the next generation of surgeons, and to being
leaders in research that changes lives.
DEPARTMENT OF SURGERY
Department of Surgery
The Department of Surgery at Texas
Children’s Hospital represents a
dedicated team of pediatric-focused
surgeons from nine surgical divisions –
Congenital Heart, Dental, Neurosurgery, Ophthalmology, Orthopaedics,
Otolaryngology, Pediatric General Surgery, Plastic Surgery and Urology. In
conjunction with our partners in Pediatric and Adolescent Gynecology and
Transplant Services, we have over 60 full time surgeons and more than 500
Texas Children’s Hospital and Baylor College of Medicine employees focused
on ensuring children get the care they need.
With an annual operating revenue budget in excess of $300 million, our team’s
tireless efforts are demonstrated in the approximately 25,000 operating room
cases and 100,000 outpatient visits completed in 2012. Significant external
research support and activity are highlighted by millions of dollars in external
research funding and numerous articles and presentations given nationally and
internationally each year.
Our team is dedicated to caring for children in and around the greater Houston
area through our four community health centers and two Texas Children’s
Hospital locations. Additionally, we take great pride in caring for children at other
hospitals in the Houston area and from all 50 states and over 70 countries around
the globe. When parents want the very best for their child, we are humbled that
they make Texas Children’s Hospital their choice. It is an honor to care for these
children and a responsibility we do not take lightly.
5
6
DEPARTMENT OF SURGERY
2012
*
D epartment of S ur g er y O verv i ew
S U RG IC AL DIVI S ION
2 012 *
CLINIC VISITS
2 012 *
O P E R AT I N G R O O M
CASES
Congenital Heart Surgery
1,421
771
Dental
2,354
804
Neurosurgery
5,388
969
Ophthalmology
16,158
1,283
Orthopaedics
21,883
2,182
Otolaryngology
19,715
9,838
Pediatric and Adolescent Gynecology
5,509
237
11,300
5,567
Plastic Surgery
4,152
1,080
Transplant Services
2,950
96
Urology
11,213
2,093
102,043
24,920
Pediatric General Surgery
TOTAL
* P ro j ected
Operating room cases are defined as cases when operating room staff and supplies
are used. Cases with multiple procedures count as one case and are attributed to
the service line of the primary surgeon.
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital locations. Clinic visits include outpatient visits by Texas
Children’s Hospital and Baylor College of Medicine faculty only.
DEPARTMENT OF SURGERY
Texas Children’s Hospital West Campus
Texas Children’s Hospital West Campus is Houston’s first community hospital
designed, built and staffed exclusively to care for children. Outpatient services
opened in December 2010, and inpatient services and the Emergency Center
opened in April 2011. This state-of-the-art 514,000-square-foot facility
incorporates best practices in pediatric treatment and serves the community as
the premier resource center for child wellness and healing.
Within an ambulatory surgery center model, the following Department of
Surgery divisions provide outpatient clinic and/or surgical coverage at Texas
Children’s Hospital West Campus: • Orthopaedics (added onsite after hours care in 2011)
• Ophthalmology
• Otolaryngology
• Pediatric General Surgery (added onsite after hours care in 2011)
• Pediatric and Adolescent Gynecology
• Plastic Surgery (added in 2012)
• Urology
7
8
DEPARTMENT OF SURGERY
Over the past year, we established a multispecialty Sports Medicine Program.
This program provides comprehensive and convenient diagnosis, evaluation
and treatment for all types of pediatric and young adult athletic-related injuries
and conditions. A $10 million capital expansion is planned in 2013 to allow the
program to be based at Texas Children’s Hospital West Campus.
Additionally, a top strategic focus this year was to expand emergency and
operating room coverage for anesthesiology, orthopaedics and pediatric general
surgery. The purpose of this initiative was to better serve the community and
add capacity to the system. Perioperative services are now available seven days a
week, including after hours.
Moving forward, Texas Children’s Hospital West Campus will continue to
expand existing surgical capabilities, particularly within orthopaedics, pediatric
general surgery, plastic surgery and otolaryngology, as well as the Emergency
Center. In addition, we will augment our services with coverage by more surgical
divisions and increase the number of available operating rooms. The facility is
moving toward a higher level of care that will enable more complex, inpatient
surgeries in the future.
2012
*
O perat i n g R oom C ases C ompleted at T e x as C h i ldren ’ s Hosp i tal W est C ampus*
1,814
Otolaryngology
771
Pediatric General Surgery
363
356
Urology
Orthopaedics
Ophthalmology
Plastic Surgery
65
12
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital West Campus.
DEPARTMENT OF SURGERY
Texas Children’s Pavilion for Women
Fully opened in March 2012, Texas Children’s Pavilion for Women enhances the
Department of Surgery’s capabilities to care for women, mothers and babies.
As a leader in the fields of obstetrics, gynecology, fetal and pediatric medicine,
the Pavilion for Women offers the most advanced technologies and treatments
available from before conception to after delivery.
A long list of amenities and technology, including an expanded neonatal intensive
care unit, augment current newborn surgical capacity. The Fetal Surgery Program
benefited dramatically from new operating rooms accommodating in utero
surgical procedures including spina bifida repair, twin-twin transfusion syndrome
laser therapy, interventional cardiology and balloon tracheal occlusion for severe
congenital diaphragmatic hernia. If surgery such as an EXIT procedure is needed,
the baby can be transported quickly to the main hospital via the pedestrian sky
bridge, also known as the Miracle Bridge.
SEPT
AUG
JUL
394
OCT
378
404
405
329
2012
JUN
326
MAY
286
APR
282
MAR
242
FEB
JAN
268
P A T I E N T B I R T H S A T T E X A S C HI L D R E N ’ S P A V I L I O N F O R
W O M E N in 2012
9
10
DEPARTMENT OF SURGERY
With the Pavilion for Women, Texas Children’s has opened the door to
expanded adult surgical capabilities. An extremely active caseload of obstetric
and gynecologic procedures is being performed and will continue to grow.
William Fisher, M.D., Director of Baylor College of Medicine’s Elkins Pancreas
Center and a renowned pancreatic surgeon, is the Department of Surgery’s link
to the Pavilion for Women as the Medical Director of Adult Surgery at Texas
Children’s Hospital. Dr. Fisher oversees the non-obstetrics and gynecology
growth of surgery at the Pavilion for Women.
2012
*
O perat i n g R oom C ases C ompleted at T
e x as
C h i ldren ’ s P av i l i on for W omen *
771
Fetal
11
Pediatric General Surgery
Urology
114
3
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Pavilion for Women.
DEPARTMENT OF SURGERY
Surgical Outcomes Center
This year, the Departments of Surgery and Quality at Texas Children’s Hospital
teamed up to establish an innovative Surgical Outcomes Center that will
track, analyze and report the outcomes of procedures within Texas Children’s
Hospital. The Surgical Outcomes Center provides a central resource and
infrastructure to examine surgical outcomes data in order to identify where
performance can be improved and valuable research can occur.
The Surgical Outcomes Center is working closely with physicians to:
• Collect data on procedures, complications and outcomes
• Analyze trends in data
• Assimilate outcomes information to improve beside care through
protocol establishment and review
• Establish hospital and national benchmarks
• Optimize financial models
• Ensure accurate reporting to external stakeholders
• Report long-term functional outcomes
Moreover, the Surgical Outcomes Center will enable surgical faculty to
answer key questions patients, families and legal guardians have about medical
conditions. For example, the number of procedures that have been done at
Texas Children’s Hospital, typical results and if those results are improving
over time, estimated cost of the operation, what long-term quality of life and
functional outcomes to expect and more.
The Surgical Outcomes Center’s team of research nurses, computer
programmers, data architects and specialists, outcomes analysts and research
statisticians will work closely with Department of Surgery physicians to reach
these goals.
11
12
DEPARTMENT OF SURGERY
Surgical Quality Programs
The Department of Surgery is integral to the overall quality and safety mission
of Texas Children’s Hospital. Quality and outcomes management uses a specific
methodology to optimize safety, efficacy and efficiency of care delivery. Current
institutional quality goals include decreasing specific hospital-acquired conditions,
serious safety events and preventable re-admissions. Additionally, the Department
of Surgery, through the newly developed Surgical Outcomes Center, tracks
clinical outcomes and also provides process and outcomes data to several
national collaboratives.
In the past year, the Surgical Quality Team, led by Thomas Luerssen, M.D.,
F.A.C.S., F.A.A.P., Chief Quality Officer Surgery and Chief of Neurosurgery
at Texas Children’s Hospital, has completed projects focused on the surgical
safety checklist, obtaining current and accurate operative reports, tracking a
series of “triggers” that impacts the outcome of surgical patients or procedures,
and prevention of serious safety events. A project aimed at reducing acute
postoperative pain in the three days following surgery resulted in a decrease of
moderate or severe pain by almost 50%.
American College of Surgeons, National Surgical Quality
Improvement Program (NSQIP)1
Texas Children’s Hospital began participating in the Pediatric NSQIP program
in 2011. Pediatric NSQIP currently has 47 participating pediatric sites and is the
first multispecialty outcomes-based program to measure the quality of children’s
surgical care. David E. Wesson, M.D., Associate Surgeon-in-Chief, Chief of
the Department of Surgery and Medical Director of Trauma Services at Texas
Children’s Hospital is Texas Children’s surgeon champion for the program.
NSQIP collects prospective data on more than 130 data points on all patients over
18 years of age undergoing major operations who meet program criteria. Data
is collected by a highly trained surgical clinical reviewer. After the data is analyzed
and risk-adjusted, an annual report is provided to each site that benchmarks its
outcomes against other participating sites.
Because of our recent partnership with NSQIP, statistically significant information is not available
to share at this time. We look forward to including this data in subsequent versions of our
annual report.
1
DEPARTMENT OF SURGERY
Berlin Heart EXCORВ® Pediatric
Recently, the United States Food and Drug Administration (FDA) granted
humanitarian device exemption for the Berlin Heart EXCORВ® Pediatric Ventricular
Assist Device – the only pediatric mechanical circulatory support device designed
specifically for infants and small children. This was a landmark day for physicians
who treat children dying of heart failure whose only hope is a heart transplant.
Small children awaiting heart transplantation face a long time on the waiting list
due to limited availability of donor organs and a mortality rate while waiting of
approximately 25 percent due to progressive organ system failure. Before this FDA
ruling, physicians longed for a reliable circulatory support device so children could
survive until an appropriate donor heart became available.
The journey for the FDA’s approval began with a multi-year, multi-institution study
led by Texas Children’s Hospital. Starting in 2005, a trans-Atlantic dialogue was
initiated between the Berlin Heart Corporation, clinicians in North America and
the FDA to design and conduct the first ever prospective pediatric ventricular
assist trial in the world. The study design addressed questions of safety and benefit
of the Berlin Heart in supporting children with heart failure until they received a
heart transplant. This extremely ambitious study involved detailed analysis and
ongoing multicenter data collection coordination in critically ill children with rapidly
progressive heart disease.
During the course of the study, Texas Children’s implanted 27 Berlin Hearts –
more than any other center in the U.S. – and our results were very encouraging.
This groundbreaking trial has become part of the rich legacy of surgical
advancements that have happened at Texas Children’s Hospital.
Findings from this unprecedented study were
published in the New England Journal of Medicine
in August 2012.2 Outcomes for 48 children
(infants – 16 years) who received the Berlin
Heart from 2007 – 2010 were compared
to patients supported by extracorporeal
membrane oxygenation (ECMO).
The
n e w e ng l a n d j o u r na l
of
m e dic i n e
original article
Prospective Trial of a Pediatric Ventricular
Assist Device
Charles D. Fraser, Jr., M.D., Robert D.B. Jaquiss, M.D., David N. Rosenthal, M.D.,
Tilman Humpl, M.D., Ph.D., Charles E. Canter, M.D.,
Eugene H. Blackstone, M.D., David C. Naftel, Ph.D., Rebecca N. Ichord, M.D.,
Lisa Bomgaars, M.D., James S. Tweddell, M.D., M. Patricia Massicotte, M.D.,
Mark W. Turrentine, M.D., Gordon A. Cohen, M.D., Ph.D., Eric J. Devaney, M.D.,
F. Bennett Pearce, M.D., Kathleen E. Carberry, R.N., M.P.H.,
Robert Kroslowitz, B.S., and Christopher S. Almond, M.D., M.P.H.,
for the Berlin Heart Study Investigators
From Texas Children’s Hospital (C.D.F.,
L.B., K.E.C.) and Baylor College of Medicine (C.D.F., L.B.), Houston, and Berlin
Heart, The Woodlands (R.K.) — all in
Texas; Duke Children’s Hospital and
Health Center, Duke University School of
Medicine, Durham, NC (R.D.B.J.); Lucile
Packard Children’s Hospital, Stanford University School of Medicine, Stanford, CA
(D.N.R.); the Hospital for Sick Children,
University of Toronto, Toronto (T.H.), and
Stollery Children’s Hospital, University of
Alberta School of Medicine, Edmonton
(M.P.M.) — both in Canada; St. Louis
Children’s Hospital, Washington University School of Medicine, St. Louis (C.E.C.);
Heart and Vascular Institute and Department of Quantitative Health Sciences,
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University,
Cleveland (E.H.B.); University of Alabama
School of Medicine, Birmingham (D.C.N.,
F.B.P.); Children’s Hospital of Philadelphia, Perelman School of Medicine of the
University of Pennsylvania School of
Medicine, Philadelphia (R.N.I.); Children’s Hospital of Wisconsin, Medical
College of Wisconsin, Milwaukee (J.S.T.);
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis
(M.W.T.); Seattle Children’s Hospital, University of Washington School of Medicine,
Seattle (G.A.C.); C.S. Mott Children’s
Hospital, University of Michigan Health
System, Ann Arbor (E.J.D.); and Children’s
Hospital of Boston, Harvard Medical
School, Boston (C.S.A.). Address reprint
requests to Dr. Fraser at Texas Children’s
Hospital, Baylor College of Medicine,
6621 Fannin St., WT 19345H, Houston, TX
77030, or at [email protected].
A BS T R AC T
BACKGROUND
Options for mechanical circulatory support as a bridge to heart transplantation in
children with severe heart failure are limited.
METHODS
We conducted a prospective, single-group trial of a ventricular assist device designed
specifically for children as a bridge to heart transplantation. Patients 16 years of age
or younger were divided into two cohorts according to body-surface area (cohort 1,
<0.7 m2; cohort 2, 0.7 to <1.5 m2), with 24 patients in each group. Survival in the
two cohorts receiving mechanical support (with data censored at the time of transplantation or weaning from the device owing to recovery) was compared with survival
in two propensity-score–matched historical control groups (one for each cohort)
undergoing extracorporeal membrane oxygenation (ECMO).
RESULTS
For participants in cohort 1, the median survival time had not been reached at 174 days,
whereas in the matched ECMO group, the median survival was 13 days (P<0.001 by the
log-rank test). For participants in cohort 2 and the matched ECMO group, the median
survival was 144 days and 10 days, respectively (P<0.001 by the log-rank test). Serious
adverse events in cohort 1 and cohort 2 included major bleeding (in 42% and 50%
of patients, respectively), infection (in 63% and 50%), and stroke (in 29% and 29%).
CONCLUSIONS
Our trial showed that survival rates were significantly higher with the ventricular
assist device than with ECMO. Serious adverse events, including infection, stroke,
and bleeding, occurred in a majority of study participants. (Funded by Berlin Heart
and the Food and Drug Administration Office of Orphan Product Development;
ClinicalTrials.gov number, NCT00583661.)
N Engl J Med 2012;367:532-41.
DOI: 10.1056/NEJMoa1014164
Copyright В© 2012 Massachusetts Medical Society.
532
n engl j med 367;6
nejm.org
august 9, 2012
The New England Journal of Medicine
Downloaded from nejm.org by Shaun Custard on August 9, 2012. For personal use only. No other uses without permission.
Copyright В© 2012 Massachusetts Medical Society. All rights reserved.
Fraser CD Jr, Jaquiss R, Rosenthal D, Humpl T, Canter C, Blackstone E, Naftel D, Ichord R, Bomgaars L,
Tweddell J, Massicotte M, Turrentine M, Cohen G, Devaney E, Bennett Pearce F, Carberry K,
Kroslowitz R, Almond C. Prospective trial of a pediatric ventricular assist device. N Engl J Med 2012;
367:532-541.
2
13
14
DEPARTMENT OF SURGERY
DEPARTMENT OF SURGERY
B erlin Heart EXCOR ® Pediatric Clinical Trial – Outcomes
Smaller Patients
(body surface area < 0.7 m2)
Median duration of support
Longest time a child was
supported by the device
Larger Patients
(body surface area ≥ 0.7 m2
but < 1.5 m2)
Median duration of support
Longest time a child was
supported by the device
Berlin Heart
EXCORВ® Pediatric
ECMO
28 days
5 days
174 days
21 days
At 174 days, 88%
of patients had
been successfully
transplanted
At 21 days,
25% of patients
had died
Berlin Heart
EXCORВ® Pediatric
ECMO
43 days
5 days
192 days
28 days
At 192 days, 92%
of patients had
been successfully
transplanted
At 30 days,
33% of patients
had died
These data demonstrate that the Berlin Heart EXCORВ® Pediatric improves the
chances of survival for children of all ages as compared to ECMO support.
90%
Over the course of the study, which included
collaborating investigators from Harvard, Stanford
and other prestigious institutions, patients did
extremely well. In the primary cohort, more
than 90% of children were successfully bridged to
transplantation or recovery.
15
16
DEPARTMENT OF SURGERY
Department of Surgery Research Seed Grants
Texas Children’s Hospital recently issued $350,000 in surgical seed grant awards
to physicians in the Department of Surgery in order to fund the following
research projects.
Congenital Heart Surgery: Iki Adachi, M.D.
Ex Vivo Perfusion of Donor Lungs before Transplantation: Development of
“Pediatric-Specific System”
Donor lungs suitable for transplant are the rarest of all transplanted organs, and
organ shortage is most serious in small children. To expand the donor pool, ex
vivo lung perfusion (EVLP) has been developed, which can be used to assess and
even improve the function of marginal lungs prior to implantation. However,
systems are currently available only for adult lungs. This project seeks to develop
a pediatric-specific EVLP system for deployment in Texas Children’s Lung
Transplant Program. To date, Dr. Adachi has successfully developed a pediatric
EVLP system and tested its feasibility with lungs from infant pigs. He plans to
proceed to the preclinical trial phase, where the pediatric EVLP system will be
used for human donor lungs that have not been accepted by any programs and
thus are being discarded.
Neurosurgery: Andrew Jea, M.D.
Axonal Growth Stimulation by Carbon-Based Conductive Nanomaterials in Vitro
The main goal of this research seed grant is to determine the best electrical
stimulation window for primary cortical neuron cells. The focus is on preparation
of graphene-based biomaterials for tissue engineering following spinal cord
injury (SCI) and in vivo experiments using graphene-based biomaterials to
regenerate damaged tissue. Development of an automated computational image
analysis algorithm has begun, which will increase the efficiency of the quantitated
morphometric image analysis and remove the human element. Dr. Jea is also
moving forward in testing graphene in an in vivo spinal cord injury model.
Otolaryngology: Mary Frances Musso, D.O.
Magnetic Resonance Imaging in Children with Sleep Apnea
This research seed grant focuses on pediatric obstructive sleep apnea (OSA),
which can result in serious morbidity with associated growth problems,
pulmonary hypertension, systemic hypertension, cor pulmonale and
neuropsychological dysfunction. This study aims to characterize structural brain
DEPARTMENT OF SURGERY
changes in children with OSA in comparison to control children using MRI, study
the relation of MRI results and basic cognition and behavior and evaluate the
relation of MRI results to clinical polysomnography parameters. Preliminary
results demonstrate intermittent hypoxemia associated with OSA in children
alters brain morphology and is more pronounced in patients with severe OSA.
Currently no impairment of overall cognitive function has been noted.
Pediatric General Surgery: Eugene Kim, M.D.
GCSF: Friend or Foe in the Treatment of Neuroblastoma
Neuroblastoma is the most common abdominal solid tumor in children. It is a
highly aggressive malignancy with poor survival in children with high-risk disease,
the majority of whom succumb to tumor relapse. One potential candidate for
tumor recurrence is cancer stem cells, considered to be “super” cancer cells
which are resistant to chemotherapy and radiation and able to form whole new
tumors from a single cell. Dr. Kim, in collaboration with Jason Shohet, M.D., Ph.D.,
Chair of the Neuroblastoma Program at Texas Children’s Cancer Center, has
recently completed the identification, isolation and characterization of a novel
subpopulation of neuroblastoma that appear to act as cancer stem cells. This
subpopulation of cells exclusively expresses the receptor CD114, and future
efforts will be focused on targeting this cell population to inhibit tumor formation
and metastasis.
Pediatric General Surgery: Jed G. Nuchtern, M.D.
Genomic Anatomy of Chemotherapy-Resistant Neuroblastoma
Despite intensive multi-modality therapy, the 10-year survival rate for highrisk neuroblastoma patients is a disappointing 15 percent. Current efforts are
focused on developing novel therapeutic strategies to improve the prognosis of
higher-stage neuroblastoma patients. The goal of this research seed grant is to
interrogate the genome of tumor tissue to identify genetic/genomic changes that
are enriched in the tumor samples after induction therapy as a method to pinpoint
the mechanisms of chemotherapy resistance. Using laser capture microdissection,
Dr. Nuchtern is able to isolate neuroblasts before and after induction therapy and
identify genomic alterations in chemotherapy-resistant neuroblastoma tumor cells
using whole exome sequencing and array comparative genomic hybridization of
genomic DNA. Complete sets of genomic DNA have been collected from four
patients and are currently undergoing genomic analysis. In addition, the research
team continues to harvest genetic material from the remaining patients in our
tumor bank.
17
18
DEPARTMENT OF SURGERY
Pediatric General Surgery: Oluyinka Olutoye, M.D., Ph.D.
Effect of Fetal Anesthesia on the Developing Ovine Brain
The purpose of this study is to evaluate the effect of dose and duration of
anesthesia on brain cell death in the fetus. The results of the initial phase of the
study demonstrate that gestational age-dependent variability exists in the degree
of neuroapoptosis observed as part of the baseline brain development, and it
is most pronounced in the dentate gyrus. The fetal brains exposed to isoflurane
anesthesia in utero had a greater degree of neuroapoptosis most prominently
in the dentate gyrus of the hippocampus. These initial findings are encouraging
and serve as the basis for ongoing studies to assess the effect of anesthetic dose,
duration and gestational age on fetal neurotoxicity.
Pediatric General Surgery: Sanjeev Vasudevan, M.D.
The Role of DUSP26 in Neuroblastoma Tumor Growth and Chemosensitivity
The main goal of this research seed grant is to establish the protein
phosphatase, DUSP26, as an oncogene in neuroblastoma responsible for
tumor growth and chemoresistance. To date, Dr. Vasudevan has developed
multiple siRNA sequences against DUSP26 which successfully knock down
expression of DUSP26 in neuroblastoma cell lines. He has seen a significant
defect in proliferation both in vitro and in vivo in these cells, showing that
DUSP26 expression plays a critical role in neuroblastoma tumor growth. These
experiments thus far have established DUSP26 as an important oncogene
in neuroblastoma.
D E P A R T M E N T O F A N E S T H E S I O L O GY
Department of Anesthesiology
Last year, our team of highly skilled and experienced
pediatric anesthesiologists completed more than
35,000 cases, spanning the spectrum from simple
outpatient procedures to complicated, 12-hour-plus
surgeries. Our goal is to ensure each child has a safe, pain-free and stressfree experience, whether it is surgery in an operating room or a procedure or
test completed elsewhere in the hospital. This includes mobile, bedside sedation
in patients’ rooms, which can help reduce anxiety and stress during minor
surgical procedures. Additionally, five anesthesiologists worked as part of the
Cardiovascular Intensive Care Unit (CVICU) to provide specialized anesthesia
services for these complex patients.
Anesthesia for children and babies requires specifically designed and sized
equipment, and we utilize the very latest in technology, including advanced
monitors and near-infrared spectroscopy to measure brain oxygen levels during
complex cases.
The Department of Anesthesiology is committed to patient care, education and
research. We operate one of the leading fellowship programs in the United States,
providing training in general pediatric anesthesia and pediatric cardiovascular
anesthesia. Our active clinical and basic research programs are involved in more
than 20 projects.
19
20
D E P A R T M E N T O F A N E S T H E S I O L O GY
We are also dedicated to optimizing safety and surgical outcomes. On a national
level, the department participates in several pediatric anesthesia databases
that gather and evaluate outcomes data from across the nation to help identify
evidence-based protocols and best practices.
Within the hospital, our staff partners with surgeons, nurses and operating room
staff to provide the best possible surgical care for each child, including presurgical
briefings, constant communication during surgery and postoperative debriefing to
discuss ongoing care including pain management.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
The Department of Anesthesia coverage includes urgent, outpatient
and inpatient services in five locations at Texas Children’s Hospital
West Campus, including all four operating rooms and an outpatient
procedure room.
This year we implemented new state-of-the-art electronic anesthesia machines
throughout Texas Children’s Hospital. These machines enable us to deliver safe
and accurate anesthetic gas and ventilation to the smallest patients. Also, they
interface with our EPIC Anesthesia Electronic Medical Record for very detailed and
accurate recording of all the parameters for the anesthesia record. We are one of
the first pediatric anesthesia departments in the United States to have both EPIC
Anesthesia Electronic Medical Records (EMR) as well as state-of-the-art anesthesia
machines throughout the system in almost all of our locations.
With the opening of Texas Children’s Pavilion for Women, we added bedside
surgery coverage for babies who are too fragile to be moved to an operating room.
T h i s y ear
We became one of the first pediatric anesthesia programs
in the United States to completely computerize anesthesia
medical records. This comprehensive and accurate data
will help ensure the safest and most precise procedures
by immediately providing a patient’s detailed medical and
anesthesia history.
D E P A R T M E N T O F A N E S T H E S I O L O GY
Neurodevelopmental Outcomes
A multidisciplinary team from pediatric cardiovascular anesthesiology, congenital
heart surgery, pediatric cardiology, pediatric intensive care, pediatric radiology,
pediatric neurology and developmental pediatrics has enrolled a cohort of
97 neonates undergoing complex cardiac surgery for long term follow-up of
neurological events and neurodevelopmental outcomes.
Two major papers were written about this study and have been published in Annals
of Thoracic Surgery. The first3 won the J. Maxwell Chamberlain Award for the
best paper in Congenital Heart Surgery at the 2012 Society of Thoracic Surgeons’
Annual Meeting. This study found that the 20 patients with transposition of the
great arteries undergoing the arterial switch operation had a mean cognitive score
on the Bayley Scales of Infant Development III of 104.8 В± 15.0, significantly above
the reference population mean normal value. In addition, for the very first time,
these Texas Children’s Hospital investigators demonstrated an association between
preoperative MRI brain injury and later neurodevelopmental outcomes.
In the second paper4, the team demonstrated excellent cognitive outcomes at age
12 months in 35 patients undergoing a special cardiopulmonary bypass technique
with a protocol for brain monitoring developed by Dean B. Andropoulos, M.D.,
Charles D. Fraser, Jr., M.D., and E. Dean McKenzie, M.D., in the early 2000s. The
cognitive score on the Bayley Scales of Infant Development III was 100.1 В± 14.6
for this group, equal to the population norm.
In addition, the investigators demonstrated that longer duration of regional
cerebral perfusion was not associated with worse outcomes. This is the largest
outcome study ever published in regional cerebral perfusion patients.
It demonstrates the safety and efficacy of this technique and the
neuromonitoring protocol pioneered at Texas Children’s Hospital.
Andropoulos DB, Easley RB, Brady K, McKenzie ED, Heinle JS, Dickerson HA, Shekerdemian L,
Meador M, Eisenman C, Hunter JV, Turcich M, Voigt RG, Fraser CD Jr. Changing expectations for
neurological outcomes after the neonatal arterial switch operation. Ann Thorac Surg. 2012 Jun 28.
[Epub ahead of print]
3
Andropoulos DB, Easley RB, Brady K, McKenzie ED, Heinle JS, Dickerson HA, Shekerdemian LS,
Meador M, Eisenman C, Hunter JV, Turcich M, Voigt RG, Fraser CD Jr. Neurodevelopmental
outcomes after regional cerebral perfusion with neuromonitoring for neonatal aortic arch
reconstruction. Ann Thorac Surg. 2012 Jul 3. [Epub ahead of print]
4
21
D E P A R T M E N T O F A N E S T H E S I O L O GY
Magnetic resonance imaging (MRI) as a research tool to help determine the causes
of neurodevelopmental outcome problems in congenital heart disease.
A. Preoperative sagittal T1 weighted MRI of a 35-week gestational age infant with
hypoplastic left heart syndrome. White matter injury (WMI) is present in the
periventricular areas (arrows).
B. Preoperative axial proton-density T2 weighted image. Again note WMI (arrows).
C. Seven day postoperative T1 sagittal MRI after Norwood stage I palliation.
Note new intraparenchymal/intraventricular hemorrhage and infarction in the
left peritrigonal region (arrow).
D. Proton density T2-weighted image. Again note WMI and new hemorrhage.
This research has helped determine cardiopulmonary bypass, neuromonitoring,
and other techniques that result in improved neurodevelopmental outcomes at
age 12 months.
2009
2010
2011
* P ro j ected
Anesthesia case volumes include anesthesia administered by Texas Children’s
Hospital physicians at Texas Children’s Hospital locations.
36,643
35,210
2008
32,463
2007
30,757
28,366
D epartment of A nest h es i a C ases by Year
28,247
22
2012*
D E P A R T M E N T O F A N E S T H E S I O L O GY
2012
*
D epartment of A nest h es i a C ases by Location*
10
4
1,
WE S T C A M P U S
53
CON G E NI TA L H E A RT S U RG E RY
926
CLIN IC A L C A R E C E NTE R
1, 4 6 2
WE S T TO W E R
319
10 6
Anesthesia procedures in Texas Children's Hospital operating rooms
,9
20
7, 5 9 0
4
4
9, 7
31
75
18
3,
Sedation and anesthesia procedures in other Texas Children's Hospital areas
RA DIOLOGY
C A NC E R C E NTE R PATI ENT S U NDERGOING PROCEDU RES (PACU )
CA RDIAC CAT HET ERIZAT ION LA B S
GA ST ROINT EST INAL PROCEDU RE SU IT E
INT ENSIV E CARE U NIT S
M OB ILE SEDAT ION
* P ro j ected
23
24
D E P A R T M E N T O F A N E S T H E S I O L O GY
D ean B . A ndropoulos , M . D . , is Chief of Anesthesiology at
Texas Children’s Hospital and Professor of Anesthesiology and Pediatrics at
Baylor College of Medicine. He received his medical degree at the University of
California at San Diego. His residencies in Pediatric Medicine and Anesthesiology
were both at the University of California at San Francisco. In addition,
Dr. Andropoulos earned a Masters of Science degree in Healthcare Management
from the Harvard School of Public Health. His research focus is neurological
monitoring, protection and outcomes in
neonates undergoing complex open heart
surgery, for which he has received National
Institutes of Health (NIH) funding. He is the
editor of two major textbooks, Anesthesia
for Congenital Heart Disease, 2nd Edition; and
Gregory’s Pediatric Anesthesia, 5th Edition. He is
also co-principal investigator at Texas Children’s
Heart CenterВ® for the NIH-funded Pediatric
Heart Network Core Clinical Center.
CONGENITAL HEART SURGERY
Congenital Heart Surgery
The Congenital Heart Surgery Division provides
customized and comprehensive surgical care for all
aspects of pediatric and congenital heart disease.
Texas Children’s Heart Center performs nearly 800 surgical procedures annually
with outcomes among the best in the nation. Additionally, the Heart Center
is consistently ranked among the top pediatric cardiology and heart surgery
programs in the nation by U.S.News & World Report.
We treat children of all ages, including preterm and low-birth-weight newborns,
and we personalize treatments and procedures to best suit the situation of each
child and family. This tailored approach includes cardiopulmonary bypass and
neuroprotection strategies focused on the patient’s condition and needs, which
helps to achieve optimal outcomes.
25
26
CONGENITAL HEART SURGERY
Our highly specialized procedures include:
• Arterial switch procedure
• Atrial septal defect and ventricular septal defect closures
• Atrioventricular canal repair
• Cardiac valve repair/replacement
• Double-switch procedures
• Heart and lung transplantations and ventricular assist devices
• Hypoplastic left heart syndromes
• Repair of anomalous coronary artery
• Repair of Ebstein’s anomaly
• Single ventricle procedures
• Tetraology of Fallot repair
Our dedicated clinical team includes operating room nurses, nurse practitioners,
registered nurse first assists and nurse coordinators; surgical and perioperative
care technicians; perfusionists and perfusion assistants; and physician assistants.
Texas Children’s Heart, Lung and Heart-Lung Transplant Programs, among
the nation’s largest and most successful, are also part of the Congenital Heart
Surgery Division.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
For the convenience of our patients who live in the
west Houston area, the Congenital Heart Surgery
Division holds a monthly surgical consult clinic at
Texas Children’s Hospital West Campus.
CONGENITAL HEART SURGERY
A main area of focus continues to be the Pediatric Cardiac Bioengineering
Laboratory, a joint effort of Texas Children’s Hospital and Rice University led by
Jeffrey Jacot, Ph.D. Committed to developing innovative therapies that translate
into clinically relevant and beneficial solutions for our patients, this exciting field
of research holds great potential. Research is concentrated on investigating the
influences of biophysical cues such as stress, strain, shear, substrate stiffness and
electrical stimulation on the development and maturation of heart cells and
tissues. Dr. Jacot received a grant from the National Institutes of Health, with
K. Jane Grande-Allen, Ph.D., as the co-principal investigator, in order to organize
and run a symposium on Tissue Engineering for Pediatric Applications. This
symposium was held as a pre-conference workshop prior to the Tissue Engineering
and Regenerative Medicine International Society (TERMIS) in December 2011.
T HI S Y E A R
The Berlin Heart EXCORВ® Pediatric Ventricular Assist Device (VAD), the
only VAD designed specifically for use in children, received FDA approval.
Charles D. Fraser, Jr., M.D., Surgeon-in-Chief and Donovan Chair and Chief
of Congenital Heart Surgery, served as the national principal investigator for
the study leading to the approval and was invited to present the findings to
an FDA advisory panel. For more information on this groundbreaking trial,
please see page 13.
27
CONGENITAL HEART SURGERY
2009
2010
O P E R AT I N G RO O M C A S E S
2011
1,421
771
1,309
837
834
1,422
1,456
C on g en i tal Heart S ur g er y O perat i n g R oom
C ases and C l i n i c V i s i ts by Year
912
28
2012*
CLINIC VISITS
* P ro j ected
Total operating room volumes include heart and lung transplantations.
Operating room case volumes and clinic visits include procedures and outpatient
visits completed by Texas Children’s Hospital physicians at Texas Children’s
Hospital surgical locations.
CONGENITAL HEART SURGERY
M ortal i tes b y R A C H S - 1 C lass i f i cat i on in 2011
PRIMARY PROCEDURE
NUMBER OF
NUMBER OF
DISCHARGE
PROCEDURES MORTALITIES
%
MORTALITY
STS NATIONAL
BENCHMARK
Total for Risk Category 1
58
0
0.0%
0.6%
Total for Risk Category 2
233
2
0.9%
0.8%
Total for Risk Category 3
185
2
1.1%
3.4%
Total for Risk Category 4
44
2
4.5%
6.8%
Total for Risk Category 5-6
25
2
8.0%
15.5%
545
8
1.5%
3.0%
TOTAL
The Risk Adjustment in Congenital Heart Surgery (RACHS-1)5 categorization is a
widely used risk stratification model used to analyze outcomes in congenital heart
surgery. The most common surgeries for congenital heart defects are stratified
into six risk categories. Surgeries with higher risk are placed in higher categories
with category six representing congenital heart surgeries associated with the
greatest risk.
1.5%
Overall risk-adjusted hospital mortality rate for our
program in 2011 was 1.5%.6 Data collected by the
Society of Thoracic Surgeons (STS) shows the national
hospital discharge mortality rate at 3.0%.7
5
Jenkins, KJ, Gauvreau K, Newburger JW, et al., Consensus-based method for risk adjustment for
surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2002;123:110-8.
6
007-RACHS-1 Index Surg CHD Volume. Data pulled January 21, 2012.
7
Society of Thoracic Surgeons Data Harvest Report. January - December 2010.
29
30
CONGENITAL HEART SURGERY
O utcomes F ollow i n g A ort i c V alve R epa i r and
R eplacement i n C h i ldren
Surgical treatment of aortic valve (AV) diseases in childhood involves complex
decisions particularly in very small patients, and there is no consensus regarding
the optimum surgical option. The surgical outcomes for this disease at Texas
Children’s are among the best in the nation.
Total operations
97 AV repairs
188 AV replacements
68 autograft
74 homograft
36 mechanical
10 bioprosthetic
Median age at first operation
7 years (range: 1 day to 18 years)
Gender
Immediate failure of valve repair (within 24 hrs)
requiring replacement
Males = 154 (64%)
2 (2%) patients
Survival
98% for AV repairs
97% for AV replacements
Reoperations at last follow-up 8
17% for AV repairs
16% for AV replacements
Survival at last follow-up
97% for AV repairs
96% for AV replacements
Depictions of modes of aortic valve dysfunction that may be surgically
correctable including cusp restriction and prolapse.
8
Average follow-up time was 4 years (range: 8 days to 15 years).
CONGENITAL HEART SURGERY
In the setting of a subaortic ventricular septal defect, the associated
aortic valve cusp may be subject to distortion and prolapse related to
turbulent flow. The corresponding cusp elongation and prolapse may
progress to significant aortic valve incompetence.
In the setting of severe aortic valve cusp distortion, symmetric leaflet
reduction may be required as noted in this illustration. Subcommissural
sutures also aid in improving the zone of coaptation with adjacent cusps.
31
32
CONGENITAL HEART SURGERY
C h arles D . F raser , J r . , M . D . , is Surgeon-in-Chief and Chief
of the Division of Congenital Heart Surgery at Texas Children’s Hospital. His
academic appointments include Professor of Surgery in the Michael E. DeBakey
Department of Surgery (tenured) at Baylor College of Medicine, Professor of
Pediatrics at Baylor College of Medicine and Adjunct Professor of Bioengineering
at Rice University. Dr. Fraser holds the Susan V. Clayton Chair in Surgery at
Baylor College of Medicine and the Donovan Chair in Congenital Heart Surgery
at Texas Children’s Hospital. Dr. Fraser has a clinical appointment at the Texas
Heart Institute where he serves as Director of the Adult Congenital Heart
Surgery Program. Dr. Fraser’s extensive education began as an undergraduate
at the University of Texas at Austin, where he graduated with honors in
mathematics. He received his medical degree with honors from the University
of Texas Medical Branch at Galveston. His residency and fellowship training took
place at The John Hopkins Hospital. He completed additional fellowship training
in Congenital Heart Surgery at the Royal Children’s Hospital in Melbourne,
Australia. After joining the faculty at Cleveland Clinic, Dr. Fraser was recruited
to Texas Children’s Hospital in July of 1995 to
establish a dedicated pediatric congenital heart
surgery program. Since that time, he and his
team have performed corrective operations
in more than 10,000 children and adults with
congenital heart disease.
DENTAL
Dental
The Dental Division at Texas Children’s Hospital
performs more than 800 procedures each year
to ensure patients with special needs or complex
medical diagnoses receive the dental care they need.
Dental patients are treated as outpatients, inpatients or in the operating room.
With expertise in a full range of procedures, our team coordinates each patient’s
care with its pediatric subspecialists. Sometimes dental treatment, such as removal
of teeth or replacement of fillings, is needed before surgery or anesthesia can take
place or other health care needs can be addressed. Orthodontia is provided for
children with congenital craniofacial anomalies and/or cleft palates. In addition, we
ensure that the annual dental needs, such as prophylaxis or fillings, of children with
special needs are met.
33
DENTAL
We collaborate with the following surgical and medical subspecialties at
Texas Children’s Hospital to provide optimum care for patients, including
international patients:
• Nephrology
• Neurology
• Texas Children’s Heart Center
• Texas Children’s Cancer Center
M ult i d i sc i pl i nar y team
The Dental Division participates monthly in the multidisciplinary Craniofacial
Clinic to address genetic abnormalities of the face and head. This collaborative
effort brings together experts from dermatology, genetics, neurosurgery,
otolaryngology, plastic surgery, radiology and speech therapy.
D ental O perat i n g R oom C ases and C l i n i c V i s i t
2007
2008
O P E R AT I N G RO O M C A S E S
2009
2010
2011
2 , 354
804
847
2,472
2,596
778
2,559
810
759
2,593
2,758
by Year
748
34
2012*
CLINIC VISITS
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations. Clinic visits include outpatient visits by
Texas Children’s Hospital and Baylor College of Medicine faculty only.
DENTAL
A . B ruce C arter , D . D . S . , is Chief of the Dental Division and Dental
Clinic at Texas Children’s Hospital. He received his doctorate of Dental Surgery
at the University of Texas Health Science Center at Houston, where he also
received his Pedodontic Certificate. After a solo practice and teaching at his alma
mater, he joined Texas Children’s Hospital as the Dental Clinic Chief in 1984.
He is member of the American Board of Pediatric Dentistry Diplomats, the
Greater Houston Dental Society, the Texas
Dental Association, the American Dental
Association and the American Academy of
Pediatric Dentistry. In conjunction with a
grant from the National Institutes of Health,
Dr. Carter studied and published several
articles on the oral manifestations and health
of pediatric HIV patients.
35
36
N eurosur g er y
Neurosurgery
The Neurosurgery Division at Texas Children’s
Hospital, recently ranked 5th nationwide in
Neurology and Neurosurgery by U.S.News & World Report, is
one of the most active and experienced pediatric neurosurgery programs in the
nation. We complete more than 900 procedures each year to address a broad
range of neurological disorders in infants, children and young adults.
Our board-certified pediatric neurosurgeon-scientists provide surgical treatment
of neurological diseases including problems of the brain, spine and peripheral
nervous system. We are committed to discovering groundbreaking diagnosis
and treatment approaches and to training the next generation of expert
neurosurgeons.
N eurosur g er y
We take a multidisciplinary approach to care, working closely with Texas
Children’s Cancer Center, Texas Children’s Fetal Center, the Comprehensive
Epilepsy Program, neurology, adolescent medicine, developmental pediatrics,
interventional neuroradiology, otolaryngology, plastic surgery, physical medicine
and rehabilitation and urology.
Conditions treated and surgical procedures include:
• Congenital malformations of the brain and spine
• Craniofacial malformations
• Epilepsy
• Hydrocephalus
• Movement disorders
• Spinal deformities
• Tumors of the brain, spine and peripheral nerves
• Vascular malformations of the brain and spine
M ult i d i sc i pl i nar y team
Texas Children’s Hospital has developed extensive screening and diagnostic
algorithms for pregnancies with myelomeningocele (spina bifida). Spina bifida
occurs in three of every 10,000 live births in the United States, and the standard
of care is neurosurgical closure of the defect in the first days of life.
Earlier this year, the Neurosurgery Division worked closely with a multidisciplinary
team from Texas Children’s Fetal Center, pediatric general surgery, anesthesiology,
neonatology, radiology, cardiology and more to perform the hospital’s first in utero
surgery for treatment of spina bifida. The baby’s mother went into labor nearly
11 weeks after fetal closure and delievered by cesarean section. The surgery was a
success, and both mother and baby are doing well.
37
N eurosur g er y
2008
O P E R AT I N G RO O M C A S E S
2009
2010
2011
969
4,975
915
4,678
966
4,135
930
3,261
787
2,373
2007
5, 388
N eurosur g er y O perat i n g R oom C ases and
C l i n i c V i s i ts by Year
672
38
2012*
CLINIC VISITS
* P ro j ected
Operating room case volumes and clinic visits include procedures and outpatient
visits completed by Texas Children’s Hospital physicians at Texas Children’s
Hospital surgical locations.
T HI S Y E A R
The Neurosurgery Division continues to use real-time MRI-guided thermal
imaging and laser technology to destroy lesions in the brain that cause
epilepsy. This procedure is a safer and less invasive approach than craniotomy
for some patients, and it has a high rate of success in reducing or eliminating
seizures in patients ages 5 to 15. To date, the Neurosurgery Division has
completed 15 stereotactic laser ablation procedures, and all patients are
currently seizure free.
In collaboration with Rice University, the division is investigating
neuroregeneration, accomplished by growing neurons on nanomaterials, as a
treatment modality for chronic residual effects of spinal cord injuries. Funding
sources include the U.S. Army, the Neurosurgery Research and Education Fund
and Texas Children’s Hospital.
N eurosur g er y
T h omas G . L uerssen , M . D . , F . A . C . S . , F . A . A . P . , is Chief of
Neurosurgery and Chief Quality Officer Surgery at Texas Children’s Hospital.
He is also Professor of Neurological Surgery and Director of the Pediatric
Neurosurgery Program in the Department of Neurosurgery at Baylor College
of Medicine. Dr. Luerssen attended medical school at Indiana University and
completed his residency in Neurosurgery at Indiana University Medical Center.
He completed fellowship training at Children’s Hospital of Philadelphia and
then joined the faculty at the University of California San Diego. His clinical
and research focus was traumatic brain injury in childhood. Later, Dr. Luerssen
returned to Indiana University and spent 18 years as Director of the Pediatric
Neurosurgery Service at the James Whitcomb Riley Hospital for Children. In
2006, he was recruited to Texas Children’s Hospital to be Chief of Neurosurgery
and was named Chief Quality Officer Surgery in 2009. Dr. Luerssen is the past
Chairman of the Joint Section on Pediatric
Neurological Surgery of the American Association
of Neurological Surgeons and Congress of
Neurological Surgeons and past President of the
American Society of Pediatric Neurosurgeons.
He is currently Vice Chairman of the American
Board of Pediatric Neurological Surgery.
39
40
O p h t h almolo g y
Ophthalmology
The Ophthalmology Division at Texas Children’s
Hospital provides the highest-quality surgical care
for anomalies, disorders and injuries of the eyes.
Since its inception, the Ophthalmology Division has grown into one of the
premier pediatric ophthalmology surgery programs in the nation, with exceptional
expertise, depth and quality of services, and patient volumes.
We provide individualized treatment for a range of ophthalmology disorders,
including strabismus (mis-aligned eyes), retinopathy of prematurity, tear duct
obstruction, retinal detachment and genetic eye diseases, ptosis, retinoblastoma
and orbital tumors and other anomalies. The Ophthalmology Division is one of
the few programs in the nation with expertise in vitreoretinal surgery for children.
O p h t h almolo g y
Our division includes experts in:
• Cataracts
• Craniofacial abnormalities
• Glaucoma
• Inpatient ophthalmology
• Neuro-ophthalmic disorders
• Ophthalmologic plastic surgery
• Pediatric and adult strabismus
• Retinoblastoma
• Treatment of eye disorder in children with brain tumors
As one of only two programs in the United States to offer refractive surgery
(PRK laser) for children, we collaborate with Baylor College of Medicine to
achieve positive results with near-sightedness, far-sightedness and astigmatism.
Approximately 90 percent of our patients who have this procedure improve best
vision by at least two lines on the standard eye chart.
Over the past year, 11 articles were published in peer-reviewed publications,
and numerous presentations were made nationally and internationally. Our
physician-scientists are also breaking new ground in multiple areas of pediatric
ophthalmology research. Lingkun Kong, M.D., Ph.D., a post-doctoral fellow, was
involved in several studies published in major journals, including management
of strabismus in children with cataracts, childhood blindness, antibiotic therapy
in ureaplasma sepsis, placenta ureaplasma in high-risk neonates and retinopathy
of prematurity. Pending projects include investigation of levodopa for residual
amblyopia, hyperopia, amblyopia and development of an electrophysiology lab.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
Outpatient, inpatient and emergency surgical procedures are provided
at Texas Children’s Hospital West Campus, and clinic is conducted
each weekday.
41
O p h t h almolo g y
M ult i d i sc i pl i nar y team
We are members of the Retinoblastoma Center of Houston, a
multi-institution, multidisciplinary consortium dedicated to research
and innovative treatment to fight this dangerous cancer. The group
brings together experts in genetics, general surgery, ophthalmology
and oncology from several hospitals in the Texas Medical Center.
Additionally, we are part of the Neuro-oncology Team at Texas
Children’s Hospital, a multidisciplinary team of surgeons and medical
physicians with expertise in the management of complex cancers
that involve the central nervous system.В We also play an active role
on the Hearing Team at Texas Children’s Hospital, which provides
management of disorders that can result in hearing and vision
abnormalities in children.
TEXAS CHILDREN’S HOSPITAL
1,283
2011
2012*
1,218
65
2010
1,130
1,177
2009
47
2008
1,205
2007
1,105
1,139
O p h t h almolo g y O perat i n g R oom C ases by Year
1,039
42
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
O p h t h almolo g y
2,346
2010
2011
16,158
10,590
2,985 2,583
2,230
97
1,705
11,415
10,499
13,742
14,550
O p h t h almolo g y C l i n i c V i s i ts by Year
2012*
TEXAS CHILDREN’S HEALTH CENTERS
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
T HI S Y E A R
The Ophthalmology Division began performing the following procedures
this year:
situ dissection for strabismus, performed with topical anesthesia, which
allows precise titration of surgical dose with intraoperative patient feedback.
The technique facilitates surgical precision through minimized tissue
manipulation.
• In
• Periosteal
• Rectus
eye muscle transposition to treat nystagmus (shaking of the eye).
muscle posterior displacement for vertically incommitant strabismus.
43
44
O p h t h almolo g y
D av i d K . C oats , M . D . , is Chief of Ophthalmology at Texas Children’s
Hospital and Professor of Ophthalmology and Pediatrics at Baylor College
of Medicine. He received his medical degree from Texas Tech University
School of Medicine in 1987, followed by an internship in South Carolina and
residency at the Storm Eye Institute at the Medical University of South Carolina.
He completed a fellowship in Pediatric
Ophthalmology and Adult Strabismus at Indiana
University in Indianapolis, Indiana in 1994 and
joined the staff at Baylor College of Medicine in
1996. Dr. Coats is past Chair of the Ophthalmic
Knowledge and Assessment Program (OKAP),
on the Board of Directors of the Pan American
Association of Ophthalmologists and PresidentElect of the Texas Ophthalmologic Association.
O rt h opaed i cs
Orthopaedics
The Orthopaedics Division at Texas Children’s
Hospital has extensive expertise in treatment of all
types of bone, neuromuscular and spine disorders
and injuries.
Consistently ranked by U.S.News & World Report as a leading orthopaedic center
for children, we treat a variety of orthopaedic injuries and conditions, from
minor fractures to complex problems. More than 40 percent of the surgical
procedures completed in Texas Children’s Level 1 Trauma Center in 2011 were
orthopaedic-related.
45
46
O rt h opaed i cs
Our surgical expertise includes advanced approaches to:
• Back problems including scoliosis, kyphosis, spondylolisthesis and
spondylolysis
• Benign and malignant bone tumors
• Congenital deformities such as clubfoot
• Fractures, dislocations and residual effects of trauma such as malunion
and growth arrest
• Hip problems including developmental dysplasia of the hip (DDH),
slipped capital femoral epiphysis (SCFE), Legg-Calves-Perthes disease and
femoro-acetabular impingement (FAI)
• Leg-length inequality and other limb alignment problems such as
bow legs (Blount’s disease)
• Metabolic bone disease
• Neuromuscular disorders including cerebral palsy, myelomeningocele
(spina bifida), Duchenne and other muscular dystrophies
• Skeletal dysplasias
• Sports injuries including knee ligament and meniscus problems and
patella-femoral problems
Our surgeons work closely with experienced mid-level providers in order to
provide the highest level of patient care in the clinic and operating rooms. These
mid-level providers receive six months of pediatric-fracture-specific training at
Texas Children’s and are closely supervised by Orthopaedic Division faculty.
Additionally, a high-tech digital imaging system allows instant consultation with a
physician when needed. Our comprehensive support team also includes physical
and occupational therapists, cast technicians, social workers and child
life specialists.
Working in close concert with the recently established Texas Children’s Surgical
Outcomes Center, the Orthopaedic Division is currently monitoring outcomes
and procedures for supracondylar humerus fractures and spinal surgery in order
to analyze patient outcomes and improve our already high standard of treatment.
O rt h opaed i cs
The Orthopaedics Division’s specialized clinics include:
• Sports Medicine Program: Provides diagnosis, evaluation and treatment for
pediatric and young adult athletic-related injuries and conditions.
• Fracture Clinic: Our physicians partner closely with highly trained mid-level
providers to repair more than 120 broken bones each week.
• Adolescent and Young Adult Hip Clinic: The only one of its kind in the
region, this clinic focuses on diagnosis and treatment of hip conditions that
can lead to pain, disability and early onset arthritis.
• Scoliosis Clinic: Highly specialized surgeons perform procedures to correct
this skeletal deformity.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
The Orthopaedics Division, which currently operates the busiest
outpatient surgery clinic at Texas Children’s Hospital West Campus,
provides both inpatient and emergency surgery coverage.
M ult i d i sc i pl i nar y team
The Orthopaedic Division participates in several multidisciplinary clinics, including:
• Orthopaedic infection clinic with infectious disease
• Skeletal dysplasia clinic with genetics
• Spina bifida clinic with neurosurgery, pediatric general surgery and
physical medicine
• Spasticity clinic with neurology and physical medicine
47
O rt h opaed i cs
TEXAS CHILDREN’S HOSPITAL
2 ,182
356
1,826
2,093
2010
1,998
2009
95
2008
1,844
2007
1,918
1,803
O rt h opaed i c S O perat i n g R oom C ases by Year
1,601
48
2011
2012*
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
O rt h opaed i cs
21,883
4,260
4,650
3,649
3,792
131
6,998
10,235
19,417
11,508
12,429
16,352
O rt h opaed i c S C L I N I C V I S I T S by Year
2010
2011
2012*
TEXAS CHILDREN’S HEALTH CENTERS
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
W i ll i am A . P h i ll i ps , M . D . , Chief of Orthopaedics at Texas Children’s
Hospital and Professor of Orthopaedic Surgery and Pediatrics at Baylor College of
Medicine. He graduated from Notre Dame and received his medical degree from
the University of Chicago Pritzker School of Medicine. Dr. Phillips is a member of
the American Academy of Orthopaedic Surgeons (Fellow), American Academy of
Pediatrics (Fellow), American Orthopaedic Association, Scoliosis Research Society
(Fellow), Pediatric Orthopaedic Society of North
America and the American College of Surgeons.
Dr. Phillips travels around the country lecturing on
back problems in children and other orthopaedic
issues to primary care physicians.
49
50
O T O L A R Y N G O L O GY
Otolaryngology
The Otolaryngology Division at Texas Children’s
Hospital provides advanced surgical and medical
care for the entire spectrum of ear, nose, throat, and
head and neck diseases and disorders. In addition to complex
procedures, the fellowship-trained physicians in the division complete a high
number of more common surgeries such as tonsillectomies and insertion of ear
tubes. Over half of surgeries done each year are to address these
routine problems.
O T O L A R Y N G O L O GY
Surgical focus also includes:
• Airway reconstruction
• Chronic ear diseases and hearing loss
• Cleft lip and cleft palate
• Congenital and acquired diseases of the aerodigestive tract
• Cochlear implantation
• Disorders of the ears, tonsils and adenoids
• Genetic syndromes and malformations of the head, neck and airway
• Head and neck masses, congenital and acquired
• Sinus and nose disease
• Sleep apnea
State-of-the-art audiology and speech diagnostic and therapeutic services are
also offered.
To advance the diagnosis and treatment of children and babies with disorders of
the ear, nose or throat, our physicians are involved in research projects concerning
hearing, cochlear implantation, sleep apnea, neck masses and vocal fold mobility.
In addition, we are participating in a National Institutes of Health (NIH) grant
to study cochlear implants in children with multiple disabilities as well as a Texas
Children’s Hospital-funded study of sleep apnea in children.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
The Otolaryngology Division provides comprehensive inpatient and
outpatient coverage at Texas Children’s Hospital West Campus.
51
52
O T O L A R Y N G O L O GY
M ult i d i sc i pl i nar y team
The Otolaryngology Division participates in a number of multidisciplinary clinics
to address specific disorders. These include:
• Cochlear Implant Program: Specialists from otolaryngology; speech,
language and learning; audiology; neurology; psychology; and social work
evaluate children with profound sensorineural hearing loss and perform
surgical cochlear implantation when appropriate.
• Aerodigestive Disease Clinic: A team approach for complex patients
with breathing, swallowing and eating issues, this clinic brings together
physicians from gastroenterology, otolaryngology and pulmonary medicine.
• Voice and Swallowing Clinic: This clinic utilizes a collaborative approach
to evaluation, diagnosis and treatment of disorders in swallowing and
vocalization. Other team members include specialists from audiology,
speech, language and learning.
• Down Syndrome Clinic: We work with the Meyer Center for Developmental
Pediatrics to address otolaryngology issues such as sinus disease, hearing
problems and sleep apnea, which are often part of this complex
congenital disorder.
We also provide otolaryngologic services to the Cleft Lip and Palate Team
at Shriner’s Hospital for Children in Houston, Texas. This includes long-term
comprehensive care of children with craniofacial anomalies who typically have
an increased prevalence of ear and upper airway problems.
T h i s y ear
The Otolaryngology Division established the Aerodigestive Disease Clinic
in 2011 and added the first laryngologist to practice at Texas Children’s
Hospital, one of only three pediatric fellowship-trained voice specialists in
the nation. We also began offering laryngeal stroboscopy, an innovative way
of looking at vibratory characteristics of the vocal chord.
O T O L A R Y N G O L O GY
2007
2008
2009
TEXAS CHILDREN’S HOSPITAL
9,838
8,024
8,397
2010
2011
1,814
890
7,507
8,329
7,521
6,494
6,818
O tolar y n g olo g y O perat i n g R oom C ases by Year
2012*
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
53
O T O L A R Y N G O L O GY
19,715
11,709
15,239
2010
2011
3,686
4,320
9,829
2,787 2,623
564
11,214
14,562
O tolar y n g olo g y C l i n i c V i s i ts by Year
2,784
54
2012*
TEXAS CHILDREN’S HEALTH CENTERS
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
E llen F r i edman , M . D . Since 1991, she has served as Chief of
Otolaryngology at Texas Children’s Hospital and since 2009, has held the
Bobby Alford Department Chair in Pediatric Otolaryngology at Baylor College
of Medicine. Prior to that, she had hospital appointments at The Children’s
Hospital and Harvard Medical School. Dr. Friedman is on the editorial boards
ofВ a number of professional journals and has been president of the American
Broncho-Esophagological Association and the American Society of Pediatric
Otolaryngology. She is currently serving as Director of the American Board of
Otolaryngology - Head and Neck Surgery, is a representative for Otolaryngology
for the Residency Review Committee, is
on the Advisory council for the American
College of Surgeons and is President of the
Medical Staff at Texas Children’s Hospital.
Among many professional honors, she was
named theВ 2010В recipient of the Arnold P.
Gold Foundation Award for Humanism in
Medicine,В which honorsВ compassion and empathy
in the delivery of patient care. Just recently,
Dr. Friedman was recognized by the Baylor
College of Medicine Academy of Distinguished
Educators with the Fulbright and Jaworski Faculty
Excellence Award in Teaching and Evaluation.
P ed i atr i c and A dolescent G y necolo g y
Pediatric and Adolescent Gynecology
One of the few established programs for surgical
treatment of pediatric and adolescent gynecologic
disorders in the United States and the only such
program in Texas, the Pediatric and Adolescent Gynecology Division at
Texas Children’s Hospital is committed to providing the highest level of clinical
care, research and education.
Part of the Obstetrics and Gynecology Department at Baylor College of
Medicine and Texas Children’s Hospital, we offer personalized treatment for
common and rare gynecological problems in patients ranging from newborns to
21 years old. Specialties include vaginal trauma, congenital anomalies and adnexal
cysts or masses.
55
56
P ed i atr i c and A dolescent G y necolo g y
Our fellowship-trained physicians have expertise in a wide range of routine
and highly complex medical and surgical procedures, both laparoscopic and
reconstructive, including:
• Chronic conditions such as endometriosis
• Common gynecologic conditions including ovarian or tubal masses
and trauma
• Congenital anomalies of the cervix, vagina, uterus and external genitalia
• Gynecologic care for chronically ill girls and adolescents
• Puberty and menstruation issues
As an international referral center, the Pediatric and Adolescent Gynecology
Division treats a large population of young women with congenital anomalies of
the Mullerian ducts, which result in malformation of the uterus and/or vagina.
Depending on the disorder, surgical and nonsurgical treatments as well as
counseling are offered to help patients and their families cope with the diagnosis
and possible future fertility issues.
We operate one of the few fellowship programs in the United States and Canada
for pediatric and adolescent gynecology. Committed to improving the lives of
children through research, we have published 29 articles in peer-reviewed journals,
written six book chapters and presented 32 abstracts in the past five years.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
Our team of physicians provides a full range of outpatient services at
Texas Children’s Hospital West Campus.
P ed i atr i c and A dolescent G y necolo g y
M ult i d i sc i pl i nar y team
Surgeons from the Pediatric and Adolescent Gynecology Division
recently partnered with their colleagues in pediatric general surgery
and urology in a complex, 13-hour procedure to correct a posterior
cloaca, an extremely rare anorectal malformation. It was the first
procedure of its kind at Texas Children’s Hospital.
Team members participate in multidisciplinary subspecialty clinics, including:
• Gender Medicine Team: A collaboration with experts from several areas
including endocrinology, genetics, psychology and urology to address
disorders of sexual development in an ethical framework.
• Anorectal Malformation Clinic: This team of experts, which includes
surgeons from general pediatric surgery and urology, performs complex
procedures to correct congenital anomalies in which the anus and rectum
do not develop properly.
• Young Women’s Bleeding Disorders Clinic: In partnership with Texas Children’s
Hematology Center, this is one of the few programs in the nation to offer
“one-stop” care for gynecologic, hematologic and psychosocial issues for
teenagers with menorrhagia and bleeding disorders.
T h i s y ear
Over the past year, the Pediatric and Adolescent Gynecology
Division increased physician coverage at Texas Children’s Hospital
West Campus and participated in more than 25 ongoing research
projects. These include investigation of low-dose subcutaneous
depot medroxyprogesterone acetate injections or hormonal
implants in adolescents, outcomes of office management of lichen
sclerosus, and clinical and surgical outcomes in pediatric and
adolescent gynecology.
57
58
P ed i atr i c and A dolescent G y necolo g y
Adnexal Torsion Outcomes
Adnexal torsion (AT) is the fifth most common gynecologic emergency. Clinical
symptoms are the most important indicators and delaying diagnosis could
compromise ovarian function. Recently the Pediatric and Adolescent Gynecology
Division completed a study9 to determine the association between use of
emergency room (ER) pain medications and AT and which clinical and sonographic
characteristics correlated with AT.
Total surgical cases
75 from the abdominal pain cohort (N=302)
underwent surgery for presumptive AT
70.9% nausea/vomiting
11.3% fever
64.1% leukocytosis
Overall incidence
18.2% (N=55)
Mean age
11.7 years (В±3.05)
Mean ovarian size
Route of pain medicine
6.02 cm (В±2.02)
There was no statistically significant difference
in the incidence of AT (p=0.835) based on
the route (IV versus oral) of pain medication
Patients that received IV morphine were
more likely to have AT (p=<0.001)
Cases with fallopian tube torsion
without ovarian torsion
Cases of ovarian torsion with
asymmetric ovaries and/or
abnormal Doppler flow on
ultrasound
Salvage rate
10
90% containing a
paratubal/paraovarian cyst
100%
23% had peripherally-placed follicles
Cases with abnormal ovarian Doppler
flow on ultrasound were more likely
to have ovarian torsion rather than
fallopian tube torsion (p=<0.001)
92.7%
Santos, XM, Sokkary, N, Bercaw-Pratt, JL, Dietrich, JE. Association between use of pain medication,
ultrasound findings and adnexal torsion among young females presenting with acute abdominal pain.
Journal of Pediatric and Adolescent Gynecology, Vol. 24, No. 2. April 2011, pp. e59.
9
P ed i atr i c and A dolescent G y necolo g y
C onclus i ons
The clinical presentation for cases of AT can mimic other surgical and
nonsurgical causes of acute abdominal pain.
The requirement of IV morphine for pain management in cases of
abdominal pain with abnormal adnexa on ultrasound should raise the
suspicion for AT.
In cases of acute AP with sonographic findings of paraovarian/
paratubal cyst, the presence of normal ovaries on ultrasound does not
exclude the diagnosis of AT.
TORSION OVARY
TORSION FALLOPIAN TUBE ADNEXA
Following this study, the Pediatric and Adolescent Gynecology Division
completed an additional study10 to examine the postoperative course and
outcome of young females treated with detorsion (DT) of torsed adnexa alone
with or without cystectomy as treatment for ovarian torsion. A secondary
objective was to determine which operative findings correlated with higher
follicular counts following DT.
10
Santos, XM, Sokkary, N, Cass, DL, Dietrich, JE. Outcome following detorsion (DT) of torsed adnexa
in children. Fertility and Sterility, Volume 96, Issue 3, Supplement, Page S92. September 2011.
59
60
P ed i atr i c and A dolescent G y necolo g y
Total surgical cases
29
72.4% dusky/purple
3.4% necrotic
3.4% normal
20.7% not described
Mean age at menarche
11.1 years (В±0.79)
Mean duration of abdominal pain
on presentation
77.5 hours (В±78.8)
Menstrual function
100% resumed
Reoperation for removal of the salvaged ovary
0%
Instances of postoperative fever or
concern for ovarian venous thrombosis
0%
Average time of follow-up ultrasound
8.1 months (В±6.7)
Presence of ovarian follicles on the
28 patients (96.6%)
affected side following detorsion
Mean of 4.6В±1.9 and 4.7В±3.3 follicles
for right and left ovary, respectively
No correlation was found between the
side affected or gross appearance of
the torsed ovary and the number of
follicles found on follow-up ultrasound
C onclus i ons
DT alone with or without cystectomy is a safe and effective treatment,
and it should be considered the primary treatment for girls with
ovarian torsion, even for those with ovaries that appear non-salvageable.
188
187
2010
2011
114
146
177
P ed i atr i c and A dolescent G y necolo g y
O perat i n g R oom C ases by Year
237
P ed i atr i c and A dolescent G y necolo g y
2007
2008
2009
2012*
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
4,331
4,339
145
2010
2011
587 591
4,036
158
3,368
5, 509
P ed i atr i c and A dolescent G y necolo g y
C l i n i c V i s i ts by Year
2012*
TEXAS CHILDREN’S HEALTH CENTERS
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
61
62
P ed i atr i c and A dolescent G y necolo g y
J enn i fer E . D i etr i c h , M . D . , M . S c . , is Chief of Pediatric and
Adolescent Gynecology at Texas Children’s Hospital and Assistant Professor in
the Department of Obstetrics and Gynecology and the Department of Pediatrics
at Baylor College of Medicine.В She is also Division Director of Pediatric and
Adolescent Gynecology, the Fellowship Director for Pediatric and Adolescent
Gynecology and the CME Director for the Department of Obstetrics and
Gynecology at Baylor College of Medicine. She
obtained her medical degree from the Medical
College of Wisconsin in Milwaukee, Wisconsin
andВ completed her residency in Obstetrics and
Gynecology at Baylor College of Medicine. She
went on to complete fellowship training in Pediatric
and Adolescent Gynecology at the University
of Louisville in Louisville, Kentucky. During her
fellowship, she also obtained a Masters in Public
Health and Clinical Investigation. Dr. Dietrich is
currently on the editorial board of the Journal of
Pediatric and Adolescent Gynecology.
P ed i atr i c General S ur g er y
Pediatric General Surgery
The Pediatric General Surgery Division at Texas
Children’s Hospital has the depth of expertise and
specialization to provide optimal care across the
surgical spectrum – from the most routine cases to those that are rare
and complex. Each child receives personalized care from the physician most suited
to the case, ensuring the best possible outcomes.
63
64
P ed i atr i c General S ur g er y
The range of surgical procedures performed by the division include:
• Abdominal and thoracic surgery
• Fetal surgery
• Minimally invasive surgery, including laparoscopic and thorascoscopic
diagnosis and treatment
• Oncologic surgery
• Surgery to treat congenital disorders and malformations
• Trauma and critical care
In addition, specialized care is offered in the areas of:
• Adolescent metabolic (bariatric) surgery
• Anorectal malformation/colorectal disease
• Chest wall deformity repair (pectus excavatum)
• Endocrine and biliary surgery
• Surgery to treat congenital disorders and malformations
• Inflammatory bowel disease
Our research programs are supported by the National Institutes of Health (NIH),
Cancer Prevention Research Institute of Texas (CPRIT), private foundations,
Texas Children’s Hospital and Baylor College of Medicine. Current basic research
includes fetal wound healing and molecular oncology; clinical research includes
cancer therapies, necrotizing enterocolitis, morbid obesity and biliary atresia.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
The Pediatric General Surgery Division provides full coverage at
Texas Children’s Hospital West Campus, including daily clinics
and elective surgeries as well as extended hours for emergency
procedures seven days per week.
P ed i atr i c General S ur g er y
M ult i d i sc i pl i nar y team
The Pediatric General Surgery Division collaborates with numerous surgical
divisions at Texas Children’s Hospital and supports and enhances the hospital’s
medical subspecialties. Working closely with Texas Children’s Cancer Center, the
division addresses the complex surgical care of children with cancer and has one
of the few dedicated pediatric surgical oncology teams in the nation.
As part of a surgical oncology team, specialists in the Pediatric General Surgery
Division recently performed a successful procedure to remove a hepatoblastoma
in an 11-week-old baby. Hepatoblastoma is an exceedingly rare malignant tumor,
and only 150 cases are diagnosed in the nation each year. The tumor, which was
the size of grapefruit, was removed intact with minimal damage to the patient’s
liver. Doctors say the child has an excellent prognosis.
T h i s y ear
The opening of Texas Children’s Pavilion for Women, which has the latest
innovative technology including 3D and 4D ultrasound, PET, PET/MRI and
fetal echocardiograms, has expanded the Pediatric General Surgery Division’s
capabilities to perform delicate in utero surgical procedures.
This year, in collaboration with Texas Children’s Fetal Center, the division:
• Performed
the region’s first two successful in utero fetal interventions
to treat severe congenital diaphragmatic hernia (CDH) with endoscopic
tracheal occlusion.
• Launched
the first fetal interventional program in Texas to treat hypoplastic
left heart syndrome (HLHS).
• Completed
the first successful fetal surgery to treat spina bifida at
Texas Children’s Hospital.
65
66
P ed i atr i c General S ur g er y
Neuroblastoma Outcomes
Jed G. Nuchtern, M.D., Chief of Pediatric General Surgery and Pediatric Surgeon
within Texas Children’s Cancer Center, reported the findings of a 10-year
national study that found babies younger than 6 months old with small, isolated
neuroblastoma tumors excel in overall progress and survival when the tumor is
monitored without surgical resection. Results of the study were presented at the
American Surgical Association’s annual meeting in April 2012.
Eighty-three babies were followed carefully for at least 15 months. Sixteen had
surgery due to staging changes. The three-year overall survival for the 83 babies
was 100 percent with median follow-up now of three years. Overall,
81 percent of the babies on the observation arm were spared the
need for surgery.
The investigators are planning an expanded study to include patients who are
1 year old at diagnosis and have larger neuroblastoma tumors.
P ed i atr i c General S ur g er y
Adolescent Bariatric Surgery Outcomes
The Adolescent Bariatric Surgery Program (ABSP), a component of the Pediatric
General Surgery Division, has been performing the laparoscopic Roux-en-Y
Gastric Bypass since 2004 to alleviate the effects of life-threatening co-morbidities
associated with morbid obesity. The ABSP multidisplinary team includes a surgeon,
nurse, psychologist, and dietitian and evaluates each patient for a minimal period
of six months to ensure the patient’s readiness for surgery and commitment to
lifestyle change. Post-surgery, patients are extensively followed and evaluated by
the ABSP team to promote adherence to lifestyles changes. The outcomes of the
procedure from January 2011 through August 2012 are provided below.
O P E R A T I V E D A T A 11
Number of cases
20 (13 female, 7 male)
Average pre-operative body mass index
Average age
Average length of stay12
52.7 kg/m2
16.3 years
4.3 days
30 day complications13
Reoperation-abdominal Sepsis
Ateletasis
Marginal ulcer
Pancreatitis
4
1
1
1
1
P O S T - O P E R A T I V E D A T A 14
Number of patients
Average pre-operative body mass index
52.9 kg/m2
Average body mass index (1 year post-operative)
36.2 kg/m2
Average weight lost
Average percent excess weight loss
11
18
42.3 kg
62.8%
Operative data from January 2011 – August 2012
One case involved a re-operation and a total length of stay of 15 days. Excluding this case, the
average length of stay was 3.7 days.
12
13
Reoperation and ateletasis occurred in the same patient
14
One year postoperative follow-up occurred from January 2011 - August 2012
67
P ed i atr i c General S ur g er y
Monotherapy Antibiotic Initiative for Appendicitis
Over the past year, the Surgical Outcomes Center and the Pediatric General
Surgery Division have worked to standardize, monitor and improve the care of
our patients with appendicitis through the use of real-time data that monitors
patient volumes and outcomes simultaneously.
The first initiative was to improveВ the utilization of antibiotic monotherapy
(ZosynВ®) for children undergoing an appendectomy for appendicitis by 50 percent
since data has shown that many of the organisms cultured at the time of surgery
were resistant to the current antibiotic regimens. As of July 2012, the Surgical
Outcomes Center has more than 95 percent compliance with our outcome
measures and no patients have developed resistance to Zosyn. Additionally, only
three patients out of the 500 treated have developed neutropenia (a potential
side effect) related to its administration.
* P ro j ected
2009
2010
1,012
2008
928
870
2007
840
1,250
T otal A ppendectom y P at i ents by Year
948
68
2011
2012*
P ed i atr i c General S ur g er y
SEPT
AUG
94%
OCT
95%
94%
88%
93%
JUL
MAY
APR
2012
JUN
90%
83%
79%
MAR
FEB
JAN
46%
90%
P at i ents R ece i v i n g M onot h erap y A nt i b i ot i c b y
M ont h of D i sc h ar g e in 2012
P ed i atr i c General S ur g er y O perat i n g R oom C ases
5, 567
11
432
4,785
2011
771
5,255
2010
4,823
5,330
5,637
5,969
6,609
by Year
2007
2008
2009
2012*
TEXAS CHILDREN’S PAVILION FOR WOMEN
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
69
P ed i atr i c General S ur g er y
11, 300
7,818
10,613
7,819
1,923 1,559
996
1,798
379
8,231
10,682
P ed i atr i c General S ur g er y C l i n i c V i s i ts by Year
2,072
70
2010
2011
2012*
TEXAS CHILDREN’S HEALTH CENTERS
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
P ed i atr i c General S ur g er y
J ed G . N uc h tern , M . D . , is Chief of Pediatric General Surgery at Texas
Children’s Hospital and Professor of Surgery and Pediatrics at Baylor College
of Medicine. He is also Director of the Pediatric Surgery Residency Program at
Baylor College of Medicine.В A graduate of Princeton University, Dr. Nuchtern
received his medical degreeВ from Harvard Medical School.В He completed his
General Surgery training at the University of Washington and a research fellowship
at the National Institutes of Health.В He received
advanced training in Pediatric Surgery at Baylor
College of Medicine.В In addition to a clinical focus
on surgical oncology and general pediatric surgery,
Dr. Nuchtern conducts a basic research program
that focuses on molecular target discovery in
neuroblastoma, a pediatric cancer. Dr. Nuchtern
is a fellow of the American Academy of Pediatrics
and the American College of Surgeons.В He is
a member of the ACS Commission on Cancer
and the Children’s Oncology Group, national
consortia of pediatric oncology clinicians and
research professionals.
71
72
P L A S T I C S ur g er y
Plastic Surgery
The Plastic Surgery Division at Texas Children’s
Hospital specializes in surgical treatment of injuries
or disorders that prevent children from functioning
fully or looking and feeling their best. We provide
comprehensive care to pediatric patients with complex surgical needs.
The team includes orthodontists, with whom we collaborate on surgical
treatment and orthodontia for children with congenital craniofacial anomalies
and/or cleft palate.
P L A S T I C S ur g er y
Our highly specialized procedures include:
• Aesthetic procedures, including reconstructive chest wall surgery; breast
reduction; birthmark, lesion and mole removal; rhinoplasty; and otoplasty
• Brachial nerve injury
• Cleft lip and cleft palate repair
• Craniofacial anomalies
• Hand surgery and microsurgical reconstruction
• Microvascular surgery for complex wounds from burns, orthopaedic injuries,
amputation or replantation of extremities; nerve and muscle transplantation
for facial nerve paralysis; or severe injury leading to tissue loss
• Traumatic injuries, including burn scar repair, tumor excision, tissue
replacement, scar tissue, deformities, skin infections and IV
infiltration wounds
Our innovative surgical techniques and therapy in the treatment of cleft lip and
cleft palate draw patients from across the nation with deformities ranging from
mildly disfiguring to extremely complex. We perform more than 400 cleft lip and
cleft palate procedures each year.
As leaders in the use of specialized surgeries, appliances and materials such as
resorbing plates and bone-mimicking adhesives, we are able to effectively treat
congenital craniofacial disorders or problems caused by injury, including facial
nerve paralysis. Our use of distraction osteogenesis to correct jaw injuries or
facial development issues decreases swelling and blood loss while avoiding wires,
bone harvesting or blood transfusion.
Dedicated to improving the lives of children through groundbreaking research,
our physicians have been instrumental in several clinical landmarks, including the
first use of tissue expanders to separate conjoined twins and the first parent-tochild nerve transplant. They are members of several international groups and
associations, including the medical advisory board of SmileTrainВ®.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
During the coming year, the Plastic Surgery Division
will expand clinic, operating room and Emergency
Center coverage at Texas Children’s Hospital
West Campus.
73
P L A S T I C S ur g er y
M ult i d i sc i pl i nar y team
Drawing upon the specialized expertise of recent recruits, we collaborate with
neurosurgery in the weekly multispecialty Craniofacial Clinic. Our role includes
plastic surgery repair of craniosynostosis, a complex surgery that involves cranial
remodeling and reshaping of bones to make the head shape more normal.
T h i s y ear
The Plastic Surgery Division has recently:
• Begun
performing orthognathic surgery, a specialized procedure to help
correct the misalignment of the upper and lower jaws in certain types of
cleft palate disorders.
• Established
a Plastic Surgery fellowship training program.
• Published
20 peer-reviewed articles and continued participation in
numerous research projects. Several of these have the potential to change
clinical practice in areas including resorbable plates for fracture fixation,
mandibular fracture fixation and craniosynostosis surgery.
2008
2009
TEXAS CHILDREN’S HOSPITAL
1,080
1,068
791
2010
12
2007
11
780
848
954
1,034
P last i c S ur g er y O perat i n g R oom C ases by Year
981
74
2011
2012*
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
P L A S T I C S ur g er y
4,152
4,104
48
2,963
3,635
P last i c S ur g er y C l i n i c V i s i ts by Year
2010
TEXAS CHILDREN’S HOSPITAL
2011
2012*
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
Plastic Surgery Outcomes
The Plastic Surgery Division participates in the Americleft Outcomes Project, a
multi-institutional project in North America involving major children’s hospitals,
centered on improving speech outcomes for children with cleft lip and cleft palate.
Other clinical outcome studies that are currently in progress with respect to cleft
and craniofacial patients include adverse events, patient and parent satisfaction,
revision rates, psychological well-being, and fistula rates. We look forward to
sharing data from these initiatives in subsequent versions of our annual report.
75
76
P L A S T I C S ur g er y
In memor i am
The Department of Surgery is deeply
saddened to share that Samuel Stal,
M.D., passed away in August 2012. A
renowned pediatric plastic surgeon,
Dr. Stal came to Texas Children’s
Hospital in 1984 following his postgraduate training in General Surgery
and Otolaryngology at the University of
Illinois and his Plastic Surgery residency
at Baylor College of Medicine. Dr. Stal became Chief of Plastic Surgery in 1987,
a position he held until his passing.
Dr. Stal was one of the only surgeons in his field to dedicate his entire career to
the treatment of children with cleft lip/cleft palate and other craniofacial birth
defects. In addition to performing thousands of life-altering surgeries on children
in the United States and recruiting top plastic surgeons and specialists to Texas
Children’s Hospital, he was instrumental in bringing much-needed plastic surgery
services abroad. Most recently, he traveled to Haiti where he operated for a
week in very difficult conditions following the devastating earthquake.
Dr. Stal’s leading surgical techniques, innovative practices and proven results
earned him frequent recognition, including being named among America’s Best
Plastic Surgeons, The Best Doctors in America and Houston’s Top Doctors. He
was a founding member and former president of the Rhinoplasty Society, an
elite group of surgeons specializing in rhinoplasty, and a founding member of the
famed Dallas Rhinoplasty Course, one of the premier teaching courses of its kind
in the world.
L arr y H . Holl i er , J r . , M . D . , F . A . C . S . , is Interim Chief of
Plastic Surgery at Texas Children’s Hospital. He is also Professor and Residency
Program Director of the Department of Plastic and Reconstructive Surgery
at Baylor College of Medicine. He earned his medical degree from Tulane
University and completed his plastic surgery residency at the University of Texas
Southwestern Medical Center, where he remained for fellowships in hand and
microvascular surgery. He also completed a fellowship in craniofacial surgery
at New York University Medical Center. Dr. Hollier specializes in pediatric
craniofacial surgery, hand surgery, facial fractures, cranial vault remodeling, and
midfacial and mandibular distraction. He has authored more than 190 articles
for scholarly and professional publications as
well as 37 book chapters and made dozens
of presentations to professional audiences
worldwide on a full range of topics related to
plastic and reconstructive surgery.
transplant serv i ces
Transplant Services
One of the most active and comprehensive pediatric
transplantation programs in the nation, Transplant
Services at Texas Children’s Hospital provides
complex, multifaceted medical and surgical care
for newborns to young adults in need of heart, kidney, liver and lung transplants.
Last year, the program’s surgeons completed 83 solid organ transplantations.
Our staff provides comprehensive, customized attention through all aspects of
the transplant process, from initial referral to hospitalization and long-term
outpatient management. Our pediatric transplant coordinators work closely with
patients, families and referring physicians to ensure the evaluation process
is convenient and efficient.
77
78
transplant serv i ces
M ult i d i sc i pl i nar y team
Transplant Services recently worked with urology, pediatric surgery
and living donor teams to coordinate and perform a living-donor
kidney transplant for a child with Stage 4 chronic kidney disease,
as well as bilateral hydronephrosis and fulguration of the posterior
urethral valve.
Additionally, surgical and medical specialists in Texas Children’s Lung
Transplant and the Liver Transplant Programs joined forces in a
16-hour procedure to perform a rare double-lung liver transplant to
treat the effects of cystic fibrosis in a 17-year-old patient. The teen,
who was diagnosed at birth with the disease, was referred to Texas
Children’s, one of the few hospitals in the nation with pediatric
organ transplant programs.
As part of one of the nation’s top pediatric hospitals, Transplant Services
offers remarkable multidisciplinary depth of care from experts in more than 40
pediatric subspecialties. We are one of the few pediatric transplant programs
to have dedicated teams for anesthesia, allergy and immunology, rheumatology,
pathology, pharmacy, intensive care and operating room nursing.
Transplant Services worked with Texas Children’s Heart Center to complete
a multi-institution clinical trial, the first of its kind, to determine the safety and
effectiveness of the Berlin Heart EXCORВ® Pediatric Ventricular Assist Device
(VAD), the first ever VAD to provide long-term cardiovascular support for
infants and children until a heart transplant is available. This trial led to the
device’s FDA approval in December 2011. For more information on this groundbreaking trial, please see page 13.
T HI S Y E A R
Ryan W. Himes, M.D., became Medical Director of Quality and Outcomes
Management for Transplant Services. Dr. Himes, a Pediatric Gastroenterologist,
has clinical and research interests in defining, measuring and improving valuedelivery in health care.
Flor Munoz-Rivas, M.D., an infectious disease specialist dedicated to prolonging
patients’ lives through the prevention of infection following transplant, joined
the Transplant Services leadership team. Dr. Munoz-Rivas also evaluates Texas
Children’s patients’ immunologic status prior to transplantation.
transplant serv i ces
KIDNEY
25
39
23
71
32
31
27
LIVER
LUNG
2010
2011
14
18
13
15
2009
13
2008
16
13
18
2007
16
11
10
14
13
17
26
51
14
11
23
70
81
83
96
T ransplantat i ons by Year
2012*
HEART
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital and Baylor College of Medicine physicians at Texas Children’s Hospital
surgical locations.
79
transplant serv i ces
1 Year P ed i atr i c T ransplant P at i ent
S urv i val R ates 15
10 0 %
87.77%
95.26%
98.59 %
95.19 %
Transplant occurred between 01/01/2009 and 6/30/2011. Pediatric Age <18
96.88 %
80
*
*
HEART (N=32)
LIVER (N=71)
TEXAS CHILDREN’S HOSPITAL
LUNG (N=29)
KIDNEY (N=34)
SRTR EXPECTED
* Per the Scientific Registry of Transplant Recipients (SRTR), there are too few
events to calculate statistically powerful expected patient survival values for
pediatric lung and kidney recipients.
J o h n A . Gos s , M . D . , is the Medical Director of Transplant Services at
Texas Children’s Hospital and Surgical Director of Liver Transplantation at Texas
Children’s Hospital, St. Luke’s Episcopal Hospital and the Michael E. DeBakey
Veterans Affairs Medical Center. He is also Professor of Surgery and Chief of
the Division of Abdominal Transplantation at Baylor College of Medicine. He
received his medical degree from Creighton University in Omaha, Nebraska
and completed his residency in General Surgery at the Barnes Hospital at the
Washington University School of Medicine Surgical
Program. Subsequently, Dr. Goss completed a
two-year multi-organ transplant fellowship in the
Division of Liver and Pancreas Transplantation at
the University of California School of Medicine in
Los Angeles, California, where he was appointed
Assistant Professor. He has been awarded the
American Surgical Career Development Award, an
American Liver Foundation Award and a Juvenile
Diabetes Foundation Award for his efforts and
leadership in transplantation. Throughout his
career, Dr. Goss has performed more than 1,000
transplantation procedures.
Scientific Registry of Transplant Recipients (SRTR). Program Specific Reports. Table 11 www.srtr.org
15
U R O L O GY
Urology
Providing surgical care for routine pediatric urological
needs as well as genitourinary problems caused by
congenital disorders, injury and other conditions, the
Urology Division at Texas Children’s Hospital is consistently ranked among the top
10 urology programs in the nation by U.S.News & World Report.
The clinically active program performs more than 2,000 operating room
procedures annually, giving us comprehensive experience and skill to treat the
entire range of urological conditions. In particular, our physicians have specialized
focus on minimally invasive, laparoscopic surgical techniques including extremely
delicate procedures in newborns and infants; anorectal malformations; urological
conditions caused by neurological problems, such as spina bifida; and management
of stone disease.
81
82
U R O L O GY
In addition, we have particular expertise in:
• Bladder extrophy and complex bladder reconstruction
• Complex incontinence patients
• Obstructive uropathy
• Repair of genital abnormalities in males including hypospadias correction
and testicular auto-transplantion
• Vesicoureteral reflux and urinary tract infection
Research is an integral part of the program, and our physicians are currently
involved in several investigations including pyeloplasty, hypospadias and intraabdominal orchidopexy. An area of specific concentration is genitourinary
development and genetics. Our physicians and fellows work closely with
internationally recognized urologic researcher Dolores Lamb, Ph.D., to study
the genetics of bladder extrophy, urethral valves, vesicoureteral reflux and the
demographics of referral for urological care.
Because urological disorders can present emotional challenges to patients and
families, we work closely with child-life specialists to help ease distress and
anxiety and provide long-term follow-up care for patients. Additionally, to train
children with urinary incontinence to become more continent, we employ a
state-of-the-art electronic biofeedback approach that helps teach children how
to strengthen and control the pelvic muscles.
T e x as C h i ldren ’ s Hosp i tal W est C ampus
Urological surgeons at Texas Children’s Hospital West Campus
provide clinic and outpatient surgery coverage as well as
urodynamic services.
U R O L O GY
M ult i d i sc i pl i nar y team
The Urology Division participates in several multidisciplinary teams and
clinics including:
• Anorectal Malformation Clinic: A team approach to surgical intervention for
congenital deformities in which the anus and rectum do not develop properly,
this clinic includes specialists from urology, pediatric general surgery and
pediatric and adolescent gynecology.
• Fetal Surgery Committee: Urology works with Texas Children’s Fetal Center
to perform complex surgeries to correct problems including spina bifida,
cloaca and other fetal anomalies.
• Gender Medicine Team: This collaboration with experts from multiple
divisions including endocrinology, pediatric and adolescent gynecology,
genetics and psychology, addresses sexual development disorders and
related ethical standards.
• Spina Bifida Clinic: A team approach to surgical intervention for infants born
with myelomeningocele, a congenital disorder in which the backbone and
spinal canal do not close before birth. This clinic includes specialists from
neurosurgery, orthopaedic surgery, urology and developmental pediatrics.
• Stone Clinic: We partner with experts in nephrology and food and nutrition
to address surgical, medical and dietary aspects of urinary stones (calculi).
83
84
U R O L O GY
T HI S Y E A R
Edmond T. Gonzales, Jr., M.D., Chief of Urology at Texas
Children’s Hospital was awarded the 2012 Urology Medal for
the Section on Urology by the American Academy of Pediatrics
(AAP). The Urology Medal is given to an individual who has
made outstanding contributions to the field of pediatric urology.
Earlier this year, a laparoscopic retroperitoneal lymph node
dissection (RPLND) to treat testicular cancer in a patient with
horseshoe kidney, believed to be the first procedure of its kind,
was performed at Texas Children’s Hospital. Horseshoe kidney,
also known as renal fusion or super kidney, affects about one
in 500 people. Approximately two to three men per 100,000
develop testicular cancer, creating an uncommon combination.
The 16-year-old patient had metastatic disease with high
embryonal and teratoma components. Since teratomas often
are resistant to chemotherapy, surgery was performed п¬Ѓrst,
followed by chemotherapy at Texas Children’s Cancer Center.
Before and after renderings of a patient treated for horseshoe kidney
U R O L O GY
2 ,093
1,727
3
363
2,095
1,792
303
2008
2,044
1,862
2007
1,907
1,851
U rolo g y O perat i n g R oom C ases by Year
2009
2010
2011
2012*
TEXAS CHILDREN’S PAVILION FOR WOMEN
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Operating room case volumes include procedures performed by Texas Children’s
Hospital, Baylor College of Medicine and private practice physicians at Texas
Children’s Hospital surgical locations.
85
U R O L O GY
11,213
5,943
10,809
3,092
2010
2011
2012*
2,178
2,111
3,158
265
5,540
6,907
12,395
U rolo g y C l i n i c V i s i ts by Year
5,223
86
TEXAS CHILDREN’S HEALTH CENTERS
TEXAS CHILDREN’S HOSPITAL WEST CAMPUS
TEXAS CHILDREN’S HOSPITAL
* P ro j ected
Clinic visits include outpatient visits by Texas Children’s Hospital and Baylor
College of Medicine faculty only.
E dmond T . Gon z ales , J r . , M . D . , is Chief of Urology at Texas
Children’s Hospital. He is also Professor of Urology in the Scott Department
of Urology at Baylor College of Medicine, Surgical Director of Texas Children’s
Hospital West Campus and holds the Edmond T. Gonzales Chair in Pediatric
Urology. He is a member of the American Academy of Pediatrics, the Society
for Pediatric Urology and the American Urological Association. Dr. Gonzales is
boarded in Urology and was awarded a sub-board in Pediatric Urology in 2008.
He completed medical school at Tulane School
of Medicine and residency training in Urology
at Duke University Medical Center. In 1973, he
joined an active practice in pediatric urology at
the Children’s Hospital of Michigan in Detroit
and then came to Texas Children’s Hospital and
Baylor College of Medicine in 1974.
INPATIENT SERVICES
Inpatient Services
87
88
INPATIENT SERVICES
Acute Care Surgical Floor
The acute care surgical floor, located on the 11th floor of Texas Children’s
Hospital West Tower, is a 36-bed surgical care unit that admits patients of all
ages from infancy to adolescents. The unit receives a wide variety of postoperative surgical patients from orthopaedics, otolaryngology, pediatric general
surgery, plastic surgery and urology. We have four beds dedicated to trauma
patients, and the team of nurses that cares for our trauma patient population.
These beds and trained staff have been key in nearly eliminating transfer denials
for trauma patients.
Cardiovascular Intensive Care Unit
The 21-bed Cardiovascular Intensive Care Unit (CVICU) admits newborns,
infants, children and young adults with heart disease. The CVICU cares
for children undergoing surgery for congenital heart disease, children and
adolescents with end-stage heart failure before and after heart transplantation
and children whose hearts can no longer adequately support them. Our
multidisciplinary team includes cardiovascular intensivists trained in pediatric
cardiology, pediatric cardiovascular anesthesiology and pediatric critical care.
They work alongside our cardiac surgeons and together with a team of highly
specialized nurses, respiratory therapists, nurse practitioners and physician
assistants to provide the best care for our patients.
Pediatric Intensive Care Unit
The Pediatric Intensive Care Unit (PICU) at Texas Children’s Hospital is one
of the largest pediatric intensive care units in the nation. We care for infants
and children from around the globe and strive to give each child and family the
best individualized care available. The 31-bed unit is staffed with critical care
physicians, advanced level practitioners and postgraduate fellows all specializing
exclusively in pediatric critical care. Our medical team works seamlessly with
a highly skilled multidisciplinary team of PICU nurses, respiratory therapists,
pharmacists, social workers and child life specialists to care for each patient.
Progressive Care Unit
The Progressive Care Unit (PCU) is a flexible 36-bed unit for pediatric patients
who are in need of very close monitoring or complex care but do not require
intensive care. Our multidisciplinary team of advanced practice providers,
physician assistants, nurses and respiratory and physical therapists cares for
both acute and chronic conditions. Nurses take the lead in coordinating care
for patients who require continuous monitoring and observation, with special
emphasis given to respiratory, neurological and surgical disorders. Many patients
depend on technological support, notably those with tracheostomies. The PCU’s
family-centered approach encourages parents to stay with their child and learn
how to care for their child upon their return home.
INPATIENT SERVICES
The Cardiovascular Intensive Care and Pediatric Intensive Care Units at Texas
Children’s Hospital are part of the Virtual Pediatric Intensive Care Unit (PICU)
System known as VPS. This is a national pediatric critical care data registry, to
which all of Texas Children’s critical care units submit data. The registry applies a
predicted mortality score – PIM 2 – for every critical care admission based upon
the child’s diagnosis and other indicators of illness on admission.
2011
CVICU Cases with PIM 2 Data
Total cases
Mortalities
Mortality rate (medical and surgical patients)
872
22
2.52%
Predicted mortality rate
5.6%
Mortality ratio (actual/predicted)
0.45
The CVICU performed much better than predicted. The CVICU’s actual
mortality rate was only 45% of the predicted rate.
PICU Cases with PIM 2 Data
Total cases
2,119
Mortalities
65
Mortality rate (medical and surgical patients)
3.07%
Predicted mortality rate
3.70%
Mortality ratio (actual/predicted)
0.83
The PICU cares for a highly complex population of both medical and surgical
critically ill children. The survival rate is 96.9%. 18% of admissions to the PICU
originated from the operating room or post-anesthesia care unit (PACU), and an
additional 104 patients were admitted as a result of traumatic injuries.
89
90
O perat i n g R oom and P er i operat i ve S erv i ces
Operating Room and
Perioperative Services
Designed especially for children, Operating Room
(OR) and Perioperative Services at Texas Children’s
Hospital provide comprehensive and specialized
capabilities for surgeries ranging from routine to
extremely complex. More than 24,000 procedures were completed in
30 operating rooms at five sites within Texas Children’s Hospital, Texas Children’s
Hospital West Campus and Texas Children’s Pavilion for Women in 2012. From
admission to recovery, our support team of more than 300 is driven to ensure an
optimum experience for patients and physicians.
Many of the surgical suites are fully equipped and integrated with endoscopic
equipment including advanced fetascopes. Same-floor instrument processing
optimizes efficiency, patient care and safety. For specialized procedures such as
fetal and heart surgery, we offer customized equipment and specially trained
support staff.
O perat i n g R oom and P er i operat i ve S erv i ces
When children are too sick to be moved to an operating or procedure room, our
mobile team, which includes a fellowship-trained pediatric anesthesiologist, travels
throughout the hospital to perform bedside procedures.
Our commitment to children goes beyond equipment and expertise. Our strong
child- and family-centered focus is one reason we consistently receive patient
satisfaction rates of 92% or higher. To help ease the anxiety many children and their
families feel before surgery, we offer a “virtual OR” simulator to help explain the
process. In addition, details including color-coded pajamas and application of scents,
such as bubble gum, to anesthesia masks help children relax and feel more at ease.
To teach our surgical teams how to work together in stressful situations, build
teamwork and optimize patient safety, our Simulation Center – the only one of its
kind in Houston and one of the few in the nation – uses the latest technology to
reproduce a realistic clinical setting.
T h i s y ear
We installed technology to stream live coverage of surgery between Texas
Children’s Hospital West Campus and Texas Children’s Hospital operating
rooms via the Internet. This interactive two-way communication allows
further consultation and collaboration and has future implications for
telemedicine and education.
Two new programs help facilitate pre-anesthesia evaluation of surgical
patients. One program focuses on high-risk pediatric patients; the other,
located in the Pavilion for Women, is designed for adult obstetric and
gynecological patients. The programs ensure that necessary lab tests are
completed before surgery and medical history is reviewed so procedures are
not delayed on the day of surgery. Pre-surgery screening helps increase OR
efficiency and safety as well as postoperative pain control.
91
92
T rauma S erv i ces and t h e C enter for C h i ld h ood Injur y P revent i on
Trauma Services and the Center for
Childhood Injury Prevention
As a crucial component of Texas Children’s Level I
pediatric trauma center, Trauma Services provides
around-the-clock coverage to evaluate and treat
more than 1,200 injured patients each year.
Teamwork is vital to the rapid and decisive actions needed to treat traumatic
injuries. Our group of pediatric general surgeons and surgical subspecialists;
emergency medicine physicians; anesthesiologists; child life specialists; social
workers; physical, occupational and respiratory therapists; and other support staff
works together effectively and efficiently when seconds matter.
T rauma S erv i ces and t h e C enter for C h i ld h ood Injur y P revent i on
93
Dedicated space for trauma cases is available in the emergency center, main
operating room suite and inpatient units. Approximately 70 percent of all trauma
cases come from within our catchment area, which consists of nine counties
covering more than 9,500 square miles. In addition, 50 percent of trauma patients
seen at Texas Children’s Hospital are transferred from other hospitals, and 95
percent of these transfer requests are completed in fewer than 30 minutes. The
majority are completed within 15 minutes and in one phone call.
To enhance the team’s multidisciplinary performance as well as build proficiency in
trauma assessment and patient care, we partner with Texas Children’s Simulation
Center to conduct monthly trauma simulations.
M ult i d i sc i pl i nar y team
After an 18-month-old girl was attacked by a dog, causing a serious injury that
destroyed the left side of her face, physicians from otolaryngology, plastic surgery,
pediatric general surgery, radiology and the Department of Anesthesiology
worked together to complete the complex and delicate surgical repair.
3D reconstruction of patient 3D reconstruction of patient
on day of injurynearly one year later
94
T rauma S erv i ces and t h e C enter for C h i ld h ood Injur y P revent i on
T HI S Y E A R
When the Houston/Harris County Child Fatality Review Team, a
multidisciplinary, multi-agency group to review child deaths and
develop prevention strategies, was in danger of being discontinued
because of budget cuts, Texas Children’s provided staff and funding
to continue it uninterrupted. We are currently working to improve
overall efficiency of the team and raise awareness of children’s
health and safety issues.
As part of our outreach and education activities, we provided
trauma nursing education through the Emergency Nurses
Association Trauma Nursing Core Course (TNCC), helping 147
nurses receive verification as TNCC providers, and 10 others
become instructor candidates or course directors.
Accidental injuries are the leading cause of death in children 14 years old and
younger in the United States. To help educate parents and prevent injuries, Texas
Children’s Hospital created the Center for Childhood Injury Prevention, which
receives more than $500,000 in grants each year to teach parents how to keep
their children safe in the car, outdoors and at home.
In 2011, the Center for Childhood Injury Prevention:
• Educated more than 10,000 children and parents on outdoor safety, including
bicycle, pedestrian and water safety and over 12,000 people on home safety
topics, including safe sleep, childproofing, and fire prevention and response
• Inspected 4,318 car seats and distributed 1,682 new car seats to children
in need
• Provided 1,275 bicycle helmets to low-income children
• Trained more than 30 child passenger safety technicians throughout
the community
T rauma S erv i ces and t h e C enter for C h i ld h ood Injur y P revent i on
1,242
1,254
1,250
2010
2011
2012*
615
80 0
1,041
T rauma A dm i ss i ons by Year
2007
2008
2009
* P ro j ected
Trauma admissions include admissions at Texas Children’s Hospital Main Campus.
T rauma A dm i ss i ons by Surgical Division
4%
2011
14%
42%
22%
ORTHOPAEDICS
PEDIATRIC GENERAL SURGERY
NEUROSURGERY
OTHER*
* Other
includes ophthalmology, otolaryngology, pediatric and adolescent
gynecology, plastic surgery and urology. Trauma admissions include admissions
at Texas Children’s Hospital Main Campus.
95
T rauma S erv i ces and t h e C enter for C h i ld h ood Injur y P revent i on
T rauma A dm i ss i ons by Cause
2011
TRAMPOLINE
BIKE
44
MOTOR
VEHICLE
CRASH
45
50
ACCIDENT
54
SPORTS
61
FALL
70
99
282
549
96
NON
AUTOACCIDENTAL MOTIVE
TRAUMA
(CHILD ABUSE)
OTHER*
* Other
includes traumatic incidents related to monkey bars, animals, burns, drops
and more.Trauma admissions include admissions at Texas Children’s Hospital
Main Campus.
T rauma A dm i ss i ons by Injury Location
13%
2011
31%
6%
19%
HEAD
ARM
LEG
31%
FACE
OTHER*
* Other
includes abdomen, chest, neck and spine.
Patients may experience more than one mechanism of injury per traumatic event.
Trauma admissions include admissions at Texas Children’s Hospital Main Campus.
T rauma S erv i ces and t h e C enter for C h i ld h ood Injur y P revent i on
T rauma A dm i ss i ons by Severity
Injury Severity Scores (ISS)
2%
5%
2011
13%
80%
MINOR INJURY, ISS 1-9
MODERATE INJURY, ISS 10-15
MAJOR INJURY, ISS 16-24
SEVERE INJURY, ISS ≥25
Trauma admissions include admissions at Texas Children’s Hospital Main Campus.
14%
D av i d E . W esson , M . D . , isВ Associate Surgeon-in-Chief, Chief of
the Department of Surgery and Medical Director of Trauma Services at Texas
Children’s Hospital. He obtained his medical degree and completed his general
surgery training at the University of Toronto and pursued his training in Pediatric
Surgery at the Hospital for Sick Children in Toronto. Dr. Wesson joined the Baylor
faculty as Professor and Chief of the Pediatric General Surgery Division and
Chief of the Pediatric General Surgery at Texas
Children’s Hospital in 1997. In 2007, Dr. Wesson
was honored with appointment as the William J.
Pokorny, M.D. Professor of Pediatric Surgery at
Baylor College of Medicine. As a member of the
American College of Surgeons (ACS) Committee
on Trauma, Dr. Wesson has been an ACS Trauma
Center Site Visitor since 1991. In this capacity,
he is a member of the national ACS site survey
team for Trauma Center designation. He also is a
founding member of the International Society of
Child and Adolescent Injury Prevention and serves
on the editorial board of the Journal of Trauma.
97
98
MEDICAL STAFF DIRECTORY
Department of Surgery at Texas Children’s Hospital
D epartment of S urg ery Leaders h i p
Julie Hoang, R.N., M.S., C.R.N.A.
Charles D. Fraser, Jr., M.D., Surgeon-in-Chief
Paul W. Hopkins, M.D.
David E. Wesson, M.D.,
Associate Surgeon-in-Chief
Matthew D. James, M.D.
Thomas G. Luerssen, M.D., F.A.C.S., F.A.A.P.,
Chief Quality Officer
Aimee Kakascik, D.O.
Edmond T. Gonzales, M.D., Surgical Director,
Texas Children’s Hospital West Campus
Constance W. LaGrone, R.N., M.S., P.N.P.
D epartment of A nesth es i olo gy
Dean B. Andropoulos, M.D., Chief
Cheryl R. Faust, M.P.H., Practice Administrator
Melanie J. Alo, M.D.
Rahul G. Baijal, M.D.
Beth M. Barraza, R.N., M.S., P.N.P.
Sandra L. Benavides, R.N., M.S., P.N.P.
Monique Bernsten, R.N., M.S., P.N.P.
Sudha A. Bidani, M.D.
Glorianne Bond, R.N., M.S., P.N.P.
Kenneth M. Brady, M.D.
Casey A. Brimmage, R.N., M.S., C.R.N.A.
Maria M. Bruno, R.N., M.S., C.R.N.A.
Michelle R. Caballero, M.D.
Katrin A. Campbell, M.D.
Carlos J. Campos, M.D.
Lisa A. Caplan, M.D.
Nicholas P. Carling, M.D.
Julia H. Chen, M.D.
Camille M. Colomb, M.D.
Erin R. Depew, R.N., M.S., C.R.N.A.
Kristy D. DiMascio, R.N., M.S., C.R.N.A.
R. Blaine Easley, M.D.
Jessica H. Emerald, R.N., M.S., P.N.P.
Christopher R. Estrada, M.D.
Mary A. Felberg, M.D.
Priscilla J. Garcia, M.D.
Nancy L. Glass, M.D.
Chris D. Glover, M.D.
Cheryl A. Gore, M.D.
Erin A. Gottlieb, M.D.
Kalyani Govindan, M.D.
Stuart R. Hall, M.D.
Tekesha Henry, R.N., M.S., C.R.N.A.
Lisa D. Heyden, M.D.
Helena Karlberg Hippard, M.D.
Javier E. Joglar, M.D.
Joanna L. Klaas, R.N., M.S., C.R.N.A.
Kate O. Lee, R.N., M.S., C.R.N.A.
Yang Liu, M.D.
David G. Mann, M.D.
Virgina F. McWilliams, R.N., M.S., P.N.P.
Angela M. Medellin, R.N., M.S., P.N.P.
Douglas J. Miller, M.D.
Wanda C. Miller-Hance, M.D.
Princy Mohan, R.N., M.S., P.N.P.
Emad B. Mossad, M.D.
Pablo Motta, M.D.
Jessica L. Mouton, R.N., M.S., C.R.N.A.
Kim P. Nguyen, M.D.
Olutoyin A. Olutoye, M.D.
Elyse C. Parchmont, R.N., M.S., C.R.N.A.
Nihar V. Patel, M.D.
Mary E. PiГ±a, R.N., M.S., C.R.N.A.
Robert W. Power, M.D.
Jason Reynolds, M.D.
Carlos L. Rodriguez, M.D.
Amber P. Rogers, M.D.
Nicole M. Sevier, R.N., M.S., P.N.P.
Thomas L. Shaw, M.D.
Kristen D. Sheehy, R.N., M.S., C.R.N.A.
Shakeel A. Siddiqui, M.D.
Kristen Sowers, R.N., M.S., P.N.P.
Stephen A. Stayer, M.D.
Adam Stone, M.D.
Imelda M. Tjia, M.D.
Laura Torres, M.D.
David F. Vener, M.D.
Mehernoor F. Watcha, M.D.
Tracy R. Watkins, R.N., M.S., P.N.P.
Erin Williams, M.D.
Saeed Yacouby, R.N., M.S., C.R.N.A.
Jennifer G. Yborra, R.N., M.S., P.N.P.
David A. Young, M.D.
Michael Zelisko, M.D.
MEDICAL STAFF DIRECTORY
Con g en ital Heart S urg ery
Shannon B. Antekeier, M.D.
Charles D. Fraser, Jr., M.D., Chief
Tanisha George Daugherty, PA-C
Shaun E. Custard, M.H.A., M.B.A., F.A.C.H.E.,
Practice Administrator
Howard R. Epps, M.D.
Iki Adachi, M.D.
Jennifer Harris, R.N., C.P.N.P.-P.C.
Jeffrey S. Heinle, M.D.
Amy G. Hemingway,В R.N., M.S.N., C.N.S,
C.P.N.P.-A.C.
Vermicker L. Ible, R.N., C.P.N.P.-P.C.
E. Dean McKenzie, M.D.
Carlos M. Mery, M.D.
Yuji Naito, M.D. (Instructor)
Mary Tran, PA-C
Frank T. Gerow, M.D.
Darrell Hanson, M.D.
Kevin S. Horowitz, M.D.
Meghan M. May, M.D.
Scott D. McKay, M.D.
Matthew S. Miller, PA-C
Scott B. Rosenfeld, M.D.
Janai A. Sells, PA-C
Vinitha R. Shenava, M.D.
Lisa D. Stringer, PA-C
Lindsey E. White, PA-C
D ental
Opal J. Willmon, PA-C
A. Bruce Carter, D.D.S., Chief
Lisa D. Wilsford, PA-C
Mary D. Kana, M.B.A., Practice Administrator
Vincy D. Zachariah, PA-C
Bryan F. Boshart, D.D.S., M.S.
Otolary n g olo gy
N eurosurg ery
Ellen M. Friedman, M.D., Chief
Thomas G. Luerssen, M.D., F.A.C.S., F.A.A.P.,
Chief
Jerry W. Lin, M.D., Ph.D., Chief, Hearing Center
Lorraine M. Cogan, M.S.W., Practice Administrator
Ryan A. Breaux, M.H.A., M.B.A.,
Practice Administrator
Brandy Berger, R.N., N.P.
Peggy Blum, Manager, Audiology
Robert J. Bollo, M.D.
Tina R. Bradshaw, R.N., F.N.P.
James P. Carter, M.A., C.C.C.-S.L.P., Manager,
Speech Language and Learning
Daniel J. Curry, M.D.
Linda C. Brock, P.N.P.
Robert C. Dauser, M.D.
Binoy M. Chandy, M.D.
Andrew H. Jea, M.D., F.A.C.S., F.A.A.P.,
F.A.A.N.S.
Carla M. Giannoni, M.D.
William E. Whitehead, M.D., M.P.H.
Deidre R. Larrier, M.D.
O phth almolo gy
David K. Coats, M.D., Chief
Wendy S. Jordan, M.B.A., Practice Administrator
Jane C. Edmond, M.D.
Mohamed A. Hussein, M.D.
Evelyn A. Paysse, M.D.
Paul G. Steinkuller, M.D.
Kimberly G. Yen, M.D.
John K. Jones, M.D.
Mary Frances Musso, D.O.
Julina Ongkasuwan, M.D.
Vicki L. Owczarzak, M.D.
Kathy Shelly, PA-C
Marcelle Sulek, M.D.
Ped i atr i c and A dolescent
Gy necolo gy
Jennifer E. Dietrich, M.D., M.Sc., Chief
Philip J. Weindorff, Practice Administrator
O rth opaed i cs
Jennifer L. Bercaw-Pratt, M.D.
William A. Phillips, M.D., Chief
Jennifer Parker Kurkowski, WHNP
Binta O. Baudy, M.P.H., Practice Administrator
Xiomara M. Santos, M.D.
David P. Antekeier, M.D.
99
100
MEDICAL STAFF DIRECTORY
Ped i atr i c General S urg ery
Kidney Transplant Program
Jed G. Nuchtern, M.D., Chief
Christine A. O’Mahony, M.D., Surgical Director
David E. Wesson, M.D., Associate
Surgeon-in-Chief
Lars J. Cisek, M.D.
Paul K. Minifee, M.D., Clinic Chief
Liver Transplant Program
Cynthia F. Miley, Practice Administrator
John A. Goss, M.D., Surgical Director
Mary L. Brandt, M.D.
Christine A. O’Mahony, M.D.
Darrell L. Cass, M.D.
Lung Transplant Program
Bradley P. Herold, PA-C
Jeffrey S. Heinle, M.D., Surgical Director
Clair M. Johny, PA-C
Iki Adachi, M.D.
Eugene S. Kim, M.D.
Charles D. Fraser, Jr., M.D.
Timothy C. Lee, M.D.
E. Dean McKenzie M.D.
Monica E. Lopez, M.D.
Mark V. Mazziotti, M.D.
Allen L. Milewicz, M.D.
Bindi Naik-Mathuria, M.D.
Oluyinka Olutoye, M.D., Ph.D.
Ashwin P. Pimpalwar, M.D.
J. Ruben Rodriguez, M.D.
Sanjeev A. Vasudevan, M.D.
Veronica A. Victorian, PA-C
Mona Jaimee Westfall, R.N., M.S.N., C.P.N.P. A.C./P.C.
Plasti c S urg ery
U rolo gy
Edmond T. Gonzales, M.D., Chief
Barkha Chandwani, Practice Administrator
Lawrence J. Cisek, Jr., M.D., Ph.D.
Nicolette Janzen, M.D.
David R. Roth, M.D.
Jessica Schuh, PA
Joanna Marroquin, P.N.P.
Inpati ent S erv i ces
Lara S. Shekerdemian, M.D., F.R.A.C.P., F.A.A.P.,
M.H.A., Chief
Larry H. Hollier, Jr., M.D., F.A.C.S., Interim Chief
Ped i atr i c Intens i ve C are U n it
Mary D. Kana, M.B.A., Practice Administrator
Jeanine M. Graf, M.D., Medical Director
Edward P. Buchanan, M.D.
Gail Parazynski, R.N., M.S.N., Director, Nursing
David Khechoyan, M.D.
Laura Monson, M.D.
Deborah D’Ambrosio, R.N., M.S.N., N.E.-B.C.,
Assistant Director
John Wirthlin, D.D.S.
Progressive Care Unit
Transplant S erv i ces
John A. Goss, M.D., Medical Director
Ryan W. Himes, M.D., Medical Director of
Quality and Outcomes Management
Fernando Stein, M.D., Medical Director
Gail Parazynski, R.N., M.S.N., Director, Nursing
Jacqueline P. Williams, R.N., M.S.N.,
Assistant Director
Jennifer J. Hiser, M.H.A., Director
Cardiovascular Intensive Care Unit
Heart Transplant Program
Paul A. Checchia, M.D., F.C.C.M., F.A.C.C.,
Medical Director
Jeffrey S. Heinle, M.D., Surgical Director
Iki Adachi, M.D., Co-Surgical Director,
Mechanical Circulatory Support
E. Dean McKenzie, M.D., Co-Surgical Director,
Mechanical Circulatory Support
Charles D. Fraser, Jr., M.D.
Carlos M. Mery, M.D.
Gail Parazynski, R.N., M.S.N., Director, Nursing
Gay N. Matthews, R.N., M.S.N., Assistant Director
Acute Care Surgical Floor
Elizabeth Brown, R.N., M.S.N., M.H.A., O.C.N.,
Director, Nursing
Roxanne M. Vara, R.N., B.S.N., M.B.A.,
Assistant Director, Nursing
MEDICAL STAFF DIRECTORY
O perati n g Room and
Te x as C h i ldren ’ s Hospital
Per i operati ve S erv i ces
W est C ampus
Judy Swanson, R.N., M.B.A., Director,
Perioperative Services
Edmond T. Gonzales, M.D., Surgical Director
Lynn A. Huffman, R.N., M.B.A., Assistant Director,
Operating Rooms
Ronald Loosle, R.N., M.B.A., Assistant Director,
PACU/Anesthesia
Sheila Winchester, R.N., M.B.A.,
Assistant Director, Perioperative Services,
Texas Children’s Pavilion for Women
Beth Barraza, P.N.P.
SandraВ Benavides, P.N.P.
MoniqueВ Berntsen, P.N.P.
Gloriane Bond, F.N.P.
Casey Brimmage, C.R.N.A.
Maria Bruno, C.R.N.A.
Erin Depew, C.R.N.A.
Kristy Di Mascio, C.R.N.A.
JessicaВ Emerald, P.N.P.
Tekesha Henry, C.R.N.A.
Shannon McCord, M.D.,
Director of Patient Care Services
Ramon Enad, R.N., M.B.A., Assistant Director,
Perioperative Services, Texas Children’s Hospital
West Campus
Trauma S erv i ces
David E. Wesson, M.D., Medical Director
Bindi J. Naik-Mathuria, M.D.,
Assistant Medical Director
Mary Frost, R.N., B.S.N., Assistant Director
David M. Delemos, M.D.
Daniel M. Rubalcava, M.D.
Mona Jaimee Westfall, R.N., M.S.N., C.P.N.P.
A.C./P.C.
C enter for C h i ld h ood Injury
Preventi on
Mary Frost, R.N., B.S.N.,В Assistant Director
Julie Hoang, C.R.N.A.
S urg i cal O utcomes C enter
Joanna Klass, C.R.N.A.
Kathy Carberry, M.P.H., Director
Constance Lagrone, P.N.P.
Toni Fontenot, M.B.A., Manager, Research
Kate Lee, C.R.N.A.
Virginia McWilliams, F.N.P.
AngelaВ Medellin, P.N.P.
PrincyВ Mohan, P.N.P.
Jessica Mouton, C.R.N.A.
Elyse Parchmont, C.R.N.A.
Maria Pina, C.R.N.A.
NicoleВ Sevier, P.N.P.
Kristen Sheehy, C.R.N.A.
Kristen Sowers, P.N.P.В TracyВ Watkins, P.N.P.
Saeed Yacouby, C.R.N.A.
JenniferВ Yborra, P.N.P.
101
6621 Fannin Street | Houston, Texas 77030
832-826-5779
surgeoninchief @ texaschildrens.org
texaschildrens.org/surgery
To make a referral, please visit texaschildrens.org/refer
©2012 Texas Children’s Hospital. All rights reserved.

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