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Alumnus Develops Innovative Procedure for Congenital Heart Disease

JAVOIS,ALEXANDER1_500In medical school, Alexander Javois, ’88 MD, loved reading EKGs. This attraction led him to a career in pediatric cardiology and to become an expert on the use of catheterization techniques to treat congenital heart diseases.

Currently a pediatric interventional cardiologist at Advocate Children’s Hospital at Christ Medical Center in Oak Lawn, Ill., Dr. Javois remembers spending his spare time on Saturday mornings at Feinberg reading EKGs, which he then would hand off to cardiologists to mark up and show him his mistakes.

“I found it fascinating to be able to look at 10 seconds of heart rhythms and have the EKG tell so much about the health of a patient,” he explains.

Later, during his pediatric rotation, Dr. Javois decided to pursue a career in pediatric cardiology.

“I was fascinated by the uniqueness of different types of birth defects of the heart that are seen in pediatric patients, rather than treating adult heart disease,” he says.

Dr. Javois also found the idea of watching children grow up to fulfill a life after treatment rewarding, and over the course of his career, he felt he could continually offer more options to children to make a healthier heart, many of them non-surgical.

When not in class or on rotations, Javois also enjoyed participating in intramural sports with the dentistry students and has fond memories of living in the on-campus dorms.

“I remember going to the end of my hallway in Abbott Hall and studying there with a $10 million view of Lake Michigan,” he says.

After graduating with his medical degree from the Feinberg School of Medicine, Dr. Javois completed his residency in pediatrics at St. Louis Children’s Hospital, which is affiliated with Washington University, and his fellowship in pediatric cardiology at Advocate Christ Hospital and Medical Center in Illinois.

Catheters instead of surgery

As a pediatric  interventional cardiologist, he treats birth defects of the heart by using catheters to insert an implant to prop open or seal vessels, which often eliminates the need for surgery.

In 2003, an Illinois couple came to Dr. Javois when they learned their son, Ian, had one of the most life-threatening heart birth defects, hypoplastic left heart syndrome (HLHS) with intact atrial septum. In HLHS, the left side of the heart is underdeveloped and can’t effectively pump blood through the body, leaving the right side of the heart to do all of the work.

Alexander Javois, '88 MD, enjoys a game with his family.

Dr. Javois enjoys a game with his family.

While babies are still in their mother’s womb, they normally have an opening between the left and right sides of the heart that closes a few days after birth. Having HLHS with intact atrial septum meant that immediately after Ian was born, he would have no way of getting oxygen-rich blood to the rest of his body.

After reviewing the scientific literature on this defect, Dr. Javois began to develop a plan.

“People had addressed this issue without a lot of luck,” he explains. “The usual treatment is to transfer babies with this defect to the NICU after being born and stabilize them before treating them. There is no way to stabilize a child who is dying, who can’t get oxygenated blood to the body.”

Dr. Javois thought, “Why not have Ian’s mother deliver the baby in the catheter lab?” That approach would allow him to perform an atrial septostomy on Ian right away. In atrial septostomy a small hole is created between the upper two chambers of the heart.

To prepare for the procedure, Javois did extensive planning and enlisted the help of 38 people who would be in the room during the surgery, including anesthesiologists, nurses and technicians.

“We were all nervous up to the last moment, but we rehearsed so much that when the day came everything fell into place naturally,” recalls Dr. Javois. “The nature of dealing with children with birth defects and critically ill children prepared us over the years to handle crises, and the team approached this case beautifully.”

He attributes the success of Ian’s outcome to being prepared, having great teamwork and the quick turnaround enabled by back-to-back procedures in the catheter lab.

“Ian looks like any other 12-year-old, and he is active in school and gym class. I have four daughters, and Ian is like the son I never had,” says the physician who still sees the pre-teen for periodic check-ups.

Since then, Dr. Javois has performed the procedure 12 times and has continued to refine the process to make it more efficient. He and his team wrote a case study that was published in Catheterization and Cardiovascular Interventions, which led Dr. Javois to act as a consultant to other physicians from around the world to help them apply his approach to their own patients.

“It is very rewarding to know that other people have adopted it,” he admits. “It is a lot of fun to hear their stories and their approach. That’s the academic nature of our practice, to share ideas in literature and in life.”