Cardiac Surgery at the Cleveland Clinic.

Founded in 1921 as a multidisciplinary physician-based practice with an emphasis on teamwork, Cleveland Clinic developed a focus on cardiothoracic diseases early in its history. From the development of coronary angiography and coronary artery bypass grafting to more recent advances in the management of heart valve disease, Cleveland Clinic surgeons have sought to contribute to cardiac surgery through a combination of innovation and careful analysis of patient outcomes.

History of Cardiothoracic Surgery at Columbia University: A Century at the Vanguard of Clinical Care, Education, and Innovation.

The Columbia University Cardiothoracic Surgery Program dates back to the earliest days of the specialty itself, when the first pioneers ventured into the chest, and eventually the heart, to treat diseases previously believed to be beyond the reach of medicine. This spirit of innovation, creativity, and vision has grown over the ensuing century and has driven the development of advances that have defined the specialty and saved countless lives. From novel techniques for the repair of complex congenital cardiac defects and acquired cardiovascular diseases, to comprehensive management of lung and esophageal maladies, and to the marvel of minimally invasive and percutaneous interventions, the march of progress has never been stronger, more dramatic, or more consequential that it is at Columbia today. Fueled by people who -- as descendants of those early pioneers -- have been raised in the "Columbia culture," the commitment to innovation and education has never been greater.

From Catheters To Ventricular Assist Devices: 60 Years of Cardiovascular Experiences With William L. Winters, JR., M.D.

Automatic typewriters, transistor radios, microfiche, black and white television…while considered high-tech in the 1950s, these technologies seem limited when viewed from the 21st century. The same is true for cardiovascular medicine, which back then relied on electrocardiograms and X-rays for most diagnoses. In the 60 years since, advances in medical capabilities have progressed at a staggering pace. Patient research that once required months poring over paper charts is now reduced to hours using electronic medical record databases. Diagnostic images that once took days to process can now be accessed instantly through ultrasound and magnetic resonance imaging. While a half-century ago no one would have imagined accessing any and all information with a 5-second Google search, so too would noninvasive heart surgery been considered unimaginable. Since the 1950s when he graduated from medical school, William L. Winters, Jr., has been a first-hand witness to breathtaking innovations in cardiovascular medicine-both globally and in Houston. Author of Houston Hearts: A History of Cardiovascular Surgery and Medicine at Houston Methodist DeBakey Heart & Vascular Center and long-time medical editor of the Methodist DeBakey Cardiovascular Journal, Dr. Winters sat down with the journal editors this past April to share his insights from the last half-century of medical practice.

The ten advances that have defined modern cardiology.

Modern cardiology was born early in the twentieth century. Here I list and review what I believe to be the ten most important advances in the twentieth century in this field. They are as follows: electrocardiography, cholesterol-induced atherosclerosis, cardiac catheterization, cardiovascular surgery, coronary angiography and percutaneous coronary angioplasty, the coronary care unit, the development of new cardiovascular drugs, preventive cardiology, cardiac imaging, and implanted cardiac pacemakers/defibrillators.

The rise of cardiovascular medicine.

Modern cardiology was born at the turn of the nineteenth to twentieth centuries with three great discoveries: the X ray, the sphygmomanometer, and the electrocardiograph. This was followed by cardiac catheterization, which led to coronary angiography and to percutaneous coronary intervention. The coronary care units and early reperfusion reduced the early mortality owing to acute myocardial infarction, and the discovery of coronary risk factors led to the development of Preventive Cardiology. Other major advances include several cardiac imaging techniques, the birth and development of cardiac surgery, and the control of cardiac arrhythmias. The treatment of heart failure, although greatly improved, remains a challenge. Current cardiology practice is evidence-based and global in scope. Research and practice are increasingly conducted in cardiovascular centres and institutes. It is likely that in the future, a greater emphasis will be placed on prevention, which will be enhanced by genetic information.

Gentleman, rebel and believer: the radial way.

The manuscript highlights some historic milestones of the universal trans-radial approach (TRA) and describes some characteristics that "radialists" share (at least in the author's opinion). The author argues against common misconceptions about the TRA, like the use of more iodine contrast, more X-ray exposition, a lower rate of successful angioplasty. Data illustrating the conversion from a trans-femoral approach catheterization laboratory to a complete TRA laboratory are presented, showing the speed of the switch and the rapid clinical benefit observed. The author concludes with possible future directions for TRA supporters, on how to optimize the material for the puncture step, how to reduce the radial occlusion rate and how to promote the TRA as the first access for acute coronary syndromes managed invasively.

Advances in paediatric interventional cardiology since 2000.

Interventional paediatric and congenital cardiology is expanding at a rapid pace. Validated techniques (such as aortic or pulmonary valve dilatations and occlusion of persistent ductus arteriosus and atrial septal defects) are improving thanks to the use of smaller introducers and sheaths, low-profile balloons and novel devices. Moreover, catheter-based interventions have emerged as an attractive alternative to surgery in other fields: pulmonary valve replacement, balloon and stent implantation for native and recurrent coarctation, and percutaneous closure of ventricular septal defects. On the other hand, percutaneous interventions in the paediatric population may be limited by patient size or the anatomy of the defect. Hybrid approaches involving both cardiac interventionists and surgeons are being developed to overcome these limitations. Based on a better understanding of cardiac development, fetal cardiac interventions are being attempted in order to alter the history of severe obstructive lesions. Finally, some interventional procedures still carry a low success rate-for example, pulmonary vein stenosis, even with the use of conventional stents. Biodegradable stents and devices are being developed and may find an application in this setting as well as in others. The purpose of this review is to highlight the advances in paediatric interventional cardiology since the beginning of the third millennium.

1929-2009: 80 anos de cateterismo cardíaco - uma história dentro da história / 1929-2009: 80 years of cardiac catheterization - a history within history

Neste artigo, o autor revisa os acontecimentos primordiais que originaram o cateterismo cardíaco, o surgimento do termo e os primeiros registros experimentais diretos da atividade cardíaca no final do século XIX. Ressalta as circunstâncias que cercaram a inauguração do cateterismo cardíaco no homem por Werner Forrsmann, há 80 anos, e depois sua introdução na medicina prática por Cournand, Richards e Baldwin, na década de 1940. Examina o desenvolvimento do cateterismo cardíaco direito e depois esquerdo, os acontecimentos que permitiram o desenvolvimento da angiocardiografia e a grande expansão das indicações do exame cardíaco por cateter, a partir da década de 1960. Mostra o desenvolvimento da ideia de angioplastia transluminal periférica e coronariana por Charles Dotter, enfatizando as figuras de Andreas Gruentzig e Richard Myler e as conquistas fundamentais, como os stents, que permitiram o extraordinário progresso desse procedimento, que tem dominado a cardiologia intervencionista. Aponta, a partir da visão de quem tem vivido grande parte dessa história, a importância do método para o desenvolvimento da cardiologia experimental, clínica e terapêutica nas últimas três décadas.

In this article, the author reviews the early steps of the cardiac catheterization, the development of this term and the first direct experimental records of the heart movements in the end of the 19th century. The circumstances regarding the inauguration of cardiac catheterization in human beings by Werner Forrsmann eighty years ago and the application of the method in clinical medicine by Cournand, Richards and Baldwin between 1940 and 1950 are highlighted. The development of right and left cardiac catheterization, the facts that enabled the development of angiocardiography and the expansion of its indications after 1960 are reported. The author also reports how Charles Dotter created the concept of peripheral and coronary transluminal angioplasty and magnifies the contributions of Andreas Gruentzig and Richard Myler, as well as fundamental achievements such as stents, which led to an extraordinary improvement of this procedure which has been the basis of interventional cardiology. Based on the point of view of one who has experienced a major part of this history, he points out the importance of this method for the development of the experimental, clinical and therapeutical cardiology in the last three decades.

Catheter-based management of aortic valve regurgitation in experimental cardiology.

Non-surgical management of aortic valve disease has been given considerable attention. Several recent publications have already reported its use in clinical practice. The main issue is to get an understanding of the pathophysiological processes and, most importantly, extensive experimental activity. In addition to testing various animal models, technical and material aspects are also being intensively investigated. It is not clear yet whether the durability and applicability of this promising development will be comparable with the standard of current cardiac surgery. Nonetheless, even the use of some models as a temporary approach helping to improve the circulatory status, not allowing safe surgery, is certainly justified. At any rate, a new stage of research and clinical application has been set off. However, experimental background continues to be simply indispensable. The paper is a short review of the issue.

Recollection about Werner Forssmann as a surgeon.

The impact of Werner Forssmann on his clinical team during his time at the Protestant Hospital in Duesseldorf is described. Many residents came from foreign countries, especially from Argentina. The daily work of the clinics is depicted and the character of Werner Forssmann as a surgeon is understood from his education.

When cardiology became a separate matter.

The cardiac catheter technique established by Werner Forssmann in 1929 not only introduced the era of modern cardiology, but also led to the identification of this specialist field and its practising doctors, the cardiologists. The intentionally scientifically oriented Deutsche Gesellschaft für Kreislaufforschung, founded in 1927, acquired a clinical focus with the Commission for Clinical Cardiology thanks to the cardiac catheter cardiologists trained mainly in other countries. Today this society is the German Society for Cardiology, subtitled Cardiac and Cardiovascular Research, with a membership of 5,339 (July 31st 2004). Simultaneously, the impulse for the specialist fields to become independent within the framework of the new advanced educational regulations came into force in 1972 leading to the first branches of internal medicine, cardiology, gastroenterology and pneumology, followed by the establishment of independent departments, clinics and university chairs in cardiology. (At the end of 2003 a total of 3,059 internal specialists in cardiology were working in Germany and there were 393 independent facilities, including 33 university chairs in cardiology.) In addition, 10-14 cardiac centres combining both adult and pediatric cardiology together with cardiac surgery. When setting up intensive care wards, the main impulse also came from cardiology, achieving a totally new dimension when coronary angiography and bypass surgery made it possible to make an exact diagnosis as well as to provide an efficient therapy, right up to interventional methods with acute PTCA in recent cardiac infarction. The necessary step towards informing the population led to the establishment of the German Heart Foundation in 1979 with a membership of 46,795 (December 31st 2003) and a scientific board of 436 highly qualified cardiologists. The development presented here would not have been possible without the cardiac catheter.

Coronary arterial revascularization: past, present, future: part I--historical trials.

Advances in coronary artery revascularization have been accompanied by clinical trials evaluating these advances. From the Coronary Artery Surgery Study and Bypass Angioplasty Revascularization Investigation to the more recent Arterial Revascularization Therapy Study (ARTS1) and the Medicine, Angioplasty, or Surgery Study (MASS2), these clinical trials provide us with a rationale for the way we conduct clinical practice. This paper reviews the data supporting historical revascularization strategies for our patients, including medical therapy, angioplasty, and bare metal stents. Several recurrent themes emerge. These include a need for increased revascularization in patients who undergo percutaneous treatments, the durability of surgical arterial revascularization, and the importance of medical therapy as the mainstay of treatment. Part II will address newer therapies.