Fifty years of medicine: The surgical heritage of a pioneer – Paul Cartier MD (1919–2008)

Abstract

Department of Cardiovascular Surgery, Montreal Heart Institute, University of Montreal, Montreal, Quebec Correspondence: Dr Raymond Cartier, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8. Telephone 514-376-3330 ext 3715, fax 514-376-1355, e-mail rc2910@aol.com For more than 45 years, Dr Paul Cartier was active in the field of cardiovascular surgery at the Hotel-Dieu Hospital of Montreal, Quebec. During these years, he witnessed and took part in many premieres in cardiovascular surgery, which made him a privileged actor in this field. The following is a brief review of his long career. When Dr Paul Cartier finished medical school in 1947, medicine had a long way to go. Abdominal aortic aneurysms were treated by proximal and distal ligation, and Dr Clarence Crafoord had just performed the first surgical correction of a congenital aortic coarctation. As well, Dr Charles P Bailey had not yet rehabilitated ‘closed’ mitral commissurotomy, synthetic vascular grafts were science fiction, peripheral vascular surgery was more synonymous with amputation, and thoracic surgery was just emerging. After obtaining his medical degree at the University of Montreal (Montreal), Dr Cartier initiated his surgical residency at the same university with specific orientation in thoracic surgery. In 1951/1952, he left for St Louis, Missouri (USA), where he was appointed as a resident in thoracic surgery under Dr Evarts A Graham (who performed the first pneumonectomy for lung cancer) and Dr T Burford. Then, he moved to Case Western Reserve University in Cleveland, Ohio (USA), under the supervision of Dr Claude S Beck. Although Beck was trained as a neurosurgeon, he had a great deal of interest in congenital and acquired heart disease. During those days, he was busy mastering his astonishing ‘Beck II’ operation, which consisted of direct anastomosis between the coronary sinus and the descending aorta for the purpose of increasing retrograde coronary blood flow to the ischemic heart. In 1952/1953, Dr Cartier moved again, but this time to France − to Broussais Hospital (Paris) − to work with Dr Charles Dubost who, in 1953, performed the first aorto-iliac homograft bypass for an infrarenal aortic aneurysm. Under Dubost’s supervision, he learned the clinical potential and limitations of closed heart mitral commissurotomy (through a left thoracotomy on a beating heart). During the same journey, he also spent time with Dr Marceau Servel, then staff surgeon at St Joseph Hospital (France), whose major interests were in vascular, lymphatic and cardiac surgery. On his way home, he stopped in London, Great Britain, to observe Dr Russell Brock, a pioneer in pediatric cardiac surgery, performing (with the instrument named after him) congenital pulmonary stenosis corrections on the beating heart. Finally, in 1953, Dr Cartier was appointed the position of thoracic surgeon at Hotel-Dieu Hospital of Montreal. His long-lived career was then launched on three different fronts: pediatric cardiac surgery, adult thoracic and cardiac surgery, and peripheral vascular surgery. We will review these three aspects of his outstanding career and point out the distinguishing features that made Dr Paul Cartier a pioneer in the field of cardiovascular surgery.