Texas Heart Institute Research Articles

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases

Doris A. Taylor, PhD, Hon DSc: Director, Regenerative Medicine Research, Director, Center for Cell and Organ Biotechnology at Texas Heart Institute and Texas A&M University

Doris A. Taylor, PhD, Hon DSc: Director, Regenerative Medicine Research, Director, Center for Cell and Organ Biotechnology at Texas Heart Institute and Texas A&M University

GROUP A STREPTOCOCCUS AND RESPIRATORY SYNCYTIAL VIRUS INFECTION COMPLICATED BY ACUTE MYOPERICARDITIS AND DIFFUSE ALVEOLAR HEMORRHAGE

SESSION TITLE: Critical Care 2 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: The incidence of acute myopericardtis (AMP) is estimated to be 1 in 10 cases per 100,000 persons, with acute viral infections accounting for most (1% to 5%) of the cases (1). Diffuse Alveolar Hemorrhage (DAH) has a spectrum of disorders associated with it, systemic vasculitis being the most frequent one (2). However, Group A streptococcus (GAS) and Respiratory syncytial virus (RSV) are rarely reported as causative pathogens of AMP or DAH. We report a case of GAS and RSV infection complicated by AMP and DAH. CASE PRESENTATION: A 36-year-old male with Addison's disease on hydrocortisone and fludrocortisone, presented with lethargy and shortness of breath for 2 days. His vital signs were significant for a temperature of 101.7°F and blood pressure of 78/53 mm/Hg. On physical exam he had neck edema, palpable tender cervical lymph nodes and tonsillar exudates bilaterally. Centor score was 4.His labs were remarkable for a leukocytosis, lactic acidosis and elevated creatinine at 1.7mg/dl. The rapid streptococcal test and RSV polymerase chain reaction were positive. Computed tomography of the neck revealed severe edema of bilateral palatine tonsils extending to aryepiglottic folds, high-grade stenosis at the level of the nasopharynx and bilateral cervical lymphadenopathy. The patient was emergently intubated for airway protection. He was administered broad spectrum antibiotics and stress dose steroids and transferred to the intensive care unit. Despite initial treatment, he clinically deteriorated and progressed to shock. An Electrocardiogram showed diffuse ST- segment elevation and PR-segment depression in V5, V6 and lead II. Troponin I was elevated at 17ng/ml. A transthoracic echocardiogram was performed which showed diffusely hypokinetic left and right ventricle suggesting a component of AMP. Colchicine was initiated. Due to progressive hypoxemia, the patient underwent bronchoscopy which revealed increasing red blood cells in sequential bronchoalveolar lavage aliquots. During a prolonged ICU course, there was gradual clinical improvement with resolution of shock, AMP and DAH. The patient was successfully extubated and had a complete recovery. DISCUSSION: GAS and RSV are frequently encountered infections that typically have an innocuous course in immunocompetent adults. However, there is a paucity of literature describing RSV or GAS in correlation with fulminant AMP and DAH. AMP and DAH are medical emergencies that can be fatal if left untreated. High index of suspicion and prompt diagnosis and treatment are crucial for complete recovery. CONCLUSIONS: We not only depict rare infectious entities through our case, but we stress the importance of considering AMP and DAH as potential life threatening complications of RSV and DAH, especially in immunocompromised adults. Reference #1: Bhaduri-McIntosh S, Prasad M, Moltedo J, Vαzquez M. Purulent pericarditis caused by group A streptococcus. Texas Heart Institute Journal. 2006;33(4):519. Reference #2: Park MS. Diffuse Alveolar Hemorrhage. Tuberculosis and Respiratory Diseases. 2013;74(4):151-162. https://doi.org/10.4046/trd.2013.74.4.151. DISCLOSURES: No relevant relationships by DHRUBAJYOTI BANDYOPADHYAY, source=Web Response No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Susannah Kurtz, source=Web Response No relevant relationships by James Salonia, source=Web Response

MOUNIER-KUHN SYNDROME: A RARE CAUSE OF A COMMON DISEASE

SESSION TITLE: Imaging SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Mounier-Kuhn syndrome is a rare disorder manifesting radiologically by marked dilatation of the trachea and main bronchi and symptomatically early in life with recurrent bronchopulmonary infection and bronchiectasis. We report a patient with late onset bronchiectasis caused by Mounier-Kuhn disease. CASE PRESENTATION: A 68-year-old male was hospitalized repeatedly for treatment of recurrent bronchopulmonary infection characterized by excessive sputum production, fever and worsening dyspnea. He was an ex-smoker with 36 pack-year smoking history. Chronic comorbidities include bilateral upper lobe smoke-induced centriacinar emphysema and idiopathic bilateral lower lobe bronchiectasis. Physical examination revealed a thin man with bilateral wheezing, clubbing, SpO2 of 90% on room air and temperature of 100.9 F. Labs were unremarkable except for leukocytosis. Chest x-ray demonstrated emphysema and persistent bibasilar opacities. He was treated with antibiotic, bronchodilator and nutritional support. CT chest without contrast showed predominantly lower lobe bronchiectasis with superimposed pneumonia. The trachea was dilated with a cross-sectional diameter of 40 mm; left and right main bronchi were 28 mm each. Pulmonary function testing revealed obstructive ventilatory defect with reduced FEV1/FVC ratio of 67% and FEV1 of 1.5 liters. Fiberoptic bronchoscopy revealed a very dilated trachea with an elliptical shape, with dynamic airway during suctioning and coughing. Copious amounts of mucopurulent secretions were aspirated from both lungs. Bronchoalveolar lavage was negative for bacteria. The bronchoscopy findings coupled with the findings on CT chest confirmed a diagnosis of Mounier-Kuhn syndrome. The patient was prescribed chest percussive device to promote mobilization of respiratory secretions to reduce recurrent bronchopulmonary infections. DISCUSSION: Mounier-Kuhn syndrome, also known as tracheobronchomegaly, is a rare condition that occurs due to congenital weakness/atrophy of the muscular and elastic tissue of the tracheal and bronchial walls. Clinical manifestations range from asymptomatic disease to recurrent lower respiratory infections progressing to severe respiratory failure and death. Diagnosis is made by CT: diagnostic criteria are tracheal diameter >30mm, right bronchial diameter >24mm and left bronchial diameter >23mm. Symptomatic patients are treated with chest physiotherapy and antibiotics during bouts of infection. Tracheal stenting and tracheobronchoplasty may be needed in severe cases. This patient had a history of recurrent lower respiratory infections, met CT criteria and demonstrated characteristic findings of Mounier-Kuhn syndrome. CONCLUSIONS: Mounier-Kuhn syndrome is characterized by dilation of the trachea, impaired clearance of airways secretions and recurrent lower respiratory infections that can lead to bronchiectasis; diagnosis is made radiologically by CT. Reference #1: Celik B, Bilgin S, Yuksel C. Mounier-Kuhn Syndrome: A Rare Cause of Bronchial Dilation. TEXAS HEART INSTITUTE JOURNAL. 2011;38:194-196. Reference #2: Simkins A, Maiti A, Cherian SV, Trujillo DO, Estrada-Y-Martin RM. Mounier-Kuhn syndrome. Postgraduate Medical Journal. 2017;93:642-642. Reference #3: Simon M, Vremaroiu P, Andrei F. Mounier-Kuhn syndrome. Journal of bronchology& interventional pulmonology. 2014;21:145. DISCLOSURES: No relevant relationships by Mona Alipour, source=Web Response No relevant relationships by Farhad Arjomand, source=Web Response No relevant relationships by Jennifer Chiu, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Ankur Mogla, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response

Sequential aneurysms of the internal carotid artery with fibromuscular dysplasia

A 50-year-old woman presented with a 6-month history of left-sided neck discomfort and headaches. She denied any history of lateralizing neurologic deficits and denied vascular risk factors including smoking and connective tissue disorders. Her physical examination demonstrated a tender pulsatile mass on the left side of the neck and an associated carotid bruit. Carotid duplex ultrasound revealed four left internal carotid artery (ICA) aneurysms consistent with aneurysmal degeneration secondary to fibromuscular dysplasia. Computed tomography angiography of the neck confirmed these findings and revealed a bovine aortic arch without significant occlusive disease. The largest aneurysm measured 2.0 cm in diameter with three smaller “string-of-beads” dilations extending to within 1 cm of the skull base (A/Cover). Treatment options included ongoing surveillance, open repair with an interposition graft, and endovascular repair using stent grafts to exclude the aneurysms. The patient rejected surveillance, given her symptoms and concern for thromboembolization. Open repair was deemed high risk because of the superior extent of the aneurysms. Therefore, we proceeded with an endovascular strategy using transfemoral access to select the left common carotid artery. Embolic protection was deferred because of the low atherosclerotic burden, and awake neuromonitoring was performed. Selective arteriography demonstrated the known left ICA aneurysms (B). A 0.018-inch wire was used to traverse the ICA aneurysms. A 6-mm × 5-cm Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) stent graft was placed distally and overlapped with an 8-mm × 5-cm Viabahn stent graft proximally to accommodate tapering of the native vessel. Completion arteriography revealed aneurysm exclusion and excellent flow to the intracranial ICA (C). The patient was maintained on clopidogrel postoperatively. At 1 month, she was free from complications, and follow-up computed tomography angiography demonstrated aneurysm exclusion and patent stent grafts (D). The patient's consent was obtained for publication. Extracranial carotid artery aneurysms (ECAAs) are rare and have primarily been treated with open surgery.1McCollum C.H. Wheeler W.G. Noon G.P. DeBakey M.E. Aneurysms of the extracranial carotid artery. Twenty-one years' experience.Am J Surg. 1979; 137: 196-200Abstract Full Text PDF PubMed Scopus (231) Google Scholar Common causes of ECAAs remain atherosclerosis and trauma; however, fibromuscular dysplasia is responsible for 8% to 11% of all ECAAs.2El-Sabrout R. Cooley D.A. Extracranial carotid artery aneurysms: Texas Heart Institute experience.J Vasc Surg. 2000; 31: 702-712Abstract Full Text Full Text PDF PubMed Scopus (294) Google Scholar, 3Fankhauser G.T. Stone W.M. Fowl R.J. O'Donnell M.E. Bower T.C. Meyer F.B. et al.Surgical and medical management of extracranial carotid artery aneurysms.J Vasc Surg. 2015; 61: 389-393Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar Endovascular repair of ECAAs is increasingly used to decrease morbidity and mortality associated with repair of ECAAs complicated by redo surgical fields or prior radiation exposure and for those that extend to the skull base.2El-Sabrout R. Cooley D.A. Extracranial carotid artery aneurysms: Texas Heart Institute experience.J Vasc Surg. 2000; 31: 702-712Abstract Full Text Full Text PDF PubMed Scopus (294) Google Scholar, 3Fankhauser G.T. Stone W.M. Fowl R.J. O'Donnell M.E. Bower T.C. Meyer F.B. et al.Surgical and medical management of extracranial carotid artery aneurysms.J Vasc Surg. 2015; 61: 389-393Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar, 4Zhou W. Lin P.H. Bush R.L. Peden E. Guerrero M.A. Terramani T. et al.Carotid artery aneurysm: evolution of management over two decades.J Vasc Surg. 2006; 43 (discussion: 497): 493-496Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 5Li Z. Chang G. Yao C. Guo L. Liu Y. Wang M. et al.Endovascular stenting of extracranial carotid artery aneurysm: a systematic review.Eur J Vasc Endovasc Surg. 2011; 42: 419-426Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar

A Path Forward for Regenerative Medicine.

Although clinical trials of cell-based approaches to cardiovascular disease have yielded some promising results, no cell-based therapy has achieved regulatory approval for a cardiovascular indication. To broadly assess the challenges to regulatory approval and identify strategies to facilitate this goal, the Cardiac Safety Research Consortium sponsored a session during the Texas Heart Institute International Symposium on Cardiovascular Regenerative Medicine in September 2017. This session convened leaders in cardiovascular regenerative medicine, including participants from academia, the pharmaceutical industry, the US Food and Drug Administration, and the Cardiac Safety Research Consortium, with particular focus on treatments closest to regulatory approval. A goal of the session was to identify barriers to regulatory approval and potential pathways to overcome them. Barriers identified include manufacturing and therapeutic complexity, difficulties identifying an optimal comparator group, limited industry capacity for funding pivotal clinical trials, and challenges to demonstrating efficacy on clinical end points required for regulatory decisions. Strategies to overcome these barriers include precompetitive development of a cell therapy registry network to enable dual-purposing of clinical data as part of pragmatic clinical trial design, development of standardized terminology for product activity and end points to facilitate this registry, use of innovative statistical methods and quality of life or functional end points to supplement outcomes such as death or heart failure hospitalization and reduce sample size, involvement of patients in determining the research agenda, and use of the Food and Drug Administration's new Regenerative Medicine Advanced Therapy designation to facilitate early discussion with regulatory authorities when planning development pathways.

In Memoriam: Robert J. Hall, MD (1926–2018)

In Memoriam: Robert J. Hall, MD (1926–2018)

Doris Taylor: All Heart.

There’s an undeniable warmth to Doris Taylor, Director of Regenerative Medicine Research and of the Center for Cell and Organ Biotechnology at the Texas Heart Institute and Texas A&M University in Houston. Professionally, she may be most famous for engineering the first bioartificial mammalian heart.1 But, on a personal level, her own heart is compassionate, generous, and not remotely artificial. Taylor went through great turmoil in early childhood, but rather than mentally closing herself off to pain and difficulty, she’s endeavored throughout life to ease the pain and suffering of others. In a recent interview with Circulation Research , she explained that she does this in two ways. At a community-level, she’s an ardent advocate for social justice, spending her spare time promoting local political organizations and spearheading worthy causes, while at the global-level, her scientific research adds to the body of medical knowledge that enables innovations, improves treatments, and saves lives. Doris Taylor Her research has certainly, and consistently, broken new ground. Her pioneering stem cell research, regenerative medicine strategies, and investigations of sex-specific physiological differences have driven new lines of enquiry in cardiovascular disease research and have also challenged established attitudes toward how such diseases might be treated.2–6 I was born in San Francisco and I had a twin brother. We were born very prematurely and, in those days, premature twins didn’t live, so neither of us were supposed to survive. My mother told us that the doctor came in and told her, if she was religious and believed in doing something for the end of life, she should do it for us. So, she called the hospital chaplain and he came, but then, according to my mother, the minute he left the room, my brother and I rallied. It was as if we’d …

Saccular Aneurysm of the Extracranial Internal Carotid Artery

While surgery for stenotic lesions of the internal carotid artery (ICA) remains a common procedure performed by vascular surgeons, aneurysmal disease in this area continues to present less frequently. It has been estimated that operations for carotid aneurysms may account for at most 2% of all carotid artery interventions. Although pseudoaneurysms following endarterectomy continues to be the most common pathology (in up to 58% of cases) several other aetiological processes are possible. These include atherosclerosis, fibromuscular dysplasia, trauma and carotid dissection. The natural history of these aneurysms is not entirely known as few centres have accumulated sufficient experience. However, in keeping with most published series, 43% of patients with ICA aneurysms presenting to the Texas Heart Institute suffered from symptoms related to cerebral ischemia. This relatively high risk of cerebral events has led many vascular surgeons to advocate intervention for most of these aneurysms. This report describes the presentation and subsequent successful surgical treatment of a large asymptomatic, atherosclerotic internal carotid aneurysm in an elderly women. Case Report

Cardiac Angiosarcoma: A Rare Cause of Recurrent Pericardial Effusion

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Cardiac angiosarcoma is a rare entity. Early diagnosis is delayed due to generalized symptoms. Diagnosis is made when specific symptoms related to tumor growth are investigated. CASE PRESENTATION: A 20 y/o female presented with pleuritic chest pain, treated as pericarditis. After one month, she developed fatigue and dyspnea. CT chest was remarkable for bilateral pleural effusions and pericardial effusion. She underwent pericardiocentesis. Pericardial bacterial and fungal evaluation was unrevealing. ANA, anti dsDNA, antihistone, complement levels, RF, HIV, acute hepatitis panel, RPR, coccidiomycosis and CMV titers, toxoplasma Ab, ANCA levels, coxsackie B, and IgM EBV were negative. She had a positive IgG EBV and her symptoms were attributed to viral perimyocarditis. She continued to have right-sided chest pain and was admitted to the hospital after three months. Her vital signs and physical examination were unremarkable. Cardiac MRI revealed a large mass, 4.1 x 6.3 x 4.8 cm, anterior to the right atrium and extending to the AV groove and proximal SVC, along with a moderate pericardial effusion. On perfusion images, there was gadolinium uptake at the anterior most part of the tumor with three hypoperfused areas portraying vascularity. Left heart catheterization showed extensive vascularization in the angiographic location of the right atrium where the tumor was located. She underwent tumor resection. The mass was extensive, beyond the right atrial free wall, on the right ventricle surface, pericardial metastasis and underneath an innominate vein on top of the aorta. Pathology displayed an aggressive high-grade angiosarcoma with a sheet-like growth pattern. Tumor cells had CD31 membranous and ERG nuclear staining. She was stable after surgery and further managed with paclitaxel. DISCUSSION: Over the years, the diagnosis of cardiac sarcomas has improved due to a combination of physical examination, ekg, cardiac catheterization, echocardiography, CT scan and MRI. It mostly involves the right atrium, presenting as pericardial effusion and/or cardiac tamponade in about 56% of cases. Complete or partial surgical resection is done for palliation or complete cure. Angiosarcomas are mostly resistant to chemotherapy and radiotherapy. However, recently paclitaxel and pegylated-liposomal doxorubicin have shown efficacy in treating angiosarcoma. CONCLUSIONS: Overall, even with the new imaging techniques for diagnosis and management, cardiac sarcomas still carry a poor prognosis with a 5-year survival rate of 14%. Reference #1: Blackmon, Shandra H., and Michael J. Reardon. “Surgical Treatment of Primary Cardiac Sarcomas.” Texas Heart Institute Journal 36.5 (2009): 451-452. Reference #2: Loukas, Marios. “Primary Cardiac Angiosarcoma - A Review”. Medical Science Monitor 20 (2014): 103-109. Reference #3: Skubitz, Keith M., and Philip A. Haddad. “Paclitaxel And Pegylated-Liposomal Doxorubicin Are Both Active In Angiosarcoma”. Cancer 104.2 (2005): 361-366. DISCLOSURE: The following authors have nothing to disclose: Sidra Khalid, Richard Meredith, Allan Klein No Product/Research Disclosure Information

Rebel Heart

This article discusses features and advantages of BiVACOR, an artificial heart machine. It also presents a brief overview of medical successes of Billy Cohn, a medical doctor. The BiVACOR heart is a rotary pump with a single moving part that consists of two impellers on a magnetically suspended rotor. Cohn along with his older brother built homemade gadgets, rocket engines, and a variety of incendiary devices in the garage. As Cohn progressed in his medical career, he never stopped tinkering. He was fast becoming one of the finest heart surgeons in the country, yet he spent his free time in his home workshop, prototyping medical devices to assist his operations. Cohn and O.H. ‘Bud’ Frazier, a cardiac surgeon who had performed more than 1000 heart transplants, led the work on AbioCor from the Texas Heart Institute in Houston and worked on a completely novel approach to artificial heart design—continuous flow. The heart, built by the two surgeons, is set out to build would replace those metaphorical flappy wings with fixed ones.

Change of Heartbeat.

The article presents the research carried out by the research team, from the Baylor College of Medicine, Rice University and Texas Heart Institute, to create the heartbeat regulator that obtains power from microwaves rather than wires.

The Texas Heart Institute

In 1962, Dr Denton A. Cooley founded the Texas Heart Institute (THI), which he considered to be his greatest achievement. At the time, he was practicing at both St. Luke’s Episcopal Hospital (SLEH) and Texas Children’s Hospital (TCH) in the Texas Medical Center in Houston, Texas, and was already considered one of the most renowned cardiovascular surgeons in the world. In 1956, he and his team had performed the first open-heart operations in Houston, and by 1962, SLEH and TCH had the most active open-heart surgical program in the world. Nevertheless, they were still regarded as general hospitals. To establish these hospitals as premier sites for cardiovascular medicine, Dr Cooley wanted to create an affiliated institute focused on cardiovascular medicine research and education. It would have no patients of its own, but it would draw patients from around the world to SLEH/TCH for treatment. The idea of affiliating a specialty institute with 1 or more pre-existing hospitals had a strong precedent at Dr Cooley’s alma mater, Johns Hopkins Hospital, in Baltimore. From the beginning, the Institute’s mission has been to reduce the devastating toll of cardiovascular disease through innovative programs in treatment, education, and research. On July 13, 1962, at a joint meeting of the 2 hospital boards, Dr Cooley presented his proposal for the project, and the joint boards tentatively approved his plans. On August 3, 1962, the THI charter was officially registered in Austin, the state capital. Dr Cooley immediately began raising funds to build the Institute and finally reached his goal in 1966, after he learned that the Ray C. Fish Foundation, a relatively new charitable group, was seeking a worthy project. The foundation had been established on behalf of a man who had died of heart disease. Its director, Robert R. Herring, agreed to donate $5 …

In Memoriam: Grady L. Hallman, MD (1930–2017)

In Memoriam: Grady L. Hallman, MD (1930–2017)

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases.

Ray C. Fish (1902–1962) was a leading figure in Houston's natural gas industry and a philanthropist. He believed in the American dream of “opportunity for success.” The Ray C. Fish Foundation was established so that others might be encouraged to broaden man's self-knowledge and to keep the American dream alive. After its founder's death from heart disease, the Fish Foundation granted $5 million to make the Texas Heart Institute a reality. For this reason, the Institute's highest professional award is given in honor of this extraordinary man. The award recognizes those whose innovations have made significant contributions to cardiovascular medicine and surgery. The 1st Texas Heart Institute Medal and Ray C. Fish Award for Scientific Achieve-ment in Cardiovascular Diseases were presented in 1972 to Dr. Norman Shumway. Since 1972, 29 other highly deserving recipients have been so honored by the Institute. The complete Roll of Recipients appears on the next page. Figure. James T. Willerson, MD

In Memoriam: Denton A. Cooley, MD (1920–2016)

Einstein must have had Denton A. Cooley in mind when he wrote that.We said goodbye to Dr. Cooley on 28 November 2016 in a beautiful ceremony at Trinity Episcopal Church in downtown Houston. His eldest daughter, Mary Cooley Craddock, and his son-in-law and the Surgeon-in-Chief at Texas Children's Hospital, Dr. Charles D. Fraser, Jr., eulogized Dr. Cooley, emphasizing his personal side and his love of family, his loyalty to his Texas Heart Institute team and to his friends, his pride in the Texas Heart Institute, his desire to see it flourish long after he was gone, and his dedicated care of patients. In addition to his greatness as a heart surgeon, these were all qualities that we recognized and admired as part of Dr. Cooley. He always inspired us to do our best in our professional and personal efforts, and to make certain that “patients come first.”The Texas Heart Institute, founded in Houston by Dr. Cooley, has a name and a reputation that are recognized throughout the world. It is a place where great care has been given and continues to be given to patients with every imaginable cardiovascular disease—some of the conditions so serious that physicians elsewhere have told those patients they are “too sick to be helped” or are “beyond the ability of our center to help you.” Here at THI, these same people most often are helped and are returned to useful and productive lives.The Texas Heart Institute is also recognized worldwide as a “go-to place” to receive the highest quality of training to become an outstanding heart surgeon, cardiologist, interventional cardiologist, electrophysiologist, anesthesiologist, pathologist, and more. Further, we are recognized for the original development and clinical application of left ventricular assist devices, and for helping a greater number of severe-heart-failure patients with these devices than has any other medical center in the world. Today, we are performing pioneering work in detecting and treating vulnerable atherosclerotic plaque, as well as in developing new cell-based therapies to regenerate injured hearts and blood vessels.It is fair to state that in most foreign countries the best-recognized names within the Texas Medical Center—the world's largest medical center—are the Texas Heart Institute and The University of Texas M.D. Anderson Cancer Center.For the Texas Heart Institute, that reputation has been built through the pioneering efforts of Dr. Cooley and the outstanding cardiac surgeons who formed his team; through the efforts of our equally outstanding cardiologists at work across the spectrum of cardiovascular disease; and through the dedication of our nurses, technical support staff, and other members of our professional staff. For more than 50 years, these efforts have been almost entirely supported by grants and philanthropy, most often contributed by generous and grateful Houstonians.Nor are we finished. The Texas Heart Institute will expand its effort to help large numbers of patients by broadening its endeavor to develop interventional and surgical therapies that are ever-more minimally invasive and catheter based, while maintaining and advancing our skills in cardiovascular surgery and the continuing development of cardiac support devices. Similarly, we seek to further develop and clinically apply cell-based and gene-manipulation therapies that in the future, we believe, will often prevent cardiovascular disease in human beings; and when prevention is not possible, we will modify cardiovascular problems so that patients can live long and productive lives.To Dr. Cooley, we say this: We are very grateful for your mentoring, your leadership, your inspiration, your encouragement, and for the personal example you have set for us all. Please be assured that we shall continue what you began. We shall see it through until cardiovascular disease is no longer the major killer of men and women throughout the world.

Denton Arthur Cooley, MD.

Denton Arthur Cooley, MD, a pioneering heart surgeon, died November 18, 2016, at age 96. He was born in Houston, TX, on August 22, 1920, to Ralph Clarkson Cooley and Mary Fraley Cooley. From the beginning, Cooley’s career in medicine and his contributions to humanity seem to have been foreshadowed. His father was a prominent Houston dentist, and the attending obstetrician at his birth was Dr Ernst William Bertner. Bertner would be part of the team that developed the renowned Texas Medical Center where Denton Cooley later established the now world-acclaimed Texas Heart Institute (THI). In the early 1890s, Cooley’s paternal grandfather, Daniel Denton Cooley, helped found the Houston Heights, a major suburb of the growing city of Houston. Denton A. Cooley’s pioneering career spanned the history of modern cardiovascular surgery. Beginning in the late 1940s, he developed many of today’s commonly used cardiovascular procedures and devices. Nevertheless, he is probably best known for performing the first successful human heart transplant in the United States (1968) and the world’s first human implantation of an artificial heart (1969). Many of Cooley’s other contributions, however, are equally important: the first repair of an aortic aneurysm (1949); the first repair of a ruptured abdominal aortic aneurysm (1954); the first repair of a ventricular septal defect that developed after a heart attack (1956); the first successful carotid endarterectomy (1956); new techniques for repairing diseased heart valves and congenital heart defects…the list goes on to include >30 such firsts. In some way, Cooley participated in every major development in cardiovascular surgery. With characteristic humility, he always said, “My good fortune professionally came from the fact that I began my career when heart surgery was in its infancy, when surgeons were free to discover and innovate. I’ve been a participant in so many breakthroughs primarily because …

Introduction to the Seventeenth Symposium on Cardiac Arrhythmias: Words in Honor of Dr. Ali Massumi.

My name is Mehran Massumi and I am the son of Ali Massumi, the man who started this electrophysiology conference 17 years ago.Ali Massumi was born on 15 January 1945 in the town of Nain, Iran. In 1971, he graduated at the top of his class from the University of Tehran, where he met his wife (eventually to become my mother), Vida. Upon completion of his medical training, the couple moved to Buffalo, New York, where my father completed his internal medicine residency at Millard Fillmore Hospital. Next, with my older brother in tow, my parents moved to Houston, where my father pursued his fellowship in Cardiovascular Diseases at the Texas Heart Institute. He graduated from his fellowship in 1979 and joined the prestigious Hall-Garcia Cardiology Associates, where he remained a partner during the entire course of his medical career.Throughout his professional life, my father received many accolades and was widely considered one of the best clinical electrophysiologists in this field. He was routinely named amongst the best cardiologists by local, state, and national media outlets; and he was the personal physician to many members of the Royal Family of Oman.But it wasn't the awards or praise that drove him to be great. He was a teacher, who loved nothing more than to teach. When he gained a full professorship at the Baylor College of Medicine, he was the youngest physician at the time to do so. Loved by the fellows whom he helped to train, he won so many “Attending of the Year” awards that a moratorium was placed on his winning, in order to give other physicians a chance. He trained more than 180 cardiologists and more than 30 electrophysiologists, many of whom are sitting here today.My father passed away on 13 March 2015, just 3 weeks after last year's conference. Despite failing health and generalized weakness from lymphoma, he still mustered the energy to attend the event, a testament to how much he cared about continuing education in the field of cardiac electrophysiology.Although we all wish he were here today to open this year's meeting, I am positive that he is looking down on us from above and could not be happier that his memory and his conference live on. I know that this conference is in the very capable hands of his partners, Drs. Mohammad Saeed, Abdi Rasekh, and Mehdi Razavi, 3 colleagues whom he very much admired and respected.On behalf of myself, my family, and my father's colleagues at St. Luke's Hospital and the Texas Heart Institute, I want to thank all of you for your attendance at this symposium that meant so much to him.

The Future of Onco-Cardiology: We Are Not Just "Side Effect Hunters".

Cancer treatments in general share various detrimental effects in common, especially upregulation of cardiovascular risk factors. Therefore, the science of onco-cardiology should not be restricted in scope to the side effects of each specific cancer drug. In particular, premature aging induced by cancer treatment may contribute to the chronic health problems of cancer survivors. About 1 660 000 people, including more than 12 000 children below the age of 18 years, are newly diagnosed with a malignancy in the United States every year.1 The American Cancer Society reported that in 2016 there are 15.5 million cancer survivors in the United States (http://www.cancer.org/cancer/news/news/report-number-of-cancer-survivors-continues-to-grow). At present, the 5-year survival rate of patients treated for cancer is 67%. Seventy-five percent of children in whom cancer is diagnosed today will live for at least 10 years; 20% will survive for longer than 35 years.1 Although these numbers are impressive compared with those from decades ago, further improvement of cancer survivors’ life span as well as quality of life and functional status is still necessary. Approximately 75% of cancer survivors have some form of chronic health problem. Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in this population, particularly after recurrent or second malignancy. The risk of CVD in cancer survivors is 8× higher than that of the general population. The relative risks of coronary artery disease and heart failure in cancer survivors are 10× and 15× higher, respectively, than their siblings without cancer.1 Cancer treatments, including chemotherapy and radiation, can lead to both short- and long-term cardiovascular complications. Evidence of subclinical cardiac and vascular damage was observed in more than 50% of survivors 5 to 10 years after chemotherapy.1 Onco-cardiology is a medical subspecialty concerned with the diagnosis and treatment of CVDs and organ failure mediated by microcirculatory or macrocirculatory …

Outcomes of 3309 Thoracoabdominal Aortic Aneurysm Repairs

Objective: Since the pioneering era of E. Stanley Crawford, our multimodal strategy for thoracoabdominal aortic aneurysm repair has evolved. We describe our approximately 3-decade single-practice experience regarding 3309 thoracoabdominal aortic aneurysm repairs and identify predictors of early death and other adverse postoperative outcomes. Methods: We analyzed retrospective (1986-2006) and prospective data (2006-2014) obtained from patients (2043 male; median age, 67 [59-73] years) who underwent 914 Crawford extent I, 1066 extent II, 660 extent III, and 669 extent IV thoracoabdominal aortic aneurysm repairs, of which 723 (21.8%) were urgent or emergency. Repairs were performed to treat degenerative aneurysm (64.2%) or aortic dissection (35.8%). The outcomes examined included operative death (ie, 30-day or in-hospital death) and permanent stroke, paraplegia, paraparesis, and renal failure necessitating dialysis, as well as adverse event, a composite of these outcomes. Results: There were 249 operative deaths (7.5%). Permanent paraplegia and paraparesis occurred after 97 (2.9%) and 81 (2.4%) repairs, respectively. Of 189 patients (5.7%) with permanent renal failure, 107 died in the hospital. Permanent stroke was relatively uncommon (n 1⁄4 74; 2.2%). The rate of the composite adverse event (n 1⁄4 478; 14.4%) was highest after extent II repair (n 1⁄4 203; 19.0%) and lowest after extent IV repair (n 1⁄4 67; 10.2%; P<.0001). Estimated postoperative survival was 83.5% 0.7% at 1 year, 63.6% 0.9% at 5 years, 36.8% 1.0% at 10 years, and 18.3% 0.9% at 15 years. Conclusions: Repairing thoracoabdominal aortic aneurysms poses substantial risks, particularly when the entire thoracoabdominal aorta (extent II) is replaced. Nonetheless, our data suggest that thoracoabdominal aortic aneurysm repair, when performed at an experienced center, can produce respectable outcomes. (J Thorac Cardiovasc Surg 2016;151:1323-38) From the Division of Cardiothoracic Surgery, Surgical Research Core, Michael E. DeBakey Department of Surgery, Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; and CHI St Luke’s Health–Baylor St Luke’s Medical Center, Houston, Tex. Read at the 95th Annual Meeting of The American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. Received for publication May 1, 2015; revisions received Dec 1, 2015; accepted for publication Dec 14, 2015; available ahead of print Feb 19, 2016. Address for reprints: Joseph S. Coselli, MD, One Baylor Plaza, BCM 390, Houston, TX 77030 (E-mail: jcoselli@bcm.edu). 0022-5223/$36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2015.12.050 Scanning this you to the a view the AA see the URL article. The Journal of Thoracic and Cardiovascular Surg Outcomes of TAAA repair differ by Crawford extent.