Pioneer in Cardiology: Axel Haverich, MD, PhD - Circulation [PDF]

May 12, 2009 - May 1997 among a professor of surgery, his young surgeon son, and a visiting German heart ... who is toda

2 downloads 12 Views 579KB Size

Recommend Stories


Alexander Zlotnik MD, PhD
Never wish them pain. That's not who you are. If they caused you pain, they must have pain inside. Wish

Michael Dahlweid, MD, PhD
Never let your sense of morals prevent you from doing what is right. Isaac Asimov

Paola Guglielmelli, MD, PhD
Almost everything will work again if you unplug it for a few minutes, including you. Anne Lamott

barbara nylund phd md
At the end of your life, you will never regret not having passed one more test, not winning one more

Paulo Pereira, MD, PhD
Do not seek to follow in the footsteps of the wise. Seek what they sought. Matsuo Basho

Otto Kamp, MD, PhD, FESC
Learn to light a candle in the darkest moments of someone’s life. Be the light that helps others see; i

Δρ. Παπασταματίου Μιλτιάδης MD, PhD
Be like the sun for grace and mercy. Be like the night to cover others' faults. Be like running water

Michael C. Milone, MD, PhD
Don't ruin a good today by thinking about a bad yesterday. Let it go. Anonymous

DELLA MORTE DAVID, MD, PhD
Be like the sun for grace and mercy. Be like the night to cover others' faults. Be like running water

mr piergiorgio solli md, phd
We can't help everyone, but everyone can help someone. Ronald Reagan

Idea Transcript


European Perspectives in Cardiology

Pioneer in Cardiology: Axel Haverich, MD, PhD Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

“My Overall Aim Is to Rebuild an Entire Human Heart From ‘Ourselves.’ I’ve Got About 10 Years Before I Retire, and I Think We Will Do It by Then”

T

Axel Haverich, head of the Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany, and clinical director of the Hans Borst Centre for Heart and Stem Cell Research, Hannover, Germany, talks to Barry Shurlock, MA, PhD.

he Republic of Moldova is a small country of about 4.5 million people, located north of the Black Sea delta of the River Danube. It is wedged between Romania and the Ukraine, from which it is separated by Transnistria, a narrow breakaway Russophone strip, like a layer of cartilage in a knee joint. It is largely a Romanian-speaking remnant of the former Soviet Union with many unresolved conflicts, and it has had a complex history. For nearly half a century (47 years) before 1991, when it became independent, it was part of the former Soviet Union. In 2001, it elected a communist government. When the ruling Commmunist government recently won an election large numbers of people took to the streets. Romania, an EU member, allegedly fomented the demonstrations, and has offered Moldavians passports. Moldova is reckoned to be Europe’s poorest country, but the capital, Chişinău, is home to a number of large hospitals, where doctors battle against the odds to care for their patients. Under the umbrella of the State Medical and Pharmaceutical University “N. Testemitsanu” (named after a prominent scientist and public health protagonist) is the Heart Surgery Centre, where a chance meeting occurred in May 1997 among a professor of surgery, his young surgeon son, and a visiting German heart surgeon carrying out a nofee work over the weekend. This meeting led to something

On other pages...

that one day may be in the history books. The professor was Anatol Cebotari, MD, at that time head of the Heart Surgery Centre, and his son was Serghei Cebotari, MD, who is today a heart surgeon at the Hannover Medical School. The visitor was Axel Haverich, MD, PhD, who now heads the Division of Thoracic and Cardiovascular Surgery at the Hannover Medical School. At the time, Professor Haverich was experimenting with the use of tissue-engineered heart valves in sheep, with funding gained from a Gottfried Wilhelm Leibniz Prize, won a few years earlier.

“We Realised That Myocardium Would Be Difficult to Reconstruct Because of the Many Small Blood Vessels, so We Thought Why ot Start With Heart Valves?” Named after the famous German mathematician, run by the German Research Foundation, and established in 1986, the Gottfried Wilhelm Leibniz Prize awards 10 prizes a year; each prize is worth up to €2.5 million. It is considered the highest honour for a German researcher, and several of its recipients have also won Nobel Prizes. Professor Haverich, who at the time was head of the Division of Cardiovascular Surgery at the Christian Albrechts University, Kiel, Germany, recalls, “I can still remember the day in January 1995. I came back from [theatre] and my secretary said, ‘You must call the dean—you’ve won the Leibnitz prize.’

Spotlight: Jose Zamorano Gomez, MD, FESC Jose Zamorano Gomez, professor of medicine, University Complutense of Madrid, Madrid, Spain, director of the Cardiovascular Institute, University Clinic San Carlos, Madrid, president of the European Association of Echocardiography, and secretary of the European Society of Cardiology, says, “I am going to commit part of my life to merging the cardiovascular risk factor with imaging to better assess the real risks for our patients.” Page f107

Circulation: European Perspectives

f103

Circulation May 12, 2009

Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

Circulation: European Perspectives

f104

Circulation May 12, 2009 ‘No, no, it’s a mistake,’ I said. ‘He wants to talk to you,’ she insisted. I couldn’t believe it, but it was true. I was the first surgeon ever to win it!” He still is the only surgeon on a list peppered with mathematicians, philosophers, theoretical physicists, and the like. Professor Haverich won the prize for his work on heart–lung and isolated lung transplantations. A year later, he left Kiel to return to the top job at Hannover, where he was appointed head of his former alma mater, the Division of Thoracic and Cardiovascular Surgery of the Hannover Medical School. There, armed with prize money of 3 million Marks (≈ €1.5 million), he set up the Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), which currently has a professional and technical staff of 38. As a transplant surgeon, Professor Haverich realised there would probably never be enough hearts available for all patients with end-stage disease, and the only solution was to make artificial ones. He describes how he and the LEBAO team developed the idea of tissue-engineered heart valves: “The concept started with the entire heart. We realised that muscle [myocardium] would be difficult to reconstruct because of the many small blood vessels, so we thought why not start with heart valves? I was aware of some work on deposition of endothelial cells on artificial surfaces for below-knee grafts. And decellularisation had been around since 1991. So, with a little idea from here and an idea from there, we managed to do what no one else had done.”

father and there are children in Moldova who will die if we don’t operate.’ It was at a time when cooperation between Moldova and Israel on paediatric surgery had ceased. Of course, I was nervous. Doing cardiac surgery at the time in Moldova was an adventure. However, we operated in May 2002, and I’m glad to say both patients are doing very well.1 The first was a boy, then aged 11, who just got his baccalaureate and now wants to go to medical school—to be a cardiac surgeon! And the second was a girl, then aged 13, who got married 4 months ago and is now pregnant.”

“Since September 2008, Implantation of the Valves Within Germany Has Been Made Possible by an Exceptional Regulation” Professor Haverich’s decision to leapfrog European Union regulations and implant the first 19 tissue-engineered heart valves in Moldova enabled him to gain 7 years in his research project, but it has not gone without criticism. It may have even cost him the German Future Prize for 2008, awarded each year by the president of Germany to support outstanding research. He and his colleagues, Dr Cebotari and Dr Michael Harder, were shortlisted for the award. The German press accused them of using the Moldavian children like “rabbits,” and they did not win the prize. Professor Haverich rebuts the accusation by pointing out that the operation probably saved the children’s lives, and the children are, in any event, all “doing well.” He adds, “I was upset and disappointed by the result, not only for myself but for my colleagues. There were A tissue engineerd human heart valve prior to implantation. ethical issues. European regula“There Are Children in Photograph courtesy of Professor Haverich. tions always complicate things. It Moldova Who Will Die if We would have taken a lot of time to get through the regulatory Don’t Operate” processes—in fact, there was no regulatory body that could The astonishingly novel approach—to take a valve, strip it consider the concept. Serghei Cebotari was the driving force of its cells, and repopulate the allograft scaffold with autoto start the work in Moldova.” logous cells from the recipient—took 6 years to perfect Tissue-engineered valves are marketed by a company with animals before the technique had been sufficiently closely associated with the University of Hannover that spetested for clinical use. During this period, Professor cialises in products and new technologies for cardiovascular Haverich met Dr Cebotari. With the help of a European and cardiothoracic surgery. These valves are expected to have Association for Cardiothoracic Surgery fellowship, considerable advantages over existing mechanical valves, Professor Haverich offered Dr Cebotari a post in LEBAO, which require lifelong anticoagulation, and animal valves, where the Moldavian worked on the problem. which are of limited durability.2 Since September 2008, After successfully grafting tissue-engineered valves into within Germany, implantation of the valves has been made 40 sheep, Dr Cebotari declared that the technique was possible by an exceptional regulation, and Professor Haverich ready to be used in humans. Unfortunately, science in the has to date (March 11, 2009) carried out 5 operations on chilEuropean Union was ahead of legislation, and Professor dren in Hannover. He expects to carry on, at the rate of ≈1 a Haverich had to carry out the first operations elsewhere, in week, in children and adults. Within a few months, he expects the tiny state of Moldova. He recalls, “I remember the consimilar operations to be performed elsewhere in Europe, versation. I said to Serghei when he said we were ready, probably first in Zurich, Switzerland, and Paris, France. ‘You’re kidding.’ ‘No,’ he replied. ‘I’ve spoken to my

Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

Professor Haverich (middle), with Stephanie Galeiwa (nurse, left), and Dr Gregor Warnecke (right) during a coronary bypass procedure. Photograph courtesy of Professor Haverich.

Dr Breymann (right) and Professor Haverich with a young patient on the intensive care unit the day after implantation of a tissueengineered heart valve. Photograph courtesy of Professor Haverich.

“An Italian Cardiologist Told Me Recently That She Had Carried Out Echocardiography on a Recipient and Couldn’t Detect the Artificial Valve!” Paradoxically, Professor Haverich’s vision of moving away from cadaver-associated material has been limited by the LEBAO team’s discovery that valves from pigs and calves cannot be satisfactorily decellularised and only homografts are effective. However, working with valves taken from patients who have received a heart transplantation, Professor Haverich has estimated that, within Germany alone, the current rate of 400 heart transplantations a year should yield 500 valves. He comments, “All recipients of tissue-engineered valves have done well so far. Children over 8 to 10 years of age can accommodate a tissue-engineered adult valve. We were not sure whether we would see what we had seen in sheep—that is, no long-term degeneration, but to date there clearly is no degeneration [in the children]. An Italian cardiologist told me recently that she had carried out echocardiography on a recipient and couldn’t detect the artificial valve! There is also work being carried out with tissue-engineered valves at various centres in the United States, with a different ‘recipe,’ but they have reported degeneration. They use material cryopreserved in liquid nitrogen, whereas we always use fresh homografts. There is some controversy between the 2 groups, but we are talking and getting closer and closer.”

a biodegradable coronary stent. He says, “My overall aim is to rebuild an entire human heart from ‘ourselves,’ and we are getting near it. I had my 56th birthday recently, so I’ve got about 10 years before I retire, and I think we will do it by then. I got the idea of tissue engineering muscle with jejunum as I was driving back from a skiing trip at Easter in 2001. My youngest daughter and a friend were sitting in the back of the car—and when I got the idea I said, ‘Write this down!’ The beauty with jejunum is that after decellularisation you still have the matrix of blood vessels in place.3” In May 2008, LEBAO became part of the Hans Borst Centre for Heart and Stem Cell Research, a brand-new purpose-built facility where 110 researchers (due to increase to 150) work on a range of projects concerned with diseases of the heart, blood, and liver. The centre is run by Professor Haverich as clinical director and biologist Professor Ulrich Martin as director of research. Funded to the tune of €13 million by the Braukmann-Wittenberg Foundation, a local charity, the Hans Borst Centre for Heart and Stem Cell Research is part of an ambitious cross-institution, crossdiscipline “cluster of excellence” in the city, housed under the title “Regenerative Biology to Reconstructive Therapy.” In 2006, Regenerative Biology to Reconstructive Therapy was granted €40 million by German state and federal governments to fund it for the next 5 years.

“I Got the Idea of Tissue Engineering Muscle With Jejunum as I Was Driving Back From a Skiing Trip at Easter in 2001” Professor Haverich and his team are also working on tissueengineered myocardium, using segments of jejunum, which will be decellularised and then reseeded with endothelial cells and cardiomyocytes, probably from induced pluripotent stem cells. The team has also developed

“At the Age of 21, I Found Myself Helping Him [Hans G. Borst] With an Operation. I ever Looked Back; He Had Me on the Hook” Every time Professor Haverich thinks of the Hans Borst Centre for Heart and Stem Cell Research, he cannot help but think of the man who gave his name to the building, Professor Hans G. Borst, a “hugely important mentor” and his predecessor as head of the Division of Thoracic and Cardiovascular Surgery at the Hannover Medical School. He recalls, “I remember in my second year as a medical

Circulation: European Perspectives

f105

Circulation May 12, 2009

Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

Circulation: European Perspectives

f 106

Circulation May 12, 2009 “I Want to See More Abstracts at Meetings That Are on Research Rather Than Just [Everyday] Surgery” As his career advanced and Professor Borst moved towards retirement, Professor Haverich realised that if he were to succeed him, he had to leave Hannover. The German university system has a feature—not quite a law, but a strong understanding—that candidates applying for senior positions at any university must have worked elsewhere for at least 3 years before making the application. The goal is to widen the experience of applicants, and it has the incidental effect of spreading around the expertise at centres of excellence. Hence, in 1993, Professor Haverich headed off to lead the Division of Cardiovascular Surgery at the Christian Albrechts University in Kiel, about 120 miles north of Hannover. This put him in a strong position 3 years later to contest for his mentor’s old job, which he obtained and still holds. Despite many commitments—editorial boards, government committees, and appointments to professional societies (he recently completed a stint as president of the German Society for “I Carried on Playing Thoracic, Cardiac, and Vascular [Semiprofessional Handball] Surgery)—he spends half of for 10 Years, Until I was 28” his time as a working surgeon. Professor Haverich is a “counProfessor Haverich is now try boy” who grew up in the at a stage in his career where small village of Barntrup 80 he can clearly see the major miles from Hannover. His best goals he wants to achieve. In subjects in school were “matheaddition to constructing a tissuematics, sport, and religion” (a engineered artificial heart, he careers adviser’s nightmare!), wants to encourage more cardiobut he thinks he decided to read thoracic surgeons to undermedicine because of the influtake the research in a way that ence of a family doctor. The old Three cardiac surgeons on a mountain. Outside medicine and his will take the specialty forman played piano and the family, Professor Haverich is still addicted to sports: cycling, jog- ward. He says, “I want to get young boy played cello, and ging, and working out in the gym. His passion is hill climbing and research, especially basic together with others they per- mountaineering, and he would like to do more. Three years ago, he research, into the minds of formed classical music at stood in the Western Caucasus, Russia, at a height of 18 500 feet cardiac surgeons. I want to see school and in the local church. [5642 metres], having just climbed to the top of Mount Elbrus, more abstracts at meetings When it came time to choose Europe’s highest mountain. Here he is (left), with cardiac surgeons that are on research, rather than a medical school, Haverich was Dr André Simon (middle), and Professor Gerd Walterbusch (right). just [everyday] surgery. And I playing handball in a semipro- Photograph courtesy of Professor Haverich. want to be influential in getfessional capacity for a local ting the next generation of team called Lemgo (“They are still in the top league”), and young people interested in cardiothoracic surgery. I’m glad he was obliged to train several times a week. “So I needed that interest in Germany at the moment is very high.” to go to a medical school where I could go home to train References during the week. I had a car—the team paid for it—and I 1. Cebotari, S, Lichtenberg A, Tudorache I, Hilfiker A, Mertsching H, went back 4 times a week. I carried on playing for 10 years, Leyh R, Breymann T, Kallenbach K, Maniuc L, Batrinac A, Repin O, Maliga O, Ciubotaru A, Haverich A. Clinical application of tissue until I was 28, and went to the United States to learn how engineered human heart valves using autologous progenitor cells. to do heart and heart lung transplantation. Almost more Circulation. 2006;114 (suppl I):I-132–I-137. important was that I also learnt there how to do experimen2. Lichtenberg A, Tudorache I, Cebotari S, Suprunov M, Tudorache G, tal research, with large and small animals. That was very Goerler H, Park J-K, Hilfiker-Kleiner D, Ringes-Lichtenberg S, Karck important for me.” M, Brandes G, Hilfiker A, Haverich A. Preclinical testing of tissueengineered heart valves—re-endothelialized under simulated physioHaverich’s time at Stanford University was funded by a logical conditions. Circulation. 2006:114 (suppl I);I-559–I-565. 1-year grant from the German Research Foundation. He 3. Haverich A. Cardiac tissue engineering. Eur J Cardiothorac Surg. trained with the legendary Norman Shumway, MD, and on 2008;34:227–228. his return, he was immediately appointed a senior resident Barry Shurlock is a freelance medical journalist. in Hannover. student being so impressed by one of the lectures by Professor Borst that I went up to him at the end and asked if I could watch him in the theatre. He agreed, and at the age of 21 I found myself helping him with an operation. I never looked back; he had me on the hook!” Professor Borst started his career in Munich, Germany, but for many years he worked in the United States at Harvard University, Cambridge, Mass, and Stanford University, Stanford, Calif, before returning to Germany, first to Marburg, and then in 1968 to head up thoracic surgery at the Hannover Medical School. The Hans G. Borst Award for Thoracic Aortic Surgery of the European Association for Cardiothoracic Surgery, which he helped to found, commemorates an area of surgery to which he made major contributions. He is still active, promoting the development of cardiothoracic surgery in Eastern Europe. When leaving office in 1996, he reminded Professor Haverich “to take care of the cardiac surgery programme in Moldova,” adding, “They are very good people.”

Spotlight: Jose Zamorano Gomez, MD, FESC In the Future “Imaging Data Will Be Incorporated in the Risk Classification for Patients”

A

Jose Zamorano Gomez, professor of medicine, University Complutense of Madrid, Madrid, Spain, director of the Cardiovascular Institute, University Clinic San Carlos, Madrid, president of the European Association of Echocardiography, and secretary of the European Society of Cardiology, talks to Marilou Davis, BScMedTech, R, MScBIT.

Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

s a young boy growing up in the cosmopolitan city of Madrid, Spain, Jose Zamorano Gomez wanted to be a doctor and a football player. Despite having few medical relatives, he says, “I was sure that I wanted to be a doctor. I always knew that it was going to be an important part of my life.” Now he is professor of medicine at the University Complutense of Madrid, Madrid, Spain, director of the Cardiovascular Institute, University Clinic San Carlos, Madrid, president of the European Association of Echocardiography, and secretary of the European Society of Cardiology (ESC). He embarked on medical studies in 1981 at the University Complutense of Madrid, where he was particularly influenced by Professor Pablo Gil Loyzaga, who taught cellular biology, and Professor Juan Tamargo, an expert in pharmacology. He recalls, “The 2 professors taught me how to perform a study and conduct it with proper ethics, why you set up a study, what you aim for in doing a study, and how to determine its clinical relevance.” Zamorano’s enthusiasm for basic science, specifically research involving rats, resulted in his first article1 when he was a third-year medical student. After qualification, Zamorano worked as an intern in the Department of Cardiology, where Professor Pedro Zarco, Professor Luis Sánchez Harguindey, and Professor Carlos Macaya, proved influential. Professor Zamorano recalls, “They made me see what cardiology really means. It is important to acknowledge that they ‘opened doors’ for many young clinicians like me. Their influence on me was not only as a doctor, but also on the teaching aspect of my life—they passed on the enthusiasm to be a teacher in the future, and that it is not only important to diagnose and treat, but also to teach others.”

Specialist Echocardiography Training in Germany Led to Career Opportunities in Madrid After a period of training in both transthoracic and transoesophageal echocardiography under the expert guidance of Professor Raimund Erbel, MD, director of the Department of Cardiology, University Clinic Essen, Essen, Germany, and a pioneer of these techniques, Zamorano returned to Madrid to work in the echocardiography laboratory in the University Clinic San Carlos, Madrid. Although he was the youngest in the group and some of the individuals who had trained him were already working there, Professor Macaya offered Zamorano the opportunity to be the director of the

laboratory in 1999. Professor Zamorano considers that this was an example of established professionals “promoting young people to open doors to the future and take on personal responsibilities. He says, “Together, we [the team] decided to make the echo unit one of the best labs in Europe. We started doing clinical work and became the research centre for big companies using prototypes. Also, we were one of the first echo units in Europe to use 3D Echo.” In 2004, the team decided to abandon the concept of “echo laboratory” and moved on to become a cardiac imaging centre with computed tomography and magnetic resonance imaging facilities. However, the centre remains clinically oriented, still trying to answer clinical questions. Since then, the unit has provided training in echocardiography for clinicians from Europe and South America. He says, “More than 100 people from outside Spain have been trained at the centre.” More recently, Professor Zamorano was appointed director of the Cardiovascular Institute at the University Clinic San Carlos, Madrid. Professor Zamorano comments, “Being the director does not mean that you are the best. It is just that I have to devote my time helping others develop the Institute.”

“Three Years of Work Creating a Virtual Heart” Professor Zamorano is passionate about research and has contributed to 220 articles in peer-reviewed journals. He is particularly proud of his contribution to a study on the use of 3D echocardiography in clinical settings.2 He says, “We started working with the first prototype of 3D echo many years ago. We created new formulas for calculations and made guidelines. From a research point of view, I would say it is my major contribution.” He foresees that imaging is going to become increasingly 3D. “We want to see the heart as it is in reality. Life is 3D and so is the heart. So cardiovascular imaging is going to be 3D, no doubt about that.” Professor Zamorano cites his work in the production of the “Virtual Heart” as the most enjoyable of his research career. It is a collection of 7 DVDs showing the anatomy and physiology of the heart, its illnesses, and its treatments (http://www.elmundo.es/elmundosalud/especiales/2008/01/ anatomia_corazon/localizacion_anatomica/index.html). He says, “It was 3 years of work creating a virtual heart. It is a ‘book of the 21st century.’” In considering the future development of his research career, he says, “I am going to commit part of my life to

f107

Circulation: European Perspectives

Circulation May 12, 2009

Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

Circulation: European Perspectives

f 108

Circulation May 12, 2009

Professor Zamorano says, “Interaction with cardiac surgeons is pivotal at our institution.” He is shown here with Professor Macaya (centre) and Professor E. Rodriguez (right, chief of cardiac surgery, University Clinic, Madrid). Photograph courtesy of Professor Zamorano.

merging the cardiovascular risk factor with imaging to better assess the real risks for our patients. For example, almost 33% of the people who have serious cardiovascular events are classified as intermediate risk. This shows that we can improve on stratifying risks. I am sure that cardiovascular imaging will play a vital role. Imaging data will be incorporated in the risk classification for our patients.” Professor Zamorano has become increasingly involved with the European Society of Cardiology (ESC) and the ESC is now a priority in his life. As president of the European Association of Echocardiography he says, “I will put a lot of time and effort to send a clear message to cardiologists that research is important, and that through the ESC we can grow together to help our patients.” He is also chair of the Grants Committee, and secretary of the ESC under the presidency of Roberto Ferrari, MD, PhD, FESC.

“It Is Important to Transmit Knowledge to Enable Others to Achieve More” Of all the important roles Professor Zamorano has played in the hospital, university, and different organisations, his most enjoyable are being a clinician and a teacher in the hospital. He finds that every day he does something worthwhile no matter how small. He explains, “It is really an enjoyable experience because you combine being useful for sick patients while transmitting your knowledge to young doctors who might treat you in the future.” He feels that one has to be generous in terms of teaching and says, “I have to open new pathways and work for the students and others, for the university, for research—trying to help young people and ‘open the doors’ for them so they go further than me. My mentors did the same thing for me.” His main philosophy is, “It is important to transmit knowledge to enable others to achieve more.” Professor Zamorano’s advice to young physicians who want to follow in his footsteps is, “Never lose [faith in] your own judgment. If you have a clear idea or project aim, just go there even though some people will try to distract you. I have done many things where the aims are clear but the results have not been successful. However, it does not Editor: Helmut Drexler, MD, FESC Managing Editor: Lindy van den Berghe, BMedSci, BM, BS We welcome comments. E-mail [email protected]

Professor Zamorano’s wife, Margarita, “a gastroenterologist who understands my work,” with Jamil Tajik, MD, “a worldwide cardiology leader who has influenced me.” Photograph courtesy of Professor Zamorano.

mean that they were not worthwhile. I have learned a lot from unsuccessful projects. It is also important to know what you are best at and to explore it.”

“I Remember My Mother Sitting in the First Row During the Opening Ceremony. I Consider That to Be the Happiest Event in My Entire Career” Professor Zamorano has received many research awards, but he considers the first award he received from the Spanish Society of Cardiology in 1991 to be his favourite “because I was only a research fellow then.” He adds, “The Spanish Society of Cardiology now has grants amounting to almost €1 million, and I am proud to be a member of a scientific society that is so focused on promoting research.” Another significant event in Professor Zamorano’s career took place 14 years ago. He says, “I organised the first international meeting here in Spain between the Mayo Clinic [Rochester, MN] and the University of San Carlos. More than 600 people attended, as well as Dr Jamil Tajik [MD] and many other faculty members of the Mayo Clinic. I was only 30 and it was the first time I had organised a meeting. I remember my mother sitting in the first row during the opening ceremony. I consider this as the happiest event in my entire career.” Despite his professional achievements, Professor Zamorano says his family is his greatest achievement. He explains, “I am really proud of my wife and children. My wife is a gastroenterologist who understands my work in medicine, teaching, and organisations. And my children—2 sons, aged 16 and 14, and a little princess, aged 12—are hardworking and sensible. Although I am so busy, my family comes first.” References

1. Perez Cao A, Zamorano J, Gil Oyzaga P, Tamargo J. Reducción del tamaño del infarto en ratas tratadas con nitrendipino. Congreso Nacional farmacología 1983. 2. Zamorano J, Cordeiro P, Sugeng L, Perez de Isla L, Weinert L, Macaya C, Rodriguez E, Lang R. Real time 3D echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach. J Am Coll Cardiol. 2004;43:2091–2096.

Marilou Davis is a freelance medical journalist. The opinions expressed in Circulation: European Perspectives in Cardiology are not necessarily those of the editors or of the American Heart Association.

European Perspectives Circulation. 2009;119:f103-f108 doi: 10.1161/CIRCULATIONAHA.109.192202 Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2018

Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2009 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/119/18/f103.citation

Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/

Smile Life

When life gives you a hundred reasons to cry, show life that you have a thousand reasons to smile

Get in touch

© Copyright 2015 - 2024 PDFFOX.COM - All rights reserved.