Emory Medicine All Heart




	Timeline continued from A Marriage Made in Atlanta


	Cardiologist Nanette Wenger was appointed director of the cardiac clinics at Grady Hospital. She would go on to become a leading expert in heart disease in women.


	Charles R. Hatcher performed Georgia’s first “blue baby” operation using open heart surgery. The next year, he performed Georgia’s first aortic valve replacement. Successful double and triple valve replacements followed soon thereafter. He built the heart surgery program at Emory into one of the nation’s largest and most successful, before becoming director of The Emory Clinic in 1976. He later served as director of the Woodruff Health Sciencs Center from 1984 to 1993.

	Hamilton Holmes became Emory’s first African-American medical student. He became an orthopedic surgeon and eventually was medical director of Grady Hospital. Today, each medical school class is half and half men and women and about 30%of students are minorities.

	Asa Yancey, a former medical director of Hughes Spalding Pavilion of Grady Hospital, was the first African-American member of the medical faculty. Yancey was medical director from 1972 to 1989. His son Arthur is on Emory’s faculty today.

	The Robert W. Woodruff Medical Center (later renamed The Robert W. Woodruff Health Sciences Center) was established. Also, doctors at Emory Hospital performed Georgia’s first intrauterine transfusion to save the life of a fetus threatened by Rh negative blood reaction. And Geogria’s first coronary arteriogram was done by Robert Schlant at Grady Memorial Hospital. This same year, Garland Perdue performed Georgia’s first kidney transplant.

	Charles Hatcher performed Georgia’s first successful coronary bypass surgery, at Emory Hospital.

	A $25-million expansion plan for Crawford Long Hospital was announced, including a nine-floor addition.

	Emory Hospital began a $30 million addition to patient care and teaching facilities, which was completed in 1978.

	John Stone founded Emory’s residency program in emergency medicine.

	Andres Gruentzig first performed angioplasty in Zurich, Switzerland. He joined the Emory faculty in 1980 and continued to perfect the procedure that helped shape interventional cardiology and changed forever the treatment of atherosclerosis. He died in a plane crash in 1985.

	Ralph Vogler performed Emory’s first bone marrow transplant on a patient with acute leukemia. This same year, Emory University received approximately $105 million from the Emily and Ernest Woodruff Fund, the largest gift given in an educational institution in US history and the lead gift in the $160 million campaign to support scholarships, teaching, research, and building projects across the university, including the School of Medicine.

	James F. Glenn became dean, serving till 1983. This same year, The National Eye Institute selected Emory to direct the prospective evaluation of radial keratotomy study, the largest and most comprehensive clinical investigation of this procedure to correct myopia.

	Emory doctors injected a thrombolytic agent into the coronary artery of a patient to stop a heart attack, the first use of this treatment in Georgia.

	George Brumley, then chair of pediatrics, served as interim dean till 1984.

	Richard Krause was recruited from the NIH to become dean, serving till 1988. His mandate was to build Emory’s reputation in research to be on a par with that in teaching and patient care.

	Surgeons at Emory performed Atlanta’s first heart transplant. This same year, Robert Woodruff, 95, died on March 7 at Emory University Hospital. During his lifetime, he gave away an estimated $350 million, which included $230 million to Emory University.

	Luella Klein became the first female chair of a department (gynecology and obstetrics) at Emory, serving till 1992. She also served as the first female president of the American College of Obstetricians and Gynecologists. This same year, Atlanta industrialist O. Wayne Rollins donated $10 million for construction of the Rollins Research Center. This new building doubled research space at Emory and helped set the stage for Emory researchers tp apply for and receive millions of dollars in research grants.

	John Douglas and colleagues performed the first coronary stent implant in the United States. This same year, Emory doctors inserted the first implantable defibrillator in a patient in Georgia. Also in 1987, Emory doctors performed the state’s first liver transplant.

	Emory doctors performed Georgia’s first directional atherectomy to scrape and remove plaque from arterial walls. Also this year, Emory surgeon Kirk Kanter performed the state’s first pediatric heart transplant on a 3-year-old at Egleston Hospital. Timeline continued on The Money Trail

Editor’s note: J. Willis Hurst needs no introduction. Cardiologist to President Lyndon B. Johnson, creator of the most influential textbook on the heart, founding member of The Emory Clinic, longtime chairman of medicine, and award-winning teacher, Hurst, at 83, still spends his days teaching house officers and medical students and writing prolifically. His recent “What Do Good Doctors Try to Do?”in the Archives of Internal Medicine is one of his most popular articles to date. When we asked Hurst to contribute an article to Emory Medicine on a brief history of cardiology at the School of Medicine, he graciously composed a 26-page manuscript. It took that many pages to do justice to the history, he explained. We’ve touched the highlights of his story here, but for the complete version, which includes names and activities, see: allheart.html

I am sometimes asked why Emory cardiology is consistently ranked in the top 10 of the nation’s best heart centers. Here is the story.

Note that the story, involving patient care, excellent teaching, and ground-breaking clinical and basic research, wouldn’t exist without the contributions of Emory faculty members in many departments, including medicine, pediatrics, cardiac surgery, vascular surgery, radiology, anesthesiology, physiology, and pharmacology, as well as the nursing staff. Likewise, the story unfolds in many settings: Emory University Hospital, Grady Memorial Hospital, Atlanta Veteran’s Affairs Medical Center (VAMC), Emory Crawford Long Hospital, Egleston Children’s Hospital, The Emory Clinic, dozens of satellite locations, and several research buildings.

Our story begins in the 1940s. In 1942, Eugene Stead became Emory’s first full-time chairman of the Department of Medicine. He, Jim Warren, and others developed a cardiac catheterization laboratory at Grady Hospital––only the third such laboratory in the world. Warren performed the first cardiac catheterization for diagnostic purposes in 1946.

Stead recruited Bruce Logue, a man of vision, a superb clinician,a charismatic teacher, and an excellent writer. Logue had the right combination of abilities to develop a comprehensive cardiology center here. He was the founding father of the Georgia affiliate of the American Heart Association.

I joined the faculty to work with Logue in 1950. When Paul Beeson was chairman of the Department of Medicine, my job was to teach house staff and fellows at Emory Hospital and Grady. I was charged with helping build a consulting referral practice, with a mandate also to engage in clinical research and to write.

In 1951, I urged our two cardiac surgeons to operate on one of my patients who had severe mitral valve stenosis. They did so. It was probably the first operation of that type to be performed in the South.

Because pediatric cardiology was not yet a discipline, Logue and I also served as pediatric cardiologists. I worked with a cardiac fellow to develop a new, standardized preparation of digitalis for children, which continues to be used today.

Logue and I were founding members of the Emory Clinic, which was formed in 1953 by the merger of the Private Diagnostic Clinic and several other units in Emory Hospital. This development was of utmost importance because it created a superb method for growth and financial support.

A few years later, at the age of 35, I was appointed as chairman of the Department of Medicine. I began my new job in February 1957, at the age of 36, and didn’t leave the chairmanship until 1986. It came about like this: I was drafted by the US Army for the second time in 1955. During my year’s absence from Emory, the chairmen of medicine, surgery, and obstetrics became embroiled in a disagreement with Dean Arthur Richardson, ultimately leading to their release. Becoming chairman of the department gave me new opportunities. Accordingly, for the next 30 years, I made every effort to develop all of the divisions of the department.

By 1957, the story of Emory cardiology had progressed to include three cardiologists at Emory University Hospital and one at Grady Memorial Hospital. No research space and no hard-core budget for the Department of Medicine yet existed. The National Heart, Lung, and Blood Institute gave a $25,000 annual stipend to every medical school in the nation for the teaching of cardiology. But we obviously needed more than that to support our programs. We needed many more talented people, research space, and a budget.

An important financial commitment by the Robert W. Woodruff Foundation allowed us to build new cardiac laboratories within the new Grady Hospital facilities, completed in 1958. Also, in that year, the Crippled Children’s Service of Georgia donated funds to build a cardiac catheterization laboratory in the relatively new Woodruff Research Building, which was attached to Emory Hospital and became the first cardiac catheterization laboratory located in a private hospital in Atlanta.

Each year, Emory offered the only postgraduate courses in cardiology in the Southeast. We invited national and internationally known experts to help present the courses. Hundreds of practicing physicians attended the courses, and Emory became recognized around the world as a major teaching center for cardiology. We organized the first postgraduate course in cardiology for the American Heart Association in 1963, followed a year later with the first postgraduate course in cardiology for nurses. The internationally known speakers and the participants of the courses learned what was happening at Emory, and I am pleased to say, they liked what they saw.

I created the textbook, The Heart, with Logue in the early 1960s. The book brought further acclaim to our cardiology efforts. It was becoming clear that textbooks in cardiology needed redoing. When single individuals were writing them, they took too long to finish. The first chapter would be out of date by the time the last chapter was done. So I came up with the notion of a multi-authored book. With significant contributions from Robert Schlant (director of cardiology from 1962–1986), Nanette Wenger (today well-known for her study of heart disease in women and chief of cardiology at Grady), and others, the first edition of The Heart was published in 1966. Subsequently, a new edition was created every four years. With its translation into six languages and currently in its tenth edition, it has brought international recognition to Emory cardiology. After the seventh edition, I passed the editor-in-chief responsibilities to Schlant and Wayne Alexander, the current chairman of the Department of Medicine, at which time the publishers renamed the book Hurst’s The Heart. Although there are many books on cardiology today, the Emory book continues to be popular and used worldwide.

Several other pioneering developments accompanied the decade of the 1960s. Emory physicians at Grady were the first in Atlanta to use cardiac defibrillation for the treatment of atrial fibrillation and to use a cardiac pacemaker. Schlant performed the first coronary arteriogram in Atlanta in the Grady cardiac laboratory. Robert Franch, working in the cardiac catheterization laboratory on the Emory campus, performed the first atrial septotomy in the South in 1967.

Two additional divisions to the Department of Medicine brought faculty members with cardiovascular orientations to Emory. Leon Goldberg, for example, who became director of clinical pharmacology, quickly catapulted his division of experts in cardiovascular drugs to national recognition. A division of clinical physiology was added to the department of medicine to emphasize the use of basic science principles in the clinical training of students and house officers.

At Egleston, Catherine Edwards and Dorothy Brinsfield were laying the ground work for what was to become a nationally known pediatric heart center. William Plauth was appointed director of pediatric cardiology and developed the first cardiac catheterization laboratory at Egleston in 1975.

The arrival of Charles Hatcher to the Division of Cardiothoracic Surgery during the early sixties adds another chapter to our story. By 1971, Hatcher was director of the division, and his leadership was a major force in the development of cardiac surgery at Emory. Emory cardiac surgeons became leaders in coronary bypass surgery, with patients being referred from other states and other countries. Hatcher continued as division director until 1995, also serving as director of The Emory Clinic from 1976–1984 and leading the Woodruff Health Sciences Center from 1984–1996.

Robert Guyton became director of the Division of Cardiothoracic Surgery and propelled the division to the top ranks. In the meantime, Robert Smith was developing a peripheral vascular disease service at Emory Hospital. His team became noted for their low operative risk, and Smith was among the first in the country to operate on the carotid artery using only local anesthesia.

The year 1980 marked a milestone in our history. Bruce Logue retired from his duties at Emory Hospital and The Emory Clinic and became director of the Carlyle Fraser Heart Center at Crawford Long Hospital. The center, created in 1976 thanks to the generosity of the Fraser family, thrived under Logue’s leadership.

The same year brought Andreas Gruentzig to the Emory faculty. Just three years before at a hospital in Zurich, Switzerland, Gruentzig made history by inserting a catheter into a patient’s clogged coronary artery and inflating a tiny balloon. The procedure restored blood flow to the heart, and angioplasty was invented. Through his acquaintance with Spencer King, John Douglas, and others at Emory, I recruited Gruentzig to join our team. I originally gave him adequate office space in the connector between 4E and 4G in Emory Hospital. Later I added an entire floor in the connector for his use, one-half of the entire space allotted to the Department of Medicine.

Gruentzig was a genius. While he loved life and lived on “the edge,” he was a tender, honest, and compassionate advocate for his patients. During his five years at Emory–before he and his wife were killed in a tragic plane accident–he performed more than 2,400 coronary angioplasties, sponsored an annual postgraduate course attended by hundreds, and propelled cardiology at Emory to the top ranks of world medicine.

In the 1980s, the amount of clinical research at Emory had reached the point that a fulltime statistician was needed to assess our results. Meanwhile, the cardiac surgery program was keeping pace. The first cardiac transplant performed at Emory Hospital came in 1985, followed by the first transplant in children at Egleston in 1988. Quite simply, the transplant service became recognized as one of the best in the country.

After serving as chairman of the Department of Medicine for 30 years, I retired from that position in November of 1986. I passed the reins to Juha Kokko, who appointed Wayne Alexander to lead the division of cardiology in 1988.

Alexander, who holds the R. Bruce Logue professorship, is an internationally known cardiologist and is recognized as one of the greatest department chairmen in the nation. He greatly expanded the cardiology research effort at Emory. During his tenure, a large amount of research space has become available in the greatly enlarged Woodruff Research Building. Several cardiac catheterization laboratories, a new electrophysiology laboratory, and a large echocardiographic laboratory were added to Emory Hospital. New space also has been provided for a heart failure service as well as a congenital heart disease clinic for adults.

The Emory Heart Center was created in 1993. This new organization—including the Andreas Gruentzig Cardiovascular Center at Emory Hospital, the Carlyle Fraser Heart Center at Emory Crawford Long, and outpatient cardiology with an outpatient cardiac catheterization laboratory at The Emory Clinic—was designed to be the umbrella under which clinical cardiology would thrive, fostering collaboration and coordination among the many aspects of heart disease treatment and diagnosis. Doug Morris, who is the J. Willis Hurst Professor of Medicine, was chosen to be director of the Emory Heart Center. The Heart Center has been ranked in the top 10 in the nation by US News & World Report. In 2004, Emory’s program in heart and heart surgery was ranked eighth–the only heart program in Georgia included in the nation’s top 50.

These distinctions are well earned, and the first four years of the new century continued to see growth in every area. The patient care has become increasingly sophisticated and sought after. The teaching programs for students, house officers, and fellows is increasingly popular, and the research effort has achieved international recognition.

Taking stock in 2004 was rewarding because the audit of faculty talent, space, and funds assures continued excellence in patient care. Just look at a few examples. At Emory, patients routinely can receive endoscopic cardiac bypass surgery, or hybrid coronary revascularization, or high-tech cardiac resynchronization. Emory patients likewise benefit from an ambitious research agenda, with studies ranging from women’s cardiology to basic science. For example, Peter Block, nationally known for his use of balloon dilatation of the mitral valve for mitral stenosis, has recently used the cardiac catheter to treat leakage of the mitral valve. Active research efforts at the VAMC alone include cardiac ischemic preconditioning, stem cell replacement therapy for cardiac injury, and mechanical forces and atherosclerotic disease, to just name a few. David Harrison, a superb researcher and clinician recognized worldwide, is the Bernard Marcus Professor of Medicine and director of the Division of Cardiology.

The Sibley Heart Center at Egleston opened in 2002, and 26 pediatric cardiologists contribute to our pediatric cardiology efforts. Eleven of these work at satellite locations throughout Georgia and are members of the staff of 30 hospitals.

And the solidity of our programs continues at Emory Crawford Long Hospital, where faculty members are using a biventricular pacemaker to treat heart failure.

Emory can now boast of adequate research space for cardiology in the enlarged Woodruff Research Building on the Emory campus, the Atlanta VAMC, and at Emory Crawford Long. The funding of such a large group of people comes from the money they earn from patients they take care of in The Emory Clinic or in a similar facility, from endowments, and from research grants. The annual research budget from grants awarded to the Division of Cardiology alone is more than $10 million.

Our teaching program remains strong. I’ll even go so far as to say that the teaching program in cardiology for medical students at Grady Memorial Hospital is one of the best in the nation. In addition, all categorical interns and residents in general internal medicine rotate through the cardiology service at Emory Hospital, and the Emory cardiac fellowship program is one of the largest programs in the country. A large number of cardiac fellows leave Emory to populate the hospitals of Atlanta and other cities throughout the nation and world. Many of them practice cardiology, and a significant number joins academic research institutions. In fact, Emory has trained 85% of practicing cardiologists and heart surgeons in Georgia.

From a fledgling effort in the 1940s, Emory cardiology has evolved into the top 10 of the nation’s best heart centers. And that is the story.

I continue to teach eight to 10 sessions in cardiology each week, and I write the remainder of the time. Bruce Logue’s legacy is assured because the Georgia affiliate of the American Heart Association has created an annual dinner in which the R. Bruce Logue Excellence in Medicine award is given to a worthy local physician. I join Logue, who is enjoying his retirement, for lunch about once a month. We discuss the evolution of Emory cardiology and smile. We remember when, in 1950, the two of us were the only cardiologists in the entire Emory system and there were only two cardiac surgeons. We smile because we both love Emory and look with pleasure and awe at Emory cardiology today.

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