2011 Issue 2 - Libin Cardiovascular Institute of Alberta

Why Calgary?
Dr. William Ghali, population
researcher par excellence, reveals
the answer
– pg 2
Fencing lessons foil
cardiac mysteries
Dr. Hendrik ter Keurs journey
to discovery
– pg 3
Ablation firsts
Delivery Bypass
Epicardial, on an LVAD patient,
and without X-ray
Cardiac and Neonatal team perform
unique combined surgery
– pg 4
– pg 4
Females outnumber
males 2:1
Calgary’s core cardiology program
attracts top female docs
– pg 7
Libin Life
W W W. L I B I N I N S T I T U T E . O RG 2011 ISSUE 2
FINDING WAYS TO MAKE SUDDEN DEATH
PREDICTABLE AND PREVENTABLE
T
he Canadian and Alberta Governments, along with
Medtronic and GE Healthcare, recently announced a
$40M+ multi-partner funding agreement for REFINE ICD, a
clinical trial to be led globally at the Libin Cardiovascular
Institute of Alberta (LCIA) by Dr. Derek Exner. The trial, which
arrest in individuals who have already had a heart attack.
Sudden cardiac arrest, often caused by the rapid and/or chaotic
activity of the heart rooted in abnormalities of the heart’s
electrical conduction system, is the cause of up to 50,000 deaths
in Canada and three to five million deaths globally per year.
will have 75 sites and screen 10,000 subjects across North
America, Europe and Japan, seeks to assess a novel method
devised by Dr. Exner to predict the likelihood of sudden cardiac
Subjects fitting the criteria for the trial will be randomized for
receiving an implantable cardioverter defibrillator (ICD) or for
current treatment options.
“We are hoping that we can come up with a way to better identify a
good chunk of those 50,000 people who are dying every year in Canada
from sudden death,” says Dr. Exner. “And the idea would be that we
identify who they are through this test, and that we would then
recommend therapy if our study shows in fact that these devices can
reduce the risk of death.”
Most people are aware of implantable pace makers, but ICDs have
a second additive function that may protect against sudden death.
circuits, or it actually delivers a large shock that stops the heart
from beating and resets it.”
“Firstly, ICDs work like the furnace in your house in the sense
that when the heart rate gets too slow they kick in. In addition
to this pacemaker function, they also work like an air
conditioner. If you have too many heart beats, the machine
detects that and either adds extra beats to try to stop electrical
“This is an important study with the potential to save thousands
of lives,” said Greg Weadick, Minister of Alberta Advanced
Education and Technology. “The fact that it’s happening here in
Alberta is proof that our province is quickly becoming a global
hub for innovation and research. We have the tools and the talent
to attract partners like GE and Medtronic.”
CALGARIANS LACE UP
TO SUPPORT LIBIN
C
algarians lit up the night to raise funds for
the Calgary Health Trust in support of
the Libin Cardiovascular Institute of Alberta at
the Energizer® Night Race™ on Saturday,
August 13, 2011. Participants ran either a 5
KM or 10 KM loop around Glenmore Park
while donning LED headlamps to create a
moving celebration of light – a celebration that
continued into the night at the post-race party.
The race was sold out, with more than 1,400
runners taking part. This is the first year the
event has occurred in Canada.
Dr. Derek Exner, with (seated r to l) Dr. Elizabeth Cannon, President,
UCalgary, Hon. Greg Weadick, Minister Alberta AET, Rob Anders, MP
Calgary West and Michael Emery, Medtronic. Terri Lohnes, GE
Healthcare not pictured. Photo credit — Bruce Perrault
Dr. Exner, Professor of Cardiac Sciences and Canadian Research
Chair in Cardiovascular Clinical Trials at the University of
Calgary, is currently Medical Director of Electrophysiology at
the Libin Cardiovascular Institute of Alberta. His work at the
Institute builds on a 30+ year history of the LCIA being at the
global forefront of cardiac electrophysiology research.
— Al-Karim Walli
PHILANTHROPIST TAKES
HEALTH CARE ‘TO HEART’
Alvin Libin inducted into the Calgary Business Hall of Fame
G
rowing up, local philanthropist and
business man, Alvin Libin was
surrounded by people helping people.
Born to immigrant parents who came to
Calgary from Russia in 1911, “They were very
successful here… and I grew up with them
helping people,” said Libin.
He “lived in an environment where it was about
doing things to make the community better,
helping people. My parents, particularly,
helped people come to this country, and then
get organized. It was an era of people helping
people, and that rubs off.”
“Once you start helping, there’s a lot of places to
help. And so I learned that as a kid growing up.”
Thousands of Calgarians lit up the night in support
of the Libin Institute. Photo courtesy of the
Calgary Health Trust
Volunteers manning the Calgary Health Trust tent at the
Energizer® Night Race™. Photo courtesy of the Calgary
Health Trust
It’s a lesson he continues to honour to this day.
Libin has been involved in community
development, health care and philanthropic
activities in Calgary since he began working in
long-term care in the 1960s.
A cofounder of Villacentres (a long-term care
facility), and chairman of Extendicare, Libin
was also former chairman of the board of the
former Foothills Hospital, now known as the
Foothills Medical Centre.
His charitable donations are responsible for the
creation of the Libin Cardiovascular Institute of
Alberta. Serving southern Alberta, one of the
institute’s goals is to bring excellence to heart
health care to the community.
See PHILANTHROPIST pg 2
Libin Life
Managing Editors
For more information
is published by the Libin Cardiovascular
Institute of Alberta.
Al-Karim Walli
Amber Arsneau
E [email protected]
T 403.210.6271
about the Libin Institute please visit
www.LibinInstitute.org
© 2011 Libin Cardiovascular Institute of Alberta
MESSAGE FROM
THE DIRECTOR
U
pon reflection, my first year as the Director of the
Libin Cardiovascular Institute has both been
interesting and enjoyable. I am ver y excited that we will
soon be joined by Dr. Ed O’Brien from the University of
Ottawa. Ed will take on the role as the Section Chief of
Cardiology and the Research Director of the Institute. In
addition, we are in final negotiations with a talented
cardiovascular surgeon to assume the reigns of
leadership in cardiac surger y. Our goal is to increase
the secretariat of the Institute so we can move for ward
with an aggressive, all encompassing strategic plan for
the next year. While we are proud of our excellence in
research, education and clinical care deliver y, we will
become better in each of these areas. In addition, we will
aim to be more actively involved with the community
creating strong par tnerships and knowledge translation.
The newly forming team will be in an excellent position
to achieve these goals.
I would like to take this oppor tunity to thank our many
community suppor ters who have contributed to all of the
ef for ts of the Institute. We are par ticularly pleased that
Alvin Libin was inducted into the Calgar y Business Hall
of Fame. In terms of outreach activities in the
community, we are playing a sponsorship role in the
2011 Canadian Cardiovascular Society in Vancouver. We
had a fundraising challenge for Hear t and Stroke with
the Mazankowski Hear t Institute - the Libin folks were
able to raise $25,000 in pledges for the Ski for Hear t in
2011 and were able to win the first installment of this
friendly rivalr y between us and our colleagues in
Edmonton. The stakes will likely be increased in the
next year. Multiple members are working abroad in
terms of international outreach and that work is
something that we would wish to expand in the
upcoming year as well. I am grateful to all Libin
members for working hard in this transition year to
achieve multiple successes as outlined. We are
par ticularly enthusiastic about having increased
bandwidth to advance our mission and vision in the
provision of cardiovascular care, education and research
to all of our constituents.
— Dr. Todd Anderson
PHILANTHROPIST from pg 2
Libin became chairman of the board at the Foothills
hospital in 1980, where he “really started learning
about the health field.” His education continued as the
chair of the Alberta Heritage Foundation for Medical
Research, which was very closely allied in the health
field, focused more so on research and education.
For these reasons, a jury of his peers selected him
as a laureate to be inducted into the Calgary
Business Hall of Fame, established by Junior
Achievement of Southern Alberta in 2004.
“Mr. Libin is a hometown success story and a true
role model for the today’s youth who aspire to
successful careers in business,” said Scott Hillier,
president and CEO of Junior Achievement of
Southern Alberta.
“Born and raised right here in Calgary, he has left
an enduring mark in the corporate world along with our local
community. He is a humble man and has given back to our city and
province in many ways.”
Along with John Forzani and the late Theodore Rozsa, Alvin Libin
was recently recognized at a gala in honour of their achievements.
A permanent exhibit is located in Bankers Hall East tower lobby
and showcases the past and present laureates.
The Calgary Business Hall of Fame honours the lifetime
achievements of southern Alberta’s most distinguished citizens
who serve as role models for society. Laureates are individuals who
have helped shape our province through their business success,
entrepreneurial spirit and philanthropic contributions.
Some past laureates include Senator Patrick Burns, Edward
McNally, A.E. Cross and Max Bell.
Libin, now 79, has been involved in a lot of philanthropy in the Calgary
community: “I grew up being involved. I’ve worked for the university,
I’ve worked politically, and I’ve worked for community endeavours.
Working in the community has become second nature to me.”
As a co-owner of the Calgary Flames, he explains: “At the Flames,
we do a huge amount of community work -- we work in health, we
work in amateur sport, we work in building hockey rinks, and we
work on a lot of very worthwhile causes. We’ve built this hospice
this year, the Flames House.
“We have a good community because of it, and we’re trying to
influence more people to take an involvement and, not only write
cheques, but spend some time in these organizations and help
them get going.”
Libin’s contributions to the University of Calgary and the health field
have been substantial over the years. After selling his business in 1984,
he “had an opportunity to create this charitable foundation, The Alvin
and Mona Foundation,” which was named after him and his late wife.
Libin said, “That gave me a little bit more background
in research and how important research was and how
important it was to recruit strong people to the
province of Alberta. We built up a great number of
world class people in Calgary, and that’s why today, the
Foothills Medical Centre is very strong, and is
recognized as a leading medical centre in Canada.”
The Alvin and Mona Foundation was also “the kick-start for the
cardiovascular institute.” The Libin Cardiovascular Institute of
Alberta has been pursuing excellence in heart health since 2005.
The institute coordinates all cardiovascular science education,
research and patient care within both Alberta Health Services
(Calgary) and the University of Calgary.
Libin explained the institute “is serving a great need. It’s bringing
together the researchers, the educators, and the clinicians all under
one jurisdiction. This is the first time they’ve all worked so closely
together and it’s working well.”
Libin credits the vision of the institute to Dr. Eldon Smith, a
cardiologist who is “very involved in heart and heart health
planning for this province and for the whole country.” Smith is the
chairman of the Prime Minister’s task force on cardiovascular care
for Canada.
Already colleagues, they became more closely acquainted when
Libin needed treatment for his own heart issues in the early ‘80s.
They have since become family friends and take summer fishing
trips together, “when our schedules permit,” said Smith.
Requiring funding unavailable from the province to get off the
ground, Smith said that when the time came, “Mr. Libin was ready,
willing and able,” and “Thanks to his generous donation, the
institute was born.”
“It’s exciting, there’s a lot going on. We’re having some tremendous
results and we have recruited some really outstanding people.” said
Libin. “People like Dr. Derek Exner, Dr. Matthias Friedrich, and Dr.
Paul Fedak, who are all leaders in their fields, and there are many
more examples.”
“We’ve been working through the Alvin and Mona Libin Foundation
since the mid ‘80s, and so that’s kind of the vehicle we use for
philanthropic giving.”
Dr. Todd Anderson, the director of the institute, and a graduate
of U of C’s medical school, is “recognized as one of the leading
cardiologists in this country.” Like many of his colleagues,
Anderson practices as a cardiologist while also conducting
clinical research.
The foundation provides scholarships for medical school and does a
wide variety of community work. “We are supportive of the United
Way, The Banff Centre, and the Jewish community, as well as juvenile
diabetes and dozens of other organizations over the years,” Libin said.
“The whole way heart disease is treated today is so different. It’s
like a moving target, it changes daily and hourly, so there’s an awful
lot of change taking place and a lot of new technology being used,
so it’s a very exciting time in the heart business,” Libin said.
Libin is passionate about health care. From being involved in longterm health care since his early days with Villacentres to chairing
the board of Extendicare, he has been an integral part of nursing
home development across the country.
“Heart disease is a major killer. We need to work harder, we need to
get more information out there and we need people to understand
more about what’s going on here in Calgary.”
By Evvi-Lynn Rollins
HEALING HURTING HEARTS
Heart failure is devastating to patients and has a huge impact on the healthcare system. In Alberta, researchers are trying to
remedy this problem with a number of solutions
T
hey say that home is where the heart is. But it wasn’t his heart that
pulled Dr. William Ghali back to his hometown of Calgary in 1996.
It was heart research. Dr. Ghali, a specialist in internal medicine, had
just completed a Master’s degree in public health at Boston University
and was evaluating tantalizing job offers at universities in Canada and
the United States. Besides practising medicine, Dr. Ghali wanted to do
research on the delivery of cardiovascular health services.
One job offer stood out. A position at the University of Calgary would
allow Dr. Ghali to be involved with the Alberta Provincial Project for
Outcome Assessment in Coronary Heart Disease (APPROACH). This
data collection initiative was the brainchild of Alberta cardiologist Dr.
Merrill Knudtson. His vision was to capture detailed information on
every cardiac procedure performed in Alberta and track those patients
over time. “I had just finished training on how to use health data,” says
Dr. Ghali. “Here was this incredible infrastructure that would allow
me—and many others—to do research that sheds light on very
important questions around the most effective ways to deliver cardiac
procedures. I took the job at the University of Calgary and my work with
APPROACH has shaped my career.”
Since its inception, the APPROACH database has been used to: examine how a wide range of
demographic and socioeconomic factors affect cardiac care, assess different models of cardiac care,
and look at the costs and benefits of new treatments. One recent study focused on a new
technology called drug-eluting stents. A stent is a metal tube used to keep a clogged artery open
once it has been opened during a procedure called angioplasty. But bare metal stents can be prone
to reblocking, which happens when the muscle cells that line the artery wall grow over the stent,
necessitating a repeat procedure. A drug-eluting stent is a metal stent that has been coated with a
2
drug to prevent cell growth. Healthcare systems around the world have been
struggling with whether drug-eluting stents are worth the extra cost. Dr.
Ghali’s team, which included his colleagues Dr. Fiona Clement and Dr.
Braden Manns, used APPROACH data to perform a detailed costeffectiveness analysis on these stents. They determined that for some
patients the new technology is not necessary because they are not prone to
reblocking. However, for patients with diabetes or complex lesions the use of
drug-eluting stents is justified.
“Medical research is producing so many wonderful innovations but they all
come with a cost,” notes Dr. Ghali. “Decision-makers need better information
to make better decisions on what to fund and how best to utilize new
technologies like drug-eluting stents. The APPROACH database continues to
reveal important insights into outcomes and costs, and show us how we can
do an even better job of caring for patients.”
About the Researcher
Dr. William Ghali receives funding from Alberta Innovates – Health
Solutions, funded by the Alberta Heritage Foundation for Medical Research
Endowment Fund. He is a professor in the Departments of Medicine and Community Health
Sciences, University of Calgary, and director of the Calgary Institute for Population and Public
Health. Dr. Ghali is also a Member of the Libin Cardiovascular Institute of Alberta.
This article was originally published in the Fall 2010 issue of AHFMR Research News magazine and
has been reprinted with permission. You can read AHFMR Research News on-line at www.ahfmr.
ab.ca/researchnews.
Story by Connie Bryson
‘FOILING’ MYSTERIES IN A PATH TO KNIGHTHOOD
AHFMR Senior Investigator Hendrik ter Keurs
A
ccording to the Oxford English Dictionary, the term
‘fencing’ dates back to the late 16th century, and refers to
“the action or art of using the sword scientifically.” This
integration of art and science was something that may not have
completely dawned on Hendrik ter Keurs, MD PhD, upon having
been introduced to the sport of fencing at the age of eight, but it
was certainly a thread that followed him and continues to follow
him as an AHFMR Senior Investigator. Known in scientific
circles for his work in understanding heart pump function and
the adverse electrophysiological impacts resulting from a failing
heart, it is his journey that teaches us as much as his work.
During his undergraduate studies, Dr. ter Keurs developed a
strong interest in physiological measurements and was
subsequently hired by the Department of Physiology at Leiden
University immediately after completing a BSc equivalent in
1963. Unlike a vast majority of medical doctors, Dr. ter Keurs,
following his basic science interest, pursued a PhD in physiology
Dr. ter Keurs delivering an acceptance speech on the occasion of receiving
the Knighthood in the Order of the Dutch Lion in April of 2001 from Ms.
Irene Bakker, Honorary Dutch Consul, on behalf of Queen Beatrix of the
Netherlands. (Photo courtesy of Hendrick ter Keurs)
Soon after starting his experimental cardiology training, Dr. ter
Keurs’ research interest became quite focused on trabeculae,
small bundles of cardiac muscle, in an effort to understand the
heart by looking at one of the heart’s building blocks. During his
extended training, which was interlaced with an abundance of
research, Dr. ter Keurs spent a half year in Seattle during which
time he visited San Franscisco to deliver a lecture. As it turns
out, one of the members of the audience was Dr. John Tyberg,
who upon arriving in Calgary in 1984 started discussions that
finally led to Dr. ter Keurs landing in Calgary soon thereafter.
knowledge, Her Majesty Queen Beatrix of The Netherlands
bestowed Dr. ter Keurs with a Knighthood in the Order of the
Dutch Lion in 2001.
Recently asked what final thoughts he’d like to have included
should an article ever show up in the newspaper, Dr. ter
Keurs said with a smile, “make sure you let the readers know
that John Tyberg is a pinch older than me.”
It seems there is still a little bit of fencing left. En Guarde!
— Al-Karim Walli
While the above summary only speaks to the “beginning” and
does not in any way do justice to a journey with many facets, it
provides a glimpse into the plan, which was to follow the heart
and feed curiosity, with the understanding that the universe
takes care of the rest.
“I trained for my Ph.D. degree in Henk’s laborator y [from
1985 to 1989] that had just relocated from the University of
Leiden in the Netherlands,” says Dr. Pieter de Tombe, who is
now Chair of the Department of Cellular and Molecular
Physiology at Loyola University Chicago.
“I was extremely fortunate to be offered the opportunity to join
the group and relocate myself from the Netherlands. Of course, I
received superb training in physiology from Henk, but there was
something even more important that I learned, and this is
related to the general level of excitement and enthusiasm that
transpired tremendously in Henk’s research group. That is, the
strong sense of ‘curiosity’ that we experienced in his lab: to make
an observation in the laboratory, think about it, develop
hypotheses and then to go and design experiments to figure out
‘how it works’. This is what characterizes Dr. Henk ter Keurs,
and I believe his greatest contribution to science has been to
transfer his ‘curiosity’ to his trainees.”
There is at least one additional facet that should be noted. In
his fencing career that lasted thirty-six years in parallel to all
the training and research, Dr. ter Keurs was able to achieve a
“I believe his greatest contribution to science
has been to transfer his ‘curiosity’ to his trainees”
(’70) prior to completing requirements for the medical doctor
designation (’72). While he was following his heart, the subspecialty of cardiology had ironically not entered the picture to
that point. Dr. ter Keurs was working in the area of
neurosciences and the change was rooted in an issue not
unknown to the scientist – funding. As a result, with input from
mentors, he was enlisted in experimental cardiology in 1972.
2011 Libin Bash: Cardiaxe!
T
his year’s Libin Bash, a murder mystery dinner, was a
smashing success with over 250 staff, trainees and
members in attendance.
national ranking of 2nd overall in Holland, once losing by a
hair, 5-4, to the then world champion.
“You learn more from losing than winning,” philosophizes Dr. ter
Keurs on the lessons from his sport.
As it turns out, the lessons learned resulted in the forming of a
true champion. In recognition of his contributions to scientific
A cardiac muscle trabecula photographed in 1989 by Dr. Pieter
de Tombe upon completion of his PhD under the supervision of
Dr. Hendrik ter Keurs. Dr. de Tombe is currently Chair of the
Department of Cellular and Molecular Physiology at Loyola
University Chicago. (Photo courtesy of Dr. Hendrick ter Keurs)
NATIONAL HONOUR FOR LIBIN
INSTITUTE’S APPROACH TEAM
O
n March 21, 2011, the Canadian Institutes of Health
Research (CIHR) and the Canadian Medical Association
Journal (CMAJ) acknowledged top achievements in Canadian
health research that have had a significant impact on health,
health care and health research. Work of the APPROACH team,
led by Drs. Merril Knudtson, William Ghali and Diane Galbraith,
was selected as one of only six of these top achievements in all of
Canadian health research.
Government of Canada press release:
The Alberta Provincial Project for Outcome Assessment in Coronary Heart
Disease (APPROACH) team was established as a cardiac registry initiative to
t r a c k t h e l o n g - t e r m o u t c o m e s o f a l l p a t i e n t s u n d e r g o i n g c a rd i a c
catheterization in Alberta. APPROACH is now one of the largest, most
comprehensive cardiac registries in the world with more than 140,000 patients
from Alberta. APPROACH is applying learnings to manage wait lists and track
new diagnostic techniques, procedures and other cardiac conditions.
Dr. Ian Graham, Vice President for
Knowledge Translation at CIHR, further added:
Photo credit: David Wilkinson
“The winners of this award have demonstrated the key purpose
of health research – translating research knowledge into
practical health outcomes. The accomplishments recognized
today are a testament to how translating knowledge into practice
can have a direct impact on the lives of Canadians.”
Congratulations to the APPROACH team for having received this fantastic recognition!
3
CALGARY ABLATION FIRSTS
DELIVERY BYPASS
Most of us have experienced the sensation that our hearts are “skipping a beat.” It can be nothing more than an
occasional temporary pause in the regular beat or a premature beat that makes one pump of the heart seem
particularly forceful. The heart of the problem, so to speak, is electrical. Heartbeats are triggered by electrical
impulses that are generated within the heart itself. When things don’t function as they should, arrhythmia can be
the result. Arrhythmia is the medical term that refers to a variety of abnormal heart rhythms caused by a change
in the usual sequence of electrical impulses.
Cardiac ablation, the scarring or destroying tissue in your heart that triggers an abnormal heart rhythm, is a procedure
that can correct arrhythmias. Ablation typically uses catheters — long, flexible tubes inserted through a vein in your groin
and threaded to your heart — to correct structural problems in your heart that cause an arrhythmia.
Epicardial Ablation
D
r. Vikas Kuriachan and specialist Nurse Clinicians from
Cardiac Electrophysiology (EP) completed one of the first
Epicardial Ablations in Western Canada.
Typically this procedure is performed in patients with recurrent
ventricular tachycardia (VT) on antiarrhythmics and receiving
multiple, recurrent, symptomatic implantable cardioverterer
defibrillator therapies. Initially an endocardial ablation is tried. But
in some patients, the critical parts of the VT circuit may not be
successfully ablated within the endocardium. Hence, in such
patients an epicardial approach is necessary. Many of these
patients have end-stage cardiac disease and the main goal of the
procedure is not to cure, but to decrease the burden of
symptomatic VT. This procedure may also be useful in patients
whose endocardial chamber cannot be safely accessed. These
approaches are mostly for VT, but in rare cases may be necessary
for supraventricular arrhythmias.
“I have done three of these here so far and all have gone well. Such
procedures require the involvement of many people and we have a
great team of EP nurses, cath lab staff, interventional cardiologists,
cardiac anesthesia, diagnostic imaging, cardiac surgery and others
to make such procedures feasible,” says Kuriachan.
Percutaneous epicardial access is currently undergoing
investigation regarding left ventricular lead placement for
Cardiac Resynchronization Therapy (CRT) devices in some US
centres, which may make this approach applicable for CRT
implants in some patients in the future. The Libin Institute is also
setting up to perform other non-endocardial ablation approaches
such as transcoronar y ethanol ablation and surgical windows for
epicardial access.
— Amber Arsneau
Ablation in a Patient with a VAD
D
r. Kuriachan and the EP/cath lab team, along with the
support from the Transplant Clinic and Dr. Debra Isaac,
performed a complete atrioventricular (AV) nodal ablation
procedure for atrial fibrillation in a patient with a Left Ventricular
Assist Device (LVAD). The patient also has an implantable
cardioverter defibrillator (ICD) previously implanted. Due to a
rapidly conducting AF, he had been receiving inappropriate shock
therapies from his ICD. Maximal pharmacological approach was
not able to suppress AV nodal conduction. Therefore, it was
decided to perform the ablation procedure.
J.L. “Sam” and Beverly Mozell Hear t Rhythm Treatment Research and
Education Laboratory. Inset: Fluoroscopic left anterior oblique image of
epicardial ablation catheter (and a wire) along with other endocardial
catheters in a patient with a CRT-D during the epicardial VT ablation.
This is one of the first cases in Western Canada where an ablation
procedure has been performed on a patient with an LVAD. The
procedure was successful and the patient was discharged the
following day.
— Amber Arsneau
No-Fluoro Ablation a Necessity
for Mom to Be
O
n February 18, 2011, Calgarian Tanya Dunphy gave birth to
a healthy baby boy, her third son. This happy occasion was a
cause for a special celebration as 33 year-old Tanya had presented
during pregnancy with a continuous rapid heart rhythm (about
4
160 beats per minute). “I could
hear my heart pounding and
feeling tired, but I was
pregnant and working hard,
running a day home and
working part-time in retail,”
she says.
Tanya was diagnosed with
incessant supraventricular
tachycardia (SVT) and
admitted to Foothills Hospital
Tanya Dunphy with son Jacob.
in December 2010 when 28
(Photo courtesy of T. Dunphy)
weeks pregnant. She was
referred by her obstetrician, Dr. Stephanie Cooper, to Calgary
internal medicine specialist Dr. Paul Gibson and Libin member Dr.
Yorgo (George) Veenhuyzen for a cardiac consult.
‘Tanya had most likely had this SVT for many years,” suggests Dr.
Veenhuyzen. “She was known to have had it at least five years prior
to this pregnancy, but hadn’t been advised to follow any specific
treatment. When someone has their heart rate go fast for months
or years at a time, their heart function can become weak. This
turned out to be the case for Tanya. She had very weak heart
function in the midst of her pregnancy. You worry in these
circumstances about the fetus; the concern is whether the child is
receiving enough blood and developing well.”
Tanya Dunphy was treated with anti-arrhythmic medication to control
the SVT. A very short acting medication called Adenosine was able to
momentarily restore normal rhythm, but after a few seconds, when the
medication effect wore off, she would immediately go right back into
rapid SVT. Her heart rate did slow a little (to about 130 beats per
minute) with longer acting medication, but neither normal rhythm nor
normal heart rates could be achieved.
“In these circumstances, the best way to get the heart squeezing
function to return to normal is to restore normal heart rhythm and
normal heart rates,” explains Dr. Veenhuyzen. “If Tanya had not
been pregnant, we would have done a catheter ablation procedure.
Normally the patient lies on a comfortable table and we use an X-ray
camera to know where the catheters are going. The concern with
Tanya was that her developing baby would be exposed to X-rays,
and could suffer adverse effects from the radiation.”
On December 10 2010, Dr. Veenhuyzen performed a catheter
ablation on Tanya. She was 29 weeks pregnant. The obstetrics team
did a fetal assessment prior to and following the procedure. The
procedure was unusual on two counts; the first was that the patient
was pregnant, and the second was that Dr. Veenhuyzen employed a
state-of-the-art Electro Anatomic Mapping System to localize the
arrhythmia, with no X-rays. With this ENSITE Velocity System
(from St. Jude Medical, Minneapolis, Minnesota), he was able to
map a real-time, three-dimensional accurate illustration of Tanya’s
beating heart without exposing her baby to radiation. Following the
ablation, Tanya’s heart function recovered to normal.
“The procedure was a great success,” he says. “We found the spot
the SVT was coming from; we ablated it and that immediately
restored normal heart rhythm. We’ve become very confident
using this new technology in recent years, and very comfortable
knowing where the catheters are when we do. We typically use the
system in conjunction with X-rays, but we were able to do the
entire procedure on this occasion using just this mapping system
and no X-rays. This has been done in other centres in the world,
for other types of SVT, but it’s still a cutting edge thing to do.
We’ve shown we can do it safely and for a pregnant patient,
whereas pregnancy used to be considered a condition where
catheter ablation should never be performed. It’s very reasonable
now given the technology we have to consider doing catheter
ablation procedures on pregnant women when the circumstances
warrant it because extremely little, or, as in Tanya’s case, no
radiation exposure may be required.”
“I’m very grateful and feel wonderful,” says Tanya. “I have more
energy. My son, Jacob, is perfect, a happy, healthy baby. It was a
great thing not to have to worry about the x-rays. Dr. Veenhuyzen
is amazing. Everyone at Foothills really wanted to help me. They
gave me a gift.”
— Barbara Kermode-Scott
Cardiac and Neonatal team perform
unique combined surgery
I
t’s pretty unusual for a heart surgeon to go into the operating
room to perform surger y and post-op the patient comes out
with a newborn baby!
This is exactly what happened last year in Calgary.
On June 8, 2010, cardiovascular and thoracic surgeon Dr. Teresa (Terry)
M. Kieser performed an excision of a right atrial mass in a 26 year old
woman just moments after Dr. Stephen Wood performed a cesarean
section on the patient. Dr. Wood delivered a healthy baby boy.
This combined surgery was undertaken at Foothills Hospital on a patient
who was 29 weeks pregnant and also had a suspected pulmonary
embolism. The young woman had presented when almost 27 weeks
pregnant and was admitted. She had delivered a healthy son eight years
earlier – without incident. Since her son’s birth she had developed
systemic lupus erythematosus, antiphospholipid syndrome and cardiolipin
syndrome. After developing lupus, she had tried repeatedly to have
another child, but had sadly failed to carry any of her multiple pregnancies
to term - until this one. One issue with each pregnancy was that she was
prescribed the anticoagulant Coumadin to prevent clots. Each time the
young mother became pregnant again, she was prescribed a different
anticoagulant, enoxaparin, to reduce the danger of adverse events. During
this pregnancy, the patient was again advised to switch from Coumadin to
enoxaparin, but refused. As the pregnancy progressed she developed
increasing shortness of breath and pleuritic-type chest pain. On
investigation, an echocardiogram revealed a very large mass in her right
atrium. It was unknown whether it was a clot or a myxoma. The Obstetrics
service referred her to Cardiac Surgery for an assessment. After further
investigation and consultation with the Obstetrics service, Dr. Kieser opted
to do a right atriotomy to remove the mass.
Reach! out
“Dr. Wood performed his cesarean section very deftly and quickly,”
said Dr. Kieser. “Then we reprepped and draped the patient, placing
a neck line in, in anticipation of her cardiac surgery. There were now
two large masses… We placed the patient on cardiopulmonary
bypass… We removed two very large lesions. They looked like
organized balls of clot, certainly not like myxomas.”
FOREMOST EXPERT RECEIVES
LIBIN/AHFMR PRIZE
P
rofessor A. John Camm visited Calgary on
March 8, 2011 to formally receive the 2010
Libin/AHFMR Prize for Excellence in
Cardiovascular Research. Professor Camm, a giant
in cardiac electrophysiology research, delivered a
public lecture during his visit on the topic, “The Scourge of
Atrial Fibrillation: why it’s not nice to fib.”
The abnormal heart rhythm, atrial fibrillation (AF), is so
common it is almost becoming normal. Assuming an average
life span, one in four people will develop AF. The major
significance is its relationship to stroke, as a person with AF
has, on average, a five per cent annual probability of stroke.
Furthermore, these strokes tend to be severe.
The Libin/AHFMR Prize for Excellence in Cardiovascular
Research is awarded once every two years to an
outstanding international researcher whose work is
deemed to have had a major impact on the understanding,
prevention, recognition or treatment of cardiovascular
disease and/or the understanding and promotion of cardiovascular
health. The prize was established in honor of Dr. Alvin Libin for his
many contributions to the AHFMR including service as board chair.
The award is also meant to recognize Dr. Libin’s contribution to the
health system in Alberta, and to recognize his particular interest in
the cardiovascular sciences.
You can learn more about this prestigious award at:
http://www.libin.ucalgar y.ca/about/prizes_awards.php
NEW HOPE WITH LEADING-EDGE
CARDIAC PROCEDURE
S
outhern Albertans too sick or weak to undergo life-saving
open-heart surgery now have new hope thanks to a leadingedge cardiac procedure available at the Libin Cardiovascular
Institute of Alberta’s Foothills Medical Centre site.
Transcatheter aortic valve implantation (TAVI) is a less invasive
method for replacing diseased aortic valves than traditional
open-heart surgery. Patients with aortic stenosis – the
degeneration and hardening of aortic valves – often
experience shortness of breath, chest pain and fatigue.
Many die within two years without treatment.
hospital three or four days after the procedure, half the time they
would spend in hospital following open-heart surgery.
“Some of them have
absolutely no other option.
This is a leading-edge
procedure and is a cure
without having to undergo
major surgery. It’s much
better for these high-risk
patients to be treated closer
to home. Just imagine
someone who is 92 having
to travel to a new city, away
from their family, to
undergo a major medical
procedure.”
Dr. Faisal al-Qoofi, a Clinical Assistant Professor at the
Libin Cardiovascular Institute of Alberta, University of
Calgar y, conducted the first TAVI procedure in Calgar y
in Februar y of this year. Dr. al-Qoofi, inaugural
recipient of the Peter F. Russell Clinical Cardiology
Fellowship Award, completed advanced training at the
University of Chicago after completing his cardiology
training in Calgar y.
With its genesis in the home buildingNow
business,
TAVI offers a lifeline to patients who are not
candidates for conventional surgery.
the Cal Wenzel Family Foundation most
recently
The procedure can be done one of two ways: the replacement
“It is important to listen to the patient and heed their wishes – within
made of cow tissue, can be inserted in the femoral artery, at
made
a commitment of $3.5 million valve,
in support
reason,” concludes Dr. Kieser. “In this case, we are extremely
the groin, then moved through to the chest, pushing the diseased
pleased with the outcomes.”
of
health research – strengthening thevalveresearch
out of the way or, surgeons can also insert the valve directly
through
Barbara Kermode-Scott
foundation
today will directly impact thethe tip of heart via a small incision in the chest.
Either way, the procedure takes two to four hours and requires a
health of the community tomorrow. team of cardiologists, cardiac surgeons, nurses, technologists and
an anesthesiologist. Many patients can be safely discharged from
S
odium experts from around the world representing the various
World Health Organization (WHO) regions, along with
Canadian experts from coast to coast, convened in Calgary in
October 2010 to discuss monitoring and evaluating population
sodium consumption. The technical meeting was the second of
three such meetings, the first having been held in the United
Kingdom on creating an enabling environment for the reduction of
salt intake, and the third expected to take place by 2012 on the role
of fortified salt in iodine deficiency prevention. The meeting, cochaired by the Libin Institute’s Professor Norm Campell, was very
successful, resulting in a report that will in part inform the WHO
Global Strategy on Diet, Physical Activity and Health, as well as the
global prevention and control effort of Noncommunicable Diseases.
You can read the entire Calgary meeting report on the WHO
website at:
www.who.int/dietphysicalactivity/reducingsalt/en/index.html
Taking advantage of the many notable delegates of the Calgary
meeting, the Libin Institute subsequently hosted, with generous
support from AstraZeneca Canada, Merck Canada and others, a
conference on vascular disease prevention. With the objective
of sharing global best practice with the local medical community,
the conference was successful in attracting a significant cross
section of physicians, nurses, pharmacists and others involved
in cardiovascular health.
“Our patients are usually very elderly, with multiple medical
problems,” says Dr. Dean Traboulsi, Director of the Cardiac
Catheterization Lab and Interventional Cardiology at the
Libin Institute.
The
Cal Wenzel Family Foundation is firmly
Both the mother and child did very well following surgery.
rooted
in its commitment to build a better Calgary,
The collaboration among the surgical team (OR nursing, Cardiac
OR nursing, Anesthesiology, Obstetrics/Gynecology and
quite
literally from the ground up.
Neonatology) performing this combined surgery was
“phenomenal”, says Dr. Kieser. “Everybody took to heart the idea of
making this work for the baby and for the mom, and it worked like
clockwork. Everyone got together beforehand to help out and plan
this in advance. Thankfully we had the time to plan.”
Libin Hosts WHO and
Government of Canada Meeting
Delegates of the technical meeting jointly convened by the World Health
Organization and the Government of Canada in Calgary.
(Photo credit: Robin Kuniski)
Ronald Jones underwent the procedure March 5, 2011. Today,
the 71-year-old is back to his old self as an active square dancer.
Before the procedure, he was practically bedridden.
“I could hardly breathe. I could hardly walk. Even going up three
steps was tough. I would stand up and run out of air,” he says.
“I felt the difference right after the operation – it’s like night and
day. I can’t say enough thanks to the skilled TAVI team who gave
me a new lease on life. I’m even going square dancing again.”
Dr. Sonia Angell, Director, Cardiovascular Disease Prevention and
Control Program, New York City Department of Health and Mental
Hygiene. (Photo credit: Bruce Perrault)
Thank you!
The gift from the Cal Wenzel
Family Foundation will impact
the lives of many individuals
and families, including:
Reach! out
• The approximate 15-20%
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affected by asthma; $1 million
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Vascular disease prevention panel. Professor Franco Cappucio, Director
of the ESH Centre of Excellence in Hypertension & Cardio-Metabolic
Research at Warwick Medical School, addresses a question from the
audience, with Emeritus Professor Eldon Smith of the University of
Calgary and Godfrey Xuereb of the World Health Organization looking
on. (Photo credit: Bruce Perrault)
Thank you!
The Power of Partnership
The gift from the Cal Wenzel Family Foundation
• The approximate 15-20% of Alberta children
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to workandwith generous
philanthropic
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southern
Emeritus Professor Eldon Smith, Chair, Steering Committee of the
Canadian Heart Health Strategy and Action Plan.
(Photo credit: Bruce Perrault)
The Power of Partnership
Reach! continues to work with generous philanthropic leaders like the Cal Wenzel
Family Foundation to achieve a new world standard of health for southern Albertans.
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Professor Norm Campbell, Canadian Chair in Hypertention Prevention
and Control, and a Member of the Libin Cardiovascular Institute of
Alberta. (Photo credit: Bruce Perrault)
5
HEART OF GLASS
Cardiologist and researcher Dr. Henry Duff has found
a unique way to give back to the Heart and Stroke
Foundation − the organization that has funded
research through his whole career
E
ver y Tuesday night from 5 p.m. until 10 p.m., Dr. Henr y
Duff takes a step back from the stresses involved with
being a medical scientist and steps into a realm of creativity:
glass blowing.
His interest in the art form was sparked as a student in a
chemistry lab, when his class used glass blowing techniques to
fabricate chemistry equipment − a process Duff says is “still
cool”. As his interest lingered, his wife bought him a weekend of
art classes as a birthday gift one year. In the 12 years since, he
has taken classes at the Alberta College of Art and Design,
summer courses in Red Deer and proudly showcases and sells
his work online, at local craft shows and at the Museum Shop at
the Glenbow Museum.
“It’s mainly a diversion in my life, it’s a creative outlet,” Duff
admits. “I’m a cardiologist and a researcher so it gets stressful. When you’re three feet away from a
2500 degree flame, you’re in the moment and not thinking of anything else. If you are not focused,
you might get burned.”
While the intense colors and unique shapes of the
pieces are striking and would undoubtedly be
rewarding in itself, Duff says it’s the process of
creating them that keeps him hooked. The entire
process of blowing a piece of glass takes
approximately 45 minutes to an hour, so it’s quick
to satisfy. They are then put into a kiln to build
strength and durability, after which time they are
ready to serve their ornamental purpose-that is if
they turn out.
“Sometimes you think it will be gorgeous and it comes out (of the kiln) a mess and vice versa,” he
says, laughing as he described the end result, often a mysterious and obscure discovery.
While the hobby is soul-satisfying, Duff has chosen to share his passion in a unique way. Since he
began selling his pieces, he has donated all proceeds to the Heart and Stroke Foundation. His
current donation amount sits at approximately $1,500.
“The Heart and Stroke Foundation is everything me. They’ve funded research throughout my
whole career.”
The Heart and Stroke Foundation funds research, educates patients and implements preventative
programs, all of which Duff equates with what he refers to as a “fabulous organization, pivotal to
cardiovascular research and fundamental to many careers.”
Duff says the Heart and Stroke Foundation also targets young investigators and puts an emphasis
on the careers of young people-something he considers very important. So important in fact that
this year the money he donates to the organization will be for ‘Young Mavericks’ which strives to
reach young investigators and to get corporate citizens to see the value in young mavericks
starting a new research direction.
Visit www.duffglass.com to see more of Dr. Duff’s works.
— Kathryn Sloniowski
This article was originally published in the Fall 2011 issue of UCalgary Medicine magazine and has
been reprinted with permission. You can read UCalgary Medicine on-line at
http://medicine.ucalgary.ca/magazine/.
LIBIN IN SURGICAL
OUTREACH TO GUYANA
D
r. Kishan Narine has recently returned from a surgical outreach to Guyana on behalf of the
Royal College of Physicians and Surgeons of Canada (RCPSC) and with the support from the
Libin Cardiovascular Institute. Guyana, formerly
British Guyana, is roughly the size of the United
Kingdom and is situated on the northern coast of
South America. It is part of the Caribbean
Community and its capital city, Georgetown, is
home to the Caribbean Secretariat. Despite
significant natural resources including aluminum,
manganese, uranium, gold and diamonds, it was
listed as the second poorest country in the
western hemisphere after Haiti until recently.
Under the leadership of the current president,
Bharat Jagdeo and his administration, Guyana
has progressively transformed itself over the last
decade to a stable and progressive economy,
although still poor by western standards.
At present there is no dedicated cardiac center in
Guyana and the development and establishment
Bharrat Jagdeo, President of Guyana (left) with
of such a center is a Governmental priority.
Dr. Kishan Narine. (Photo courtesy of Kishan Narine)
While in Guyana, Dr. Narine was involved in the
training of local surgeons under the curriculum of the RCPSC in patient care at the Georgetown
Public Hospital. He also served in an advisory role to the Government in the development of
cardiac care as well as medical care overall.
Prior to joining the Libin
Institute, Dr. Narine, a
trained Cardiothoracic
Surgeon, was the Associate
Head of Cardiac Surgery
and Surgical co-Director of
Cardiac Transplantation at
the University Hospital,
Ghent, in Belgium. The
Department of Cardiac
Surgery in Ghent has a well
established program for
development aid and two
earlier visits by him to
Guyana while at Ghent led
to the establishment of a
catheterization laboratory
Dr. Kishan Narine (2nd from right) with trainees at the Georgetown Public
and a cardiac operating
Hospital. (Photo courtesy of Kishan Narine)
room. The current efforts
were inspired by the work and discussions of Sir Magdi Yacoub who leads the Chain of Hope
cardiac surgical charity from the UK and Dr. Alain Carpentier of France who heads the Alain
Carpentier Foundation and introduced a ‘trickle down’ cardiac program more than a decade ago in
Vietnam. The latter differs from the conventional acute primary care response to medical need in
the developing countries in that it seeks to establish specialized care with the intent of upgrading
local infrastructure and expertise in centers that can in turn not only provide specialized care, but
can also contribute to sustainable care on the primary front by local training.
Together with the Government of Guyana, a sustainable program for cardiac care is now being
developed. Dr. Narine was fully supported by the division of Cardiac Surgery and by the RCPSC
whose efforts in Guyana are being coordinated by UCalgary Medicine alumni Dr. Brian Cameron,
Professor of Surgery and Director of the International Surgery Desk, McMaster University. The
Libin Institute is proud to be involved in this desperately needed care in Guyana as it is in other
developing regions.
INNOVATING TO EDUCATE CARDIAC SURGEONS
T
he University of Calgary Cardiac Surgery Training Program
is proud of the work it has done to establish itself as an
innovative and unique program, despite its young age. Beyond the
usual surgical curriculum, we have hosted both a focused
academic enrichment day and the 4th Annual Alberta Cardiac
Surgery Residents’ Day. Taking place on September 16th and 17th
of this year, these academic events were a unique mix of
multidisciplinary rounds, academic presentations, wet labs and
networking opportunities designed specifically for the residents.
Calgary was pleased to welcome visiting professor and keynote
speaker Dr. Joeseph Bavaria of the University of Pennsylvania
(Philadelphia, Pennsylvania) to both these events. Dr. Bavaria is
a knowledge and opinion leader in academic cardiac surgery
with expertise in the surgical treatment of complex thoracic
aortic disease. Dr. Bavaria brought knowledge and training
experience in Thoracic Endovascular Aortic Repair (TEVAR),
stent grafts and complex hybrid surgery of the aortic arch. He
also provided invaluable mentoring and networking
opportunities for our residents.
This year’s focused academic day was titled, “Thoracic Aortic
Surgery” and commenced with multidisciplinary Thoracic
Aortic Rounds, followed by Grand Rounds presented by Dr.
Bavaria. The morning didactic lectures were presented by our
chief resident, Dr. William Kent, as well as physicians from
Cardiology, Radiology and Anaesthesia. Topics discussed
6
included Hybrid Arch Repair,
Aortic Imaging and IRAD, as
well as TEVAR for Acute and
Chronic Type B Aortic
Dissections. Following the
morning sessions,
intraoperative opportunites
with Drs. Bavaria, Andrew
Maitland and Jehangir
Appoo were available to the
residents, during which
valve-sparing aortic root
replacement was performed.
The afternoon wrapped up
with resident-focused
academic sessions with Dr.
Bavaria. Our residents had
Computed Tomographic Angiogram
the opportunity to listen to a
(CT) Reconstruction of Hybrid Aortic
presentation from Dr.
Arch Repair using Open and
Endovascular Techniques
Bavaria entitled, “How to be
an Academic Cardiac Surgeon and Career Planning,” during
which they received personalized career advice.
The 4th Annual Cardiac Surgery Residents’ Day was a
collaborative effort between the training programs at the
Universities of Calgary and Alberta (Edmonton). Alternating
host years, this educational day consists of three hours of
didactic lectures, two hours of wet labs and two hours of clinical
case presentations. Residents’ Day not only focuses on
enhancing knowledge, but provides opportunities for
interpersonal interactions throughout the day via case
discussions and clinical scenarios. Best-practices are also
reviewed with the diverse group of surgeons in attendance.
This year, Dr. Bavaria addressed the group on the topics of
TEVAR and TAVI. Dr. Paul Fedak (Libin) discussed the advances
in the treatment of congestive heart failure made through his
basic science and translational research in mechanical device,
stem cell and tissue engineering platforms. The afternoon wet
labs included a variety of clinical stations complementing the
didactic presentations of the morning. Stations of note were
complex mitral annular reconstruction using biocompatible
tissue patches, TEVAR simulation and the Bentall procedure.
During dinner, residents presented complex clinical scenarios.
This platform provided the opportunity for residents and
surgeons to discuss clinical management strategies and make
evidence-based decisions for complex clinical encounters.
The University of Calgary’s Cardiac Surgery program is excited
to have come so far in its short existence. We look forward to
continuing to use innovative strategies to ensure our residents
are knowledgeable and well prepared for their future careers as
cardiac surgeons.
— Christina Faulkner
LIBIN ABROAD:
T
Sandra, who works with Dr. Derek Exner, first saw the call for
volunteers in an American Society of Echocardiography
newsletter. Dr. William Battle, a cardiologist from Washington,
DC, led his team to Cap-Haïtien and then on to Milot. Although
without many of the amenities common to Western hospitals, the
hospital in Milot was a relatively comfortable and an established
health care centre in the region.
“I know for myself that I have always wanted to volunteer in a
setting such as this, but I never imagined my skills as a
technologist would be useful.”
The Centre for Rural Development of Milot (CRUDEM) is the
organization that supports the hospital with two Catholic sisters
manning the turrets. With the help of volunteers like Sandra, the
goal of the echocardiography centre is to be running
independently in one year and to establish servers that would
allow for cases to be reviewed remotely.
Sandra Owen in Haiti
he sentiment rings close to the familiar adage, “Give a man
a fish and he will eat for a day, teach a man to fish and he
will eat for a lifetime.” A noble sentiment and a task recently
approached by Sandra Owen, an echocardiography technician
from Calgary, when she volunteered her time in Haiti.
Certainly, the trip was not without its
frustrations. Many of the healthcare
volunteers were stifled with the difficulty of
ordering and prescribing, as the patients
were often unable to afford the
recommended course of action. The
temptation to personally pay the $20 USD
for a patients’ echocardiogram had to be
resisted in order to maintain the structure
and operating process. Many of the
diseases and wounds were far progressed
beyond what would be seen in most
developed countries.
Echo lab at the Hôpital Sacré Coeur in Milot, Haiti. Pictured from left to right are Dr. Joseph Job,
Yolene Louis-Charles, Sandra Owen, and Dr. William Battle. (Photo courtesy of Sandra Owen)
Before leaving to Haiti, Sandra raised
money for the hospital through a bottle
drive, mercilessly raiding the recycling
bins of friends and family. This interviewer
took it upon herself to consume as much
San Pelligrino as possible, for the cause - which raised more
than $1,500.
Shortly after being informed of her volunteer dates, word of the
Cholera epidemic in Haiti spread. Dr. Battle encouraged his team
with his insight: “Haiti will always be Haiti.” There will never be a
perfect time to go, but there is never a bad time to help.
“The most exciting part
is giving them a skill
and helping them become
more independent.”
It was certainly difficult to avoid obsequious flatter y during
the inter view; Sandra’s modest approach, respect for the
Haitian medical staff and the recognition that she was simply
a visitor in their hospital was humbling. Moving away from a
sentiment that such devastation is a fait accompli, the
recognition that a difference can still be made by single
individuals is continually inspiring.
More volunteers are of course needed to meet the goal of
running independently within a year. The next target on the list:
cardiac surgery.
For more information, visit www.crudem.org or contact Sandra
via e-mail [email protected]
— Anna Schmidt
CARDIOLOGY PROGRAM ATTRACTS TOP
FEMALE DOCTORS
D
on’t try telling Dr. Lisa Welikovitch that female medical
residents have an unfair advantage when applying to the
Libin Institute’s postgraduate cardiology training program at the
University of Calgary.
Statistics may show that her program has the highest percentage
of female cardiology residents in the country—six out of the
nine residents currently enrolled in the highly competitive and
prestigious three-year national program are women. But for
Welikovitch, who had been the program director for over a
decade, that’s merely a statistical anomaly, albeit one that she is
still proud of.
“We pick the best candidates, period. We don’t have a quota
system and we don’t favour women. There are simply more
female doctors out there than ever before. It kind of just
happened,” she says matter-of-factly.
The Libin Cardiovascular Institute of Alberta’s training
program attracts medical residents looking to specialize in
cardiology from all across North America. The program
director inter views about 60 to 70 applicants ever y year, with
three or four eventually getting selected.
“What we look for is a good fit. They have to want to come to
Calgary, have done the research about our program and
obviously need to know what kind of lifestyle they’re signing up
for,” Welikovitch adds.
Rather than being seen primarily as female-friendly, the quality of
the program and facilities is the biggest drawing card for
residents. The core program has 31 blocks of mandatory clinical
rotations, with an additional four elective blocks, and four
research blocks. The program is flexible in supporting trainees to
spend elective time at training sites outside Calgary, if appropriate.
There is a well-developed curriculum which is supported by
Academic Half Day sessions, daily educational rounds and formal
bedside teaching of cardiovascular physical examination skills. A
focus on the acquisition of skills and knowledge required of an
excellent clinician is combined with teaching and evaluation of
the CanMeds roles as outlined by the Royal College.
Research is a mandatory component of the program. A wellestablished infrastructure and extensive human resources
facilitates the involvement of trainees in clinical and basic
laboratory research projects.
Most of their training takes place at the Foothills Medical
Centre, close to the university’s Health Research Innovation
Centre, which houses state-of-the-art research facilities including
wet and dry labs.
In short, it is a grueling program as residents put in long hours
and are inherently on call for emergency situations. Traditionally,
Dr. Lisa Welikovitch, left, is a trusted mentor for many female cardiology residents such as Tasnim Vira. (Photo Credit: Riley Brandt)
cardiology has been viewed as a man’s domain because it was
thought many women MDs could not juggle the time demands—
especially if they wanted to start a family. Welikovitch knows all
this first hand and has mentored many female residents in the
program about how to help them find balance.
It is this fact that made Dr. Angela Kealey choose the Libin
program, as well as personal encouragement from Welikovitch
that cardiology could fit with her life.
“I told her that I wanted to have kids and she said ‘so?’” Kealey
said. “She basically convinced me that it would be difficult, but
doable.” A program graduate in 2008, Kealey is now a staff
cardiologist at Foothills Hospital. She took time off during her
training to have her two children.
“It wasn’t fun at first, but as I got further along in my
pregnancies there was a tacit agreement that I wouldn’t get the
really awful overnight calls because I was so sapped of energy.
That really helped.”
“It was definitely part of the appeal for me,” adds Dr. Anna
Bizios, who started the program in 2009 and is currently on
maternity leave with her first child. “My fellow residents, both
male and female, were really supportive when I was pregnant—
and Dr. Welikovitch has an open door policy with us to drop in
and talk about any issues and how to cope with the program.”
“There are better support systems in place to help women get
through it than when I did it,” Welikovitch says. “Women
shouldn’t have to be penalized for having a family. Most also
have very supportive partners and that is critical because it is
such an intense time in their lives. They need that to succeed.”
“These doctors are passionate about cardiology and want to
make a difference. They know that the lifestyle can be
challenging, but they also realize that cardiology impacts so
many people.”
Originally appeared in U magazine www.umag.ca
By Bob Hearn
7
An Honoured Partner
T
he Heart and Stroke Foundation,
since about 1970, has been a
partner of the Libin Cardiovascular Institute of Alberta, funding
research that has impacted the lives of millions of Canadians.
The Institute is most thankful for this fantastic support!
A DIVERSITY OF TRAINEES
Being a thematic institute comprising the full breadth and depth of the
cardiovascular sciences, the Libin Institute’s body of trainees demonstrates
a diversity of research and education pursuits. In this issue of Libin Life,
we’d like to share a sampling.
Anna Schmidt
Current pursuit: MD-PhD at the University of Calgary 2008-2015 (PhD candidate in the
Cardiovascular Sciences Dept; MD Class of 2015)
Super visor or Program Lead: Todd Anderson and Matthias Friedrich (co-supervisors)
Degrees/Institutions: Bachelor of Arts, major in Molecular Biology from
Princeton University (2002-2006).
Research interests and long term goals: I am very interested in the progression and
presentation of cardiometabolic diseases. My research projects focus on the use of cardiovascular
magnetic resonance imaging and biomarkers for (1) the early detection of cardiovascular disease in
patients diagnosed with type 2 diabetes, and (2) the assessment of the cardiac phenotype of obese
adolescents before and after weight loss. In the longer term, I am excited for medical school and
would be very interested in a career in cardiology.
The 2011 Libin Team at the Heart and Stroke Foundation (HSF) Ski for
Hear t event receiving the Spirit Award. The team raised over $25,000
for the HSF!
A pinch about yourself: I grew up in the Yukon. I am afraid of birds. I love to cook. If I had
another career I would do something creative, like painting or writing. Maybe in the south of France?
Libin Sponsors the Canadian
Cardiovascular Congress
William Kent MD, MSc
Current pursuit: Completion of residency training in Cardiac Surgery
Program Director: Dr. William Kidd
Degrees/Institutions: Resident in Cardiac Surgery
Resident in Cardiac Surgery
Residency in General Surgery
Doctor of Medicine
MSc in Neuroscience
BA (Hon) in Psychology T
his year, the Canadian Cardiovascular Congress finds itself
in beautiful British Columbia, our fine neighbours to the
West. The Congress, hosted by the Canadian Cardiovascular
Society and the Heart and Stroke Foundation of Canada, is the
largest gathering of cardiovascular and allied health
professionals in the country. The Institute is extremely proud to
be a Gold-Plus sponsor of the 2011 congress in support of overall
scientific program development and delivery. Watch for our
Members and Trainees throughout the program, and visit us at
booth 610 in the Community Forum for more information.
New to the Institute
Strategic Advisory Board!
University of Calgary
University of Alberta
Queen’s University
Queen’s University
University of Western Ontario
University of Western Ontario
07/2010 – present
07/2008 – 06/2010
Received 06/2008
Received 04/2003
Received 10/2001
Received 04/1996
Research interests and long term goals: As chief resident in Cardiac Surgery this year, I’ll be
completing my residency next spring. I then plan to pursue further training in a fellowship program.
With a particular interest in minimally invasive cardiac surgery, I intend to obtain skills in transcatheter aortic valve implantation, thoracoscopic arrhythmia surgery, port access mitral valve
repair and thoracic endovascular aortic repair. Through my additional interest in clinical research,
I’m investigating innovative techniques for post-operative wound management and less invasive
hybrid approaches to thoracic aortic disease. Outside the hospital, I have two young daughters who
divert my attention from the challenges of residency and keep me very busy.
Patrick Boyle
Current pursuit: Postdoctoral Fellowship at the Institute for Computational Medicine,
Johns Hopkins University (as of Sep. 1 2011)
Super visor or Program Lead: Dr. Edward J. Vigmond (Calgary),
Dr. Natalia Trayanova (Baltimore)
Degrees/Institutions: Ph.D. Biomedical Engineering, University of Calgary (2011);
B.Sc. Computer Engineering, University of Calgary (2005)
Research interests and long term goals: The goal of my research is to use simulations of
cardiac structure and physiology to better understand cardiac electrophysiology. Using a detailed 3D
model of the rabbit ventricles, I have explored the contributions of the Purkinje system (PS), a
specialized network of fast-conducting fibres, in the response to electric shocks and during episodes
of arrhythmia. My plan is to continue research in this area, focusing on the PS as a source of ectopic
activity and on its role during long-duration ventricular fibrillation.
Wayne Chiu, ME, ICD.D
Founder, Trico Developments
M
r. Wayne Chiu is the Founder of Trico Developments
Corporation and Trico Homes Inc. Mr. Chiu, a Mechanical
Engineering graduate from the University of Manitoba, a
qualified Master Builder and past Director of the Professional
Home Builders’ Institute, continues to be active in all aspects of
strategic land development and construction. Mr. Chiu holds an
Institute Certified Director Designation (“ICD.D”).
Recognition of community involvement:
• The City of Calgary Community Achievement Award in 2008
• Volunteer Calgary Leaders in Business Award in 2007
• Immigrant of Distinction Business Award by the Immigrant
Aid Society in 2004
• Generosity of Spirit Award by the Association of Fundraising
Professionals (Calgary Chapter) for his philanthropic work
within the community in 2004
Jamie Ross Mitchell
Current pursuit: Post-Doctoral Fellow, Departments of Cardiac Sciences and
Physiology & Pharmacology
Super visor or Program Lead: Dr. John V. Tyberg and Dr. Israel Belenkie
Degrees/Institutions: B.Sc.- Universite de Montreal;
M.Sc. – University of Calgary;
Ph.D.- University of Calgary
Research interests and long term goals: During my M.Sc., I completed studies of heart-lung
interaction with a focus on the hemodynamic effects of mechanical ventilation. During my Ph.D.
program, I extended these studies to an animal model of Acute Respiratory Distress Syndrome
with a special focus on the effects of volume loading on pulmonary vascular resistance. I have
since been involved with human studies looking at the hemodynamic effects of a vascular neck
restraint in partnership with the Calgary Police Service and cardiac magnetic resonance imaging
of heart failure patients after vasodilation therapy. My research interests would be to continue
working in the broader areas of hemodynamics and looking at the development of stress
cardiomyopathy models (Takotsubo cardiomyopathy).
A pinch about yourself: After spending four years in Montreal, I was happy to return to Alberta,
in particular Calgary, as the proximity to the mountains is hard to beat. This affords me the
opportunity to indulge in my hobbies of mountain biking and rock/ice climbing throughout the year.
1403 - 29th Street NW
Calgary, AB, Canada T2N 2T9
T 403.210.6271
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