Remembering the Female Clinicians Who Revolutionized Pediatric Cardiology

Editor’s Note: The following speech served as the Mullins Lecture on women in medicine, which was presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2018 Scientific Sessions (4/25–4/28).

Pediatric cardiology as a subspecialty was founded by women at the start of the 20th century. At a time when medicine was a man’s game, several female physicians pioneers overcame countless obstacles by virtue of their intellect and persistence to build the basis of congenital heart disease care today. In this lecture, through a historical review, I outline their contributions enhancing their breakthroughs.

First to recognize is Dr. Maude Abbott, who in 1936 published the famous Atlas of Congenital Cardiac Disease. Recognized as a landmark reference textbook, where she described and classified 1,000 heart specimens, with correlation between congenital cardiac anatomy and clinical findings including electrocardiography. She also included novel concepts of comparative anatomy, suggesting that defective heart development was responsible for the resulting heart defect.

Dr Helen Taussig is considered the mother of pediatric cardiology, as she was the pioneer who established the subspecialty as such. In the early 1900’s there were no pediatric cardiologists. Few pediatricians had developed an interest in rheumatic fever, but the true understanding of congenital heart disease allowing therapeutic breakthroughs we owe to Helen Taussig. Her biggest contribution was the design of an operation which allowed to increase pulmonary blood flow in children with severe cyanosis and would become lifesaving. The same procedure is performed today on a regular basis all over the world, in a modified fashion, while the essence of the palliative procedure remains exactly the same. (This is the Blalock Taussig shunt.) In addition, Dr Taussig was a devoted teacher. She initiated a fellowship in Pediatric Cardiology, through which she trained the future pioneers and medical leaders in the field.

Among her fellows, Dr Mary Allen Engle became the first director of pediatric cardiology at what is now New York-Presbyterian Hospital/Weill Cornell Medical Center. She was instrumental in creating the Division of Pediatric Cardiology, which she ran for 30 years, and was later named in her honor. She is credited with many research breakthroughs, including the use of gamaglobulin for therapy in Kawasaki disease, heart failure secondary to left to right shunt in ventricular septal defects, and the long-term complications of the Mustard operation. She also helped establish pediatric cardiology as the first subspecialty section in the American Academy of Pediatrics in 1957, and played a key role in the organization of the World Congress of Pediatric Cardiology in New York City in 1985.

Dr. Stella Van Praagh was a very relevant figure in our field, given her dedication to education and major contributions to the understanding of various complex and simple heart defects. Stella was born in Crete, Greece, and after graduating in Athens came to the US for medical training. She was a fellow under Helen Taussig, and also did training with John Keith in Toronto. She married Dr Richard Van Praagh in 1962 and with him developed the Cardiac Registry at Boston Children’s, as a center for advancing the understanding of the pathology of congenital cardiac disease. She authored of more than 100 scientific publications, lectured and taught trainees in cardiology and cardiac surgery from all over the world. She possessed the clarity of thought and language that made even the most complicated of cardiac malformations comprehensible to everyone.

Across the Atlantic, Dr. Jane Somerville became a leader in the field in London, England, with her teachings and influence soon expanding all over the world. She was mentored by pioneers like Dr. Paul Wood. She developed expertise in primarily pediatric cardiology especially congenital heart surgeries.The classification of pulmonary atresia with VSD goes with her name. She carries the credit of creating the idea of a common scientific session involving both pediatric cardiology and cardiac surgery, which has translated over time into the World Congress of Pediatric Cardiology and Cardiac Surgery. She is the founder of the GUCH (Grown up children with congenital heart disease, known in the US as Adult Congenital Heart Disease) as a subspecialty within cardiology.

A particular pioneer woman physician to recognize in the field of interventional pediatric cardiology is Dr Jean Kan, whose major contribution was the groundbreaking paper on pulmonary valve balloon dilation in 1982. Following this breakthrough, the field of interventional cardiology expanded with growing discoveries in the use of balloon angioplasty and valvotomy procedures applied to congenital heart defects.

Dr. Roberta Williams was a pioneer in the field of echocardiography since the early 70s, defining the initial correlations between anatomy and echocardiography to allow for accurate diagnosis- necessary for surgical repair and catheter intervention. She founded the Echo Lab at Boston Children’s in 1973 and was the first medical director of a dedicated Pediatric Cardiac Intensive Care Unit there. She then became chief of pediatric cardiology in UCLA and has dedicated to education and training, playing key leadership roles at several prestigious institutions, including the American Academy of Pediatrics.

It is also important to recognize Dr. Jackie Noonan, known internationally for her description of what is known as Noonan’s syndrome. We also owe to her some pivotal contributions in the early 70s, including the first original description of 101 patients with hypoplastic left heart syndrome. Following her training in Boston, she served for 39 years as director of pediatric cardiology in the University of Kentucky.

Dr. Maria Victoria de la Cruz was a female pioneer who in 1956 proposed the revolutionary concept of applying the principles of embryology to the interpretation of complex CHD, the result of irreversible developmental errors. During the 60’s and 70’s she completed experimental studies on insults on the embryonic heart.

Throughout the country there were other women physicians with leadership roles at several institutions in the US. Some had been former Helen Taussig’s fellows. Among these, Dr. Ruth Whittemore, a Yale professor who conducted groundbreaking research in pediatric cardiology based on data from clinics she founded in 1940’s. A major contribution was her population study on the genetics of congenital heart disease.

Charlotte Ferencz, who was also an ex- Helen Taussig fellow, was principal investigator for the regional Baltimore-Washington Infant Study, a population based study of congenital heart disease.

There were several other women pioneers, including: Grace Wolff (pioneer in pediatric electrophysiology, author of seminal studies on WPW, sudden death after tetralogy of Fallot repair), recipient of the PACES life achievement award), Janet Baldwin, Eugenia Doyle, Sylvia Preston Griffiths, Cora Lenox, and more. They all paved the way to the way we practice medicine today, and help empower many more women leaders in the field who followed with major contributions, including Jane Newburger, Vickie Vetter, Robyn Barst, and many more women.

Dr. Jacqueline Kreutzer is a professor of Pediatrics at the University of Pittsburgh School of Medicine. She is the director of the Cardiac Catheterization Laboratory at the Children’s Hospital of Pittsburgh of UPMC.

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