History

 

By William L. Hart, MD, FACC, FACP, FAHA
Ventura Cardiology Consultants, 1962–1992, ret.

The monumental advances in medical science that followed World War II led to the emergence of subspecialists in order to keep abreast of this explosion of knowledge. Cardiology subspecialists were now required to address the health problems of the Western world. Demonstrating the value of cardiology sub-specialty training required patience and persistence, for it has always been a challenge for any practitioner to introduce new procedures, protocols and disciplines into a community with established practice patterns. In 1962, when the first cardiologist arrived in Ventura County, the entire practice of cardiovascular medicine was about to change.

During the latter part of the nineteenth century and starting with Augustus Waller, the advent of electrocardiography (enhanced by innovations of Dutch physiologist Willem Einthoven in 1905) provided practitioners of cardiology with a novel diagnostic tool, the electrocardiogram (ECG), which set their discipline apart from the rest of medicine. This initially curious device would become clinically invaluable and won Einthoven the Nobel Prize in Medicine in 1924. Werner Forsmann performed the first documented human cardiac catheterization procedure in 1929 - on himself - just thirty-four years after Wilhelm Roentgen discovered X-rays in 1895. There being no suitable catheters at the time, Forsmann improvised using a urological catheter, inserting it into his own heart through a vein in his arm and, with the aid of a fellow resident, proceeded to walk to the X-ray department in order to verify what he had just performed. André Cournand and Dickinson Richards of Columbia University used cardiac catheterization in 1941 for the first time to measure intracardiac pressures and cardiac output for which they shared the Nobel Prize in Medicine with Forsmann in 1956. It was in 1958 that Mason Sones performed the first selective coronary arteriogram at the Cleveland Clinic. Before that date, invasive cardiac catheterizations were performed mainly for valvular and congenital heart disease.

Clinical studies, such as the landmark Framingham Study, kept apace with technical advancements. This seminal population study showed that high blood pressure, smoking and elevated cholesterol were major risk factors for the development of coronary heart disease and propounded the “lipid hypotheses” of atherosclerosis. Echocardiography, followed by thrombolytic therapy to dissolve clots in coronary arteries, was developed and refined, and open-heart surgery became almost universally available, followed by coronary angioplasty in the 1970s and coronary stents in the 1990s. Permanent pacemaker and automatic implantable cardiac defibrillators have become commonplace. Cardiac imaging with MRI and CT has more recently added to our noninvasive diagnostic armamentarium. Significant major advances in cardiology continue to develop at a furious rate.

On July 23, 1962, Dr. William L. Hart, the first trained cardiologist in Ventura County and the first invasive cardiologist in the Tri-Counties (Ventura, Santa Barbara and San Luis Obispo Counties) began practice in Ventura as a new provisional medical staff member of the Foster Memorial Hospital, later to become Community Memorial Hospital. He was fresh from training at UCLA, one of only fourteen invasive cardiology training centers in North America at that time. That same year just 142 trainees were produced, whereas about 3,000 are presently trained annually in the United States. It was also in 1962 that Dr. Hughes Day in Kansas City introduced the concept of the Coronary Care Unit in the United States for treating acute myocardial infarction. This revolutionized cardiac and critical medical care and introduced the concept of specialized units for the critically ill patient. The author was privileged to introduce this concept to Ventura County with the first Coronary Care Unit in 1964, where he was Director for many years. Prior to the advent of the CCU, mortality rates for heart attacks were about 30 percent, whereas the present figure is about 2 percent. As there were no CCU-trained nurses then, the author, along with group members Drs. Charles Stephenson and Paul Fillmore, provided funding for Mrs. Verene Gingerich, RN, to attend Dr. Henry Marriott’s first CCU nurse training program in Florida. Mrs. Gingerich was Community Memorial Hospital’s first CCU Head Nurse. The nursing care in the CCU shortly became so superior that many surgeons soon began to admit their critically ill patients there, and the CCU was expanded.

In November 1962, the Ladies’ Auxiliary presented their first donation to CMH, a cardiac defibrillator. Dr. Hart had requested this new state-of-the-art equipment that he had used at UCLA and performed Ventura County’s first cardioversion at CMH. He also developed the first heart catheterization laboratory and implanted the first cardiac pacemaker, just six years after Dr. C. Walton Lillehei implanted the first pacemaker at the University of Minnesota. Dr. Hart founded CMH’s Physiology Department, establishing disciplined ECG interpretation by qualified readers, and he introduced exercise treadmill stress testing in conjunction with Professors Hal Kattus of UCLA and Merv Ellestad of UC Irvine. He also founded the first pacemaker clinic in California at UCLA in conjunction with Dr. Ray Ligouri of Oxnard and Dr. Mike Bilitch of USC (who founded the pacemaker clinic at USC simultaneously). He was a senior investigator for many major pharmaceutical companies for cardiac drugs. Dr. Hart, at his own time and expense, presided over virtually all of the intensive care nursing courses in the county for over ten years, deeming it his civic responsibility.

In 1964, the second cardiologist began practice in Ventura, Dr. Thomas Q. Kong, Sr. Dr. Kong had attended Dartmouth College as an undergraduate and then Cornell Medical School for his MD degree and served his residency at the Cleveland Clinic, where he developed his skills in cardiac catheterization and coronary angiography from the pioneer Dr. Mason Sones, noted above. In 1969, Dr. Kong joined Dr. Hart in the practice of cardiology along side internists Drs. Stephenson and Fillmore of the Loma Vista Medical Group. The field of cardiology was continuing to expand and the demands were dramatically increasing, with the average hospital census often being twenty to thirty patients each for Drs. Hart and Kong. Shortly before 1970, Dr. Newton Friedman began the practice of cardiology in Ventura. He received his MD degree from the Medical College of Cornell University and completed residency training at University of California, San Francisco General Hospital and Wadsworth General Hospital in the UCLA program. He then completed a cardiopulmonary fellowship at Scripps Clinic and Research Foundation where he developed skills in echocardiography and introduced that diagnostic discipline to Ventura County.

In 1976, the name of the group was changed to Ventura Cardiology Consultants to more accurately portray the character of the practice, as it was primarily a subspecialty group of cardiologists. After considerable urging by the established cardiologists, CMH opened the cardiac surgery program in 1977, and a new era in medicine was introduced to Ventura. In 1977, Dr. Friedman formally joined with Drs. Hart and Kong and merged his expertise in echocardiography with the group. Dr. Daniel Clark, who received his MD degree from Tufts Medical School, followed by residency at Greenwich Hospital and cardiology fellowship at University of Miami, joined the practice shortly thereafter. After ten years of service, Dr. Clark transitioned to become the Director of Cardiology at Ventura County Medical Center.

Since then, a number of talented cardiologists have entered practice in Ventura. Dr. Thomas Q. Kong, Jr., the son of the late Dr. Thomas Kong, Sr., joined Ventura Cardiology Consultants in 1997. Dr. Kong received his MD degree from Albany Medical College, and he completed residency training as well as adult and interventional cardiology fellowship training at Northwestern University in Chicago, where he was Chief Fellow under Dr. Robert Bonow, then president of the American Heart Association. Dr. Kong has served for years as the Medical Director of the Cardiac Catheterization Laboratory at Community Memorial Hospital. Dr. Nolan J. Mayer came to Ventura Cardiology in 2000. Dr. Mayer graduated from UC Davis School of Medicine and completed general cardiology and pacemaker training at UC Irvine.  He has been Director of Clinical Research for a decade and has been the group’s Principal Investigator on several pivotal clinical trials that have been published internationally.  Next, Dr. Craig S. Mansour joined the practice in 2003. Dr. Mansour received his MD degree from UC Irvine and completed internal medicine residency, general cardiology, and nuclear cardiology training at Emory University School of Medicine and Grady Memorial Hospital, serving as Chief Resident of Internal Medicine before serving a fellowship in cardiology at Emory. Dr. Alejandro Garcia and Dr. John H. Pang both joined the practice in 2010.  Dr. Garcia, fluent in English, Spanish and French, began practice in Ventura County in 1998 and thus added considerable coronary interventional, peripheral vascular interventional, and cardiac pacing skills and experience.  Dr. Pang, fluent in English and Korean, studied intensively at Northwestern University’s Feinberg School of Medicine under Dr. Charles J. Davidson, who was also Dr. Kong’s mentor, and brought to the group contemporary, catheter-based techniques for atrial septal defect (ASD) and patent foramen ovale (PFO) closure, placement of ventricular assist devices for critical heart failure in cardiac transplant candidates and recipients, endomyocardial biopsy, and knowledge of transcatheter aortic valve implantation (TAVI).