King of Hearts
By Virginia Heffernan

Toronto has Tirone David's dad to thank for enhancing the city's reputation as a leading centre for cardiac care.

David, one of the world's top heart surgeons, longed to be a chemist when he was younger. His father insisted on a medical career.

"My father was a frustrated doctor who had to abandon his schooling during the great depression," says David, an Officer of the Order of Canada. "I hated medical school in first year. I fainted at the sight of blood."

David eventually grew to love medicine and the study of the heart. Now colleagues from all corners of the earth flock to his operating room to watch him tackle extraordinary cases.

Born in Brazil and trained in the United States and Canada, David joined the faculty at the University of Toronto in 1978 after exploring a number of career paths, including working alongside missionaries in equatorial Africa.

The affable surgeon exemplifies Toronto's reputation as a top international centre for cardiac care, but he is not the first or only physician to do so.

"There is a legacy of people who have left their mark in Toronto," says David.

In 1961, William Mustard at the Hospital for Sick Children pioneered a surgical procedure to correct transposition of the great arteries of the heart, the defect associated with blue babies.

More recently, a research team led by Richard Weisel at Toronto Hospital won international acclaim for developing a revolutionary new therapy for cardiovascular disease. It uses the patient's own transplanted heart cells to replace damaged tissue.

And following in Mustard's footsteps at sick kids hospital is Marlene Rabinovitch. She is a world leader in the diagnosis and treatment of pulmonary complications in children with congenital heart defects.

This concentration of excellence doesn't happen just anywhere. It requires a setting that encourages creativity.

"Environment is indispensable. You must have an environment that supports you and encourages you to learn new things," says David.

Toronto provides that setting by tapping into charitable organizations like the Heart and Stroke Foundation, the largest financier of non-commercial cardiovascular research in Ontario. Private donors also help to top up the limited government funding available for heart research.

Meanwhile, the University of Toronto has been instrumental in collaborating with the Toronto Hospital to train the next generation of top physicians and ensure that the best minds in the field stay here.

The academic liaison has made the cardiac division at the Toronto Hospital one of the 10 ten in North America for academic productivity, measured by the number of scientific publications and peer-reviewed presentations produced by faculty.

The latest feather in Toronto's cap is the $25 million Peter Munk Cardiac Centre at the Toronto Hospital. The new centre features six operating rooms and a large intensive care unit. Munk, chairman of Barrack Gold Corporation, spearheaded the fundraising campaign for the centre by contributing the initial $6 million required the renovate the 35-year-old Gerrard Wing of the hospital.

But fundraising is the last thing on David's mind as he cuts into the heart of 19-year old patient undergoing his second open-heart surgery. David hopes he can save the patient's valve, which has developed an aneurysm since the previous operation six years ago.

But the teenager's valve is stretched and torn beyond repair. David chooses to replace it with an artificial one.

On the closed-circuit TV perched in the corner of the operating room, it looks as though someone has pressed the fast forward button when David starts stitching the coronary arteries to the white, corrugated valve that resembles a cross between a toilet paper roll and a slinky toy. Within a matter of moments, David rips off his surgical gloves. The operation is complete.

If the artificial valve performs as expected, the patient will be middle-aged before he returns to the operating table. And as long as Toronto continues to strive for excellence in matters of the heart, a new generation of Tirone Davids will be ready to greet him there.