In 1959, Dr. Ralph Berg and a team of other surgeons successfully performed the first open-heart surgery at Sacred Heart Medical Center, making Spokane only the seventh open-heart surgery center in the country and the first outside a major university.


In the decades following, that operation has joined many others performed hereincluding transplant surgeriesin helping to put Spokane on the map as a notable center for cardiac care, observers here say. Equally important, however, has been the contribution of cardiologists herethe doctors who diagnose and treat the heart systems without open-heart surgery.


They introduced the Inland Northwestand in some cases the stateto such now-common procedures as angiograms, balloon and stent angioplasties, and implantable pacemakers and defibrillators. They also have been key players in researching cardiovascular disease.


After the almost revolutionary changes in cardiac surgery of the 1960s and 1970s that first put Spokane on the map, its been the practice of cardiology that has changed most drastically. Today we see the pendulum swinging again, with both surgeons and cardiologists refining techniques and finding new ways of treating cardiovascular problems, says Mike Nowling, former CEO for more than 10 years of the Heart Institute of Spokane.


Perhaps the most noteworthy of contributions from cardiologists was that made by Dr. Marcus DeWood who, along with Spokane co-authors Julie Spores, a nurse anesthetist, and five fellow cardiologists, doctors Robert Notske, Lowell T. Mouser, Robert Burroughs, Michael S. Golden, and Henry T. Lang, published research findings in 1980.


The Heart Institutes 1997-98 Report to the Community said the dramatic findings were that in every recorded heart attack, one of the coronary arteries has been blocked acutely by a blood clot. Immediate surgeries restore blood to the heart. Spokane revolutionizes the worlds understanding of coronary events and changes how coronary medicine is practiced. This collective body of research is known today as the Spokane experience.


Published in The New England Journal of Medicine, the study contradicted conventional thinking at the time that the primary cause of heart attacks was a narrowing of blood vessels.


DeWoods study provided critical insight into the causation of heart attacks. It was critical, says Dr. Harold Goldberg, of Spokane Cardiology PS.


Spokane Cardiology is one of four major cardiology groups that have evolved here and helped to boost Spokanes reputation in cardiac care. The others are Heart Clinics Northwest PS, Inland Cardiology Associates PS, and Rockwood Cardiology. Together, those groups now employ more than 350 people, including 55 cardiologists.


Yet, at one time cardiology wasnt held in the same esteem as other medical specialties.


One of the founders of Spokane Cardiology, the oldest of the four groups, retired cardiologist Dr. Paul Shields, says his profession wasnt well-received when he arrived in Spokane in 1961, and that it took a couple of years before he was accepted as a contributing member of the medical community.


Shields later also practiced in Hawaii, and now spends time both there and in Spokane.


Not coincidentally, it was in 1962 when the first temporary pacemaker was utilized in Spokane to complement early pacemaker placement, the latter being a technological advancement that would prolong the lives of many people who otherwise likely would have died within six months to two years, Shields says.


He now considers the advent of pacemakers to have been one of the most important cardiac developments he saw in his 30-plus years of medical practice in Spokane and Hawaii.


Goldberg says that Shields, who co-founded Spokane Cardiology in 1969 with Dr. Ken Sutherland, was instrumental in bringing the first temporary pacemakers and direct-current defibrillators to Spokane.


Those temporary pacemakers were wired, mostly out-of-body devices that are still used today to control a patients heartbeat during placement of implantable pacemakers, which use electrical impulses to stimulate the heart muscles artifically to contract. The direct-current, or D/C, defibrillators, still used in hospital settings, are devices that give an electric shock to restore normal heartbeats in hearts that are beating rapidly or chaotically, Goldberg says.


Pacemakers have come a long way since the first units, which required the surgical opening of the recipients chest cavity and extending of wires to the heart from the device, which at that time was placed in the patients abdomen.


Defibrillators, too, have improved immeasurably since their inception as a wall socket A/C plug-in that electrically shocked the heart. Theyre now battery-operated electronic devices placed in the body that provide continuous monitoring of heart rhythms and can administer paced beats or shocks to treat dangerously irregular heartbeats, whether theyre too slow or too fast.


In 1984, Spokane Cardiology referred a patient to Stanford University, where the patient received one of the first 100 implantable cardioverter-defibrillators ever inserted in a human being. That patient, whos still alive, had defibrillating patches sewn directly onto the heart muscle with stimulating electrical coils placed there that were triggered by wires extending from the defibrillator placed in the abdomen, Goldberg says.


Those initial defibrillators lasted about 18 months before they needed to be replaced, and were about the size of a pack of cigarettes. They now last about six years, are about the size of a matchbox, and routinely are placed in the left upper chest, Goldberg says.


The first local coronary angioplasty procedure, or insertion of a balloon to clear an artery blockage, was performed by Dr. Tom Mouser of Rockwood Cardiology, says Teri Diogo, the clinics office manager. The smallest of the local cardiology groups, with three and a half full-time cardiologists and six full-time employees, Rockwood Cardiology inserts pacemakers into its patients, but does no work with defibrillators, says Diogo.


She says that Dr. David Stagaman, who currently is on staff there, has done a lot of innovative research on congestive heart failure.


Meanwhile, another of the four groups, Inland Cardiology, was the first independent clinic here to open its own diagnostic catheterization lab, at a cost of $2 million, in 2003, says Tim Shea, clinic manager at Inlands Northpointe clinic. Shea says the lab specializes in diagnostic angiograms, or moving X-rays of the blood vessels in the heart, a technique of heart evaluation Shields says he first introduced to the state of Washington in 1965.


Spokanes major hospitals have operated such cath labs for years prior to that, as did the Heart Institute of Spokane, a consortium which was previously owned by a group of Spokane cardiologists, cardiac surgeons, and Sacred Heart. In June of last year the Heart Institute became a subsidiary of Sacred Heart, says Maureen Goins, Sacred Heart spokeswoman.


Angiograms are used to diagnose coronary-artery disease and to assess the condition of arteries previously treated for such disease.


Inland Cardiology which started in 1982 and now employs 15 cardiologists and about 90 people in all.


Spokane Cardiology employs 15 cardiologists and about 125 workers.


Another of its major contributions to the areas heart-care legacy came in the early 1970s when, says Goldberg, it worked with Spokane Community College to create a college course to train technicians to perform echocardiograms, what was then the visionary technique of using reflections from high-frequency sound waves to form a picture of the internal structure of the heart.


Only the military had such echocardiogram training available at that time, Goldberg says.


The group distributed a list of the firsts it claims its practice had brought to the Spokane area, including the first fast CT scanner privately owned in the U.S. to image coronary calcium at a time when this was an emerging technology, and the first use of a laser here to open arteries in the heart and legs.


The largest of the four local cardiology groups, Heart Clinics Northwest PS, was formed in 1995 when the Spokane Heart Clinic and Cardiac Consultants, with histories back to the late 1970s or early 1980s, merged, says Mary Odenthal, chief operations officer there. Heart Clinics Northwest employs 22 cardiologists and 134 employees.


Among Heart Clinics Northwests contributions, says Odenthal, were the clinical efforts of Dr. Timothy Lessemeier, who did research and was a study coordinator for the nationwide MADIT II study on defibrillators.


She asserts the results of the study, which was concluded in about 2003, were responsible for a Jan. 1 federal change in philosophy that now extends Medicare coverage to include defibrillators in some cardiac patients.