circulation: european perspectives in...

European Perspectives in CardiologyEuropean Perspectives in Cardiology

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f139Circulation June 18, 2013

On other pages...Spotlight: Emmanuel Messas, MD, PhDEmmanuel Messas, professor of cardiovascular medicine, Department ofCardiovascular Medicine, and head, Vascular Unit and UltrasoundCardiovascular Lab, Hôpital Européen Georges Pompidou, PARCC,Université Paris Descartes, Paris, France, describes his work on mitralregurgitation after myocardial infarction and ultrafast Doppler techniquesto image intramyocardial blood flow and its dynamics. Page f143

Hanneke Takkenberg, MD, PhD, is professor of clinicaldecision making in cardiothoracic interventions,

Department of Cardiothoracic Surgery, Erasmus Uni -versity Medical Center, Rotterdam, The Netherlands. Hergroup’s latest article in Circulation1 reported on the surgi-cal outcome of discrete subaortic stenosis in adults. Theinternational multicentre study was designed by Denisevan der Linde, MSc, PhD, a “young outstanding medicalgraduate and researcher” supervised by Professor Takken -berg and cardiologist Professor Jolien Roos-Hesselink,MD, PhD.

Dr van der Linde travelled to Canada and Belgium tocollect the data from 313 adult patients who had under-gone surgery for discrete subaortic stenosis at 4 centres. Shethen applied innovative mixed-effects and joint models toassess the postoperative progression of discrete subaorticstenosis and aortic regurgitation as well as the need forreoperation.

The study concluded that survival is excellent aftersurgery for discrete subaortic stenosis, but reoperation forrecurrent discrete subaortic stenosis is not uncommon.

Professor Takkenberg comments, “Due to the tremen-dous improvements made in the past decades in the diag-nosis and treatment of congenital heart disease duringchildhood, cardiac surgery practice is increasingly con-fronted with young adult patients with complex congenital

heart disease. A major challenge in studying outcome aftercongenital cardiac surgery is that most single-centre patientcohorts are small, which makes it hard to draw any validconclusions on determinants of outcome. Denise’s studyillustrates that successful collaboration in the field of con-genital heart disease research is feasible and meaningful,and the finding that additional myectomy is of no addedvalue and is associated with an increased risk of heart blockis important information for cardiac surgeons.” Dr van derLinde defended her PhD thesis with honours on April 19,2013.

“The Model Proved Useful for Clinicians to Assess the Advantages and Disadvantages of the DifferentTreatment Options for Individual Patients”Over the past decade, Professor Takkenberg’s interestshave focused on heart valve research, and specifically thedevelopment of evidence-based models to predict individ-ual patient outcome.

When she started working in Erasmus MC in 1996, thegroup in Rotterdam had just started experimenting with theuse of simulation models to predict age and gender-specificoutcome of patients with a Bjork-Shiley convexo-concaveheart valve prosthesis. Professor Takkenberg says, “Theseprostheses had a tendency toward outflow strut fracture, withserious and usually deadly consequences. Using simulation

Spotlight: Hanneke Takkenberg, MD, PhD

Hanneke Takkenberg, professor of clinical decision making in cardiothoracic interventions,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,The Netherlands, talks to Mark Nicholls.

“Good Medical Decisions Require not only Evidence andConsideration of the Clinical State and Circumstances of the Patient, but also Informed Patient Preferences”

June 18, 2013, pp.139-144forpress5.6.13Messas_Cir Euro Template 1 06/06/2013 17:19

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models, it was possible to weigh the hazard of a strut frac-ture against the risk of preventive removal of the heartvalve prosthesis and provide evidence-based advice topatients.

“When I started working in Rotterdam, I focused on thedevelopment of evidence-based microsimulation models topredict outcome after aortic valve replacement with differenttypes of heart valve prostheses and on reporting clinical out-come of the Rotterdam prospective human tissue valvecohort, eventually applying the microsimulation models tothis cohort.2,3 The model proved to be useful for cliniciansto assess the advantages and disadvantages of the differenttreatment options for individual patients, for example toweigh the lifetime risk of a reoperation after bioprostheticaortic valve replacement versus the lifetime risk of majorbleeding events after mechanical aortic valve replacement.However, it remains difficult to assess which is worse forthe individual patient: a reoperation or a bleeding. This is avalue-sensitive issue.”4

Another strong area of research in Rotterdam involvedhuman tissue valves, with the centre performing a large vol-ume of Ross procedures and homograft aortic valve replace-ments every year, and maintaining a prospective database.5,6

Professor Takkenberg has been a council member of theSociety for Heart Valve Disease since 2007, where she ischair of its working group on epidemiology and a member ofthe aortic valve repair working groups. She was also a mem-ber of the Valvular Heart Disease Taskforce that producedthe recent European Society of Cardiology and the EuropeanAssociation for Cardiothoracic Surgery guidelines on themanagement of valvular heart disease.7 As a member of theNetherlands Association for Cardiothoracic Surgery, shechairs the Heart Valve Decision Aid Working Group, and shewas a member of the National Data Registration Audit Com -mittee and the KinCor Working Group (design and initiationof a new Dutch paediatric cardiology patient registry).

Work by another researcher that has had the most impacton Professor Takkenberg’s work and the way she thinks is anarticle in 2000 by Per Kvidal, MD, from the Department ofCardiology, University Hospital, Uppsala, Sweden.8Professor Takkenberg says, “Per Kvidal opened my eyes tothe fact that life expectancy after aortic valve replacement ismarkedly reduced, in particular in young adult patients.Although observed survival is worse in older patients, rela-tive survival is inversely associated with patient age: theobserved/expected mortality ratio of patients <50 years ofage is 4.5 compared with the age-matched generalpopulation. In contrast, patients ≥70 years of age have a lifeexpectancy comparable to the general population. Theseobservations form the foundation of my microsimulationstudies of age and gender-specific patient outcomes afteraortic valve replacement with different types of prostheses.”

“I Will Make Sure That a Decision Aid BecomesAvailable for Heart Valve Patients Next Year”Professor Takkenberg studied medicine at the University ofGroningen School of Medicine, Groningen, The Nether -lands, and the Vrije University of Amsterdam, qualifyingfor an MD in 1994. She says, “Early on in medical schoolI was fascinated by congenital heart defects and volunteeredto help out with experimental research in lambs in whichcongenital anomalies were surgically created. The setting ofthe operating room and the ingenious way the researchersdid their measurements amazed me. I then decided to pursuea career in the field of cardiovascular disease.”

In 1993, Professor Takkenberg had the opportunity tospend 2 months at the California Pacific Medical Center, SanFrancisco, CA, where she worked in the heart transplanta-tion lab with Winston Wicomb, PhD, a biochemist who usedto run the heart transplantation labs for Christiaan Barnard,MD, in South Africa. Under the “inspiring supervision” ofDr Wicomb, Professor Takkenberg developed a workingheart model in rabbits within 2 months and from there “aprofound passion for cardiovascular research.”

In 1994, Professor Takkenberg travelled to Los Angelesto work in the Department of Cardiothoracic Surgery at theCedars-Sinai Medical Center under Alfredo Trento, MD,FACS. She says, “I worked there for 2 years in the hearttransplantation lab as a research fellow studying the effectof chronic alcohol use in donors on transplanted hearts10

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Professor Takkenberg chaired the TOP committee of the DutchFemale Physicians Association that promotes female medicalleadership and is cofounder of the Erasmus MC Network forWomen in Academic Medicine (VENA). She says, “In 2006,together with Professor Roos-Hesselink, I founded VENA to pro-mote female medical leadership and was cochair until 2011. It isgreat to see that since 2006 a lot has changed in my institution:VENA has empowered female medical specialists and researchersto network more actively, improve their career planning, andbecome more visible within our organisation. VENA has alsopushed the Erasmus MC organisation to stimulate high-potentialyoung female medical specialists and scientists through manage-ment development programmes and courses and commit chairs ofdepartments to actively push their young female academic tal-ent.” Photograph courtesy of Professor Takkenberg.



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and built my first database of heart transplantation recipi-ents. I also worked in the heart transplantation procurementteam, collecting donor hearts for transplantation throughoutthe West Coast. This experience at Cedars-Sinai made merealise that I preferred research to clinical practice because itallowed me to push knowledge forward and work on bettersurgical treatment for future patients with heart disease.”

In 1996, Professor Takkenberg returned to TheNetherlands as a research fellow at the Department ofCardiothoracic Surgery, Erasmus University MedicalCenter, and worked for an MSc and a PhD in clinical epi-demiology. From 2007 and 2012, she was associate profes-sor and director of the Research Division at ErasmusUniversity Medical Center. Then in November 2012,Professor Takkenberg was appointed to her current role asprofessor of clinical decision making in cardiothoracicinterventions. She describes obtaining the post as herproudest achievement and says, “My current positionallows me to work with young and enthusiastic researcherswho are eager to learn and excel. The position also allowsme to expand my research to advance prognostic modellingin the field of cardiothoracic interventions, implement sim-ulation models in shared decision-making tools, and trans-late complex knowledge to a format that is comprehensibleto patients.”

Professor Takkenberg’s department chief, Ad Bogers,MD, PhD (see http://circ.ahajournals.org/content/120/1/f1),has helped shape her career. She says, “I owe a lot toProfessor Bogers. He has always supported me: his doorwas—and still is—always open for advice and guidance.”

Professor Sir Magdi Yacoub, MD, FRS, FRCS, FRCP,has also been inspirational. Professor Takkenberg explains,

“He [Professor Sir Magdi Yacoub] taught me to always staycurious, question every observation, and remain a modestperson who serves the patient. His genius and creative mindand his perseverance are what I admire most. I had the priv-ilege to collaborate with him on several occasions, usuallyon projects concerning the Ross procedure. Now retired, heis still active as a surgeon and scientist through his Chain ofHope charity (see http://circ.ahajournals.org/content/114/9/f133) to develop sustainable clinical and research cardiaccentres for the treatment of children and young people withheart diseases in countries where the facilities for such treat-ments are unavailable. He is a truly remarkable man.”

Professor Takkenberg enthusiastically embraces a num-ber of teaching roles for the Erasmus MC medical curricu-lum, the Cardiovascular School Erasmus Rotterdam PhDand research seminar programmes, the European Asso -ciation for Cardiothoracic Surgery educational programme,The Netherlands Association for Cardiothoracic Surgeryeducation programme, the Netherlands Institute for HealthSciences MSc Clinical Research programme, and self-initi-ated international student exchange with internationallyrenowned institutes.

Within the Erasmus MC medical curriculum, togetherwith Professor Willem Helbing, MD, PhD, and ProfessorRoos-Hesselink, Professor Takkenberg initiated the 3rd-year minor Congenital Heart Disease in 2010. She alsoteaches evidence-based informed shared decision makingas part of the MSc Medicine programme at Erasmus MCand supervises PhD theses. She says, “I truly enjoy teach-ing informed shared decision making to 4th-year medicalstudents, helping them realise that good medical decisionsrequire not only evidence and consideration of the clinical

Circulation June 18, 2013 f141

Professor Takkenberg says her most important and most enjoyable research was a lengthy review of the Ross Procedure.9 She describesthe work as “a truly multidisciplinary effort” triggered during “an inspiring daylong informal meeting” in November 2005 when her col-laborators (shown above) examined explanted autograft specimens under the microscope and hypothesised about determinants of dura-bility of the Ross procedure. “Following the meeting, I started working on the systematic review on outcome after the Ross procedurebecause we all agreed that the individual case series were all too small and usually with a limited follow-up duration and thus insuffi-cient to explore determinants of outcome,” says Professor Takkenberg. “The work took >3 years, but the results were of great value tothe Ross community.” From left to right, standing: Professor Roos-Hesselink, Professor Takkenberg, Professor Paul Schoof, paediatriccardiac surgeon, UMC Utrecht, Professor Bogers, Loes Klieverik, PhD student, Professor Lex van Herwerden, chief of cardiac surgery,UMC Utrecht, Sir Magdi Yacoub, and Pieter Zondervan, pathologist, Erasmus MC; sitting: Martijn van Geldorp, PhD student, SietskeZoontjes, medical student, and Dr Robert-Jan van Suijlen, pathologist, UMC Maastricht. Photograph courtesy of Professor Takkenberg.



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state and circumstances of the patient but also informedpatient preferences.

“Additionally, supervising my PhD students is the bestthing ever. I try to make the PhD trajectory an adventurousjourney for them, not only focusing on their particular PhDsubject, but also broadening their horizon by stimulatingthem to travel for short or longer research visits abroad.”

Professor Takkenberg advises people wanting to followa career in medicine, cardiology, or cardiac surgery to“work hard, have a heart for patients and their families,always be curious, and keep an open mind.” She adds,“The 21st-century doctor has an extremely challenging rolein an ever-changing society where disease-related informa-tion (reliable and unreliable) can be found anywhere, newinsights into disease and treatment options seem to emergeevery day, and keeping up is like chasing a moving target.Make sure to keep a good work–life balance.”

In the future, Professor Takkenberg plans to “developand implement in clinical practice evidence-based shared

decision-making tools for cardiothoracic interventions.”She says, “As chair of the Dutch Association for Cardio -thoracic Surgery quality project ‘Heart Valve DecisionAid,’ I will make sure that a decision aid for Dutch heartvalve patients becomes available next year. The decisionaid will first be tested in experimental and implementationresearch, additionally employing microsimulation modelsto ascertain evidence-based individualised patient prognos-tication. Finally, we also intend to explore the synergybetween optimised decision making and cost-effectivenessof different cardiothoracic intervention options.”

References1. van der Linde D, Roos-Hesselink JW, Rizopoulos D, Heuvelman HJ,

Budts W, van Dijk AP, Witsenburg M, Yap SC, Oxenius A, SilversidesCK, Oechslin EN, Bogers AJ, Takkenberg JJ. Surgical outcome of dis-crete subaortic stenosis in adults: a multicenter study. Circulation.2013;127:1184–1191.

2. Takkenberg JJ, Eijkemans MJ, Steyerberg EW. Simulation techniquesto support prosthetic valve choice in aortic valve replacement. AnnThorac Surg. 2001;72:1795–1796.

3. Takkenberg JJ, Eijkemans MJ, van Herwerden LA, Steyerberg EW,Lane MM, Elkins RC, Habbema JD, Bogers AJ. Prognosis after aorticroot replacement with cryopreserved allografts in adults. Ann ThoracSurg. 2003;75:1482–1489.

4. van Geldorp MW, Eric Jamieson WR, Kappetein AP, Ye J, Fradet GJ,Eijkemans MJ, Grunkemeier GL, Bogers AJ, Takkenberg JJ. Patientoutcome after aortic valve replacement with a mechanical or biologicalprosthesis: weighing lifetime anticoagulant-related event risk againstreoperation risk. J Thorac Cardiovasc Surg. 2009;137:881–886.

5. Takkenberg JJ, Klieverik LM, Bekkers JA, Kappetein AP, Roos JW,Eijkemans MJ, Bogers AJ. Allografts for aortic valve or root replace-ment: insights from an 18-year single-center prospective follow-upstudy. Eur J Cardiothorac Surg. 2007;31:852–860.

6. Mokhles MM, Rizopoulos D, Andrinopoulou ER, Bekkers JA, Roos-Hesselink JW, Lesaffre E, Bogers AJ, Takkenberg JJ. Autograft andpulmonary allograft performance in the second post-operative decadeafter the Ross procedure: insights from the Rotterdam ProspectiveCohort Study. Eur Heart J. 2012;33:2213–2224.

7. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G,Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A,Falk V, Lung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, SchulerG, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, WindeckerS, Zamorano JL, Zembala M; ESC Committee for Practice Guidelines(CPG); Joint Task Force on the Management of Valvular Heart Diseaseof the European Society of Cardiology (ESC); European Associationfor Cardio-Thoracic Surgery (EACTS). Guidelines on the managementof valvular heart disease (version 2012): the Joint Task Force on theManagement of Valvular Heart Disease of the European Society ofCardiology (ESC) and the European Association for Cardio-ThoracicSurgery (EACTS). Eur J Cardiothorac Surg. 2012;42:S1–S44.

8. Kvidal P, Bergstrom R, Horte LG, Stahle E. Observed and relative sur-vival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–756.

9. Takkenberg JJ, Wang HM, Trento A, Popov A, Freimark D, Eghbali K,Wang CH, Blanche C, Czer LS. The effect of chronic alcohol use onthe heart before and after transplantation in an experimental model inthe rat. J Heart Lung Transplant. 1997;16:939–945.

10. Takkenberg JJ, Klieverik LM, Schoof PH, van Suylen RJ, vanHerwerden LA, Zondervan PE, Roos-Hesselink JW, Eijkemans MJ,Yacoub MH, Bogers AJ. The Ross procedure: a systematic review andmeta-analysis. Circulation. 2009;119:222–228.

Contact details for Professor Takkenberg: Department ofCardio-Thoracic Surgery, Bd563m, Erasmus UniversityMedical Center, P.O. Box 2040, 3000CA Rotterdam, TheNetherlands. Tel: +31-10-7035413. Fax +31-10-7033993.

Mark Nicholls is a freelance medical journalist.

Professor Takkenberg with her family. She is married to Mark DeGroot and they have 4 daughters between 4 and 17 years of age.Away from medicine, her interests include holidays with her familyon her favourite Dutch island, Ameland, with a barbecue on thebeach, horse riding, reading, and biking. She particularly enjoysliterature on advances in medical sciences. Professor Takkenbergsays, “One of my daughters required, and luckily survived, a stemcell transplantation in 2009. It was tough to be ‘on the other side’as the parent of a patient and it made me realise that there is somuch work to do to improve patient information and support. Thisexperience pushed me, in 2010, to become an active volunteer for theDutch Childhood Cancer Parent Organisation, a national organi-sation of parents of children with cancer. We provide support, infor-mation, and advocacy for patients, parents, and families and I findit fulfilling to help out.” Photo courtesy of Professor Takkenberg.



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Circulation June 18, 2013 f143

Emmanuel Messas, MD, PhD, professor of medicineand cardiologist, Department of Cardiovascular

Medicine and head, Vascular Unit and UltrasoundCardiovascular Lab, Hôpital Européen Georges Pompidou,PARCC, Université Paris Descartes, Paris, France, is thelast author of a recent article in Circulation.1 This articledemonstrates that comprehensive annular and subvalvularrepair improves long-term reduction of both chronicischaemic mitral regurgitation and left ventricular remodel-ling without reducing global or segmental left ventricularfunction at follow up.

Professor Messas and his colleagues undertook thisresearch for the Leducq Foundation Mitral Valve Disease:From Genetic Mechanisms to Improved Repair (MITRAL)Transatlantic Network, for which the European coordinatoris Albert A. Hagège, MD, PhD, professor of cardiology,Hôpital Européen Georges Pompidou, and member of theFrench Institute of Health and Medical Research (Unit633), Paris, France. The US coordinator is Professor RobertA. Levine, MD, Massachusetts General Hospital, Boston,MA, and Harvard Medical School, Boston. The networkreceived substantial funding for their research, which wascarried out from 2008 to 2013.

Other members of the group based at Paris Cardio -vascular Research Centre at Hôpital Européen GeorgesPompidou (PARCC) are Professor Michel Desnos, MD,Professor Phillipe Menasché, MD, world-known ProfessorAlain Carpentier, MD, PhD, who pioneered mitral valverepair and who gave Professor Messas his initial passion forvalve disease, Alain Bel, MD, and Catherine Szymanski,MD, who is first author of the study.

“Ischaemic mitral regurgitation is diffi-cult to treat,” says Professor Messas.“After myocardial infarction, left ventricu-lar remodelling results in mitral regurgita-tion. Treatment is to use a ring, but this hashigh rates of recurrence of mitral regurgita-tion and the left ventricular remodellingremains.” Professor Messas comments,“We need to treat the cause: the left ven-tricular remodelling.”

The idea behind the research camewhen Professor Messas was a research fel-low at Massachusetts General Hospital,when he looked at ways to decrease mitral

valve leaflet tethering by disconnecting the leaflet from thedisplaced papilary muscles. “The question is which chordaeto cut: the basal or the marginal? If you cut the basal chor-dae, there is no prolapse and you improve the shape of themitral leaflet and improve mitral regurgitation; if you cutthe marginal chordae, the result is prolapse,” says ProfessorMessas.

“From 2000, when we worked on the acute model, to2012, we have collaborated with Professor Levine onmitral valve disease research funded by the NationalInstitutes of Health. Together with Professor Levine andProfessor Hagege, we have published several articles inCirculation on the efficacy of mitral valve chordal cuttingto reduce chronic ischaemic mitral regurgitation and leftventricular remodelling.2–5”

“Ultrafast Imaging With Ultrasound Has Emerged as aUnique Novel Technique for Tissue Imaging”Professor Messas studied for a BA in mathematics from theAcademy of Paris before working for his medical degree atthe University of Paris. After 2 years as a cardiovascularfellow at Broussais Hospital, Paris, he decided to focus oncardiology. He then won a fellowship in cardiology at theInstitute of Science and Medical Research, Paris, underProfessor Hagege. In 1999, he spent 2 years as a researchfellow at Massachusetts General Hospital under the men-torship of Professor Levine, who has guided his careerdevelopment. In 2006, Professor Messas was awarded hisPhD in biomedical engineering from the Institute ofScience and Medical Research.

Spotlight: Emmanuel Messas MD, PhD

Emmanuel Messas, professor of medicine and cardiologist, Department of CardiovascularMedicine, and head, Vascular Unit and Ultrasound Cardiovascular Lab, Hôpital Européen Georges Pompidou, PARCC, Université Paris Descartes, Paris, France,talks to Paula Hensler MD.

“Ultrasound Imaging Can Help Better Understand and TreatIschaemic Mitral Regurgitation”

Professor Messas (2nd right) with from left to right, Professor Menasché, ProfessorHagege, and Professor Michel Desnos. Photograph courtesy of Professor Messas.



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The opinions expressed in Circulation: European Perspectivesin Cardiology are not necessarily those of the editors or of the American Heart Association.

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Editor: Christoph Bode, MD, FESC, FACC, FAHAManaging Editor: Lindy van den Berghe, BMedSci, BM, BSWe welcome comments. E-mail: [email protected]

References1. Szymanski C, Bel A, Cohen I, Touchot B, Handschumacher MD,

Desnos M, Carpentier A, Menasché P, Hagège AA, Levine RA, MessasE; Leducq Foundation MITRAL Transatlantic Network. Compre -hensive annular and subvalvular repair of chronic ischemic mitralregurgitation improves long-term results with the least ventricularremodeling. Circulation. 2012;126:2720–2727.

2. Messas E, Guerrero JL, Handschumacher MD, Conrad C, Chow CM,Sullivan S, Yoganathan AP, Levine RA. Chordal cutting: a new thera-peutic approach for ischemic mitral regurgitation. Circulation.2001;104:1958–1963.

3. Messas E, Pouzet B, Touchot B, Guerrero JL, Vlahakes GJ, Desnos M,Menasché P, Hagège A, Levine RA. Efficacy of chordal cutting torelieve chronic persistent ischemic mitral regurgitation. Circulation.2003;108(Suppl 1):I1111–I1115.

4. Messas E, Yosefy C, Chaput M, Guerrero JL, Sullivan S, Menasché P,Carpentier A, Desnos M, Hagege AA, Vlahakes GJ, Levine RA.Chordal cutting does not adversely affect left ventricle contractile func-tion. Circulation. 2006;114(Suppl 1):I1524–I1528.

5. Messas E, Bel A, Szymanski C, Cohen I, Touchot B, HandschumacherMD, Desnos M, Carpentier A, Menasché P, Hagège AA, Levine RA.Relief of mitral leaflet tethering following chronic myocardial infarc-tion by chordal cutting diminishes left ventricular remodeling. CircCardiovasc Imaging. 2010;3:679–686.

6. Osmanski BF, Pernot M, Montaldo G, Bel A, Messas E, Tanter M.Ultrafast Doppler imaging of blood flow dynamics in the myocardium.IEEE Trans Med Imaging. 2012;31:1661–1668.

7. Pernot M, Couade M, Frank M, Mirault T, Blanchard A, Niarra R, AziziM, Emmerich J, Tanter M, Messas E. Real-time evaluation of the localcarotid pulse wave velocity using ultrafast echo imaging in healthypopulation. Eur Heart J. 2012; 852:33 (Abstract Suppl).

8. Faugeroux J, Nematalla H, Li W, Clement M, Robidel E, Frank M,Curis E, Ait-Oufella H, Caligiuri G, Nicoletti A, Hagege A, Messas E,Bruneval P, Jeunemaitre X, Bergaya S. Angiotensin II promotes tho-racic aortic dissections and ruptures in Col3a1 haploinsufficient mice.Hypertension. 2013;Apr 29. Epub ahead of print.

Contact details for Professor Messas: Pôle Cardiovasculaire,Service de Médecine Vasculaire-HTA, Hôpital Européen G.Pompidou, 20 rue Leblanc, 75908 Paris Cedex 15. INSERMU633,PARCC,Université Paris Descartes, Paris, France.Tel: +33 1 56 09 37 55. E-mail: [email protected] Paula Hensler is a freelance medical writer.

As head of the Vascular Unit, Professor Messas workson a new strategy to treat patients with polyvascular dis-ease and anticoagulation protocols for deep vein thrombo-sis and atrial fibrillation. He recently changed his researchand work focus from valvular heart disease to common andrare vascular disease but using the same philososphy basedon using advanced ultrasound technique to better under-stand and treat cardiovascular disease. He has started a col-laboration with Professor Mathias Fink, PhD, InstitutLangevin, École Supérieure of Industrial Physics andChemistry, Paris, and uses ultrasound to better understandvascular disease. The ultrafast technique developed byProfessor Fink’s lab can with the same probe image at highframe rate the arterial pulse wave and send a shear wave onthe arterial wall to calculate local arterial stiffness. Thisrevolutionary technique can also calculate in real time,local myocardial stiffness and intramyocardial blood flowand its dynamics. Other collaborators at the InstitutLangevin are Professor Michael Tanter, PhD, and MathieuPernot, PhD. The research is sponsored by the FrenchSociety of Cardiology with collaborations from the AgenceNationale de Recherche and Societe Française de MedicineVasculaire. Professor Messas says, “Ultrafast imaging withultrasound has emerged as a unique novel technique for tis-sue imaging at ultra high frame rates (up to 10, 000images/s).”6,7

Professor Messas has recently conducted research andpublished on rare vascular diseases such as vascular Ehlers-Danlos syndrome. He collaborates with Professor XavierJeunemaitre, MD, PhD, at the Centre for Rare VascularDiseases, Hôpital Européen Georges Pompidou, Paris. Otherteam members at the centre include Professor PierreFrancois Plouin, MD, PhD (see http://circ.ahajournals.org/content/127/15/f85), Dr Tristan Mirault, Dr Michael Frank,Dr Julie Faugeroux, Dr Lahlou Laforet, and Jean MichaelMazala. The results of their animal study on the effects ofangiotensin II in Ehlers-Danlos syndrome have been pub-lished recently.8

Professor Levine and Professor Messas at the King David Hotel,Jerusalem, Israel, during the last Israeli Heart Association meet-ing. Professor Messas is married with 4 children. He comes froma long line of rabbis; his father was chief rabbi of Paris, and hisgrandfather was chief rabbi of Jerusalem, Israel. ProfessorMessas believes in social responsibility; he serves his Parisneighbourhood as a vice-mayor and is president of the localJewish community. Photograph courtesy of Professor Messas.

Professor Messas (left) with his colleagues, from left to right, DrValentine Gautier, Dr Michael Frank, Professor Jeunemaitre, JeanMichael Mazella, Dr Juliette Albuisson, and Professor Plouin.Photograph courtesy of Professor Messas.



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