Aldo Ricardo Castañeda, MD, PhD: What Is He Really Like?

An excellent overall biosketch of my friend Aldo R. Castañeda, MD, PhD was published in 2006 on the occasion of his induction into the Pediatric Cardiology Hall of Fame [1]. However, my present task is very different. For those who may not know him personally, I shall try to give you a glimpse of the real Aldo, the man behind the 378 scientific publications and the towering international reputation as a superb congenital heart surgeon, based on my personal recollections of having worked with Dr. Castañeda at the Children's Hospital Boston from 1972 to 1994.

For me it all started when our Search Committee asked me to call Dr. Jesse E. Edwards, the legendary cardiovascular pathologist who was then working in the twin cities of Minneapolis and St. Paul, Minnesota. By telephone I asked Jesse Edwards, an old friend, what he thought of Aldo R. Castañeda – who was being considered as a possible successor to Dr. Robert E. Gross. As most readers will know, Dr. Gross was retiring after a brilliant career as the founder of congenital heart surgery. He had successfully ligated a large patent ductus arteriosus in a 7 œ ‐year-old girl on August 26, 1938, when his Chief, Prof. William E. Ladd, was out of town on his summer holidays.

In response to my question, Dr. Edwards could not say enough good things about Aldo Castañeda. Dr. Edwards went on and on, telling me how spectacular Aldo really was as a cardiac surgeon. Then he suddenly stopped in mid-sentence and said, “Oh, I hope you don't get him! I hope you don't get him!” Dr. Edwards thought that they needed Aldo just where he was, in Minneapolis/St. Paul. A stronger recommendation in favor of Dr. Aldo Castañeda would be impossible to imagine, coming as it did from a world famous cardiac pathologist.

I passed on Dr. Edwards' thoughts to our Selection Committee and soon – over some illustrious competitors – Dr. Castañeda was selected and was offered the position. He accepted it.

What happened when Aldo arrived at Children's Hospital Boston ([Fig. 1])? He transformed the Cardiology and Cardiac Surgery services. Immediately, he brought us into the modern age. As the cardiac pathologist, I had a front row seat to this change. Gone were the thick black silk sutures of the pre-1972 days. Now we were looking at fine, perfectly placed polyethylene green sutures – an amazing transformation. A legend developed at Children's Hospital Boston that BC really stood for Before Castañeda.

Fig. 1 Aldo R. Castañeda (left) and Robert E. Gross (right) at Children's Hospital Boston in 1972.

Many other remarkable changes occurred. Weekly lab and lecture sessions were instituted in the Cardiac Registry – the cardiac pathology lab, just for cardiac surgery residents. These sessions were often conducted by Stella Van Praagh, my incomparable pediatric cardiologist and pathologist wife. A native of Crete, Greece, née Stella Zacharioudaki, my wife was also a superb cook. Out of her little office, Stella would bring hot homemade Easter bread covered with melted butter, or homemade baklava, or spinach-cheese pie. That's how her lecture-lab sessions would frequently start: by reviving tired residents who often had been up at least half the previous might. We also did weekly teaching sessions mainly for the cardiology fellows. No one was ever turned away. We also provided private sessions for any of the permanent staff who wanted to talk about anything cardiac.

I'll never forget one day (among many) when Aldo came to the Cardiac Registry. He and I were talking about the tetralogy of Fallot over real, well-washed heart specimens. I was telling and showing Aldo what I thought the tetralogy really is, namely, underdevelopment (hypoplasia) of the subpulmonary conus arteriosus (or infundibulum), with the sequelae of subpulmonary conal hypoplasia [2] – which results in the tetralogy of anomalies so well described by Fallot in 1888 [3]. Then Aldo said, “ Well, Ricardo, if what you are saying is true, all we need to do is to patch open the right ventricular outflow tract, close the VSD, and excise little or no right ventricular outflow tract myocardium”.

Aldo understood, and that's what he then started doing. The effects were amazing. Our tetralogy of Fallot patients stopped dying. This then gradually led to what later would become known as the Castañeda doctrine:

Operate as soon postnatally as the patient needs it. Whenever possible, do corrective surgery, not palliative surgery. One operation is better than two (or more).

And so Aldo Castañeda became the “father” of neonatal and first-year-of-life corrective congenital heart surgery.

But Aldo was more than a world-class congenital heart surgeon. We received visiting cardiologists and cardiac surgeons from all over the world and Aldo often spoke to his visitors on his rounds in their own languages – a rare occurrence in an American hospital. His Spanish was perfect, as was his Italian. His German was fluent, but (I was told) with a dreadful Bavarian accent. Aldo and his family had fortunately survived the Second World War in and near Munich. His French was good, but a bit slow. He had no knowledge of Greek, but a considerable acquaintance with Hellenic culture, literature, and history. I once heard Aldo give a lecture to a roomful of his colleagues in which he talked about the Apollonian surgeon – a remarkable leitmotif for a scientific address.

There is so much more that should be said. Rather than self-aggrandizement, either personal or departmental, Aldo had the wisdom to do the opposite. Instead of trying to inflate the importance of his Department of Cardiac Surgery, Aldo sought to minimize, or if possible to erase interdepartmental boundaries, so that everyone could work more closely together as a team. Aldo introduced the concept of the Cardiovascular Program. Cardiology, Cardiac Surgery, Cardiovascular Radiology, Cardiac Pathology, the Cardiology and Cardiac Surgical nurses, the echo technicians – all were part of our Cardiovascular Program.

At our monthly Pathology Conferences where our cardiovascular fatalities were presented with great care, it was not rare for Prof. Aldo Castañeda to interrupt the presentation and say, “No, no. I just did a bad operation.” This kind of courageous intellectual honesty then led to a careful consideration, right there in the conference room, on how we could do it better next time.

Aldo also has a charming sense of humor ([Fig. 2]). He bears no resemblance to the cold, aloof, dour professor glowering at the viewer in some of his published photographs. For example, one day I was telling Aldo that he was like a slightly younger brother. I was born in April 1930 and Aldo was born in July of the same year. I said that if I had not been a couple of months premature, we would have been virtually the same age. Aldo's reaction was, “Ricardo, Ricardo, if you'd been full-term, you might have amounted to something. Why, you might even have become a cardiac surgeon!” Then tapping me on the head he said, “Myelination, my boy, myelination!”

Fig. 2 Aldo R. Castañeda at Children's Hospital Boston (about 1990).

In closing, I would like to propose a toast to a truly outstanding octogenarian, a man of many great accomplishments, to Aldo Castañeda!

References

• 1 Vida V L, Sade R M, Stellin G. Aldo R. Castañeda.  Cardiol Young. 2006;  16 221-228
• 2 Van Praagh R, Van Praagh S, Nebesar R A, Muster A J, Sinha S N, Paul M H. Tetralogy of Fallot: underdevelopment of the pulmonary infundibulum and its sequelae. Report of a case with cor triatriatum and pulmonary sequestration.  Am J Cardiol. 1970;  26 25-33
• 3 Fallot A. Contribution à l'anatomie pathologique de la maladie bleue.  Marseille – Médical. 1888;  25 77-93 138-158 207-223 270-286 341-354 403-420