From Colombia to Yale cardiology: Dr. Carlos Mena-Hurtado
While attending high school in his native Colombia, Carlos Mena-Hurtado used to frequently drop in on his older brother Alvaro, who was studying medicine at the University of Antioquia, the nation’s top medical school and one of the oldest in South America. All of that time in his brother’s classes convinced Mena-Hurtado, the son of a social worker and an English teacher, to apply. Though it was a challenge to land one of 40 spots available for 5,000 applicants to the prestigious institution, he was accepted. It was the beginning of a what’s become a distinguished career in cardiology.
“Cardiology started to grow on me during med school,” said Mena-Hurtado, speaking in his office at Yale School of Medicine. “What I liked about it was the fact that you can do quick interventions that would change patient outcomes.” As he was completing his medical school education in Medellín, he applied for a scholarship that would allow him to continue his training through a series of rotations at institutions outside of his university. One of the possible institutions was Yale.
Yet the young doctor had doubts. “It was a long shot,” he recalled. “I was from a developing country, at a public university, and didn’t speak English fluently. So it wasn’t necessarily the easiest thing to do.”
“The best rotation”
Mena-Hurtado took the first step, which involved passing board examinations to qualify as a foreign medical student. In the fall of 1999, he worked in a small community hospital in a remote area of Colombia, which was a requirement in his country for having received a free medical education. At the facility, which had only four in-patient beds, Mena-Hurtado typically treated children with respiratory illness or mothers in labor. While he was on-call one night, he heard a knock on the door.
“When I opened the door, it was a bunch of armed men asking for the physician on call. I said, ‘Why?’ And they said, ‘We need that person.’ So when you’re in Colombia and something like that happens, you know you are being taken,” he explained.
In Colombia, plagued for decades by revolutionary movements such as the FARC and ELN, kidnappings were not uncommon. That night, Mena-Hurtado understood that he and his best friend, also a physician, were seized because they had valuable medical skills. He later learned that his captors had recently been in a confrontation with the Colombian army, suffering injuries that required medical attention.
Over the course of his captivity, Mena-Hurtado applied his clinical skills to treating the wounded, sick children, and pregnant women in the guerrilla camps. “I had the training,” he recalled. “The problem is that there were not many resources.”
After weeks of uncertainty, when one day blended into the next, just as suddenly as Mena-Hurtado and his friend had been taken, they were released. The pair walked for hours to the nearest town, where they called their families, who had had no word of their whereabouts or fate.
As a result of the traumatic events, Mena-Hurtado suffered some PTSD-related nightmares and sleeplessness. Yet, looking back, he also sees a silver lining. “I have mixed feelings because I do think that was one of the best experiences ever in my life, as a physician, because it taught me to think outside the box,” he said. “I had no resources, yet I had to figure out many different ways to treat people without all the fancy stuff that physicians would get. So in that respect, I would say — and this is ironic — but that was one of the best rotations I ever had as a medical student.”
To the heart of it
Once at Yale, Mena-Hurtado did a series of clerkships, including one on the cardiology floor at the VA in West Haven with Dr. Steven Pfau. While doing clinical rotations over several months, he continued to polish his skills and his English. The experience confirmed his decision to leave Colombia permanently and pursue a career in cardiology at Yale. A mentor, Dr. Stephen Hout, a professor of medicine who directed the primary care internal medicine program, helped Mena-Hurtado navigate the process of getting a U.S. visa and entering the residency program.
But Mena-Hurtado’s path to interventional cardiology truly crystallized once he landed the fellowship in cardiology. “Interventional cardiology is a specialty where you have the ability to do procedures within the heart for a specific pathology,” he explained. “The most common one would be heart attack in which you have a blocked artery and we’re able to get into that area and clean it up with a balloon and then put a stent and open up the artery.” Another example is a narrow valve that cardiologists open with the use of wires, balloons, and stents, he said.
At that time, the cardiology team at Yale was just beginning to expand the reach of their interventional techniques. Under the tutelage of Dr. Henry Cabin, Dr. Michael W. Cleman, and Dr. Michael S. Remetz, Mena-Hurtado developed a niche in vascular medicine. Because the same process that leads to blockages in the heart creates blockages in other parts of the body, it was a natural extension of his training. “Up until that point the interventional group would concentrate on the heart,” he said. “With Remetz, I learned to do procedures outside the heart and developed the vascular medicine program.”
Though not his original intention, vascular medicine has become the focus of his work. “I never thought I would be doing angioplasties in the legs, in the arm, in the neck,” he explained. “When I was an interventional fellow, I was able to learn the skill set, and it has become my career. It literally fell in my lap.” As medical director of the vascular program at Yale, Mena-Hurtado trains physicians to become leaders in this emerging field.
Another innovative outgrowth of Mena-Hurtado’s work is the Critical Limb Ischemia Clinic, a multidisciplinary clinic run in collaboration with Yale’s podiatry team. Critical limb ischemia is a restriction of blood supply to lower limbs, a condition associated with high mortality. “There we see patients referred from all over state and beyond with either non-healing ulcers or to offer a second opinion before limb amputation,” he explained. The clinic has developed into a flagship program. “It has changed people’s lives, and that is what medicine is all about.”
Advancing vascular medicine
As a leader in the interventional team, Mena-Hurtado has had a hand in several significant clinical trials that are reshaping vascular medicine. One recent trial tested what would become the first drug-coated angioplasty balloon approved for use in the United States. Explaining the device’s purpose, he said, “During angioplasty, we open up the balloon and the medication is spread in the wall of the artery and prevents re-narrowing of those segments.” The device, Lutonix® 035 drug-coated balloon (DCB), was approved in 2015.
Additional trials involve the same technology to treat new artery-clogging lesions, as well as previously treated lesions, in different parts of the body. Mena-Hurtado is principal investigator for two clinical trials testing other Lutonix devices that will expand treatment options and reduce recurrence of peripheral vascular disease. He’s involved in a National Institutes of Health (NIH)-sponsored trial, BEST-CLI, which is probing the optimal way to treat critical limb ischemia.
The interventional team is also researching techniques to treat carotid artery disease and hypertension. The NIH-sponsored CREST-2 clinical trial will determine whether surgery or stenting is better for preventing strokes in patients with blockages in their carotid arteries, major blood vessel in the neck. Another focus of the vascular program is a procedure known as renal denervation therapy, which uses a catheter with an electrode tip to disrupt nerves in the kidneys, a process that lowers blood pressure. “If it works,” says Mena-Hurtado, “we can treat hypertension better. We can stop certain medications for patients.”
To bring the most cutting-edge interventional technologies to trial, Mena-Hurtado often travels outside of the United States, including to his native Colombia. Through the Yale Cardiovascular section’s First In-Man research program, he said, “we go to different countries and conduct trials that allow us to have access to technology and understand the role of many devices before they are introduced in the United States.”
For his work, Mena-Hurtado was recently recognized by his alma mater, the University of Antioquia, with the highest honor bestowed to alumni. A statement about the award says it acknowledges alumni for original contributions to science and states that recipients have “the responsibility and duty to represent the University around the globe delivering the highest amount of scientific knowledge possible.”
Asked about his goals and legacy, Mena-Hurtado said, “I think that the ultimate goal is to change the way vascular medicine is delivered in New England and in the country. We’re doing that by collaborating with other specialties to develop programs to deliver the care that patients need.”