In Memoriam: María Victoria de la Cruz, Cardiac Embryologist

Pienso que el ser humano es el producto de la interacción entre él y el contexto socioeconómico y histórico en que vive.

—María Victoria de la Cruz

The international scientific community mourns the loss of María Victoria de la Cruz, MD, one of the world's foremost cardiac embryologists, who succumbed to recurrent kidney cancer on 30 November 1999. A few days before her death, Dr. de la Cruz had returned from an international meeting of pediatric cardiologists in the Caribbean. She was probably in her ninth decade but had long ago stopped counting her years.

María Victoria de la Cruz was born in Sancti-Spíritus, Cuba. Her father was a distinguished and enlightened lawyer, who early instilled in her not only a love for culture and truth but also an unwavering integrity. She received her medical degree from the University of Havana in 1943. Because of her instinctive interest in the essence and origin of things, she was drawn to the basic sciences. In 1945, she met Dr. Demetrio Sodi Pallares, founder of the Mexican School of Electrocardiography, who urged her to transfer to the National Institute of Cardiology in Mexico City. The first center in the world to be exclusively devoted to cardiology, that institution had been founded by Dr. Ignacio Chavez in 1944. Under Dr. Chavez's guidance, Dr. de la Cruz became interested in the emerging field of cardiac embryology. In 1947–48, she studied biology at the National Polytechnic Institute in Mexico City. In 1949–50, with a grant from the Rockefeller Foundation, she visited the University of Michigan in Ann Arbor, Columbia University in New York City, and the Carnegie Institute and Johns Hopkins University in Baltimore. At these institutions, she met with cardiac anatomists and embryologists and studied renowned collections of human embryos and malformed hearts. Cardiac embryology became the focus of her life as an investigator, teacher, and practitioner.

In 1951, in fulfillment of a promise to Dr. Chavez, Dr. de la Cruz returned to Mexico's National Institute of Cardiology. There she founded one of the world's first (and most prolific, in terms of publication) cardiac embryology departments. Throughout her long career, she worked closely with Dr. Espino Vela, the Institute's chief of pediatric cardiology, and trained a large number of cardiologists, anatomists, and biologists. She remained at the Institute until 1976, when she transferred to Central University in Caracas. Three years later, she relocated to the Ramón y Cajal Hospital in Madrid. In 1983, she returned to Mexico City, where she founded two additional cardiac embryology laboratories, including one at the Hospital Infantil de México, where she continued to work for the rest of her life.

Dr. de la Cruz's many fundamental contributions to our knowledge of congenital heart diseases and cardiac embryology include various publications that are now regarded as classics. In 1956, she and P. da Rocha proposed the revolutionary concept of applying the principles of descriptive embryology to the interpretation of complex congenital heart defects, which these researchers proposed to consider the result of irreversible developmental errors. ¹

From 1953 through 1985, Dr. de la Cruz's group wrote a lengthy series of articles concerning the anatomy of almost all the congenital heart defects. In these articles, as in her daily classroom work, she consistently emphasized the primacy of an orderly, structured, anatomic description that could be appropriately integrated with embryologic concepts and also applied in a practical manner to physiologic and surgical objectives.

Dr. de la Cruz's findings in descriptive embryology (especially of the living leghorn chick embryo) were summarized in two books: Development of the Chick Heart, ² and Living Morphogenesis of the Heart. ³ In these monumental syntheses and in numerous journal articles, she made fundamental contributions to the understanding of the normal morphogenesis of the heart. She saw the heart as being composed of individual, integrated segments, each entailing a specific developmental destiny, as evidenced by her area-labeling experiments in living chick embryos subjected to direct microscopic monitoring.

Beginning in 1963, Dr. de la Cruz pioneered experimental studies concerning the pathogenic influence of physical, chemical, and biologic insults on the embryonic heart. She was interested not only in the teratogenic effects of common environmental elements (hyperthermia, mechanical forces, viruses, chemicals) and of genetic manipulations, but also in the abnormal embryogenetic sequences that lead to well-known clinical heart defects.

Dr. de la Cruz came finally to agree that the future of developmental studies lay well beyond morphologic techniques, within the realm of molecular biology. During the final years of her life, as she planned the future of her beloved department of developmental biology and experimental embryology, she tried to surround herself with team members who could carry on her legacy in the new fields of genetics and molecular biology.

Without question, Dr. de la Cruz's involvement in my pursuit of new and fundamental directions in the study of coronary arteries has been one of the greatest privileges of my professional life as a practicing cardiologist. Last year, our long association was crowned by her basic-science contributions to a book on coronary artery anomalies that I edited. ⁴

Like others who knew and admired Dr. de la Cruz, I can testify to her intensely focused personality and disciplined intellect. Throughout her career, she had a great respect for scientific method and structure and a remarkable ability to formulate comprehensive, unifying hypotheses. She will be remembered not only for these qualities but also for her wit, humor, generosity, diplomatic skill, and tenacious faith in humankind.