It took just hundred years for cardiac surgery to advance to what it is today.Before 1896, surgeons considered heart to be "inviolable" and it was stated that operating directly on the pulsating heart can be done but the patient will not survive,In 1896, Ludwig Rehn, a German Surgeon, sutured a wound in the heart caused by stab injury. Discovery of X-ray in 1895 and electrocardiographic recording in 1924, paved the way for the better understanding of diseases of the heart. In 1929, Warner Frossman from Germany did the first right heart catheterization on himself.
Rehn and Sauerbrock from Germany did the first partial pericardiectomy for constrictive pericarditis (1913). Mitral stenosis was one of the earliest intra cardiac lesions to be treated surgically. Cutler and Levine (1923) using a special knife attached to the finger and Souttar using digital dilatation were the earliest surgeons to treat rnitral stenosis. However, effective closed mitral valvotomy procedures were established by Harken and Bailey in the US and Brock in UK.The dawn of Paediatric cardiac surgery was on August 26, 1938 when Robert Gross, at the soston Children's Hospital, ligated ductus arteriosus in a seven years old girl.
Crafoord and Nylin in Sweden (1944) and Gross in USA (1945) repaired coarctation of aorta.Alfred Blalock, cardiac surgeon at Johns Hopkins University, on the suggestion of Helen Taussig, a cardiologist, did the first palliative shunt between subclavian,artery and pulmonary artery for cyanotic heart disease. This is known as BT shunt (Blalock-Taussig). This was a direct anastomosis of the end of subclaviannartery to the side of pulmonary artery. Mark de Leva1 (1981) used a PTFE (Poly Tetra Fluoro Ethylene) graft between subclavian artery and Pulmonary artery(Modified BT Shunt).
John Lewis (1953) from University of Minnesota, USA, closed atrial septal defect by surface hypothermia and inflow occlusion method. However, the first open heart surgery using heart lung machine was done on May 6, 1953, by John Gibbon. He successfully closed atrial septal defect in a young giil. Next four patients operated by Gibbon died "and he stopped doing cardiac surgkjr altogether. John Gibbon is considered to be the father of cardio pulmonary bypass.
Dr. Walton Lillehei (1954) used low flow controlled cross circulation to close a ventricular septal defec't in a chjld. He connected mother's circulation to the child's and stopped its heart coillpletely to close a VSD. Using the same technique, Lillehei did the first total correction of tetrology of Fallot and the first repair of atrio ventricular septal defect. No doubt that the position of father of open-heart surgery should be resei-ved for Dr. Lillihei. Operations using controlled cross circulation have the possibility of 200 per cent nlortality for a single operation.
Al the same hme, John Kirklin at Mayo Clinic started successfully pelforming open-heart surgery using modified pump oxygenator. of Gibbon. Two surgeons,Lillehei and Kirklin, working 60 miles apart are credited with all the developments of early open-he& surgery practice and the training of many young cardiac surgeons. They are the heroes, deserving to be remembered by generations to come as pioneers in modern day cardiac surgery. It is a cruel trick of fate that there is no "Lillehei Operation" or "Kirklin Procedure" in
Cardiac Surgery.
The next developmeilt was the introductioil of prosthetic valves. Albert Starr (1961) with the collaboration of Edwards laboratories introduced the first prosthetic valve. (Star-Edward Valve). It was a ball and cage valve. Later on, tilting disc (Medtronic Hall) and bileaflel valves (St. Jude) with better haemodynarnics were introduced. All the mechanical valves needed life long anti coagulation. Different bio prosthetic valves and later on homografts became available. Ross (1979) used pulmonary autograft for replacing aortic valve and a homograft in pulmonary position (Ross Operation). Michael De-Bakey and Denton Cooley working independently at Houston, Texas contributed a lot towards surgery of aortic aneurysm.
Walton Lillehei trained two youilg surgeons - Christian Barnard from South Africa and Norman Shumway from Stanford University. While Shumway was trying to solve the problem of rejection of transplanted heart, Christian Barnard did successful heart transplantation in I967 at Cape Town and became world famous: However the operation soon fell into disrepute as early rejection could not be detected and immuno suppressive drugs were not available. After the introduction of trans venous endocardia1 biopsy and Cyclosporine A in 1980s, transplantation gained general acceptability, due to the efforts 01 Noiman Shumway at Stanford University.
Vineberg (1946) implanted a mammary artery pedicle (with its end and branches bleeding) into ischaemic left ventricular myocardium. It worked by establishing connection with myocardial sinusoids and later on with coronary arteries as proved by angiogram.
Mason Sones (1959) introduced selective coronary arleri'ography at the Cleveland clinic. This was the first step for direct coronary artery surgery. In May 1967,Favoloro and Effler at the Cleveland clinic did the first reversed saphenous vein bypass graft for blocked right coronary artery. Garret and De-Bakey at Houston pel-formed this operation at about the same time. Green (1968) from New York is credited with the first internal mammary artery graft. Carpentier tried radial artery as a conduit for coronary artery bypass in 1970s but had poor results because of spasm of radial artely. In 1990s, C. Acar reintroduced radial artery grafting after using diltiazem to overcome arterial spasm.
Kantrowitz (1968) used intra aortic balloon counter pulsation (IABP) for temporary circulatory support. Cooley and associates (1969) used temporary left ventricular assist devices (LVAD) for the same purpose and as a bridge to cardiac transplantation. Right ventricular (RVAD) and bi-ventricular assist devices are also available.
Total artificial heart (TAH) using JARVIK 7 (1982) where patient is connected to an external artificial power source, has now been successful up to 607 days. The patient has only limited mobility and chances of infection are high. A completely implantable total artificial heart is the ultimate goal.Sir Isaac Newton said "If I can see further, it is by standing on the shoulders of giants". This is true for the success of a cardiac surgeon today.
Rehn and Sauerbrock from Germany did the first partial pericardiectomy for constrictive pericarditis (1913). Mitral stenosis was one of the earliest intra cardiac lesions to be treated surgically. Cutler and Levine (1923) using a special knife attached to the finger and Souttar using digital dilatation were the earliest surgeons to treat rnitral stenosis. However, effective closed mitral valvotomy procedures were established by Harken and Bailey in the US and Brock in UK.The dawn of Paediatric cardiac surgery was on August 26, 1938 when Robert Gross, at the soston Children's Hospital, ligated ductus arteriosus in a seven years old girl.
Crafoord and Nylin in Sweden (1944) and Gross in USA (1945) repaired coarctation of aorta.Alfred Blalock, cardiac surgeon at Johns Hopkins University, on the suggestion of Helen Taussig, a cardiologist, did the first palliative shunt between subclavian,artery and pulmonary artery for cyanotic heart disease. This is known as BT shunt (Blalock-Taussig). This was a direct anastomosis of the end of subclaviannartery to the side of pulmonary artery. Mark de Leva1 (1981) used a PTFE (Poly Tetra Fluoro Ethylene) graft between subclavian artery and Pulmonary artery(Modified BT Shunt).
John Lewis (1953) from University of Minnesota, USA, closed atrial septal defect by surface hypothermia and inflow occlusion method. However, the first open heart surgery using heart lung machine was done on May 6, 1953, by John Gibbon. He successfully closed atrial septal defect in a young giil. Next four patients operated by Gibbon died "and he stopped doing cardiac surgkjr altogether. John Gibbon is considered to be the father of cardio pulmonary bypass.
Dr. Walton Lillehei (1954) used low flow controlled cross circulation to close a ventricular septal defec't in a chjld. He connected mother's circulation to the child's and stopped its heart coillpletely to close a VSD. Using the same technique, Lillehei did the first total correction of tetrology of Fallot and the first repair of atrio ventricular septal defect. No doubt that the position of father of open-heart surgery should be resei-ved for Dr. Lillihei. Operations using controlled cross circulation have the possibility of 200 per cent nlortality for a single operation.
Al the same hme, John Kirklin at Mayo Clinic started successfully pelforming open-heart surgery using modified pump oxygenator. of Gibbon. Two surgeons,Lillehei and Kirklin, working 60 miles apart are credited with all the developments of early open-he& surgery practice and the training of many young cardiac surgeons. They are the heroes, deserving to be remembered by generations to come as pioneers in modern day cardiac surgery. It is a cruel trick of fate that there is no "Lillehei Operation" or "Kirklin Procedure" in
Cardiac Surgery.
The next developmeilt was the introductioil of prosthetic valves. Albert Starr (1961) with the collaboration of Edwards laboratories introduced the first prosthetic valve. (Star-Edward Valve). It was a ball and cage valve. Later on, tilting disc (Medtronic Hall) and bileaflel valves (St. Jude) with better haemodynarnics were introduced. All the mechanical valves needed life long anti coagulation. Different bio prosthetic valves and later on homografts became available. Ross (1979) used pulmonary autograft for replacing aortic valve and a homograft in pulmonary position (Ross Operation). Michael De-Bakey and Denton Cooley working independently at Houston, Texas contributed a lot towards surgery of aortic aneurysm.
Walton Lillehei trained two youilg surgeons - Christian Barnard from South Africa and Norman Shumway from Stanford University. While Shumway was trying to solve the problem of rejection of transplanted heart, Christian Barnard did successful heart transplantation in I967 at Cape Town and became world famous: However the operation soon fell into disrepute as early rejection could not be detected and immuno suppressive drugs were not available. After the introduction of trans venous endocardia1 biopsy and Cyclosporine A in 1980s, transplantation gained general acceptability, due to the efforts 01 Noiman Shumway at Stanford University.
Vineberg (1946) implanted a mammary artery pedicle (with its end and branches bleeding) into ischaemic left ventricular myocardium. It worked by establishing connection with myocardial sinusoids and later on with coronary arteries as proved by angiogram.
Mason Sones (1959) introduced selective coronary arleri'ography at the Cleveland clinic. This was the first step for direct coronary artery surgery. In May 1967,Favoloro and Effler at the Cleveland clinic did the first reversed saphenous vein bypass graft for blocked right coronary artery. Garret and De-Bakey at Houston pel-formed this operation at about the same time. Green (1968) from New York is credited with the first internal mammary artery graft. Carpentier tried radial artery as a conduit for coronary artery bypass in 1970s but had poor results because of spasm of radial artely. In 1990s, C. Acar reintroduced radial artery grafting after using diltiazem to overcome arterial spasm.
Kantrowitz (1968) used intra aortic balloon counter pulsation (IABP) for temporary circulatory support. Cooley and associates (1969) used temporary left ventricular assist devices (LVAD) for the same purpose and as a bridge to cardiac transplantation. Right ventricular (RVAD) and bi-ventricular assist devices are also available.
Total artificial heart (TAH) using JARVIK 7 (1982) where patient is connected to an external artificial power source, has now been successful up to 607 days. The patient has only limited mobility and chances of infection are high. A completely implantable total artificial heart is the ultimate goal.Sir Isaac Newton said "If I can see further, it is by standing on the shoulders of giants". This is true for the success of a cardiac surgeon today.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.