Heart History

The heart is historically a challenging surgical organ. A famous European surgeon of the 19th century Theodor Billroth exclaimed once that the man who would dare to operate on the human heart would lose respect from the medical society. Medical doctors of the past times hardly believed the heart could be operated on. However, the technical and scientific advantages of the second half of the 20th century allowed repairing of cardiac defects. The fascinating history of heart surgery will be reviewed here briefly followed by an example how the heart disease is improved today.


The First Heart Surgeries


Surgical interventions on the heart had been limited to wound closures with simple sutures during wartime events or other accidents in the ancient times. William Osler, a noted Canadian physician of the 19th century, believed there was “only limited clinical interest in congenital heart defects” because of poor prognosis and absence of treatment options for these conditions. Medical doctors of the past met numerous objective obstacles. The anatomy of the heart had not been detailed, heart embryology was far from deep understanding, and surgical instruments, as well as techniques, were applied to the abdominal organs and extremities mostly. Finally, the heart-lung bypass machine was introduced into engineering only after the World War II.


The first heart intervention belongs to the American surgeon Robert Gross. In 1937, he performed a patent ductus arteriosus ligation on an eight-year-old girl in Boston. The girl survived and lived beyond 75 years. Although this was not a cardiac but more a major vessel intervention, the surgery itself was a psychological breakthrough for the medical society to approach the heart. A cardiologist Helen Taussig inspired Alfred Blalock, a surgeon from Baltimore, to create a surgical patent arterial duct in a child who suffered from a cyanotic congenital heart defect. In 1943, he succeeded to do so with a procedure known today as the Blalock-Taussig shunt.


In 1953, John Gibbon conducted the first open-heart surgery, an intervention when the heart was opened and intracardiac sutures were placed, on a baby at Jefferson Medical School in Philadelphia. In this operation, a hole between the atria, a secundum type atrial septal defect, was closed by the heart-lung machine. The 18-year-old woman survived. However, since the cardiopulmonary bypass technique was still imperfect, his following surgeries carried lethal ends, the fact that disappointed Gibbon severely. Gibbon himself dedicated 23 years of his life to this project. He carefully attended the discovery of heparin and understood the importance of anticoagulation for the save conduction of artificial circulation. In these machines, the blood contacts with non-biological surface and easily clots. Therefore, heparin administration was important to preserve its liquid state. He started with experiments on dogs and received no funds from the National Institutes of Health. In the late 1940’s, he cooperated with the IBM Сorporation to manufacture the human version of the heart-lung machine. The first model required colossal amounts of blood for the initial filling and thus failed to work. The next model (the predecessor of the modern cardiopulmonary bypass) was more successful.


Gibbon deciphered everything in the modern open-heart surgery technology — how to anticoagulate, how the roller pump should rotate, how to drain the blood from the heart and pump it back, and how to clean the air from the blood during oxygenation. Dr. John Gibbon returned to general thoracic surgery after the series of cardiac surgeries, became the Chairman of Surgery at Jefferson and ironically died of a heart attack while playing tennis at the age of 69. After the personal disappointments associated with lethality, open-heart surgery was shifted towards a “cross-circulation technique” for some years. In this approach, the mother’s body was used as the oxygenator, which is a history today. In the 1950’s, John W. Kirklin, who used the pump-oxygenator and successfully performed a series of open-heart surgeries, re-evaluated and improved Gibbon’s ideas at the Mayo Clinic by. The cardiac surgery era started.


Cardiopulmonary Bypass Machine


The key idea of the cardiopulmonary bypass machine is to stop the heart while maintaining the cardiac output. The body gets the necessary amounts of blood and oxygen because the machine pumps them into the ascending aorta. At the same time, the heart stops after special solutions into the coronary arteries infused (called cardioplegia). It is safe to put a human under these condition for at least three hours, a time sufficient for most heart procedures. The blood is drained from the right heart chambers decompressing the organ. The venous blood is collected in the venous reservoir and rolled into the oxygenator. Here, the blood gains oxygen and cools to lower the body temperature. The line then injects the oxygenated blood into the aorta bypassing the heart.


Open-heart Procedure Today


Nowadays, open-heart surgery is safely performed on individuals in all age groups or heart pathologies throughout the world. For example, in 1994 over 2,000 open-heart surgeries were carried out daily. The heart-lung machine enables surgeons to implant artificial valves and to repair the natural. They can bypass the coronary atherosclerotic stenosis and prevent myocardial infarction. Heart transplantation is possible with the artificial circulation. Therefore, a vast majority of congenital heart defects can be safely repaired under this condition.


The secundum type atrial septal defect today is performed with the risk of lethality of less than 0.1 %. The operation is done through a minimally invasive access. For example, a limited skin incision just a few centimeters long is performed. The venous cannulas are inserted into the superior and inferior vena cavae to drain the blood from the heart, the aorta is cannulated to deliver the oxygenated blood into the ascending aorta. The aorta is clamped to prevent air embolism when the heart is opened. After the completion the intracardiac procedure the heart is closed, the aortic clamp and cannulas removed, and the incision is closed.


Atrial septal defect closure through a limited access. B. The secundum type atrial septal defect is shown through the opened right atrial wall.


Heart surgery has a magnificent and an interesting history. This is a new area of medical service that launched some 60 years ago. Today, it offers sophisticated and effective help to children and adults with heart disorders. The operations, once regarded as absurd are today scientifically grounded and carry low risks to the patients.


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