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The History of Pediatric Cardiology and Cardiovascular Surgery
Pediatric cardiology and pediatric cardiac surgery
have developedinterdependently
CHD: Primordial heart?CHD: Primordial heart?
FISH 1A+1V
AMPHIBIA 2A+1V Snakes rudiment. VS
REPTILES 2A+2V Turtles spongy VS
BIRDS 2A+2V Alligators VSD
MAMMALS 2A+2V
Early scientific foundations1785 William Withering introduces Foxglove
1790 Luigi Galvani--electrical stimulation of frog muscle
1808 Humphrey Davy identifies Na, K, Mg, Ca, Sr, & Ba
1830s Claude Bernard--wide-ranging experiments
1830s Michael Faraday--electricity: anode, cathode, electrolyte, anion and cation.
1880s Joseph Lister--antiseptic surgery (phenol)
1883 Ringer shows that K inhibits, Ca stimulates heart
1887 Augustus Waller--Hg cardiogram 1903 Willem Einthoven invents the string galvanometer EKG
1895 Wilhelm Conrad Roentgen--X-Rays
1896 Scipinio Riva-Rocci--Hg sphygmomanometer
1900 Karl Landsteiner--biocompatibility, ABO system
The danger of touching the heart
"Surgery of the heart has probably reached the limits set by Nature to all surgery. No method, no new discovery, can overcome the natural difficulties that attend a wound of the heart."
Stephen Paget, 1896The Surgery of the Chest
Anesthesia for Thoracic Surgery
21 And the LORD God caused a deep sleep to fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead thereof.
22 And the rib, which the LORD God had taken from man, made he a woman, and brought her unto the man. -- Genesis 2
Humphrey Davy--1800
“As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations…”
Control of the airway
But that life may in a manner of speaking be restored to the animal, an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again and the animal take in air. Andreas Vesalius, 1543
Early Open Heart Surgery With Early Open Heart Surgery With Heart-lung MachineHeart-lung Machine
C.Dennis 1952 2/2 Died
J.Gibbon 1953 5/6 Died
J.Helmsworth 1953 1/1 Died
D.Dodrill 1953 2/2 Died
G.Clowes 1953 2/2 Died
W.Mustard 53/54 5/5 Died
17/18 94.5%
Controlled Cross-circulationControlled Cross-circulation3/26/54-7/19/553/26/54-7/19/55
NO. MORT. <2Y MORT.
VSD 28 8(28%) 16 6(37%)
TOF 11 4(36%) 5 3(60%)
CAVC 4 3(75%) 3 2(67%)
IPS 2 0
45 15(33%) 24 11(49%)
William Harvey
Ludwig Rehn
Humphrey Davy
Horace Wells
Rudolph Matas
Werner Forssmann
John Gibbon
The price of innovation
The more radical (important) the innovation, the greater the ridicule and vilification by colleagues
“I did not repeat the operation because I could not get another case. Although my patient made an uninterrupted recovery, the Physicians declared that it was all nonsense and in fact the operation was unjustified. In fact, it is on no use to be ahead of one’s time.”
Extracardiac Repair and Extracardiac Repair and PalliationPalliation
PDAPDA R.GROSS 08/26/38 R.GROSS 08/26/38
COARCT. C.CRAFOORD 10/01/44COARCT. C.CRAFOORD 10/01/44
S-P SHUNT BLALOCK-TAUSSIG 11/29/44S-P SHUNT BLALOCK-TAUSSIG 11/29/44
P-A BAND DAMMON-MULLER 1952P-A BAND DAMMON-MULLER 1952
Pediatric Cardiac SurgeryPediatric Cardiac Surgery
1953-1969
* Early Palliation
* Elective Repair at ± 5 to 6 Years
1970-1982
* Primary Repair in Infancy
1983 * Primary Repair in Neonates
Surgical Mortality According Surgical Mortality According To Age And YearsTo Age And Years
0%
5%
10%
15%
20%
25%
30%
35%
<1Y 1-5 Y 6-12Y >12Y
1954-641990-2000
Pediatric Cardiology: Summary1938-Essentially no Rx for CHD
Pioneers-pathologists, cardiologists, surgeons, imaging experts, intensivists, interventionalists
2002-Rx for virtually all CHD, BUT mort./morb.:ventricular functionarrhythmiacnsvalves/conduitspulm hypertension
New frontiers-causation, gene-based Rx, CHF Rx, Arrhythmia Rx, imaging, safety of CPB, PVRAn incredibly exciting run--much for the future