The History of Pediatric Cardiology and Cardiovascular Surgery

The History of Pediatric Cardiology and Cardiovascular Surgery Pediatric cardiology and pediatric cardiac surgery have developed interdependently

CHD: Primordial heart? FISH AMPHIBIA REPTILES BIRDS MAMMALS 1 A+1 V 2 A+1 V Snakes rudiment. VS 2 A+2 V Turtles spongy VS 2 A+2 V Alligators VSD 2 A+2 V

Scientific medicine begins

Marcello Malpighi— 1661

Anton van Leeuwenhoek— 1674

Antoine Lavoisier— 1777

Early scientific foundations 1785 William Withering introduces Foxglove 1790 Luigi Galvani--electrical stimulation of frog muscle 1808 Humphrey Davy identifies Na, K, Mg, Ca, Sr, & Ba 1830 s Claude Bernard--wide-ranging experiments 1830 s Michael Faraday--electricity: anode, cathode, electrolyte, anion and cation. 1880 s 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, 1896 The 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

“As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations…” Humphrey Davy--1800

Crawford W. Long--1842 Horace Wells--1844 William T. G. Morton--1846 Charles Jackson--1846

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

John Hunter— 1667 James Curry— 1815 John Snow— 1858 J O’Dwyer— 1885 (peroral) Rudolph Matas— 1902

Vascular surgery

Cardiac Catheterization

Heart-lung bypass Von Frey and Gruber--1885

Early Open Heart Surgery With Heart-lung Machine C. Dennis J. Gibbon J. Helmsworth D. Dodrill G. Clowes W. Mustard 1952 1953 53/54 2/2 5/6 1/1 2/2 5/5 17/18 Died Died 94. 5%

Controlled Cross-circulation 3/26/54 -7/19/55 VSD TOF CAVC IPS NO. 28 11 4 2 45 MORT. 8(28%) 4(36%) 3(75%) 0 15(33%) <2 Y 16 5 3 MORT. 6(37%) 3(60%) 2(67%) 24 11(49%)

The price of innovation The more radical (important) the innovation, the greater the ridicule and vilification by colleagues William Harvey Ludwig Rehn Humphrey Davy Horace Wells Rudolph Matas Werner Forssmann John Gibbon

“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. ”

PED CARD HX: NADAS

Extracardiac Repair and Palliation PDA COARCT. S-P SHUNT P-A BAND R. GROSS 08/26/38 C. CRAFOORD 10/01/44 BLALOCK-TAUSSIG 11/29/44 DAMMON-MULLER 1952

Pediatric Cardiac Surgery 1953 -1969 * Early Palliation * Elective Repair at ± 5 to 6 Years 1970 -1982 1983 * Primary Repair in Infancy * Primary Repair in Neonates

Surgical Mortality According To Age And Years

Pediatric Cardiology: Summary 1938 -Essentially no Rx for CHD Pioneers-pathologists, cardiologists, surgeons, imaging experts, intensivists, interventionalists 2002 -Rx for virtually all CHD, BUT mort. /morb. : ventricular function arrhythmia cns valves/conduits pulm hypertension New frontiers-causation, gene-based Rx, CHF Rx, Arrhythmia Rx, imaging, safety of CPB, PVR An incredibly exciting run--much for the future