Transcript No Slide Title

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
1A+1V
2A+1V Snakes rudiment. VS
2A+2V Turtles spongy VS
2A+2V Alligators VSD
2A+2V
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
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, 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
1953
1953
1953
53/54
2/2
5/6
1/1
2/2
2/2
5/5
17/18
Died
Died
Died
Died
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%)
<2Y
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
* Primary Repair in Infancy
1983 * Primary Repair in Neonates
Surgical Mortality According
To Age And Years
35%
30%
25%
20%
1954-64
1990-2000
15%
10%
5%
0%
<1Y
1-5 Y
6-12Y
>12Y
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