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The evolution of Heart surgery

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josh doughty

on 5 March 2012

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Transcript of The evolution of Heart surgery

The Evolution of Heart Surgery
The evolution of heart sugery was slowed for centuries by a lack of knowledge and technology. Significantly, the general anesthetics such as, ether and chloroform, were not developed until the middle of the 19th century. These agents made major surgical operations possible, which created an interest in repairing wounds to the heart.
The first operation was preformed by Henry C. Dalton who was superintendent of the St. Louis City Hospital from 1886 to 1892, and later a professor of abdominal and clinical surgery at Marion Sims College of Medicine.
The operation occurred on September 6, 1891 at the City Hospital, on a twenty-two-year-old man who had been stabbed in the chest. Upon arrival of the patient, Dalton cleaned the wound and applied a dressing of antiseptic gauze. After several hours, the patient's condition worsened: the left side of his chest became dull to percussion; his temperature and pulse rate rose; his breathing became shallow; and he complained of considerable pain. He was taken to the surgical amphitheatre, where Dalton made an incision over the fourth rib and removed about six inches of it. After tying the severed intercostal artery to control bleeding and removing the blood from the pleural cavity, Dalton observed a transverse wound of the pericardium about two inches in length. With a sharply curved needle and catgut, he closed the wound by continuous suture, overcoming great difficulty caused by the heart pulsations. The pleural cavity was then irrigated and the chest incision closed without drainage. The patient made "an uninterrupted, rapid recovery." The published report of the operation appeared in the state medical association's journal and another local periodical in 1894, and in the Annals of Surgery the following year.
It's impossible to be sure who performed the first operation but as far as recorded history goes it was...
A favorite of the Emperor, who commented, 'If the army ever erects a monument to express its gratitude, it should do so in honor of Larrey', he was ennobled as a Baron on the field of Wagram in 1811 after preforming what is still thought to be the first operation on the pericardium to repair a tear in the pericardium caused by a stab wound to the chest.
Dominique Jean Larrey (8 July 1766 – 25 July 1842) was a French surgeon in Napoleon's army and an important innovator in battlefield medicine.
Baron Dominique Jean Larrey
Axel Cappelen
The axilla (or armpit, underarm) is the area on the human body directly under the joint where the arm connects to the shoulder.
Before we get started lets take a look at the inivators in surgery that took us to the first sucessful heart suregery
Daniel Hale Williams (January 18, 1856 – August 4, 1931) was an American surgeon. He was the first African-American cardiologist, and is attributed with performing the first successful surgery on the heart. He also founded Provident Hospital, the first non-segregated hospital in the United States.
In 1893 he repaired the torn pericardium of a knife wound patient, James Cornish, the second on record. He performed this surgery at Provident Hospital, Chicago, on 10 July 1893 About fifty-five days later, James Cornish had successfully recovered from the surgery.
He ligated a bleeding coronary artery in a 24 year old man who had been stabbed in the left axillae and was in deep shock upon arrival. Access was through a left thoracotomy. The patient awoke and seemed fine for 24hrs, but became ill with increasing temperature and he ultimately died from what the post mortem proved to be mediastinitis (inflamtion of the chest tissue) on the 3rd postoperative day
Dr. Ludwig Rehn
Modern Medical Developments and apparatus
Since the first succesful heart surgery in 1896 we have made many medical advances. These medical developments have aloud heart sugery to move from this era of primative sergury to our modern day procedures.
One of the more common types of heart surgerys today would be a Conroary bypass surgery. Over 500,000 of these are preforemed each year in the US. This surgery is used when a coronary artery has become blocked with plaque, The sergon takes a vein form the paitients arm or leg and creates a "bypass" by grafting the vein to the blocked atery allowing oxygen-rich to once agian reach the heart muscle.
The evolution of heart surgery continues to make unpresidented advancements. Research is currently exploring and the use of robotics in open heart surgery. An annuloplasty is starting to replace the more invasive open heart surgerys is some cases.
The first successful surgery of the heart, performed without any complications, was by Dr. Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on September 7, 1896
In the 1953 the first sucessful use of life support machines or the heart-lung machine, aloud surgons to continue their persuits in the feild of heart surgery. The world's first human heart transplant was performed by Christiaan Barnard on December 3, 1967 in Cape Town South Africa.
Christiaan Barnard
Approximetly 3,500 heart transplants are preformed worldwide each year. Of these transplants 72% are male and 28% female. Out of these transplants approxinetally 73% remain successful after 5 years, for females the average is slightly lower at 67%.
How was anesthesia discovered? Anesthesia for surgery was introduced in America only in the 1840s. Before this time, surgical patients were simply expected to withstand the pain of the procedure. Alternatively, they were intoxicated with alcohol or opiates. Humphry Davy (1778-1829), a famous English chemist, discovered through self-experimentation that nitrous oxide relieved headache and dental pain, but his report went unnoticed in the medical community; it did, however, led to the use of "laughing gas", and later ether, for entertainment at parties!
The first demonstration of surgical anesthesia was by Horace Wells (1815-1848), an American dentist who had observed the effects of nitrous oxide at a traveling medicine show. Wells had some of his own teeth extracted painlessly under nitrous oxide, but during his first pubic demonstration, in Boston in 1845. Despite the fact that the patient reported no awareness or memory of pain, the demonstration was judged a failure, and Wells mocked, because the patient screamed and struggled throughout the procedure. However, Wells's failure was observed by another dentist, William Morton, who began experimenting with ether. In 1846, Morton demonstrated the surgical removal of a tumor in a patient who showed no signs or reports of pain. By 1847, ether and chloroform were firmly established as general anesthetics on both sides of the Atlantic. Except for childbirth: physicians worried about the effects of chemicals would have on the fetus, and also worried that the absence of pain would impair the bonds between mother and child.
Later, it was discovered that morphine lessened the amount of chloroform needed to produce complete anesthesia. In the early 20th century ether and chloroform werereplaced by halogenated hydrocarbons such as halothane (sometimes, a mixture of nitrous oxide and oxygen, or intravenous narcotics such as fentanyl, are used instead of a volatile agent). In 1942, Griffith and Johnson administered curare to reduce reflexive responses to surgical incisions (and artificial respiration to maintain breathing). This yielded the "balanced anesthesia" procedure still in use today: a "cocktail" of drugs to induce loss of consciousness, eliminate pain, and calm the operative area.
BUT even before we get to them it makes sense in a way to say the that the evolution of heart surgery was really started by peoples instincts to aim for the heart in battle seeing as all of the first operations we to repair stab wounds to the preicardium or heart.
Introduction and History
Coronary heart disease (CHD) - most common type of heart disease caused by artery narrowing and reduced blood suppy to the heart.
Heart attack
High blood pressure
Ischemic heart disease
Heart rhythm disorders
Tachycardia
Heart murmurs
Rheumatic heart disease
Pulmonary heart disease
Hypertensive heart disease
Aortic Stenosis
Atrial Septal Defect
Atrioventricular Canal Defect
Bicuspid Aortic Valve
Coarctation of the Aorta
Complete Congenital Heart Block
Congenitally Corrected Transposition of the Great Arteries or Great Vessels
Coronary Artery Anomaly
DCRV: Double Chamber Right Ventricle
Dextrocardia
DiGeorge syndrome
Double Aortic Arch
Double Outlet Right Ventricle
Ebstein's Anomaly
Eisenmenger's syndrome
Endocardial Fibroelastosis
Holt-Oram syndrome
Hypertrophic Cardiomyopathy
Hypoplastic Left Heart syndrome
Hypoplastic Right Heart syndrome
Interupted Aortic Arch
Isolated Non-Compaction of Left Ventricular Myocardium
Kawasaki Disease
Left Ventricular Outflow Tract Obstruction
Long QT syndrome
Major Aorta/Pulmonary Collateral Arteries
Marfan syndrome
Mitral Valve Prolapse
Noonan syndrome
Partially Anomalous Pulmonary Venous Return
Patent Ductus Arterious
Pulmonary Atresia
Pulmonary Stenosis
Right Ventricular Outflow Tract Obstruction
Single Ventricle
Tetralogy of Fallot
Total Anomalous Pulmonary Venous Drainage or Total Anomalous Pulmonary Venous Return
Transposition of the Great Arteries or Vessels
Tricuspid Atresia
Truncus Arteriosis
Ventricular Septal Defect
Williams syndrome
Other syndromes that involve the Heart
types of heart diseases and defects
Heart-Lung Machine

During your surgery, the heart-lung machine provides circulatory support to the major organs. After the blockages are bypassed, or the valve is replaced or repaired, you will be taken off the heart-lung machine.
Many people will be involved in a “team” approach to your care. These caregivers may include:

Your surgeon
The anesthesiologist who will administer the anesthetic during your surgery
A physician’s assistant, a specially trained professional able to help the physician in many tasks
Your primary care physician
Consult physicians, if your medical condition so requires
Nurses
Lab and X-ray personnel
A respiratory therapist, trained in assisting the breathing functions
An exercise physiologist who will work with you on rehabilitation after your surgery
A social worker who will help you with planning needs after you go home
A dietitian
A cardiac surgical coordinator who will oversee your care before, during and after your stay
Many others who are here to make sure you receive the best possible care
An American surgeon named John H. Gibbon Jr. (1903-1974), began pursuing the goal of total artificial circulation in 1931 after a young female patient died of blocked lung circulation. Gibbon realized that it was necessary to keep oxygenated blood circulating without use of the heart, especially to the brain, to carry out careful operations on the heart under direct vision. His pursuit was to last for almost three decades.

After years of intensive experiment, John Gibbon, his wife, Mary, and others were able to construct a heart-lung machine to allow such artificial circulation. On May 6, 1953, surgery using the heart-lung machine was successfully performed on the first human, 18-year-old girl Cecilia Bavolek, to close a hole between her upper heart chambers.
john H. Gibbon Jr.
Conclusion
So in the past 200 years since the first pericardium operation was attempted we have come a very long way in heart surgery. Not only are we able to prevent, cure or just treat nearly all our know heart problems today but we've refined the technique so much we are proloning the lives of very many people by 10 to even 20 years longer. Not to mention our operations and procedures are even very cost effective so much so that in some cases hospitals are sending patients the wrong message with there accuracy and speed because paitents submited with heart attackes or CHD are in and out of the hospital with minimal invasive surgery in less then a week giving the patients the image that they don't have that big of a problem and they ignore trying to maintian a healthy lifestyle and it ends them back in the hospital. However heart surgery is only going good places allowing people to live longer.
The stethoscope was invented in France in 1816 by René Laennec at the Necker-Enfants Malades Hospital in Paris. It consisted of a wooden tube and was monaural. His device was similar to the common ear trumpet, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a "microphone"
Robotic surgery, computer-assisted surgery, and robot-assisted surgery are terms for various technological developments that currently are developed to support a range of surgical procedures.

Robot-assisted surgery was developed to overcome limitations of minimally invasive surgery, Instead of directly moving the instruments the surgeon uses a computer console to manipulate the instruments attached to multiple robot arms. The computer translates the surgeon’s movements, which are then carried out on the patient by the robot
Hearts transplants, or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. The most common procedure is to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure) Post-operation survival periods now average 15 years
An artificial heart is a mechanical device that replaces the heart. Artificial hearts are typically used in order to bridge the time to heart transplantation, or to permanently replace the heart in case transplantation is impossible.
Artificial hearts date back to the mid-1950s when Dr. Paul Winchell first patented an artificial heart.

The Jarvik 7
In 1982, Seattle dentist Dr. Barney Clark was the first person implanted with the Jarvik-7, an artificial heart intended to last a lifetime. William DeVries an American surgeon performed the surgery. The Jarvik-7 artificial heart was designed by Robert Jarvik. The patient survived 112 days post op.

Creator of the Jarvik-7, Dr. Robert Jarvik is apparently now working on the Jarvik 2000, a thumb-sized heart pump. "This came from the understanding that people want a normal life and just being alive is not good enough." - Dr. Robert Jarvik
http://inventors.about.com/library/inventors/blartificialheart.htm
http://www.absolutemed.com/
Special thanks to Diane Campbell, BScN, CCN, heart function program nurse soldiers' memorial for letting me interview her.
axel cappelen preformed the first open heart surgery despite his patient didn't make it.
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