FEA anesthesiology and reanimation. Virgin Health Hospital of Toledo.

Section cardiac surgery.

Although it may seem surprising, the heart has been one of the most
unknown bodies throughout the history of medicine. Until the eighteenth
century heart disease are unknown and not talk about them in medical
treatises. It was in the book "anatomica Exertitatio of cordis Mortus and in
animalibus sanguinis" by W. Harvey (1578-1657) where this body is
described more precisely, for the first time, and can be considered the
beginning of Modern Medicine (1) ( figure 1, figure 2, figure 3).

Figure 1: book cover Exercitatio Anatomical

Motu Cordis et Sanguinis in Animalibus G. Harvey

However, the development of cardiology was slow, and it was not until two
centuries later (XIX century) when a series of knowledge such as
auscultation (R. Laennec) are provided, the description of heart murmurs
(J. Skoda ), the application of X-rays (WCRoentgen) or discovery ECG (W.
Enthoven), when the knowledge base of cardiology feel. However, still it is
missing a few years for the occurrence of cardiac surgery, because for
centuries the heart was considered an untouchable organ. In fact, it is said
that the road between the skin and pericardium, just three centimeters, the
man has taken more than two thousand years to cross it.
 Figure 2: Schematic flow G.Harvey

The first heart surgery was performed in 1815 by the Spanish Francisco
Romero, who performed the first successful thoracotomy followed by
pericardiectomy. In April this year, Romero presents his "Hydrotoracyc
Observatory" memory to the Society of L'Ecole de Medicine de Paris
explaining their findings. They soon detractors of them appear due to
diagnostic difficulties and the danger that offered any manipulation in the
vicinity of the heart. Billroth, one of the famous surgeons of the time, even
said in 1833 that "the surgeon who tried to suture the heart lose the respect
of his colleagues." Despite the lack of support from the scientific
community of the time, heart surgery and continued to advance in 1896,
Dr. L. Rehn; a surgeon Frankfurt, performs the first direct suturing of the
heart, a man of 22 who had a wound in the right ventricle after being
stabbed. In America, Dr. L. Hill was the first to report the surgical repair of
a heart wound in a man of 13 years (2). 1923 E. Cutler made the first mitral
valvuloplasty in Boston. However, the results of this intervention were not
good, because his valvulotome left too regurgitation, and soon the
technique was abandoned.
 Figure 3: Scheme anatomical heart-
lung G. Harvey

The first successes of cardiac surgery occurred in the decade of the 40. At
this time, R. Grass successfully performed the closure of a patent ductus
arteriosus in a child. Shortly after other heart successfully as coarctation
(C.Crafoord 1944), tetralogy of Fallot (Blalock-Thomas -Taussig 1945)
Valvular Stenosis (D. Harken, Bailey, Potts) is addressed. (Figure 4).
 Figure 4: Blalock-Taussig-Thomas

Among these surgeons increases greatly Figure Dr. D. Harken, US Navy

surgeon who, during the Second World War, extracted projectiles 134 in
the mediastinum, pericardium 55 and 13 of the heart chambers, without
any patient should die ( 3). Based on the knowledge and experience gained
during this time, Harken held in June 1948 the first successful mitral
commissurotomy. Shortly thereafter, in 1948, Bailey described five patients
undergoing mitral stenosis with commissurotomy of which only one
survived. It is at this time where the first successes are achieved. However,
so far only they have been able to carry out interventions to correct external
injuries intervene heart or the heart with what is known as "closed
techniques." It was necessary to get devices that allow oxygenate and pump
blood out of the body, to stop the heart temporalmente.Hasta when all
interventions in this field had not been successful. But in 1937, Dr. J.
Gibbon, performed the first successful cardiopulmonary bypass in an
animal. A few years later, in 1953, it would be the first surgeon to perform
an operation to "open heart" successfully, to close a heart defect in a young
woman. From this moment other devices that replace heart function
appear, but they are still very rudimentary and their use is associated with
high morbidity and mortality (4). (Figure 5). So far all interventions in this
field had not been successful. But in 1937, Dr. J. Gibbon, performed the
first successful cardiopulmonary bypass in an animal. A few years later, in
1953, it would be the first surgeon to perform an operation to "open heart"
successfully, to close a heart defect in a young woman. From this moment
other devices that replace heart function appear, but they are still very
rudimentary and their use is associated with high morbidity and mortality
(4). (Figure 5). So far all interventions in this field had not been successful.
But in 1937, Dr. J. Gibbon, performed the first successful cardiopulmonary
bypass in an animal. A few years later, in 1953, it would be the first surgeon
to perform an operation to "open heart" successfully, to close a heart defect
in a young woman. From this moment other devices that replace heart
function appear, but they are still very rudimentary and their use is
associated with high morbidity and mortality (4). (Figure 5). From this
moment other devices that replace heart function appear, but they are still
very rudimentary and their use is associated with high morbidity and
mortality (4). (Figure 5). From this moment other devices that replace
heart function appear, but they are still very rudimentary and their use is
associated with high morbidity and mortality (4). (Figure 5).

Figure 5: heart lung machine J.Gibbon

Dr. W. Bigelow starts open surgery under General Hypothermia, allowing

the heart to stop for 8-12 mints. However, this short period of time was not
sufficient to correct complex defects. 1954 CW Lillehei performs technical
cross circulation, for which participation of a family or volunteer was
necessary, the heart and lungs were connected in parallel through femoral
arteries serving as support for the duration of the intervention (5) (Figure
6 ). This technique was used for a short time (1954-1955) but allowed to
operate 45 patients and is an important development of cardiac surgery
step. At the same time, at the Mayo Clinic, John W. Kirklin et al. launched
a new program cardiac open heart surgery using for this the heart-lung
machine invented by J. Gibbon, but with some modifications that allowed
for better results. Thanks to these improvements in heart -pulmón
machines are able to perform the first heart valve replacements. 10 March
1960, Dr. Harken performs the first aortic valve replacement with a
prosthesis ball type "ball cage", repeating the procedure on another patient
days later, both with good results. In fact, many of the techniques described
by D. Harken are similar to those used today. repeating the procedure on
another patient days later, both with good results. In fact, many of the
techniques described by D. Harken are similar to those used today.
repeating the procedure on another patient days later, both with good
results. In fact, many of the techniques described by D. Harken are similar
to those used today.

Figure 6: Schematic flow

cross CWLillehei

As valve replacement surgery grew arose new models of valvular prosthesis.

Also in the 60s, Starr and Edwards devised a new prosthesis consisting of
a plastic ball (silastic) enclosed in armor Vitalio still sold today (Figure 7).
After these arose many others equally have been widely used as Beall
(1965), Smeloff-Cutter (1966), Alvarez (1966), Wada (1967), Bjork-Shiley
(1970) Lillehei (1971), etc. . Also at this time, in order to try to evade the
complications of metallic valves, new models of prosthesis biological
materials arise.

Figure 7: valvular prosthesis

Starr Edwards-

In the late 60, Carpentier et al., They developed valvular heterografts using
porcine tissues, which have been widely used. Another major advantages
offered improvements in heart-lung machines was the possibility of
opening the heart and get a direct view of the mitral valve, thus allowing its
parts and especially repair to be able to check the mechanism of injury.
Wooler et al., Reed et al. and Kay et al. They described mitral annuloplasty
techniques. Thus was born the need to develop rings to perform
annuloplasty. One of the important figures in this field was Carpentier, who
designed the rings after a careful study of the mitral pathology (6). Also at
this time a new device that corrects electrical heart defects arises. It is the
pacemaker, invented by J. Reynolds, rudimentary in its infancy but over
the years it has become one of the most sophisticated devices that are used
in modern medicine (Figure 8) .For your Meanwhile, the development of
coronary artery bypass surgery was traveling parallel to the valve surgery
course. Diseases of the coronary arteries and its consequences have always
been of great importance because of its high morbidity and mortality.
Hippocrates (s. IV. C.) and Erasistratus (s. III. C.) had already described
the clinic patients with coronary disease. Heberden, more than 200 years
ago he had described different forms of disease and coined the term angina
to describe the main symptom. Closer in time, Dr. C. Beck, in 1930, It
sutured one pedicled graft pectoral muscle on the left ventricular wall with
the hope of creating a blood flow to the ischemic myocardium side (7). The
results of this intervention were good, then repeating it in 16 more patients.
In 1946, A. Vineberg implanted internal mammary artery through a tunnel
infarction without anastomose any coronary artery. In 1958, M. Sones
discovered coronary angiography, which allowed to see the anatomy of the
coronary arteries, and what was more interesting, the exact place where the
injury was occurring. This allowed much progress in coronary surgery,
greatly improving the results thereof. And with coronary angiography,

Figure 8: Pacemaker
epicardial J.Reynolds

The first to arterial bypass surgery was RH Goetz, joining right internal
mammary artery to the right coronary artery and demonstrating its
permeability by angiography. However, the patient died one year after an
ischemic event and Goetz abandoned the technique. In 1967, Kolessov VI
published his experience in coronary bypass surgery anastomosing
mammary artery coronary, for treatment of patients with angina pectoris.
Although their results were acceptable, surviving five of the seven patients
who underwent surgery, he was harshly criticized by the Leningrad Society
of Cardiology. The biggest revolution in coronary artery bypass surgery
came from the hand of R. Favaloro, of the Cleveland Clinic, who he
described fifteen cases who performed the coronary artery bypass graft
using a saphenous vein placed enters the ascending aorta and distal to the
lesion right coronary artery. Only 3 years later, in 1969, Dudley W. Johnson
et al., Milwaukee, published a series of 301 patients who underwent
coronary disease, which was a real revolution. According to these surgeons
provided the potential vein grafts for coronary surgery it was immense, and
can be used to perform coronary artery bypass different. Despite this, over
time it was found that the permeability of the bypass was greater long-term
if the internal mammary artery was used, so it became the technique
choice.However a doubt, one of the most revolutionary techniques the s.
XX was heart transplantation. One of the researchers who provided
additional information in this field was A. Carrel, Nobel Prize winner in
physiology and medicine in 1912. This, along with C. Gurthrie, reported the
transplantation of heart and lungs in animals (8). They described a case in
which, after removing the heart of a small dog, had been implanted in the
neck of an adult dog, anastomosing the caudal ends of the jugular vein and
carotid artery to the aorta and pulmonary arteries. In 1967 the first attempt
human heart transplantation, hand C. Barnard arises. It was in 1967, in
Cape Town. The patient died 18 days after surgery. Lower and Shumway R.
N. in 1960 established technique of heart transplantation as performed
today. However many of the surgeons of the time decided to abandon this
practice because of the high mortality rate, especially associated with organ
rejection, which promoted the research of immunosuppressive drugs.
Multiple problems with patient selection, immunosuppression, rejection
monitoring, development of infections and other complications make
enthusiasm for transplantation is being lost. Yet some hospitals do not
cease in its efforts to advance the field, which saw its greatest heyday in the
80s with the emergence of Ciclosporina.Paralelo the development of heart
transplantation occurred the development of the artificial heart. The
possibility of replacing a diseased heart with an artificial device that would
provide the pumping function was one of the great dreams of the time. In
1957, the Cardiovascular Center in Osaka, at the University of Utah, T.
Akutsu was able to get a dog to live for a few hours with an artificial heart.
Fourteen years later, WJ Kolff achieved a calf lived for three months. The
first implementation in a man, as a bridge therapy to heart transplantation
was made by D. A. Cooley and Liotta in 1969. (Figure 9).
 Figura 9: corazón artificial

La cirugía cardiaca es todavía una ciencia en desarrollo. Hemos podido

comprobar cómo durante miles de años el corazón fue un órgano
desconocido e intocable, y como en apenas 50 años la cirugía cardiaca se
desarrollo a una velocidad trepidante. Es sensato pensar que en las
próximas décadas la cirugía cardiaca seguirá evolucionando y aportando
nuevas técnicas para hacer frente a otro tipo de cardiopatías que aun hoy
siguen acortando la esperanza de vida.