He concluded that some simpler way had to be developed. Based on original work of British surgeons Dr. Anthony Andersen and Dr. With this, he developed a simple extracorporeal circuit, which used a lobe of the lung to oxygenate blood flow similar to the azygos vein, allowing operation of dogs without mortality.
Since hypothermia lowers the oxygen consumption, he suggested that the use of hypothermia could increase the safety period. After much experimentation on dogs, found that irreversible ventricular fibrillation was the result of coronary air embolism. Thus, they operated 10 dogs that had previously undergone correction of atrial septal defect, closing it with "hypothermia", with the death of one dog.
In late summer of , Dr. The temperature was lowered to 26 o C, the chest was opened, the cava clamped for 5. The child was discharged 11 days postoperatively, and this was the 1st open-heart surgery performed successfully in the world. Five minutes of cardiac arrest that would revolutionize the history of heart disease.
By the year , while Dr. Taufic were performing open heart surgery with hypothermia, Dr. Lillehei and his assistants continued their research to solve the problem of oxygenating blood during complete cardiopulmonary bypass without time limit.
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Watson in England, published their experiments of cross circulation in dogs for periods up to 30min. The group of Dr. Cohen decided to develop the cross circulation with a view to clinical application, they studied the physiological variables and found that none of the "donors" in the trial died. In March , Dr Lillehei and his group felt safe enough to use the cross circulation in humans. In the Hospital of the University of Minnesota, considered very progressive, there was strong opposition to the innovative idea of Dr.
Lillehei to perform the cross circulation in humans. Wangensteen was of invaluable assistance. When a second operation was planned to be suspended last night due to the opposition, Dr. Lillehei left him a note that read: Wangensteen received the following response: Lillehei performed surgery on one-year-old boy, who had spent most of his life in hospital with pneumonia and attacks of heart failure, very small, weighing only 6. Catheterization showed a large ventricular septal defect. For the cross circulation, the father was chosen as a "support". The movement lasted 13min, during which Dr.
Lillehei closed the VSD with a continuous suture. The normal operation developed well, as well as the postoperative period until the child developed pneumonia and bronchitis, and died 11 days after the operation. The autopsy showed marked change in the pulmonary circulation. This patient also developed pneumonia but recovered and was discharged.
In late August , Dr Lillehei and his assistants had undergone eight open heart surgeries for closure of VSDs, with two deaths. Facing the seriousness of the cases, the results presented represented an unsurpassed success. Lillehei operated the 1st case of tetralogy of Fallot with total correction in a year-old boy, underdeveloped and very cyanotic, having left school because of illness.
During the cannulation had a cardiac arrest, but the heart started beating when cross circulation was established. The VSD was closed and relieved pulmonary stenosis. The patient was discharged two weeks later, just being able to play baseball and cycling. The defects were corrected and the patient was discharged cured. Until February , Dr. Lillehei and his group had operated with cross circulation 32 patients with 25 survivors. None of the seven deaths resulted from cross circulation. One of the deaths were due to complete AV block. With repetition of the cases, the cross circulation became easier with the use of a cannula in each cava and a venous reservoir.
To facilitate visualization within the heart chamber, a tourniquet was applied to the aorta, which was pressed intermittently to reduce the blood within the heart. In April , Dr Lillehei presented the results of nine operations for tetralogy of Fallot with five survivors in the Congress of the American Surgical Association in Philadelphia. The survivors had heart almost normal! During the discussion, Dr. Alfred Blalock, with all his importance, said: Blalock suggested that the ultimate solution to support the circulation during surgery would be the heart-lung machine developed by Dr.
Gibbon and not cross circulation. Gibbon had operated the 1st patient with cardiopulmonary bypass in early , but the patient died.
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In May , Dr. Gibbon operated two patients with atrial septal defect, with complete success, opening the patient's heart under cardiopulmonary bypass and the vast field of cardiac surgery, although it has not been given prominence at the time, perhaps because with hypothermia such operations were being performed routinely by Dr. Gibbon was never able to repeat his feat and, after five unsuccessful attempts, he abandoned heart surgery. Although no comment was done at the meeting in Philadelphia, Dr. Lillehei knew he had at the University of Minnesota a heart-lung more efficient, safer and much simpler than all the sophisticated machinery developed by Dr.
Gibbon, Dennis and others. All these oxygenators based on the principle of forming a thin layer of blood over a large surface placed under an atmosphere of oxygen. But another way to create a large interface between the oxygen and blood could be achieved by bubbling oxygen directly into the blood. Other attempts showed that the method of buble oxygenation was too slow and with a great tendency to foam.
Clark was able to demonstrate that it was possible to eliminate the bubbles passing the blood through a tube with sticks or glass beads treated with DC antifoan A. This was a silicone compound developed by Dow Corning Company used for frying potatoes and that is still used today in cardiopulmonary bypass. Clark et al had developed an oxygenator capable of keeping more than 20kg animals in extracorporeal circulation. DeWall, a young doctor, was initially hired as responsible for cross circulation at the University of Minnesota, after accepted as a resident.
This did not happen because of his grades were not sufficient for the requirements of the University, despite the desire of Dr. DeWall received the news, suggested Dr. Lillehei to hire him as coach of laboratory animals. Wangensteen accepted the idea and Dr. DeWall continued with the same previous activities, with the only difference that received a payment slightly higher than residents.
As a research project, which was compulsory at the University, Dr.
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DeWall he could work in the bubble oxygenator. He asked him also that not to worry about the previous publications and restarted all the research, from the beginning. DeWall had plastic tubes PVC of a firm that made the tubes for mayonnaise manufacturers. In the mayonnaise manufacture, formation of foaming was also a major problem that had been solved smearing the interior of the tubes with the DC antifoan, the same product used many years ago by Dr.
Without knowing the work of Dr. DeWall, thought that silicone DC antifoam A was good for mayonnaise and should be good for the blood. Even with antifoan A, there were still some bubbles in the blood. It was when Dr. DeWall was thought to create a helical tube of PVC so that the bubbles would be "pushed" upwards, while the more dense blood without bubbles would be addressed to the bottom of the PVC spiral. In the winter of , Dr. DeWall performed surgery on about 70 dogs using various techniques and revealing details such as the need to heat the blood, which he reached to manage the PVC spiral dipping into a container of warm water.
The connections of the tubes and filters have been progressively improved in such a way that, in May , Dr. Lillehei believed to have an oxygenator ready for human use. DeWall for the 1st time in a three year old child with VSD and pulmonary hypertension; the operation developed well, but the patient died 18 hours later. In August , they had used the oxygenator in seven children from 19 months to 7 years old, with only two deaths. All seven children woke up immediately after the operation. The two deaths were not related to cardiopulmonary bypass. Oxygenators created by Dr. DeWall have been improved with use.
But the cross circulation, which was allowed to advance one step on the long walk from the heart surgery, it was finally abolished. Unlike the complex oxygenator of Dr. Gibbon, with many moving parts, the bubble oxygenator of Dr. DeWall was elegantly simple, being constructed of plastic tubing used for the food industry, cheap and disposable, and autoclavable. Lillehei et al reached the milestone of 80 operations with the bubble oxygenator. Within two years, more than patients had been operated. The introduction of the bubble oxygenator permitted the expansion of cardiac surgery throughout the world, where there was a well-equipped hospital and doctors with preparation and willingness to make it a reality.
The attempted use of extracorporeal membrane oxygenation systems allowed, after innumerable mistakes and successes in modern membrane oxygenators, the approach of progressively more complex heart disease with good results in the short and long term. Tens of surgeons may also be mentioned, each with a significant contribution to the development of cardiac surgery. This enumeration would be tedious and probably difficult to hold the reader's memory. We believe, however, that the emphasis on the name of Dr. Nina Starr Braunwald, can serve as a beacon to illuminate this vast gallery of remarkable people.
Nina Braunwald was born in New York in and was the first woman to hold an open-heart surgery. Among other firsts, she was also the first woman to be elected to the American Association for Thoracic Surgery. In the late 50's she developed a flexible polyurethane mitral valve prosthesis with Teflon tendinae cordae, implanting it into dogs and, in , led a team that first used this prosthesis for mitral valve replacement in humans.
The patient survived the surgery and remained clinically well for several months. Braunwald also developed a ball covered mechanical prosthesis, the Braunwald-Cutter prosthesis, which came to be implanted in several patients. She was also pioneer in the use of tissue culture techniques, in order to create non-thrombogenic surface for prostheses and assisted circulation devices. In Brazil, many devoted to the field of biological and mechanical prostheses, leading the country towards self-sufficiency and international prominence.
Christiaan Barnard in Cape Town, South Africa, performed what until then was considered the first heart transplant in human. Thereafter, an avalanche of other cases was being operated, so that in a compilation of Haller and Cerruti, until October , they accounted more than 60 transplants around the world . The receiver was a man of 32 years, cowboy and bearer of dilated cardiomyopathy, probably due to Chagas disease. View or edit your browsing history. Get to Know Us. English Choose a language for shopping.
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