Outlined history of the development of the world and Polish cardiac surgery.

It was the dream of humanity to perform surgery on an open non-beating heart. Scientific and medical discoveries five thousand years ago in China, partially adopted by the Western civilization, laid, through ancient Egypt, Mesopotamia, Greece, Rome and, later on in the Renaissance, the foundations for the development of empirical medicine. The 19th and the 20th centuries shoved dynamic scientific and technical development in various fields including medicine and surgery whose importance grew with the necessity to help the patients wounded in the wars. A break-through event in the development of surgery was overcoming of pain and discovery of reasons of infections and the control thereof, and, in the case of cardiology and cardiac surgery, the discoveries in physiology of circulation and the diagnostics of cardiovascular system diseases. This review contains a brief description of medical science in the past centuries, emphasizing the most important discoveries. A focus has been placed on the contribution of general surgery and thoracic surgery to the development of Polish and World cardiac surgery. The I Congress of the Polish Surgeons was held in 1889 in the Austria occupied territory of Cracow, which celebrated its one hundredth anniversary. The main obstacles in the development of clinical cardiac surgery included intratracheal general anesthesia, antisepsis and aseptics, hypothermia, oxygenators, extracorporeal circulation, transfusions, blood clotting and thromboses and cardioplegia. The spectacular heart and aorta surgical operations performed for the first time in the world and in Poland as well as the names of cardiac surgeons employed by the important cardiac surgery centers in Poland have been mentioned. The Department of Heart, Vascular and Transplantology Surgery of Cracow, the role and the share of Fundacja Rozwoju Kardiochirurgii COR AEGRUM in Cracow (COR AEGRUM Foundation for the Development of Cardiac Surgery in Cracow) in the construction of the new facilities for the Department of Cardiac Surgery of Cracow consecrated on June 9, 1997 by pope John Paul II, have been discussed. The contribution of the Club of Polish Cardiac Surgeons to the integration of surgical community and to development of the Polish cardiac surgery has been emphasized. In summary, it has been outlined that the contemporary standards of the Polish cardiac surgery do not differ from cardiac and vascular surgery and transplantology in developed countries.

Long-term evaluation of allograft aorta and valve replacement.

A technique for the management of dissecting aortic aneurysm with aortic valve insufficiency, using allograft replacement and coronary artery reimplantation is presented. The author's experience is based in 56 allograft valve implantations. The softness of the biological material facilitates the coaptation between the valve and an often irregular, calcified bed, as well as reimplantation of coronary arteries. Allograft transplantation produces an immunological response, but this has no notable clinical significance. Long-term results are very satisfactory. Cases of endocarditis, cusp rupture and severe calcification have not been observed.

[Comparative analysis of conservative and surgical treatment of the imminent myocardial infarct]. / Komparative Analyse der konservativen und chirurgischen Therapie des drohenden Herzinfarktes.

It is reported on 108 patients with the symptoms of the impending myocardial infarction, of whom 80 patients were treated conservatively. 51 patients developed a fresh definitive myocardial infarction. 28 patients were surgically treated, 5 of them died. Therefore, in patients with instable angina pectoris the possibility of an early coronary-surgical intervention should be taken into consideration to prevent the development of a definitive myocardial infarction.

Arterialization of the coronary veins in diffuse coronary arteriosclerosis.

Since the coronary veins and capillaries are not involved with arteriosclerotic disease the authors performed experimental, and afterwards, clinical total and selective coronary vein arterialization. Acute myocardial ischaemia created for instance by ligation of the anterior descending branch, was treated by an internal mammary artery to regional coronary vein anastomosis. In 21 patients the selective arterialization of the "Vena cordis magna" or of "Vena cordis media", and total arterialization of the coronary sinus was performed. The clinical improvement and follow-up studies seem to be promising in the treatment of patients with advanced diffuse heavy coronary arteriosclerosis. In acute myocardial ischaemia with coronarographically localized coronary occlusion, the aim of regional vein arterialization is to minimize the area of infarction.

Comparative analysis of prosthetic heart valve replacement on the basis of 300 cases.

1. The 224 patients have been followed-up for postoperative intervals of 1 to 8 years after operation, and the average duration of the follow-up has been 4 years. 2. Six types of heart valve prostheses have been utilized and evaluated with the longest (9 years) period of follow-up (a Starr-Edwards prothesis) and the shortest a Björk-Shiley valve. The best clinical hemodynamic characteristics, no thromboembolic complications were observed with the Lillehei-Kaster valve. Evaluation of longterm wear and thrombosis require further follow-up studies. 3. All patients, but 21, improved in functional capacity and are NYHA class I and II. Most of the patients had heart failure at the time of operation. These patients would have had a life expectancy of about two years from the onset of symptoms. Seventy two patients with heart failure as a prime symptom have thus outlived their anticipated life expectancy. 4. Systemic embolization was the most common postoperative complication in spite of the anticoagulant therapy.