Surgery for Ventricular Tachycardia.

The treatment of drug-refractory chronic ventricular tachycardia (VT) has undergone a revolution over the last 50 years. We now have automatic implantable cardioverter defibrillator therapy with pace-terminating capabilities, and catheter ablation of VT has refined mapping and improved methods of lesion generation. Between 1980 and 1993, Houston Methodist Hospital became a leader in the diagnosis and surgical ablation of VT and other arrhythmias. This is a brief account of that period and some of the experiences and lessons that have led to significant advances used today.

[The third wave of cardiac surgery]. / La tercera ola de la cirugía cardiaca.

A review of the history of cardiac surgery around the world is made divided into three stages, the first since the beginning of humanity until 300 years BC; the second moment shows how comes the platform that would give the anatomical and functional bases of the cardiovascular system. This historic moment includes: 1. the description and analysis of the function of blood and its components; 2. the description of the normal and abnormal Anatomy of the human heart and its vessels; 3. the anatomic and functional correlation: Foundation of the deductive thinking, and 4. the anatomic and functional integration with the clinic. Finally, the third wave, which is living today, is the stage of the technological explosion that begins with procedures as thoracoscopic surgery with the concept of reducing surgical trauma through minimum approach surgery. Also the use of robotics to solve some of the alterations in the CC, another is hybrid procedures and finally the use of fetal cardiac surgery.

Se hace una revisión de la historia de la cirugía cardiaca a nivel mundial dividida en tres etapas; la primera desde los inicios de la humanidad hasta 300 años a.C, El segundo momento muestra cómo surge la plataforma que daría las bases anatómicas y funcionales del sistema cardiovascular. Este momento histórico comprende: 1. La descripción y el análisis de la función sanguínea y sus componentes; 2. La descripción de la anatomía normal y anormal del corazón humano y sus vasos; 3. La correlación anatomo-funcional: fundamento del pensamiento deductivo, y 4. La integración anatomo-funcional con la clínica. Por último, la tercera ola, que es la que se vive en la actualidad, es la etapa de la explosión tecnológica que inicia con los procedimientos toracoscópicos, con el concepto de reducir el trauma quirúrgico mediante la cirugía de mínimo abordaje. También está el uso de la robótica para solucionar algunos de las alteraciones en las Cardiopatías Congénitas, otro son los procedimientos hibridos y finalmente la cirugía fetal.

Heart transplantation.

On December 3, 1967, Christiaan Barnard (1922-2002) introduced heart transplantation in humans for the first time. The journey that took him from Groote Schuur Hospital in Cape Town, South Africa to the University of Minnesota Hospitals in Minneapolis and back to Cape Town is described through this writing. We present the seminal events forming this incredible story, starting in antiquity as the first physicians of our civilization began to consider and study the heart. The anatomy of the heart, its physiology and pathology are reviewed, as Barnard gained knowledge that formed the basis for the transplantation of 1967. He studied open heart surgery with the Minnesota group, learned how to repair congenital heart defects while in Minneapolis, and then established a heart surgery program at Groote Schuur before performing the first clinical heart transplant. Finally, Barnard studied the heart transplant technique developed by Lower and Shumway in dogs and learned how to manage immunosuppressive techniques in Virginia and Colorado. These skills completed the requirements for proceeding with the first heart transplant operation.

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.

Ite Boerema--surgeon and engineer with a double-Dutch legacy to medical technology.

Ite Boerema, 1902-1978: a Dutchman with a brilliant academic surgical career, and war hero, decorated for resistance to the Germans in World War II. As a man who regarded surgery as "engineering in medicine," we still feel his legacy in medical technology today, specifically with regard to his work on esophageal anastomoses and hyperbaric oxygen therapy. This biography places his major contributions to medicine in context of the man himself and of contemporary medicine.

Cardiac surgery for arrhythmias.

Cardiac arrhythmia surgery was initiated in 1968 with the first successful division of an accessory AV connection for the Wolff-Parkinson-White Syndrome. Subsequent surgical procedures included the left atrial isolation procedure and the right atrial isolation procedure for automatic atrial tachycardias, discrete cryosurgery of the AV node for AV nodal reentry tachycardia, the atrial transection procedure, corridor procedure and Maze procedure for atrial fibrillation, the right ventricular disconnection procedure for arrhythmogenic right ventricular tachycardia, the encircling endocardial ventriculotomy, subendocardial resection procedure, endocardial cryoablation, the Jatene procedure, and the Dor procedure for ischemic ventricular tachycardia. Because of monumental strides in the treatment of most refractory arrhythmias by endocardial catheter techniques during the past decade, the only remaining viable surgical procedures for cardiac arrhythmias are the Maze procedure for atrial fibrillation and the Dor procedure for ischemic ventricular tachycardia. Nevertheless, the 25-30 years of intense activity in the field of cardiac arrhythmia surgery provided the essential foundation for the development of these catheter techniques and represent one of the most exciting and productive eras in the history of medicine. In one short professional career, we have witnessed the birth of arrhythmia surgery, its adolescence as an "esoteric" specialty, its prime as an enlightening yet exhausting period, and finally its waning years as a source of knowledge and wisdom on which better methods of treatment have been founded. One could hardly ask for a more rewarding experience.

Kenneth K. Keown, MD: pioneer of cardiac anesthesiology.

In 1948, just 2 years out of his anesthesiology residency at Hahnemann Medical College and Hospital, Kenneth K. Keown, MD, was chosen as the anesthesiologist for the procedure that launched the era of intracardiac surgery--a mitral valves commissurotomy. Although surgery on stenotic mitral valves had met with some success as early as the 1920s, its application had lain dormant for some 25 years. In effect, Keown and Hahnemann's Chief of Thoracic Surgery, Charles P. Bailey, MD, who performed the daring operation, launched the acceptance of intracardiac procedures, showing that the heart could be invaded with a successful outcome. Keown and Bailey continued as a team through many innovative cardiac procedures, during which Keown wrote the first monograph on cardiac anesthesia in 1956. Keown was also an early innovator in perfecting methods of inducing hypothermia in cardiac surgery and is also renowned for his pioneering work in cardiac arrhythmias, using lidocaine to counteract fibrillation during cardiac surgery. In 1957, Keown returned to his home state of Missouri to build a department of anesthesiology at the University of Missouri School of Medicine. He advocated allowing only physicians trained in the specialty to administer anesthesia, and he believed firmly that anesthesiology should be a freestanding specialty separate from surgery. He also maintained a vigorous resident recruitment service. Keown held leadership positions in many medical organizations and, during a sabbatical from Missouri, served on the hospital ship Hope in Tunisia. He was Professor and Chief, and later Chairman, Section of Anesthesiology, at the University of Missouri Medical Center, and from 1969 until his death in 1985, he also served as the Center's Medical Director.

The surgical treatment of patent ductus arteriosus.1955.

Fourteen cases of patent ductus arteriosus operated upon without a fatality have been presented. All were treated by ligation and division of the ductus. The importance of the safety factor provided by the Potts-Smith-Gibson clamp has been discussed. A detailed case report of one patient whose operation was complicated by excessive hemorrhage is given in detail. No cerebral or renal damage followed a prolonged period of cardiac massage and only slight permanent cord damage resulted from complete occlusion of the aorta for over 1 hour.

[Thoracic surgery: history and present status (author's transl)]. / Thoraxchirurgie. Historisches und Erreichtes

Following adoption of the differential airways pressure principle (Sauerbruch), continuous positive airway pressure breathing, together with earlier physiological and clinical preliminary reports on artificial lung ventilation, was a major step on the way to intratracheal anesthesia, which was brought to perfection only after World War II. Up to then, the earlier method that Sauerbruch had used in his pioneer work had been prevalent in thoracic surgery. Since Sauerbruch's death, surgery of the heart and thoracic vessels has developed most successfully, while pulmonary tuberculosis now has hardly any surgical significance.