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The History of Pediatric Cardiology and Cardiovascular Surgery. Pediatric cardiology and pediatric cardiac surgery have developed interdependently. CHD: Primordial heart?. FISH 1A+1V AMPHIBIA 2A+1V Snakes rudiment. VS REPTILES 2A+2V Turtles spongy VS

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the history of pediatric cardiology and cardiovascular surgery
The History of Pediatric Cardiology and Cardiovascular Surgery

Pediatric cardiology and

pediatric cardiac surgery

have developed


chd primordial heart
CHD: Primordial heart?
  • FISH 1A+1V
  • AMPHIBIA 2A+1V Snakes rudiment. VS
  • REPTILES 2A+2V Turtles spongy VS
  • BIRDS 2A+2V Alligators VSD
early scientific foundations
Early scientific foundations
  • 1785 William Withering introduces Foxglove
  • 1790 Luigi Galvani--electrical stimulation of frog muscle
  • 1808 Humphrey Davy identifies Na, K, Mg, Ca, Sr, & Ba
  • 1830s Claude Bernard--wide-ranging experiments
  • 1830s Michael Faraday--electricity: anode, cathode, electrolyte, anion and cation.
  • 1880s Joseph Lister--antiseptic surgery (phenol)
  • 1883 Ringer shows that K inhibits, Ca stimulates heart
  • 1887 Augustus Waller--Hg cardiogram
    • 1903 Willem Einthoven invents the string galvanometer EKG
  • 1895 Wilhelm Conrad Roentgen--X-Rays
  • 1896 Scipinio Riva-Rocci--Hg sphygmomanometer
  • 1900 Karl Landsteiner--biocompatibility, ABO system
the danger of touching the heart
The danger of touching the heart

"Surgery of the heart has probably reached the limits set by Nature to all surgery. No method, no new discovery, can overcome the natural difficulties that attend a wound of the heart."

Stephen Paget, 1896

The Surgery of the Chest

anesthesia for thoracic surgery
Anesthesia for Thoracic Surgery

21 And the LORD God caused a deep sleep to fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead thereof.

22 And the rib, which the LORD God had taken from man, made he a woman, and brought her unto the man. -- Genesis 2


Humphrey Davy--1800

“As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations…”


Crawford W. Long--1842

Horace Wells--1844

William T.G. Morton--1846

Charles Jackson--1846

control of the airway
Control of the airway

But that life may in a manner of speaking be restored to the animal, an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again and the animal take in air. Andreas Vesalius, 1543

John Hunter—1667
  • James Curry—1815
  • John Snow—1858
  • J O’Dwyer—1885 (peroral)
  • Rudolph Matas—1902
heart lung bypass
Heart-lung bypass

Von Frey and Gruber--1885

early open heart surgery with heart lung machine
Early Open Heart Surgery With Heart-lung Machine
  • C.Dennis 1952 2/2 Died
  • J.Gibbon 1953 5/6 Died
  • J.Helmsworth 1953 1/1 Died
  • D.Dodrill 1953 2/2 Died
  • G.Clowes 1953 2/2 Died
  • W.Mustard 53/54 5/5 Died

17/18 94.5%

controlled cross circulation 3 26 54 7 19 55
Controlled Cross-circulation3/26/54-7/19/55
  • NO. MORT. <2Y MORT.
  • VSD 28 8(28%) 16 6(37%)
  • TOF 11 4(36%) 5 3(60%)
  • CAVC 4 3(75%) 3 2(67%)
  • IPS 2 0
  • 45 15(33%) 24 11(49%)
the price of innovation
The price of innovation

The more radical (important) the innovation, the greater the ridicule and vilification by colleagues

  • William Harvey
  • Ludwig Rehn
  • Humphrey Davy
  • Horace Wells
  • Rudolph Matas
  • Werner Forssmann
  • John Gibbon

“I did not repeat the operation because I could not get another case. Although my patient made an uninterrupted recovery, the Physicians declared that it was all nonsense and in fact the operation was unjustified. In fact, it is on no use to be ahead of one’s time.”

extracardiac repair and palliation
Extracardiac Repair and Palliation
  • PDA R.GROSS 08/26/38
  • COARCT. C.CRAFOORD 10/01/44
pediatric cardiac surgery
Pediatric Cardiac Surgery


* Early Palliation

* Elective Repair at ± 5 to 6 Years


* Primary Repair in Infancy

1983* Primary Repair in Neonates

pediatric cardiology summary
Pediatric Cardiology: Summary
  • 1938-Essentially no Rx for CHD
    • Pioneers-pathologists, cardiologists, surgeons, imaging experts, intensivists, interventionalists
  • 2002-Rx for virtually all CHD, BUT mort./morb.:
    • ventricular function
    • arrhythmia
    • cns
    • valves/conduits
    • pulm hypertension
  • New frontiers-causation, gene-based Rx, CHF Rx, Arrhythmia Rx, imaging, safety of CPB, PVR
  • An incredibly exciting run--much for the future