AS THE year comes to a close, allow me to take you back in time to revisit some of the great moments in medical science which made possible the great strides man has made in the treatment of cardiovascular diseases that benefit all of us today. I had the great fortune and privilege in 1972 to have trained as a Fellow in Cardiac Surgery under one of the world’s giants in heart surgery, Dr. Denton A. Cooley, founder and cardiac surgeon-in-chief of the Texas Heart Institute in Houston.AS THE year comes to a close, allow me to take you back in time to revisit some of the great moments in medical science which made possible the great strides man has made in the treatment of cardiovascular diseases that benefit all of us today. I had the great fortune and privilege in 1972 to have trained as a Fellow in Cardiac Surgery under one of the world’s giants in heart surgery, Dr. Denton A. Cooley, founder and cardiac surgeon-in-chief of the Texas Heart Institute in Houston.
The management of heart diseases was still in the Dark Ages during my undergraduate years in the late 50s. Physicians then did not know how to treat heart diseases, much less, save the lives of patients with these ailments. Looking back, the physicians at that time did not even know that simple aspirin had any potential role in the prevention or treatment of heart attacks. Treatment was mainly symptomatic, using pain pills or pain shots. The most sophisticated pill was the nitrate pill, a vasodilator that “relaxes open” the coronary artery, since the “current” knowledge in physiology then said angina pectoris (chest pain) was due to spasm in the coronary arteries which supply the heart muscles with oxygen and nutrition.
The first milestone that started it all was in 1628 when an English physician first described blood circulation. Inspired by that, these historical events followed:
1706 Raymond de Vieussens, a French anatomy professor, first described the structure of the heart’s chambers and vessels.
1733 Stephen Hales, an English clergyman and scientist first measured blood pressure.
1816 Rene T. H. Laennec, a French physician, invented the first stethoscope.
1903 Eillem Einthoven, a Dutch physician, developed the first electrocardiogram.
1912 James B. Herrick, an American physician, first described heart disease resulting from hardening of the arteries, a fundamental concept that led to the modern therapy of today.
1938 Robert E. Gross, an American surgeon, performed the first heart surgery (close-heart, not open-heart).
1951 Charles Hufnagel, an American surgeon, developed a plastic valve to repair the aortic valve.
1952 F. John Lewis, an American surgeon, performed the first successful open heart surgery.
1953 John H. Gibbon, an American surgeon, introduced the heart lung machine (which he published as a concept in 1937) and first used this mechanical heart and “blood purifier” to do the first “real open heart surgery” utilizing the heart lung machine, precursor of the modern day cardiopulmonary bypass machine.
1950 John Hopps, a Canadian, invented the external heart pacemaker. That same year, Willem Greatbatch introduced the concept of an implantable (internal) heart pacemaker. 1960 The first self-contained implantable heart pacemaker made by Medtronic was inserted by W. C. Lillihei. Over the years, this has been improved, made more versatile, smaller, better, and longer lasting.
1961 J. R. Jude, an American cardiologist, led a ream in performing the first external cardiac massage to re-start the heart, the foundation for today’s CPR. 1960s Denton A. Cooley of Houston, Texas, rose to world fame for his extraordinary dexterity in performing thousands of congenital heart surgeries in infants, and for being the first to successfully remove pulmonary emboli (clots in the lungs).
1965 Michael De Bakey and Adrian Kantrowitz, American surgeons, implanted mechanical devise to help the diseased heart.
1967 Christian Barnard of South Africa, performed the first whole heart transplant from one person to another. 1968 Denton Cooley performed the first heart transplant in the United States on a 47-year-old man, using a donor heart from a 15-year-old. The patient lived for 204 days. He had done 22 heart transplants over the next year, a record at the time.
1969 Denton A. Cooley implanted the first artificial (mechanical) heart on a man to “tide him over” and keep him alive while waiting for a donor heart.
1972 In the field of clinical application, Denton A. Cooley had, by this time, performed more than 10,000 open heart surgeries, more than any other surgeon in the world. That year, in his honor, the Denton A. Cooley Cardiovascular Surgical Society was founded. Its members are the more than 800 heart surgeons from 50 countries around the world whom he trained at the Texas Heart Institute (THI) in Houston. (As a Filipino-American heart surgeon, I was truly humbled to be elected as its first president.) The THI has been doing more than 30 open-heart surgeries per day since then. 1970s Michel Mirowski, M.D., and his associates, Morton Mower, Stephen Heilman, M.D., Alois Langer, PhD, and a company called Medrad in Pittsburgh, developed the automatic implantable cardiac defibrillator. In 1980, the prototype AICD was implanted at Johns Hopkins to prevent sudden cardiac death.
1982 Willem DeVries, an American surgeon, implanted a permanent artificial heart, designed by Robert Jarvic, also an American physician. O. H. Frazier and his team under Dr. Cooley at the Texas Heart Institute has performed more than 600 heart transplants, and doing extensive works on artificial (mechanical) hearts. Someday, they will be available on the shelf like pacemakers today, and heart bypass and cardiac valve surgeries would be a thing of the past.
A crazy idea.
A most worthy pioneer was Werner Forssmann, who, as a surgical resident in Germany in 1929, experimented with himself by inserting a catheter through a vein in his arm and into his heart. He walked to the basement where the X-ray machine was, and x-rayed himself to prove that the catheter was in his heart. In another experiment, he injected dye to his heart through that catheter and took x-ray film. Many of his fellow physicians were outraged by his “daring and insane” acts. This, by the way, was the origin of what we know today as coronary or heart angiogram or cardiac catheterization, that made possible life-saving procedures, like angioplasties and heart bypass surgeries all over the world. Thanks to Forssmann’s “crazy idea.”
In 1956, Forssmann was awarded a Nobel prize, shared with Dickinson Richards and Andre Cournand, physicians in New York who studied heart function and physiology using catheters.
Next week: Conclusion