The history, development and future of the cardiothoracic unit: Department of surgery, college of health sciences, University of Ghana

Abstract

In lieu of an abstract, here is a brief excerpt of the content: •165• Chapter 14 The History, Development and Future of the Cardiothoracic Unit: Department of Surgery, College of Health Sciences, University of Ghana. K. Frimpong-Boateng Vision The vision of the cardiothoracic and vascular surgery unit in the Department of Surgery is to be a world-class unit and first choice destination for management of cardiothoracic and vascular diseases in the West African sub-region and beyond. Mission Over the years the Cardiothoracic and vascular unit has remained a tertiary referral unit that has equipped its personnel with the requisite knowledge, skills and attitudes to undertake quality care, teaching and research at international standards to the ultimate satisfaction of its clients. Values The values of the unit are compassion, dedication, efficiency, sound ethical standards, punctuality, creativity and uncompromising integrity. Historical Perspectives1, 2, 3, 4 For most of history, the human heart has been regarded as a forbidden organ too delicate to tamper with. Indeed the heart was considered outside the limit of surgery. In 1881, Theodore Billroth, one of the leading surgeons in the world, remarked: “any surgeon who dared to operate on the heart would lose the respect of his fellow surgeons”. In 1896, the usually perceptive British historian Stephen Paget wrote: •166• Chapter 14 “Surgery of the heart has probably reached the limits set by nature to all surgery; no new method and no new discovery can overcome the natural difficulties that attend a wound of the heart”. Ironically, on September 9 in that same year, Ludwig Rehn, a German successfully repaired a laceration of the heart and the first epoch in the development of worldwide cardiac surgery had begun. A young gardener called Wilhelm Justus was stabbed in the chest in a park near the Main River in Frankfurt, Germany. He was found almost unconscious by the police and taken to the hospital, but not operated on until 48 hours later when his condition had deteriorated . At the operation he was found to have a laceration of the right ventricle. The bleeding was controlled with three silk stitches. Wilhelm Justus recovered, but developed an empyema (collection of pus in the chest cavity), which was drained on the 9th post-operative day. He eventually recovered and was discharged from hospital. After 1896, there were reports of other suturing of heart wounds. For example, Rikketts in Cincinnati, USA, reported 20 successful cases among a patient population of 56. In 1908, Peck in New York operated on 140 patients with heart wounds and 45 of were successful. This was acceptable because almost all patients would have died without a heart operation. Further milestones in the first epoch included the first pulmonary embolectomy which was performed by Friederich Trendelenburg at the University of Leipzig in 1907; the first widening of a stenosed mitral valve through a left ventricular approach by E.C. Cutter and S.A. Levine in Boston, USA in 1923. Henry Souttar performed the same operation through the left atrium in 1925 in London and the first successful operation of an aneurysm of the right ventricle by Ferdinand Sauerbruch in 1931. The second epoch, which brought great strides in the development of heart surgery, was based on the understanding of the haemodynamics of the normal and the failing heart through pathologic, anatomic and clinical examinations with the help of cardiac catheterization. In this respect Dr. Maude Abbott deserves special mention. Encouraged by her mentor and teacher William Osler in the Johns Hopkins University in Baltimore, she examined over 1,000 cases of •167• The History, Development and Future of the Cardiothoracic Unit: cardiac failure in children and established the relationships between clinical symptoms and pathologic-anatomic findings. She thereby laid the foundation for the classification of congenital heart disease. Her book “Atlas of Congenital Heart Disease” published in 1936 aroused the interest of paediatricians in the English-speaking world. Encouraged by the work of Maude Abbott, Robert Gross worked on the surgical management of patent ductus arteriosus (PDA) and in 1939 became the first person to publish closure of a PDA in 1939. The first closure of PDA, however, had been achieved in 1938 in Düsseldorf, Germany by Emil Frey on a 14 year old boy but he did not publish the case. At about the same time, the paediatrician Hellen Taussig worked intensively to study cardiac failure in children at the Johns Hopkins University, Baltimore. Her work encouraged Dr. Alfred Blalock, who had moved from the University of Nashville, Tennessee, to JohnsHopkins , to anastomose the...