Traumatic Beginnings
Cardiac surgery, like a lot of surgery, had quite traumatic beginnings.
· Dr Daniel Hale Williams, a Chicago surgeon, performed the first successful surgery of documented wound to the heart on July 10 1983. A 24 year old man stabbed in the chest was brought into hospital at about 7:30pm and went into profound shock during the night. Dr Williams opened his chest and tied off a bleeding artery and vein in the chest wall. There was a small tear in the pericardium and a wound in the right ventricle, “about one-tenth of an inch in length”, which was not bleeding. He stitched the tear in the pericardium but left the wound in the ventricle. Though considered bold and daring at that Dr Williams’ treatment seems to have been appropriate.
After Dr Hale Williams’ successful operation some surgeons actually sutured heart wounds. However, none of these patients survived. That was, until Dr Ludwig Rehn in September 1896
· Dr Ludwig Rehn, a Frankfurt surgeon, performed what is considered the first successful heart operation on September 7, 1896. A 22 year old man was stabbed in the heart and collapsed. The police found him in shock – pale, covered in cold sweat, extremely short of breath, irregular pulse and blood soaked pulse. He was initially treated conservatively but worsened over the next two days. Dr Rehn opened the chest through the left fourth intercostals space, noticed continuous bleeding from a hole in the pericardium, blood and clots in the pericardium, a gapping 1.5cm right wound. “Bleeding is controlled with finger pressure…”. He sutured the heart wound using a silk suture on a small intestinal needle. Patient was cured.
It is worth reviewing a section of Dr Rehn’s notes. When added to the above some lessons can be learnt – how a patient in hypovolaemic shock presents, especially following trauma, and what cardiothoracic surgeons do till this day.
These cases above mention few but perhaps the most striking early landmarks in cardiothoracic surgery. For example, all those who unsuccessfully attempted surgery of heart wounds before Dr Hale Williams and those who unsuccessfully sutured heart wounds before Dr Rehn. These two ground breaking surgeons would no doubt have learned a thing or two from the experience of the others. Likewise Dr Luther Hill who in 1902 successfully repaired a stab wound to the left ventricle causing tamponade in a 13 year old boy (1), and Dr Dwight Harken who, during World War II, removed 134 missiles from the mediastinum including 55 from the pericardium and 13 from the cardiac chambers, without a death.
Those who followed learned and those who follow continue to learn from both the successes and failure.
1) This operation by Dr Luther Hill was performed on the patient's kitchen table in a run-down house, with chloroform anaesthesia administered by a physician and lighting supplied by kerosene lamps. The patient survived the operation, however, forty years later in a bar fight the same patient was stabbed in the heart and died.