The authors analyse the experience with the surgical treatment of about 3000 patients with different forms of cardiac pathology and general lethality in 4,1% of cases. Favorable results were obtained following operations in children of the first three years of life with the open arterial duct, in 4 to 6-year-old children with coarctation of the aorta. The authors show expediency of correction of septal defects before severe disturbances of hemodynamics could develop. The closed method of correction is indicated in non-complicated forms of mitral stenosis. Patients with complicated forms of mitral stenosis, mitral insufficiency should be operated upon under conditions of artificial blood circulation.
In 1951 in our laboratory in Stockholm, we successfully used our experimental pump oxygenator: the first dogs survived 40 minutes of total cardiopulmonary bypass with right ventricular cardiotomy. In the same year extracorporeal circulation was combined with hypothermia (26 degrees to 28 degrees C) to allow lower perfusion flows, thus diminishing blood trauma and the risk of perfusion complications. To avoid air emboli during cardiotomies, the heart was "arrested" with electrically induced ventricular fibrillation (1952). Our standard perfusion technique used cooling and rewarming with left ventricular bypass, the oxygenator was used only during intracardiac manipulations and when the right ventricle was unable to maintain a sufficient pulmonary circulation. Left ventricular bypass was continued until normal body temperature was reached and the heart could be weaned off the pump. In July 1954 we successfully extirpated a left atrial myxoma in our first patient undergoing open heart surgery, a 40-year-old woman, who is still alive today. Other successful applications of open heart surgery involved resection of a huge left ventricular aneurysm after infarction in 1955, correction of supracardiac total anomalous venous return in 1956, and the first hemodynamic correction of transposition of the great arteries by atrial switch method in 1958. Also in 1958, the first totally implantable pacemaker was inserted in a patient with total atrioventricular block to eliminate the infections that occurred along the percutaneous pacemaker leads. In October 1958, we also operated on a patient with severe angina pectoris with stenosis of the left anterior descending and circumflexed arteries and occluded right coronary artery. Endarterectomy of the left coronary arteries was performed, and the arteriotomies were repaired with saphenous vein patches.
Cardiac surgery in Stockholm grew on a sound foundation of well-developed general thoracic surgery. The portal figure is Clarence Crafoord (1899-1983) who already in 1927 had succeeded with the Trendelenburg pulmonary embolectomy operation. He went on to develop lung surgery in general. With foresight he stimulated the chemists of Karolinska Institute to purify heparin, first for prophylaxis against venous thromboembolism and later for use with the heart-lung machine. In 1944 he became the first surgeon to successfully operate on patients with coarctation of the aorta. With Viking Olov Bjork and Ake Senning the heart-lung machine was improved, finally allowing its clinical use in a patient operated in 1954 for a myxoma of the left atrium, with long-term survival. This was the first successful use of the heart-lung machine in Sweden and the second in the world. He and his coworkers, first at the Sabbatsberg hospital and from 1957 at the Karolinska hospital made major contributions to cardiology and radiology, apart from the progresses in cardiac surgery. Contributions such as pressure recording from the left atrium by needle puncture in 1950, the Senning operation for transposition of the great arteries and the first use of a totally implantable cardiac pacemaker in 1958 are indeed medical history.
City Clinical Hospital n.a. S.S.Yudin, Department of Health of Moscow, Department of Anesthesiology and Intensive Care, Moscow, Russia. Electronic address: levkrich72@gmail.com.
Transesophageal echocardiography was first introduced in Russia as a component of anesthesiology monitoring in 2003 following its successful implementation in the practice of cardiac anesthesia in the United States and Western Europe. This novel opportunity for perioperative hemodynamic evaluation was enthusiastically adopted at several cardiac surgical clinics despite the presence of critical barriers. The most important of these were the lack of certification programs for anesthesiologists, limited equipment, and a lack of understanding of the responsibility of the anesthesiologist as the coordinator of perioperative therapeutic decisions. Although intraoperative transesophageal echocardiography as a part of the anesthesiology protocol has been introduced in less than 10% of Russian cardiac surgery clinics, a group of interested anesthesiologists has formed over the last 15 years. Both the technical conditions and professional mentality of anesthesiologists need to be changed substantially for successful further development of intraoperative echocardiography. This review aims to highlight the milestones, successes, and challenges in the implementation of intraoperative echocardiography in the practice of cardiac anesthesiology in Russia, which may be interesting to a wide range of cardiac anesthesiologists.
Fifty years of cardiac and pulmonary surgery 1942-1993. The beginning of open heart surgery of postoperative intensive care. The first complete left heart catheterization. Mechanical heart valves.
