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Milestones of Cardiac Surgery in Africa
1953:          Jean Demirleau in Algeria performed a closed mitral valvotomy in Africa.
1958           The first open heart surgery (closure of ASD) was performed in Africa by Christiaan Barnard in Cape Town
1967           The first world-wide human heart transplantation was performed in Africa by Christiaan Barnard in Cape Town, 
South Africa.
1960           First close (closed mitral valvotomy in Accra, Ghana by Charles Easmon
1960           The first closed mitral valvotomy in Ibadan, Nigeria.by John Weaver
1964           First open heart surgery (ASD closure by surface cooling, Accra, Ghana), West Africa by Charles Easmon.
1974           First open heart surgery in West Africa using the heart lung machine in Enugu, Nigeria by Magdi Yacoub
1978           First open heart surgery in Abidjan,Cote d‘Ivoire.by Dominique Metras
1980           The first close mitral valvotomy in Monrovia, Liberia by Charles Yankah
1989           Resuscitation of cardiac program in Ghana by Kwabena Frimpong-Boateng.
1992           The first open heart surgery in Dakar, Senegal by Mouhamadou N‘Diaye
1970           The first open heart surgery in Kampala, Uganda East Africa by Lindsay Grigg the first open heart surgeries 
(closure of ASD in deep hypothermia and circulatory arrest)
1973           The first open heart surgery in Nairobi, Kenya, East Africa was performed Eddy Knight.
2002           The first open heart surgery, paediatric program in Asmara, Eritrea by Bolous Asfour and  Andreas Urban 

1937  First PDA ligation was performed by Thomas Streider – the patient died on the 4th postop. day
1938  Gross ligated a PDA successfully in a 1 year old girl. An era of surgery of cong heart dis.
1944  Crafoord and Nylin repaired coarctation of the aorta by resection and end to end anastomosis in Sweden            
1944  Blalock (and Taussig) created a Subclavia-PA shunt to palliate a patient with TOF. This provided a hope for children and adults with cyanotic cong. heart disease

Ligation of Patent Ductus Arteriousus (PDA)
August 26, 1938, when Robert E. Gross of Boston, Massachusetts, successfully ligated a PDA.
It is largely unknown that in the same year and before Gross, Emil Karl Frey, a surgeon at the Medizinische Akademie in Dsseldorf, Germany, had already ligated a PDA successfully.

Attempts Using Closed Surgery

Congenital heart surgery is very special. It is a profession that combines art, science and skill.
Congenital heart surgery is a young specialty.  It has been characterized by a history of innovation.

The 1950’s might be referred to as the “maverick era”. Since then huge advances have been made

Closure of Atrial Septum Defect
1952, Charles Baily successfully repaired a large septal defect in a thirty-eight-year-old woman by a method which he called Atrio-septopexy
In January 1952, Charles Baily successfully repaired a large septal defect in a thirty-eight-year-old woman by a method which he called “Atrio-septopexy” (left figure). He made an incision in the right atrial wall, inserted his finger through the hole to investigate the right atrium and the defect, and then sutured the right atrial wall to the rim of the defect. He used this technique in twenty patients total, fourteen of which had the secundum defect; the mortality rate was 14.3% -- an improvement on the alternative methods which had been used during the past 4 years.
Total Cardiac Inflow Occlusion and Hypothermia
It was becoming evident that progression in Cardiac Surgery could only be obtained through the development of methods which allowed direct vision and a dry field. Two promising techniques at the time were total cardiac inflow occlusion and hypothermia

Total cardiac inflow occlusion
1940  Richard Varco, University of Minnesota: Total cardiac inflow occlusion.
Time restriction remained an obstacle for this method.

Development of Hypothermia
During the early fifties, different methods of induced hypothermia were developed – including bathing the patient in ice water (above figure), using drugs, and cooling the chest cavity with cold saline – but the major drawbacks, arrest of blood flow to the brain and other organs such as the kidneys, was still a problem.
Experimental Deep Hypothermia
1951:  W.G. Bigelow, a surgeon at the   University of Toronto, hypothermia   to obtain direct vision in intracardiac   surgeries. His successful results, on   13 monkeys in 1951, were a   promising starting point.

1952-1954 –
A concept of deep hypothermia was introduced
A patient with ASD was slowly cooled down with refrigeration blankets to 28 degree centigrade. They then opened the chest, occluded the vena cava, opened the right atrium, and closed the ASD.  

First intracardiac operation in deep hypothermia and circulatory arrest without heart lung machine
September 1952:   Richard Varco and John Lewis,  University of Minnesota.
The first intracardiac operation performed in a dry operating field under direct vision without heart lung machine.
Lewis and colleagues operated on 60 patients with atrial septal defect using deep hypothermia and 54 survived (1952 – 1954).
The first successful open heart surgery with a heart lung  machine

1953   John Gibbon
In May 6, 1953, a major breakthrough in heart surgery was achieved when John H. Gibbon, at the Jefferson Medical College in Pennsylvania, performed the first successful open heart surgery on an eighteen-year-old girl with an atrial septal defect. For this operation he used the Gibbon-IBM heart lung machine, developed over the past decade and a half, with the help of engineers from IBM in New York.

The first successful open heart surgery with a heart lung  machine

May 6, 1953 at Jefferson Medical College Hospital, Dr. John Heysham Gibbon, Jr. used the Heart-lung machine, Model II,  1951 to close ASD in a 18 year old Cecelia Bavolek. Art/Photo Collection, AG-054
Mayo-Gibbon heart-lung machine, 1958
1955: Dr. Earl Wood and Dr. John Kirklin, working with engineers from the Custom Engineering and Development Company of St Louis, Missouri, produced this more commercially viable version in 1955.
It was also used at London's Middlesex Hospital

Modification of the heart-lung machine 
developed by the surgeon John Gibbon

Early 1954 –
         Pessimism was universal
Open heart surgery –
      “Great concept but sick human heart could not  tolerate it !!!”

Use of Cross Circulation

1954 – Walton Lillehi and associates operated on a child with VSD using controlled  cross-circulation, 
University of Minnesota, USA.
A total of 47 pts were operated using this technique.
63% of these pts were alive 30 years later.

Development of the Bubble Oxygenator
1955  Richard De Wall of University of Minnesota,   together with Walton Lillehei 
The device was an instant success and was used throughout the world because it was inexpensive, easy to assemble, and heat sterilizable.  Throughout the years to come, oxygenator designs became more advanced, eventually leading to the development of membrane oxygenator and hollow fiber oxygenators


John Kirklin and colleagues  used  the modification of the Gibbon oxygenator and began to operate on intracardiac malformations successfully

Extracorporal Circulation with a Heart Lung Machine for Open Heart Surgery

History of Cardiac Surgery
Ludwig Rehn successfully stitched a wound in the heart.. 
Ludwig Rehn und Ferdinand Sauerbruch performed the first successful pericardectomy for a constricting pericarditis..
Martin Kirschner performed the first successful pulmonary embolectomy using the technique   developed in 1907 by Friedrich Trendelenburg.
Elliott Culter und Samuel Levine (cardiologist) performed in 1923 transventricular and Souttar in 1925 Soutar transatrial (auricle) mitral valve valvotomy .
First heart catheterization a self experiment by  Werner Forssmann.
Ferdinand Sauerbruch successfully operated on a right ventricular aneurysm..
Emil Frey performed the first surgical ligation of a patent Ductus arteriosus Botalli.
Clarence Crafoord performed the first successful repair of aortic coarctation by resection and end to end anastomosis.
Alfred Blalock and Helen Taussig (cardiologist) performed the first left Art. subclavia to Art. pulmonalis shunt to improve the oxygen saturation in a child with tetralogy of Fallot.
Thomas Sellors and Russell Brock independently performed transventricular pulmonary valvotomy for congenital pulmonary stenosis.
Robert Gross und Tyge Sondergaard performed atrial septal defect (closed technique).
Wilfred Bigelow developed a technique for cerebral protection during circulatory arrest.
John Lewis performed the first open congenital heart surgery in hypothermia.
John Gibbon developed a heart lung machine for open heart closure of atrial septal defect.
Äke Senning und Clarence Crafoord.resected atrial myxoma in extracorporal circulation .
Walton Lillehei, father of open heart surgery,  used the Cross-Circulation technique to correct tetralogy of Fallot-Tetralogy in a child.The circulation of the parent was connected to that of the child to maintain the circulation when the child’s heart was arrested during the open heart operation.
Äke Senning implanted the first heart pace maker.
Dwight Harken performed the first aortic valve replacement with a cage ball prosthesis.
Albert Starr performed the first mitral valve replacement with a cage ball prosthesis (Starr-Edwards Valve).
Frank Mason Sones performed the first selective coronary angiography during a heart catheterization..
Hans Borst performed aortic arch operation in hypothermia and circulatory arrest.
Rene Favalaro performed coronary artery revascularisation with a coronary artery vein graft  (CABG) and Vasilii Kolessov with Art. mammaria.
Adrian Kantrowitz performed the first  intra aortic balloon pump (IABP) counterpulsation for treating patients in cardiogenic shock.
Christiaan Barnard performed the first human orthotopic heart transplantation.
Andreas Gruentzig performed the  first coronary balloon angioplasty.
Bruce Reitz performed the first heart lung transplantation.

History of Heart Halve Surgery

Surgery of Endocarditis
Historical Developments

History of Transcatheter Heart Valve 
Repair and Implantation

Pan-African Society for Cardio-Thoracic Surgery
c/o Prof.Dr.Charles Yankah
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