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16th April 2014, 8.31 hrs (IST)
Dr. S. K. Varma, MBBS, MS, FRCS(Ed). MCh, DNB, FIACS
Senior Consultant Cardiothoracic Surgeon
Coimbatore 641018, Tamilnadu, INDIA
Phone : +91 94875 78267, 98940 59169
Web : www.skvarma.com
A Cardiothoracic Surgeon
Is a specialist in the treatment of diseases of organs in the chest (thorax), namely the heart, lungs, major blood vessels and the spaces in between them – the mediastinum. These diseases in many cases would need surgical intervention and this is the cardiothoracic surgeons forte. Cardiac surgery (surgery involving the heart) vascular surgery (surgery involving the major blood vessels) and general thoracic surgery (involving the lungs & mediastinum) are subspecialities within the broader realm of cardiothoracic surgery.
History of Cardiac Surgery
Cardiothoracic Surgery, (the field of medicine that deals with surgical treatment of the organs inside the chest) is a relatively recent sub-speciality. Surgical procedures on the human heart were unsuccessful for many years and did not develop in a big way because the constantly beating heart could not be stopped for more than 3 minutes without loss of life. Operations in the earlier days were only those that could be done on the thin covering around the heart (pericardium) without stopping the heart. The first procedure on the heart itself was performed by Axel Cappelen in 1895. He tied off a bleeding coronary artery in a young man who had been stabbed in the chest. His early postoperative period was uneventful but he died later due to fulminant mediastinitis (infection of the spaces around the heart). The first successful operation on the heart, without any complications, was performed by Dr. Ludwig Rehn in 1896. He repaired a stab wound of the right ventricle. Surgery of great vessels (aortic coarctation repair, Blalock-Taussig shunt creations, interruption of patent ductus arteriosus etc), became common as expertise gradually grew. In 1925 Henry Souttar successfully dilated a stenotic mitral valve in a young woman with mitral stenosis. But Souttar’colleagues at that time decided the procedure was too risky and not justified, and he therefore could not continue his path breaking work. In 1947 Thomas Holmes Sellors operated on a young child with Fallot’s Tetralogy and successfully dilated the stenosed pulmonary valve and right ventricular outflow tract. In 1948, Lord Russell Brock, used a special dilator to widen the pulmonary valve in three patients with severe pulmonary valve stenosis.
The technology to safely stop the heart by linking the circulation to a heart lung machine (cardiopulmonary bypass) was a milestone in history. This technology was first successfully demonstrated by John Gibbon in 1953. It was after the introduction of safe cardiopulmonary bypass that cardiothoracic surgery advanced rapidly. Today, the most commonly performed operation on the heart is the coronary artery bypass graft (CABG), also known as "bypass surgery." In this procedure, vessels from elsewhere in the patient's body are harvested and grafted (sewn together) on to the coronary arteries to bypass blockages and improve the blood supply to the heart muscle.