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Cardiac Surgery

Treating penetrating chest injuries sustained during war demonstrated that the heart was not, as once thought, untouchable. However, formal cardiac surgery was only established after key advances in blood transfusion and anaesthesia. Arthur Hollman worked alongside Professor Denis Melrose and other surgeons in the operating theatres at the Hammersmith Hospital and was closely involved in the pioneering development of open heart surgery. Interestingly, he was appointed archivist by Mr John Parker, the first and only cardiac surgeon to be president of BCS.

 

The first closed mitral valvotomies for mitral valve stenosis were carried out in the 1920’s and one of the earliest successful operations was performed in London by Henry Souttar. However it was surgery on vessels outside the heart that led the way. In 1938, Robert Gross in the USA, performed the first successful ligation of a patent ductus arteriosus. In 1944, Alfred Blalock performed the first subclavian and pulmonary artery anastomosis for Fallot’s tetralogy.

 

This catalysed a rise in surgery for congenital heart disease, which in Britain was pioneered by Oswald Tubbs at St Bartholomew’s and Russell Brock at Guys Hospital, London. The Peacock Club was formed in 1948 by Brock to discuss all aspects of management of congenital heart disease.

 

Image References

The Peacock Club minutes book. Formed in 1948 by Lord Russell Brock to discuss management of congenital heart disease. Notable BC5 members included Maurice Campbell, Ian Hill (one of the first surgical members) and Frances Gardner an early female member. The original bound minutes of the Peacock Club, donated and transcribed by Professor Tom Treasure are a unique and important document in the history of cardiac surgery and cardiology.

 

Blalock clamps, 1945. The Blalock-Taussig procedure (subclavian to pulmonary artery anastomosis) was used to palliate Fallot’s Tetralogy.

 

Henry Swan, in Denver, pioneered open heart surgery using an ice-bath to lower the metabolic demands of the tissues so that the circulation could be stopped for up to 15 minutes. Thomas Holmes Sellors, affectionately known by colleagues as ‘Uncle Tom’, was the reputed master of operating on patients under hypothermia.

 

He reported several hundred cases of atrial septal defect closure and performed the first direct operation for the relief of pulmonary stenosis.

 

The invention of the heart lung machine in 1955 made it possible to conduct much longer open heart operations. Surgeons initially focused on acquired valve disease and congenital defects but once coronary anatomy could be defined by angiography, surgical revascularisation procedures became common place.

 

The difficult challenge of protecting the myocadium during bypass was largely overcome when Mark Baimbridge and David Hearse at St Thomas’s, London developed chemical cardioplegia in the 1970s.

 

 

Image References

Sir Thomas Holmes Sellors (1902-1987) performed the first pulmonary valvotomy in the world at Harefield Hospital in 1947. He closed over 250 atrial septal defects under hypothermia at the Middlesex Hospital. Seen here in his robes as President of the Royal College of Surgeons of England.

 

A set of pulmonary valvotomes, 1950. Designed and used by Thomas Holmes Sellors.

 

Aortic punch. Used to create an opening in the wall of the aorta for coronary by-pass or other vessel anastomoses.

 

Artistic sculpture of an atrial septal defect presented to Sir Thomas Holmes Sellors by his theatre staff at the National Heart Hospital.

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