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Heart Diseases

The Open Heart

For most of medical history, the heart was seen as untouchable, limited by the difficulty of operating on the organ that kept the body alive. An 1896 book about chest surgery by Stephen Paget noted that "surgery of the heart has probably reached the limits set by nature to all surgery." But even as Paget cautioned doctors against trying unproven surgery on the heart, the effort was already being made. In 1882, German physician M. H. Block described his successful suturing of rabbit hearts, and by 1896, German physician Ludwig Rehn successfully repaired a lacerated heart using sutures.

Obstacles to more ambitious heart surgery took some time to overcome. High death rates marked a series of operations performed in the 1920s to correct mitral stenosis, the narrowing of the area where the mitral valve is located. One of the first successful operations was the 1939 operation on a child by Robert Gross of Boston to correct patent ductus arteriosus, an abnormality in which the circulatory pattern used by the fetus is not converted over to the type of circulation necessary for survival outside of the womb.

New types of surgery were made possible with a series of technological advances. In 1934, the American John H. Gibbon developed a machine that allowed the heart to stop beating during surgery while the blood was oxygenated outside the body. Gibbon spent nearly 20 years testing the machine on animals. In 1953, Gibbon became the first surgeon to operate on an open heart when he repaired an 18-year-old girl's atrial septal defect.

With new access to the heart, the treatment of heart disease changed dramatically. The development of the first electric pacemaker in 1950 enabled doctors to correct many arrhythmias and numerous types of heart block. In 1992, a total of 113,000 pacemakers were implanted in the United States, according to the American Heart Association.

A significant change in the treatment of coronary heart disease was the development of coronary bypass surgery in 1967 in the United States. The surgery uses blood vessels taken from elsewhere in the body, often the leg, to pass around diseased tissue. In 1992, about 468,000 coronary artery bypass grafts were performed in the United States, according to the AHA.

Another commonly performed procedure for individuals with coronary heart disease is angioplasty, during which narrowed arteries are stretched to enable blood to flow more easily. The surgery involves threading a tube through the body and stretching the artery by using a plastic balloon that is inflated when the tube is in the coronary artery. A total of 399,000 angioplasty procedures were performed in 1992, according to the AHA.

The most dramatic change in treatment of heart disease was the development of methods to replace the most damaged hearts with healthy human hearts or even animal hearts. The first successful human heart transplant was performed by South African surgeon Christiaan Barnard in 1967. The patient, however, died in 18 days. Though many surgeons tried the operation, success was limited, most patients dying after days or months, until the early 1980s, when effective drugs were developed to fight organ rejection. By 1993, a total of 2,300 heart transplants were performed in the United States, where the one-year survival rate is 81.6%, according to the AHA.


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Science EncyclopediaScience & Philosophy: Habit memory: to HeterodontHeart Diseases - Early Knowledge, The Middle Ages, The Artful Heart, Explosion Of Knowledge, The Critical Arteries