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Ann Thorac Surg 2003;76:322-327
© 2003 The Society of Thoracic Surgeons

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Our surgical heritage

Surgery for atrial septal defect: from the first experiments to clinical practice

^a Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
^b Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Canada

^* Address reprint requests to Dr Alexi-Meskishvili, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
e-mail: alexi@dhzb.de

The first 300 words of the full text of this article appear below.

	Introduction

 

"A more detailed history of surgery will be of use to you only later, when you have gained more insight into the merit and fallacy of certain systems, methods, and operations."

Theodor Billroth [1]

The year 2002 marked the 50th anniversary of the world’s first successful open heart operation—closure of the atrial septal defect (ASD) by F. John Lewis.

After initial success with extracardiac operations, such as the correction of patent ductus arteriosus, coarctation of the aorta, and the Blalock-Taussig shunt, cardiac surgeons began to explore intracardiac operations. The ASD surgery, because of its relative simplicity, became a logical starting point. It is of interest that before 1934 among 62 recorded autopsy cases of ASD, only one had been diagnosed correctly during life [2]. In 1941, the world experience with ASD was limited to clinical diagnosis in a few patients [3]. No effective means were available to help these patients. Many surgeons, who also contributed greatly to the development of other fields of cardiac surgery, attempted ingenious operations on the atrial septum.

	The first experimental atrial septal defect creation

 
The first experimental effort to produce ASD appears to have been that of Ivan P. Dmitrieff of Moscow. He published the results of his study in 1925 in Russian and the following year in German [4]. In his experiments, Dmitrieff pushed two atrial appendages together against the septum with his fingers to detect an exact position of the fossa ovalis and then slid an instrument through the left atrial wall underneath the finger to perforate the atrial septum.

In 1948, Blalock and Hanlon described their method for ASD creation [5]. The operation, later referred to as a Blalock-Hanlon operation, was not only the first successful clinical intervention on the atrial septum, but also remained the only palliation for children with transposition of great vessels . . . [Full Text of this Article]

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				N. V. Vasilyev, J. F. Martinez, F. P. Freudenthal, Y. Suematsu, G. R. Marx, and P. J. del Nido Three-Dimensional Echo and Videocardioscopy-Guided Atrial Septal Defect Closure. Ann. Thorac. Surg., October 1, 2006; 82(4): 1322 - 1326. [Abstract] [Full Text] [PDF]