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Ann Thorac Surg 2000;69:311-312
© 2000 The Society of Thoracic Surgeons

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Correspondence

Early Italian contributions to cavopulmonary shunt procedures

^a Thoracic and Cardiovascular Surgery, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA
^b German Heart Institute, Augustenburger Platz 1, Berlin, D-13353, Germany

e-mail: konstantinov.igor{at}mayo.edu
e-mail: alexi{at}dhzlo.de

To the Editor

We enjoyed reading the recent communication by Karl and Stellin [1] about Italian pioneers in cavopulmonary shunt procedures. The article is very timely. It gives due and well-deserved credit to individuals who displayed significant originality and determination in developing the concept of cavopulmonary shunting. They did not mention, however, the work of Dogliotti. It is also interesting to see how these early Italian contributions relate to the work of others. Thus, some comments seem to be appropriate.

It is always interesting to see how the same idea evolves in different groups, working independently and often unaware of each other’s efforts. It was undoubtedly Carlo A. Carlon, professor of Surgery at the University Medical School in Padua, who first described the concept of cavopulmonary shunt. The results of his experimental study on eight dogs were first published in 1950 in Italian [2]. However, independently from Carlon, the experimental cavopulmonary shunting was performed by Francis Robicsek in Hungary, Jose Patino and William Glenn in the US, and Tigran Darbinian and Nikolai Galankin in Russia in the early 1950s. It took a few years before the operation was applied clinically. The first clinical cavopulmonary shunt was performed independently by Evgenii Meshalkin on April 3, 1956, in Russia, by Glenn on July 17, 1958, and by Robicsek on January 9, 1959, in the US. On November 24, 1958, Bakulev and Kolesnikov submitted an article describing their clinical experience with 41 patients at The Institute of Thoracic Surgery in Moscow. Thus, by the beginning of 1960s, the unidirectional cavopulmonary shunt was extensively applied in clinical practice both in Europe and in America.

It is more difficult to say who was the first to extend this concept to a bidirectional shunt. However, the first clinical bidirectional cavopulmonary shunt was also performed in Italy and reported in 1961. This was done by Achille Mario Dogliotti in Turin [3]. After mentioning pioneering contributions of Carlon, Glenn and Patino, Schumacker, Robicsek, Galankin and Darbinian, and Bakulev, Dogliotti described 11 patients with cavopulmonary shunts, one of which was a bidirectional shunt (Fig 1). The bidirectional flow was demonstrated angiographically. To the best of our knowledge, this was the first clinical bidirectional shunt. Interestingly enough, Dogliotti transected the right pulmonary artery, attached both ends to the superior vena cava, and ligated the proximal superior vena cava. Independently from Dogliotti, Alex Haller and colleagues [4] in the US performed and reported the bidirectional shunt in 1964. They applied the technique, which is used by all surgeons today. Patino and Glenn used a temporary bidirectional shunt in their first experiments in 1950s, however, did not report the procedure at that time [5].

View larger version (26K): [in this window] [in a new window]   Fig 1. Dogliotti’s shunt. Reproduced with permission from Dogliotti AM, et al. L’intervento di anastomosi vena cava-arteria polmonare nella tetrade di Fallot e in altre cardiopatie. Minerva Cardioangiologica 1961;9:577–93.

It is always difficult for all of us to judge who was the first. In surgery, it often occurs that the firsts also have their own predecessors. The pioneering contributions of many surgeons are inseparably connected. Each of them contributed something original and precious to the total sum of our modern knowledge. The only fact that we can state with all confidence is that Italian surgeons have good reason to be proud of their heritage.

References

1. Karl T.R., Stellin G. Early Italian contributions to cavopulmonary shunt surgery. Ann Thorac Surg 1999;67:1175.[Free Full Text]
2. Carlon C.A., Mondini P.G., de Marchi R. Su una nuova anastomosi vasale per la terapia chirurgica di alcuni vizi cardiovasculari. Ital Chir 1950;6:760-765.
3. Dogliotti A.M., Actis-Dato A., Venere G., Tarquini A. L’intervento di anastomosi vena cava - arteria polmonare nella tetrade di Fallot e in altre cardiopatie. Minerva Cardioangiol 1961;9:577-593.
4. Haller J.A., Adkins J.C., Rauenhorst J. Total bypass of the superior vena cava into both lungs. Surg Forum 1964;15:264-265.
5. Glenn W.W.L. A temporary bidirectional superior vena cava-pulmonary artery shunt. J Thorac Cardiovasc Surg 1997;114:1123-1124.[Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Igor E. Konstantinov Vladimir V. Alexi-Meskishvili Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Konstantinov, I. E. Articles by Alexi-Meskishvili, V. V. Search for Related Content PubMed PubMed Citation Articles by Konstantinov, I. E. Articles by Alexi-Meskishvili, V. V.