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Ann Thorac Surg 2001;72:317-318
© 2001 The Society of Thoracic Surgeons
e-mail: actisdato{at}libero.it
e-mail: actisdato{at}hotmail.com
To the Editor
It was a real pleasure to read the letter to the editor by Igor E. Konstantinov from Rochester and Vladimir V. Alexi-Meskishvili from Berlin regarding our original work in cavopulmonary bidirectional shunt [1]. As a pioneer in cardiac surgery (my first report in this field was in October 1949 regarding the opportunity to organize a modern center to study and treat cardiac malformations) [2], I completely agree with the comment of Konstantinov that "... the firsts also have their own predecessors."
It should be of some interest that during the 1950s and 1960s the Alfred Blalock Cardiac Center of Turin was a referral center for the surgical treatment of both congenital and adult cardiac disease in Italy. Thanks to my teacher, Achille Mario Dogliotti, an intensive scientific collaboration with many other centers in Europe and outside was started. In particular a significant cooperation with the Russian team of Professor Bakulev permitted all of us a unique intermediary experience during the Cold War between Russia and US. Professor Bakulev was invited to Turin in 1957 for the International Medico-Surgical Symposium and reported the initial Russian experience of 32 patients with cyanotic cardiac disease operated with a termino-terminal anastomosis between the superior cava and right pulmonary artery. Mortality was high (9/32) because of hemorrhage and cerebral accidents. In 1959 Dogliotti was in Moscow to receive the Russian Academy Appointment. Later, during the Congress of the International College of Surgeons held in Rome in May 1960, Bakulev reported 100 more patients operated on with the same technique and with better results in mortality and morbidity. Moreover, regarding the bidirectional cavopulmonary shunt, I can remember an informal communication from the same Bakulev on experimental works by an unknown Russian researcher, to anastomose the superior cava to the right pulmonary artery and the inferior cava to the left pulmonary artery to obtain a complete exclusion of the right heart. I really do not know if this experimental work was published or where, but I can certainly say that this idea was collected and "digested" by our group. Since this date have we operated on patients with tetralogy of Fallot, tricuspid atresia, or Ebstein’s anomaly with the so-called "Bakulev procedure." In one case a bidirectional anastomosis was successfully done on February 8, 1961, on a 16-year-old boy with tetralogy of Fallot, Corvisart variety (Fig 1) [3]. The patient after 39 years is in good clinical condition and did not undergo later a radical correction of his malformation.
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Finally I would only add a brief communication regarding the 50th anniversary of the first surgical procedure to correct a cardiac disease performed in Italy. This was on a 12-year-old girl with a Fallot’s tetralogy who received a modified Blalock-Taussig shunt using a saphenous graft from her mother on March 2, 1950 [4]. She is still alive and did not undergo any radical correction later. In this context I think that it should be of some interest that to be the first in performing some surgical procedure can of course be a matter of pride; but more than this was the certainty to have made, during the long period of 50 years, our work in the best way to alleviate some human pain.
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