Early historical innovations in Mitral Valve Surgery beginning at the Johns Hopkins Hospital

MO072 

Abstract Submission 

Emily Rodriguez (1), Jin Kook Kang (2), Diane Alejo (3), W. Randolph Chitwood (4), James Gammie (5)

(1) N/A, United States, (2) Johns Hopkins University School of Medicine, Baltimore, MD, (3) N/A, Baltimore, MD, (4) East Carolina University/ECU Health System, Greenville, NC, (5) Johns Hopkins Hospital, Stevenson, MD

Emily Rodriguez    -  Contact Me
N/A

Jin Kook Kang    -  Contact Me
Johns Hopkins University School of Medicine

Diane Alejo    -  Contact Me
N/A

*W. Randolph Chitwood    -  Contact Me
East Carolina University/ECU Health System

*James Gammie    -  Contact Me
Johns Hopkins Hospital

Emily Rodriguez    -  Contact Me
N/A

Objective: In 1896, Ludwig Rehn conducted the first cardiac surgery. Elliott Cutler performed the first successful mitral valve (MV) commissurotomy in 1923. The advancement of cardiac surgery in the 27 years between these two landmarks is not well known. The objective of this study was to investigate the development of mitral valve surgery (MVS) originating at the Johns Hopkins Hospital (JHH).
Methods: We conducted an analysis of the Chesney Medical Archives and early editions of the JHH Bulletin. A detailed literature search of MVS was made in the Lancet, Boston Medical and Surgical Journal, and Surgery, Gynecology & Obstetrics through 1920.
Results: In 1905, William Halsted recruited Harvey Cushing in 1905 to lead the Johns Hopkins Hunterian Laboratory, where he worked with residents to establish surgical treatments of MV disease. William MacCallum developed the first cardiac valvulotome and a novel dog model of mitral insufficiency via the first successful attempts to produce valvular lesions via direct exposure of the heart, in 1906. In the same year, Gladys Henry determined the preferred surgical approach to the anterior surface of the heart and achieved improved access to the posterior surface by sternotomy or left thoracotomy. She reported 25 canine experiments with a 44% survival rate. MacCallum showed a trans-apical left ventricular approach was preferable to the trans-auricular approach for accessing the MV due to decreased bleeding. Bertram Bernheim invented a needle for annular ligation, inserted via left thoracotomy, to develop the first animal model of mitral stenosis, conducting a trial of 30 animals, 33% recovering, all with mitral stenosis. He noted progressive annular constriction induced bradycardia, now linked to ischemia induced AV nodal block, a possible complication of MV annuloplasty repair. 14 years before Cutler's commissurotomy, Bernheim and MacCallum confirmed their approach for opening stenotic MVs, stating that "this is a point in favor of the future possible operation on man." After moving to the Peter Bent Brigham Hospital in 1915, Cushing trained Elliott Cutler, who performed the first successful valvulotomy, using the approach developed in the Hunterian Lab.
Conclusions: In the early years of JHH, individuals developed novel animal models, cardiac surgical tools, and surgical techniques that significantly contributed to the development of MVS, laying the groundwork for future advances in surgical therapy for MV disease.

Mitral Valve Education