Sunday, July 5, 2009

In our voyage on History of Pediatric Cardiology, it is time to dwell upon the contributions of 16th century Europeans.

In AD 1578 was born a man who changed the way Cardiology should be understood. He had the gift of seeing fallacies of traditional Galenic teachings as a medical student. His concepts were so powerful that he used simplest of the equipments to prove his point. A mere tourniquet was all he required. His name was William Harvey.
He demonstrated the centripetal flow of blood in the veins aided by venous valves. His concept of circulation was as we know it today, except that he could not establish what connected arterial and venous systems, which he tried till his death in AD 1657. His idea of blood being propelled by heart into arteries and returning back via veins was completed by Marcello Malpighi, who discovered capillaries in his frog experiments in AD 1660. Malpighi also found the reason for red colour of blood by demonstrating the red blood cells. Together, Harvey and Malpighi laid the foundation for modern physiology. It was further strengthened by the invention of microscope by Antoni van Leeuwenhoek in AD 1774. Leeuwenhoek also gave the first accurate description of red blood cells and their circulation in the capillary networks of frog’s web spaces and ears of rabbits.

(Ref: Harvey W. Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus. Frankfurt:W. Fitzeri, 1628)

There was a simultaneous interest in the anatomic defects of heart in Europe. Niels Stenson, who described the Stenson’s duct of salivry gland, was an accomplished anatomist of Europe. Also called Steno at his country, he reported an interesting case in 1673. In this stillborn infant, he described the combination of bifid sternum, omphalocele, in addition to the modern description of Fallot’s tetralogy. This combination is now termed pentalogy of Cantrell. He described the infant also having syndactyly and cleft palate with harelip on the right side. As an anatomist, his interest was primarily non-cardiac. About the cardiac abnormality he wrote, "As to the cause of this phenomenon, I have nothing to say.” This appears to be the first description of Tetralogy of Fallot in the history of Pediatric Cardiology.

(Ref: Warburg E. Niels Stensen’s description of first published case of Tetralogy of Fallot. Nord Med 1942;16:3550-3551)

We shall see the further descriptions of congenital heart diseases next time.

On a personal note, untimely death of MJ showed how heterogeneous our team is! There were few who mourned the day badly; few were blissfully ignorant of who he actually was! When we saw the news popping up everyday in the dailies even after a week, Dr Anamika Metha exclaimed that we, as doctors, are losing out lots of happenings in the world. She suggested that, once in a fortnight, gathering of the team should be for non-academic discussions, wherein anybody can discuss something that inspired them. It can be a movie, music album, book, news snippet, real life incident or anything of interest. It is indeed a nice concept and we should work on it. May be, alternate Saturdays are good time.

Dr Pankaj and Dr Ritesh had a good session of RGUHS fellowship theory examination on 1st July. The questions were as expected, with no real bouncers! Their practical exams are scheduled for 7th July at Sri Jayadeva Institute of Cardiology, Bangalore. Good luck to both of them.

Dr Amol Moray left the team back to Australia. He is due for his certification examination in Pediatric Cardiology. Good luck to him from all of us in the team.

We came across an intermediate AV Canal defect with supramitral membrane in an infant. The interatrial communication was distal to the membrane and the LA appendage was connected to proximal chamber. A rare combination indeed! Our surgeons are dealing with the child now.

I saw another infant with AV discordance, DORV, l-malposed great vessels, VSD with subpulmonic extension with severe PAH. VSD is routable to MPA but not to aorta. If we decide on 2-pump repair, we will have to route LV to MPA, do an arterial switch and an atrial switch. But MPA and ascending aorta had wide discrepancy in their diameters. I don’t know if such extensive surgery is good or bad for the baby. The other palliation may be a PA band.

Please send in your inputs. How about the non-academic sessions every fortnight that is planned? Send me your suggestions on it



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