Saturday, July 11, 2009

Lets continue the fascinating journey into pediatric cardiology. Last time we saw the origin of first description of the future Tetralogy of Fallot.

William Harvey was probably the first to suggest the possibility of coronary circulation, which he mentioned in a letter to his friend, Jean Riolan, who was an acclaimed physician of his times. This led to dissection studies of coronaries by Riolan and he confirmed the same findings as his predecessor, Gabrielle Fallopius.

(Ref: Bing RJ. Coronary circulation and cardiac metabolism. In Fishman AP, Richards DW (eds): Circulation of the Blood: Men and Ideas. Bethesda: American Physiological Society, 1982, p214.)

In AD 1698, another Frenchman, Pierre Chirac, ligated the coronary vessel of a dog to produce cardiac standstill. This revived the interest in coronary anatomy. In AD 1704, Frederik Ruysch elucidated the anatomy of coronary vessels by using a special injection technique.

(Ref: Willius FA, Dry TJ. A History of the Heart and the Circulation. Philadelphia, W.B. Saunders Company, 1948, p 66)

In AD 1715, Raymond Vieussens gave his landmark description of mitral stenosis. In his book, Traite' nouveau de la structure et des causes du mouvement natural du coeur, he reported the clinical course of many patients suffering from heart disease, along with the postmortem findings. The same book contains his famous description of the internal surface of the left ventricle and the malfunctioning mitral valve. His views were seconded by Giovanni Lancisi, another noted physician of his times, who authored “De motu cordis et aneurysmatibus” in AD 1728.

(Ref: Kellett CE. Raymond de Vieussens on mitral stenosis. Br Heart J 1959; 21:440-444)

The year AD 1749 is considered as a memorable one for medical historians, more so from cardiac point of view. A book titled “Traite de la structure du coeur, de son action, et de ses maladies” was published, which systematically dealt with anatomy, physiology and pathology of the heart. It offered the results of anatomical investigations and postmortem examinations, which hitherto was unheard of. The treatise was authored by a Frenchman named Jean-Baptiste Senac. His work reveals the state of the art in cardiology before the development of percussion of the chest and auscultation.

(Ref: Smeaton WA. Senac, Jean Baptiste. In Gillispie CC (ed): Dictionary of Scientific Biography, vol. 12. NewYork, Charles Scribner's Sons, 1975)

In AD 1761, one of the greatest books on medical literature was published. It was titled “De sedibus et causis morborum per anatomen indagatis” and was authored by Giovanni Morgagni (remember Morgagnian Hernia?) who vividly described a ventricular septal defect and Single ventricle in his treatise. Historically, it was the first time these lesions were described authentically.

(Ref: Morgagni GB. De Sedibus ei Causis Morborum per Anatomen Indagates, Venetia:Remondiniana, vol 1 and 2, 1761)

In the same year, clinical cardiology saw a major turn of event, which is practical even for today. Physicians prior to this era relied on their sense of touch, sight or smell to diagnose diseases. Leopold Auenbrugger suggested the use of percussion of internal organs to further aid the clinical diagnosis. He called his system “Inventum Novum” (Novel invention). The skill of percussion was further refined by Corvisart and applied firmly to clinical evaluation. Laennac’s invention of stethoscope in AD 1819 completed the basic tools of clinical diagnosis.

(Ref: Osler W. The evolution of modern medicine. Yale; Yale University Press:1921)

We shall see the further developments next time.

On the personal note, it was a matter of pain to relieve Dr Pankaj and Dr Ritesh from their services to the team. They have successfully completed their fellowship training and are leaving for next stage of career in Pediatric Cardiology. We all wish them best of good luck for their future.

The week went quite busy, with many falling sick! Changes of season with a fresh leash of viral attacks have troubled us a bit. Academics were usual. I happened to see a {S,L,S} with single ventricle physiology! Is it reported? Can anyone come with some more data on this?

I need more followers and replies. Hope I get them!




  1. Nice Blog Kiran. I stumbled upon this searching for an answer to a particular question which I felt I would share with your readers. I am from the U.S. We have a patient with Tricuspid atresia and absent pulmonary valve, stable on PGE. There are very few reports of this in the literature and there is no standard of care or surgical intervention specific to this lesion besides shunting of some sort. Have you any experience with this?

  2. Hi

    Thanks for writing. I would have been happier if the message came with the name of the person!
    I understand that you are indeed facing a rare case scenario. Not much literature available on this.
    I discussed the scenario with the team. Our suggestion is to convert the situation to Tricuspid Atresia type A by closing the main pulmonary artery and creating a BT shunt.
    As the baby is still an infant, the pulmonary arteries may regress in size in future, so that a Fontan repair may ensue.
    However, the data is incomplete. If you have got any more data on the status of pulmonary arteries, we would be interested to know. Otherwise, a CT scan for PAs may be helpful.
    Sorry for the delay in reply. I just happened to see your response yesterday. As I dont get a response generally, I am not used to seeing!!
    If we can be of use at any other occasion, you can also send the details to my email id. Also, we would be happy if we can know further details about you.
    Thanks for the response again.