In 1628 the English Physician William Harvey who had been studying the blood and how it gets to other parts of the body figures out how blood circulates throughout the body from the heart. In 1706 the French anatomy professor Raymond de Vieussens first describes the structures of the hearts chambers and blood vessels.

In 1733 the English clergyman and scientist Stephen Hales is the first to measure blood pressure. In 1816 the French physician Rene T.H. Laennec invents the stethoscope which is used to listen to the heart sounds of the blood when the heart is in systole (contracts and pushes blood out) and when the heart is in diastole (when the heart refills with blood) and the sounds that the air in the lungs make (such as wheezing).

In 1903 the Dutch physiologist Willem Einthoven invents the electro-cardiograph that measures the electrical activity of the heart and it measures this heart activity and movement on a graph that shows lines in and upward, downward, and a straight line movement. In 1912 the American physician James B. Herrick first describes heart disease resulting from hardening of the arteries.

In 1907 John Cummings Munro wrote in the Annals of Surgery: Ligation of the ductus arteriosis. Munro was the first to suggest the feasibility of ligation of a patent ductus arteriosis.

In 1938 the American surgeon Robert Edward Gross performs the first heart surgery on a congenital heart defect called a patent ductus arteriosis (PDA). This is the beginning of heart surgery as we know it today.

Dr. Gross was born in Baltimore Maryland on July 2, 1905 and died on October 11, 1988. He is considered to be one of the greatest pioneers in heart surgery, cardiovascular surgery, pediatric surgery as well as general surgery. I was told recently that he was the first to do 45 different operations. Dr. Gross worked in pediatric surgery for more than 40 years at Children's Hospital in Boston Massachusettes.

From 1947 to 1966 Dr. Gross was the William E. Ladd Professor of Child Surgery at the Harvard Medical School and surgeon-in-chief at Children's Hospital in Boston. If you remember from our articles on esophageal atresia Dr. William Ladd is considered by most to be the father of pediatric surgery and had the first survivor in the world by the name of Millie Collins who was born with esophageal atresia and tracheoesophageal fistula. Dr. Gross was Dr. Ladds chief resident and they worked together for many years. Dr. Gross eventually filled the position of Dr. Ladd upon his retirement.

In 1938 Dr. Gross and a colleague who was a pediatrician Dr. John Hubbard worked in the laboratory on dogs and other animals as well as in the morgue (the room where they take the body of a person who has died and where they open the body to see what caused a persons death). This is how and where they figured out how to operate on a heart defect called a patent ductus arteriosis (PDA).

A patent ductus arteriosis (PDA) is a persistent connection between the aorta and the pulmonary artery that doesn't close when a baby is born and breathes on its own outside the mother. This connection between the aorta and the pulmonary artery is only normal when a baby is still in the mother. When a baby is still in the mother a baby cannot breathe on its own because the baby's lungs do not work and the baby breathes oxygen from the mother.

It is during this time while a baby is still in utero that the oxygen the baby breathes comes from the mother by this connection between the pulmonary artery, aorta, the umbilical chord and the placenta.

If this connection between the aorta and pulmonary artery persists after the birth of the baby one of problems that can occur is heart failure. This persistent connection of the pulmonary artery and the aorta is called a patent ductus arteriosis (PDA) and can cause too much blood to go to the baby's lungs and this also causes problems. There is a real risk of heart infection, endocarditis as well as death. It is in the best interest of the child to have this connection closed off no matter how small it may be.

When a baby is delivered and the umbilical chord connection between the mother and baby is cut the baby breathes oxygen on its own. During this time there are normal hormonal changes in the new born baby that are suppose to occur naturally and these hormones in the body are supposed to close of this connection between the pulmonary artery and the aorta naturally. With a patent ductus arteriosis (PDA) this does not happen. The word patent means: open. So there is a constant or persistent opening between the aorta and pulmonary artery.

The operation that Dr. Gross and associates developed was a way to ligate (tie off with thread) this persistent connection between the pulmonary artery and the aorta. Dr. Gross had asked Dr. Ladd if he would allow him to do this operation if he should have the opportunity. Dr. Ladd was firm in his manner of NO. We don't touch the heart.

Well, as the story goes and as I have been told by many surgeons that when Dr. Ladd went on vacation for a week the acting chief of surgery was now Dr. Thomas Lanman who had written extensively on babies born with esophageal atresia and operated on babies with esophageal atresia.

Dr. Lanman was approached by this young, brash and bold Dr. Gross and asked if he could operate on a patient who low and behold had a guess what? A PATENT DUCTUS ARTERIOSIS. Dr. Lanman gave his permission. On August 26, 1938 a 7 year old girl by the name of Lorraine Sweeney was brought to the operating room and was operated on for the heart defect called patent ductus arteriosis (PDA). Medical history was in the making if this little girl lived and medical history was made
because she lived being the first survivor in the world to survive an operation for a patent ductus arteriosis. Gross made medical history with his patient and assistant surgeon as well as the hospital.

Speaking with friends of Dr. Gross recently I was told that after the operation was done on Lorraine to close her PDA Dr. Gross and friends went out and by chance were at a restaurant that Dr. Ladd was at. Dr. Ladd came by and asked; Anything new, to which there was the reply No.
Lorraine was up and out of bed the very next day. Lorraine went home 10 days after surgery. Lorraine became the poster child for the American heart association and to this day when doctors meet her they want to have their picture taken with her. Lorraine went to visit Dr. Gross many times and the last time was when she was 58 years old and Dr. Gross said to her; you know Lorraine if you didn't survive I would have ended up being a farmer.

Dr. Gross went on to write about 11 others patients he operated on for the same heart defect patent ductus arteriosis (PDA) and did each operation the same way by tying off the patent ductus arteriosis (PDA). The twelfth patient he opearated on for a patent ductus arteriosis was a 14 year old girl who was also treated by tying off or ligating the patent ductus arteriosis (PDA). This girl was well after surgery and also at the time of discharge from the hospital. She went home and her family celebrated her birthday 2 weeks later at home. This girl was dancing with a friend at her birthday and she collapsed and died. At autopsy it was discovered that the ductus that was tied off had cut through the ductus and she hemorrhaged to death. Dr. Gross wrote that he never again tied of a patent ductus arteriosis (PDA).

Dr. Gross went on to write that all patients from then on whom he operated on for a patent ductus arteriosis (PDA) were surgically corrected by careful dissection and placing double clamps on the ductus and then cutting the ductus in half between the clamps and closing each half of the ductus by suturing it with thread or stitches. This became the standard operating room procedure that Dr. Gross used up until his final patent ductus arteriosis (PDA) operation that numbered one thousand six hundred ten (1610) in March of 1972.

The operation done today to close off the heart defect called a patent ductus arteriosis is by surgery the way Dr. Gross did it or by inserting specially designed coils that sit in the patent ductus arteriosis and expand it to where it prevents the flow of blood. Today this procedure is most often done in a heart catheterization lab at hospitals that specialize in heart problems. Drugs are also used to close the patent ductus arteriosis (PDA) such as prostaglandin and the use of another drug called Indomethacin if a PDA has not closed after a long time and a PDA is the only problem.

I had the wonderful opportunity to meet Lorraine in February of 2002. Lorraine came to my home with her sister and two other friends and brought a photo album of her life and the work she did with the American Heart Association with Dr. Gross, Dr. Paul Dudley White founder of the American Heart Association and Dr. Michael DeBakey. There is one great photo of her and Dr. Gross in the operating room where he did her operation back in 1938 and there is a heart model on the operating room table. There is another picture of her with a cake that she is holding in her hands in 1963 at the 25th anniversary of the American Heart Association. I took pictures of her and her family and took videos of her talking about her life and some of the pictures are on this site.

In premature infants patent ductus arteriosis is a common heart defect with increased pulmonary blood flow and a further compromising of gas exchange in an infant with respiratory distress syndrome (RSD).

With babies that are full term the persistent PDA is usually discovered at about 6 to 8 weeks of age. There is a heart murmur that is continuous in the upper left part of the chest called the sternal boarder. Blood pressure should be taken in the legs and the pulses in the groin called the femoral artery should be taken to rule out the possibility of another heart defect called coarctation of the aorta. There is a difference in blood pressure in the legs than in the arms if a baby has coarctation of the aorta.

When the pulse is taken you feel a pressure and a throbbing of an artery as blood is passing through it. This is the pressure in the heart pushing blood out called the systolic blood pressure and also the refilling of the heart with blood called the diastolic blood pressure. All arteries should throb, pulsate or beat at the same time with the same pressure and in sync with the beat of the heart. If this does not happen there is a problem in some part of the body and this is what will be challenging for the doctor to find.

The history of heart surgery, cardiovascular surgery, cardiothoracic surgery and the all the inventions to replace parts of the heart such as the mitral valve, to correct holes in the heart along with the heart lung machine or oxygenator, the extracorpeal machines, pacemakers and heart lung transplants and all of the doctors who made so many contributions beginning with Gross, Crafoord, Bailey, Lewis Harken, Gibbon, Varco, Lillehei, Gott, Cohen, Taufig, Kirklin, Dewal, Starr, Edwards and all of the others from around the world that I have not mentioned is just a miracle. There has been no time in history where so much was done in so little time to save so many people with so many problems. We are blessed to be born in a century where so much can be done to save peoples lives from so many different medical problems.