THE DEVELOPMENT OF HEART SURGERY IN HUNGARY

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP81-00280R000200130027-3
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 5
• Document Creation Date: December 22, 2016
• Document Release Date: April 11, 2011
• Sequence Number: 27
• Publication Date: November 15, 1956
• Content Type: REPORT

Sanitized Copy Approved for Release 2011/04/11: CIA-RDP81-0028OR000200130027-3
Amm~ rs w
 A Mar. ar Tudomany Tiz Eve
1945-1955 Ten Years of
Science in Hungary 1945-1959,
1955, Budapest, Pages 241-21+4
Heart surgery began toward the end of the past century with the
surgical treatment of heart damage. The first published account of
successful suturing of the heart was that of the operation performed
by Rehn in 1896 on a patient with a heart injury. Following this first
account, the number of similar surgical operations increased rapidly,
and surgeons throughout the world became bolder and more active in the
surgical treatment of various types of heart injuries. In addition to
suturing up acute heart injuries the final removal of foreign objects
from the heart also was undertaken. Hungarian doctors, such as
Genersich, Adam, Paulikovics, Muller, Fronius, Jakob, Bakay, Kiszty,
Racz, Bezsenyi, Schmidt, etc also had achieved notable success in this
field.
The successful treatment of heart injuries has saved the lives of
innumerable patients but perhaps what is more important, this branch of
surgery finally overcame the superstitious attitude which had reigned
among even the most outstanding surgeons that the heart must not be
tampered with, and that the heart was noli me tangere. In 1907 Kocher
wrote: "Even the heart, that restless and stubborn organ, could not
halt the advance of medical surgery, and thus the last organ of the
human body was conquered by the surgeon's knife."
However, there was no great progress in heart surgery during the
first decades of the century. Some attempts were made at the surgical
treatment of heart diseases, but were not very successful. During the
1920's several attempts were made at surgical treatment of certain dis-
eases affecting the heart valves, principally the Mitralis stencsis.
The unfavorable outcome of these operations and the 80% mortality rate
in such cases frightened the surgeons away from this type operation and
for a long time similar operations were not attempted.
Modern heart surgery, surgery of the large blood vessels and surgical
treatment of heart diseases began during the World War II period. The
first successful surgical closure of ductus Botalli persistens was
accomplished by Gross in 1939. This marked the beginning of a great
increase in research on the surgical treatment, extremely varied types
of congenital and acquired heart trouble, and now many thousands of
patients owe their lives and health to successful heart surgery.
Because of the disastrous effects of World War II, the field of
heart surgery got a late start in Hungary. First, the basic necessities
for the execution of heart surgery had to be acquired, such as equipment
for blood perfusion, the necessary machinery for intratracheal anestheti-
zation, etc. The first successful operation, the closure of a ductus
Botalli persistens, was performed on 15 June 1949. Thus, Hungary
lagged 10 years behind the leading foreign surgeons in this field. A
vi.Rorous attempt has been made during the past 5 years to make up this
lag.
The surgical treat-rent of congenital and acquired heart trouble
required first of all the introduction of several special diagnostic
procedures. The method of angiocardiography, which entails a series of
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successive x-ray photographs of the oath of intravenously injected
contrast material, requires; complicated and expensive machinery. Un-
fortunately, this machinery still is not available in Hun,,ary. Never-
theless, due primarily to the basic work of Fono, an,giocardiography
has become routine diagnostic method. Although the primitive equipment
which -rust be used in this procedure does not equal the performance of
the latest automatic instruments it does enable the taking of photo-
graphs which are very helpful in diagnosis.
Another diagnostic method is the heart catheter method, which was
introduced in Hungary by Halmagyi and Robicsek. Although this method
was first thought to be too dangerous and was the subject of much debate
it has now become a routine procedure. This method has enabled deep
insight into the haemodynamics of both congenital and acquired vitia,
into the problem of the blood pressure in the individual cha:,.bers of
the heart and in the shunts between various parts of the heart, etc.
Intratracheal anesthetization, which has been completely modernized
in all respects and which, when supplemented with curare is the only
method which can be used for the performance of certain heart operations,
has been perfected to its present level chiefly through the work of
Keszler and Palos. Several hundred heart operations have been performed
in Hungary without a sj.ngle death due to anesthetization.
Hypothermic surgery is coming into increased use in heart operations
in Hungary, especially in cases involving congenital heart trouble. The
task and the responsibility of the anesthesiologist is much greater in
such cases because he controls the entire complex operation and employs
many instruments for the maintenance of the basic life processes of the
organism during the sr.rgery. After a long struggle anesthesiology finally
is developing into an independent science and is beginning to occupy a
suitable place in the field of science.
The increase in experimental work in the field of heart surgery has
paralleled, and in many instances has preceded the development of
clinical work; Robicsek, Temesvari, Kudasz, Ludvan, Petri, et al. have
attained numerous achievenents in the field of pathology of the heart,
some of which have been acknowledged abroad. Hungarian internal
medicine specialists such as Kunos, Halmagyi, Hamori et al. also par-
ticipated in this excellent work.
In addition to research on problems of circulation hundreds of
experiments in heart surgery on animals have resulted in the amassing of
experience on the technique by which the walls of the heart, that
eternally moving organ, can be opened and sutured up and surgeons have
become accustomed and, so to speak, have made friends with the heart.
Even though these experiments have not eliminated the anxiety accompanying
the first human heart operation of a surgeon (which still is felt on the
occasion of each and every operation) they have greatly contributed to
confidence in the surgical treatment of the human heart.
In contrast to the very few cases of congenital heart trouble in which
surgery was recoanended during the early days of heart surgery, a series
of surgical me-sures now are available for the surgical treatment of both
congenital and acquired heart conditions.
The surgical closure if an unclosed ductus Botalli now is con-
sidered a minor operation the mortality of which is less than one-half
of one percent. In contrast to the angiocardiography, aortography and
heart catheter examinations which originally hod been perforated and the
finger-thick duct still hardly could be found during the surgery, at
 :-Tsent
basis of a simple physical exarrL.nation and the surgical operation tike,
less than one-half hour.
Following the introduction of the Blalock operation the surrical
treatment of the Fallot tetrology was solved. any children, and even
many acults owe their lives, the fact that they may go to school or may
work, ray move about freely, and the fact that instead of a life of
misery they can join in the work of the community, to this operation.
it is a Joy to see the children, and especially the parents who are very
enthusiastic over the results of this operation, and who can hardly
believe that a burden was lifted from their shoulders, a burden which
they hrd believe they would have to bear for a lifetime.
Hoti?.e%er, along, with its outstanding benefits the Blalock ape ration,
which represents a rreat advance in the field of heart surgery, also
has its oHn peculiar disadvantages. The subclavia-pulrnonrlis anastomosis
is a long and exhausting operation, and in addition it increases the
number of defects of the post-operative heart. For this reason various
attempts are being made in Hungary and throughout the world, at the
development of a surgical procedure for resolution of the stricture which
will replace the pulmonalis stricture anastomosis operation. Although
work along this line has only begun recently significant results have
been achieved with many patients with a special direct surgical operation.
The stricture of the pulmonalis valve has only recently been
recognized as an independent, congenital heart defect. For the surgical
treatment of this condition Robicsek has developed a valvulotome which
is much better than the foreign instruments. The stricture may be
resolved b a sintle movement of this instrument inserted through a
small incision in the wall of the right ventricle. The patients endure
this operation which takes less than 1/2 hour very well, and the degree
of recovery has exceeded all expectations. The patients, who previously
frequently had been completely restricted to bed, are up and about and
quite lively within a few weeks, and their cyanotic condition is replaced
with healthy, rosy cheeks. The children begin rapid development, grow
up and are no longer excluded from the play and enjoyments of their
companions.
Eisert performed the first coarctatio aortae in Hungary in 1951.
This operation also is now performed in relatively large numbers and
usually is concluded within 3 hours, compared to the first operation,
which took 7-1/4 hours. Resection of the aorta and anastomosis of the
2 vessel ends, which once was considered an heroic undertaking, no
longer is one of the most serious operations in the field of heart
surs-ery.
The greatest achievement in the field of the treatment of acquired
heart trouble is the surgical treatment of mitralis stenosis. The first
such operation in Hungary was performed by Eisert in 1951. This surgical
operation gained widespread use very slowly because most of the internal
medicine specialists justly would have preferred that only approximately
one ou'. of 10 patients necessitate this type of surgical intervention.
However, after the first few successful cases were known this justifiable
lack of confidence disappeared and at present, when the number of
operations has passed the 200 mark, the list of patients to receive this
operation requires that reservations be wade several months in advance.
The number of such operations performed in Hungary is surpassed only by
the number of operations performed in the world's largest medical
centers, and the fatality rate of this operation in Hungary is better
than at the latter centers. The surgical treatment of stenosis of the
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ritral valve has become an accepted, widely used operation in Hungary,
even more so than in many large countries.
In the field of acquired heart trouble, only initial results have
been achieved in Hungary in the surgical treatment of coronary sclerosis.
Te7nesvari and Petri have done experimental work in the comparison of the
effects of the various available surgical operations for the revasculari-
zation of heart -uscle. On the basis of these experimental results
Tenesvari initiated the use of magnesium silicate distributed within
the pericardial chamber during the cardio-pericardiopexia operation.
The initial results of this method have been encouraging.
On the basis of the foregoing it is the belief of the present author
that it can be confidently asserted that Hungarian heart surgery has
within the past 5 years made up for the retardation of the 10 years
following World War II. This viewpoint is supported by the fact that
many outstanding, surgeons, representing 9 countries, have visited
Hungary in order to gain surgical experience. Another indication of
the reputation which Hungarian heart surgery enjoys abroad is the fact
th^t several patients have been sent to Hungary from the People's
Democracies for surgical operations.
After the first steps were taken and the first achievements had
become known the Hungarian Academy of Sciences and the Ministry of
Health came to the aid of the field of heart surgery through providing
the financial and material means necessary for this very difficult and
highly responsible work. In addition to the official requirements a great
deal of aid was received from extremely varied institutions, also. The
Ministry of M.etallurg and Machine Industry especially considered it
to be very important to supply Hungarian heart surgery with the adequate
instru-ents, and set up an experir..ental shop for that purpose which has
been of inestimable value. All this obligates the Hungarian surgeons
engaged in heart surgery to match these efforts with similar enthusiasm,
to aid in the establishment of new heart surgery centers in addition to
the well-functioning Budapest and Pecs centers (the first steps for the
formation of such centers in Szeged and Eger already have been taken),
so that Hungary may achieve even greater glory in this, one of the most
vital fields of medical science.