HISTORY OF THE CATALAN CARDIAC SURGERY 2.
Specialization in surgery When
surgery was limited to a specific number of techniques, a single person
could be acquainted with them and carry them out correctly. When the
number of surgical techniques and their sophistication began to increase,
the surgeons specialization became more necessary. According
to Moisès Broggi, A.Trias Pujol was the great creator of
surgery specialization in Catalonia. At the end of the thirties, Trias
established several sections in his General Surgery Chair, with people
especially prepared and with expertise in the different specialized
fields, under the hegemonious control of the general surgeon. These
surgeons would later become the first specialists(7). With
the advent of cardiac surgery a certain conflict raised between the
classical general surgeons and the pioneer cardiac surgeons. General
surgeons would dare to operate anything; however, surgical incision on
the heart required not only the application of anesthesia and asepsis,
but also a better knowledge of cardiac pathology. Cardiac
surgery specialization in Catalonia was done via two paths: on the one
hand, by thoracic or vascular surgeons who later specialized in cardiac
surgery and learned cardiology, and on the other, surgeons who directly
specialized in cardiac surgery. The
development of cardiac surgery has been parallel to the perfection and
development of modern anesthesia methods. Cardiac surgery in Catalonia
has closely wed world progress in this field, overcoming the
difficulties of financially insufficient and non-technified hospital
medicine. The first catalan surgeons who acted on the heart were general surgeons, especially those with experience in thoracic surgery. Spurred-on by the first results obtained in cardiac surgery and its spectacularity, some surgeons carried it out spontaneously. Others like Caralps Masó, practiced it more frequently, attaining great professional success. In
the process of coming evermore closer to the heart, the first cardiac
operations were done on the pericardium. The first pericardiectomy done
in Barcelona was carried out by Caralps Masó in June 1936 on a
patient of Codina Altés with constrictive pericarditis(8). This
operation continued to be successfully practiced during the following
years(9,10). Operations on the heart began to take place in Catalonia in the fifties. The surgeon who did the first mitral commissurotomy in Catalonia was Valls Serra, who practiced it on October 25th,1952 in Barcelona(11,12). Another catalan surgical landmark was the first closure of a persistent ductus arteriosus by Soler Roig on July 23rd,1947(13) applying the technique he had learned in London. Arandes(14) and Piulachs(15-17), professors at the Medical School of Barcelona, also tried doing cardiac surgery but the results obtained made them desist. At this time, Caralps Masó stood out for his work as a cardiac surgeon. He was the first among us to practice the Blalock operation on Fallot's Tetralogy. This consisted of an anastomosis of the subclavian artery with the pulmonary artery, with the aim of alleviating the stenosis of the pulmonary artery(18). He also successfully did mitral commissurotomy(19) one of the most widespread operations in these early years of cardiac surgery. Of all surgeons, only Caralps specialized in cardiac surgery. He continued to practice it during all his professional life, also doing experimental cardiac surgery in a continuous way with his son Josep M. Also outstanding is that J.Paravisini did the correcting surgery of an aortic coarctation for the first time in Spain on March 17th, 1955(20). |
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