Open hearts. The origins of direct-vision intracardiac surgery.

Only 50 years ago, operating under direct vision within the walls of the living human heart appeared to be a surgical problem with no great hope of solution. However, technologic advances soon provided the necessary tools, and a safe, reliable, and practical technique of performing surgery within the open heart evolved in a series of stages. First, W.G. Bigelow espoused applied hypothermia as a means of protecting the vital organs during direct cardiac repair--a technique that F.J. Lewis then applied in correcting an atrial septal defect under direct vision. This was followed by C.W. Lillehei's introduction and application of controlled cross-circulation, which enabled the correction of more complex cardiac lesions. Finally, the efforts of J.H. Gibbon and J.W. Kirklin led to the creation of a reliable cardiopulmonary bypass apparatus, which enabled the many subsequent achievements well recognized in the history of surgery.