Cardiac surgery:a brief history心脏外科简史Possibly some of the greatest achievements in medical science have been those made in cardiac surgery.The first successful example was carried out in 1896 by Dr Ludwig Rehn(Germany),who repaired a stab wound to the right ventricle,Open-heart surgery itself dates form the 1950s,while bypass operations began in the mid-60s. By the 1980s,two-thirds of those receiving heart transplants survived five years or more.Today,heart surgery is robotized:incisions to the heart have been reduced to a minimum and patient recovery time is down from six months to a few weeks.也许医学上最伟大的成就是在心脏外科。
第一个成功的例子是Ludwig Rehn博士（德国）在1896年修补了右心室的刀伤，心脏手术本身始于上世纪50年代，而旁路手术开始于60年代中期。
上个世纪80年代，那些接受心脏移植的人三分之二存活五年以上。
今天，心脏手术已经机械化：切口心脏被减少到最低限度，病人恢复时间从六个月减少到几周。
One of the first pioneers in the field of cardiac surgery was Dr Dwight Harken,a US army medic serving during World WAR 2.Initially,he operated on animals to improve his skills,moving on to soldiers arriving from the European front with bullets lodged in their hearts.Dislodging them almost always proved fatal,but Harken developed a technique that enable him to cut into the wall of a still beating heart and successfully remove it.With time,more and more of his patients began to survive,proving it was indeed possible to operate on the human heart.其中一个在心脏外科领域的鼻祖是Dwight Harken博士，在2次世界大战期间的一个美国陆军军医。
最初，他在动物身上做手术来提高自己的技能，后来在那些从欧洲前线回来心脏被子弹打中的士兵身上做手术。
虽然这几乎总是致命的，但Harken提出了一个使他能进入一颗仍在跳动的心脏的壁，并成功地将子弹移除的技术。
随着时间的推移，越来越多的病人活下来了，证明了确实有可能对人的心脏进行手术。
Closed-heart surgery was the next stage in the development of cardiac surgery.Closed-or “blind”-heart surgery meant that the hart did not have to be cut open and then closed up again.It was accomplished by passing either a finger or a knife into the mitral value through an incision in the left atrium in order to remove tissue.Following initial disastrous attempts,Harken’s technique was gradually improved upon,and eventually the procedure was made safe.Hospitals across the would begin using the technique.闭式心脏手术是下一个发展阶段的心脏手术。
闭上的或者说“瞎子”心脏手术意味着心脏没有被切开，然后封闭起来。
他是通过在左心房的一个能够通过一个手指或者刀子的进入二尖瓣的切口完成的，以切除组织。
最初的灾难性的尝试，Harken的技术逐渐得到改善，最终程序变得安全。
全球的医院开始使用该技术。
However,there was still a critical issue to be resolved if cardiac surgery was to develop any further.Surgeons had to be able to work on the open heart without the patient bleeding to death.Stopping the circulation temporarily would give doctors just four minutes to carry out their intervention;however,the subsequent deprivation of oxygen to the brain would be critical,resulting in brain damage.Canadian surgeon Bill Bigelow set about finding a solution.Experimenting on dogs,he was able to show that by bringing down the patient’s body temperature,the body and the brain reduced level of oxygenated blood.This was known as the ‘hypothermic approach’.然而，如果心脏手术需要进一步发展，仍有一个关键的问题需要解决。
外科医生必须在心脏开放下工作，而不能使病人流血致死。
暂时停止循环会给医生们四分钟的时间进行干预；然而，随后大脑的氧气的剥夺是至关重要的，导致大脑损伤。
加拿大外科医生Bill Bigelow 着手寻找一个解决办法。
通过狗的实验，他能够表明，降低病人的体温，身体和大脑对充氧血的需求水平会降低。
这就是所谓的“低温疗法”。
In 1952,open-heart surgery was attempted for the very first time at the University of Minnesota.The operation,on a five-year-old girl born with a hole in the heart,was carried out by Dr Walton Lillehei and Dr John Lewis.First of all,her body temperature was reduced to 81°F.Secondary,for the ten minutes that followed,Lillehei and Lewis were able to stop the flow of blood,cut open her heart and sew up the hole.Finally,the little girl wan immersed in warm water an her body temperature brought back to normal.Her heart functioned properly for the first time.在1952年，在明尼苏达大学心脏手术被第一次尝试。
这台手术是对一个五岁的小女孩先天性在心脏出现一个大洞，是由Walton Lillehe博士和John Lewis博士进行。
首先，她的体温降到华氏81度。
接着，在接下来的十分钟里，Lillehei和Lewis可以阻止血液的流动，割开她的心脏并且缝上洞。
最后，小女孩沉在温水中，体温恢复正常。
她的心脏第一次正常运转。
But what could be done for patients whose hearts were diseased beyond repair and for whom the only solution was a new heart?Successful kidney transplants had been carried out in 1963,so why not the heart?In 1967 in South Africa,Dr Christiaan Barnard made the headlines when he transplanted the heart of a young woman into a middle-aged man.However,despite the use of drugs to suppress the rejection of the heart by the body,the patient subsequently died.但是对于那些心脏已经无法修复的病人来说该怎么办呢?唯一的解决办法是一颗新的心脏。
在1963年成功地进行了肾移植手术，那为什么不能是心脏呢？1967年在南非，克里斯琴·巴纳德博士成为头条新闻时，他把一个年轻的女人的心移植给了一个中年男人。
然而，尽管使用了抑制排斥反应的药物，病人的心后来还是死去了。
The complex problem of tissue rejection remained an issue throughout the 1970s.It was the discovery made by Dr Norman Shumway(USA) in the fjords of Norway that would revolutionize transplant surgery. Cyclosporine,found in fungus growing in the fjords,would soon be used in hospitals around the would to control organ rejection without cancelling out all resistance to infection.在上世纪70年代，组织排斥的复杂问题仍然是一个问题，。