Direct vision intracardiac surgery in man using a simple, disposable artificial oxygenator.

The successful curative treatment of many congenital malformations and acquired diseases of the heart requires an effective method for performing reparative surgery in the open heart under direct vision. The advent of controlled cross circulation as a successful method for totally by-passing the heart and lungs has demonstrated that intracardiac corrective surgery is both possible and feasible for certain of these congenital defects heretofore considered inoperable. This ability to carry out definitive reparative procedures inside the human heart under direct vision and at a reasonable risk has promised the early development of curative surgery for other congenital cardiac conditions as well as acquired diseases of the valves or coronary arteries which are not now curable by existing surgical techniques. The magnitude of these potential demands emphasizes the need for widely applicable techniques for maintenance of the patient's circulation during the by-pass interval. The essence of wide applicability is simplicity combined with effectiveness. The simple disposable artificial oxygenator herein described serves as a temporary replacement for the human lungs and appears to be a significant step forward in the fulfillment of these concepts of safety and wide applicability. This oxygenator has no moving parts, is assembled entirely from commercially available plastic tubing, and is sterilized by autoclaving. Oxygenation of the venous blood occurs by direct introduction of oxygen with coincident elimination of carbon dioxide. Because of its simplicity and the fact that the total cost of the component parts is only a few dollars, we have preferred to dispose of the oxygenator after each clinical use rather than to clean and re-use it. Seven seriously ill children have had intracardiac corrective operations utilizing this artificial oxygenator in combination with a simple pump for total by-pass of the heart and lungs. There were five successes and two deaths in this series of patients. All of the five survivors have been discharged from the hospital as normal children cured of their heart defects. Their preoperative malformations included ventricular septal defects, tetralogy of Fallot, and atrial septal defect with pulmonary hypertension.