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May 27, 2017
Pre CPB Charles Philamore Bailey

Charles Bailey (1910-1993)

The surgical treatment of mitral stenosis (mitral commissurotomy). Dis Chest, 1949, 15, 377-397

Charles Philamore Bailey
Portrait of Charles Philamore Bailey
Portrait of Charles Philamore Bailey
Cesalpino Andrea

During the early 1940's, Bailey did extensive experimental work and performed mitral valve surgery on more than 60 mongrel dogs. From his experimentation, he concluded:

"1) The approach through the left auricular appendage is the most satisfactory...

2) Production of an appreciable degree of sudden mitral regurgitation is tolerated poorly by dogs...

3) The accurate placement of an instrument to divide a mitral valve depends upon actually palpating the valve and instrument from within the auricle at the time of operation...

4) The palpating finger is well tolerated in the left auricle...

5) Dogs do not seem to develop mitral stenosis and the actual human type of pathology cannot be well reproduced in animals...

6) A considerable variety of instruments may be employed for commissurotomy.  We now prefer a backward cutting punch."

 

Cesalpino Andrea

With this research background, Bailey and his team started their clinical experience. Initially, they reported five cases of mitral commissurotomy (opening the commissure), a new term that was coined by Bailey . Four of these patients died during or early following the surgical procedure.

Bailey's first successful mitral commissurotomy was performed on June 10, 1948, six days earlier than Harken's first mitral valvuloplasty. The operation was performed through the left atrial appendage. He first placed his finger in the left atrium and proceeded with a careful palpation and then introduced a special hooked knife with malleable handle along his finger. Bailey wrote:

"The hooked Knife was inserted through the valve orifice and engaged on the lateral commissure under direct digital guidance. The knife was then drawn backward an inch, widely cutting the commissure. The finger was now inserted through the cut valve and some fine remaining fibrous strands were broken up.  The valve was now widely patent." The patient did well and remained alive for several decades.

During the same period, a third group of surgeons led by Russell Brock in England was working on the surgical management of mitral stenosis.  Brock performed his first successful "mitral valvulotomy or valvotomy" in September 1948 and published his results with a series of six patients in 1950.

These three pioneers, Harken, Bailey and Brock independently of each other treated surgically mitral valve stenosis  with success making closed intracardiac surgery a reliable therapeutic option. 

REFERENCES

Baker C, Brock R C, Campbell M. Valvulotomy for mitral stenosis: report of six successful cases. Brit Med J 1950;1:1283


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Dwight Emary Harken


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