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February 26, 2017
Pre CPB Ludwig Rehn

Ludwig Rehn (1849-1930)

Fall von penetrirender Stichverletzung des rechten Ventrikel's. Herznaht.Zbl.Chir., 1896, 23, 1048-49.

Ueber Penetrirende Herzwunden und herznaht. Arch.Kil.Chir., 1897, 55, 315-329

Ludwig Rehn
Portrait of Ludwig Rehn
Portrait of Ludwig Rehn



Prior to 1896, wounds of the heart were considered fatal injuries. In 1896, Rehn performed the first successful repair of a cardiac wound.  His pioneering work marked the beginning of cardiac surgery. In 1896, he published a brief case report and in 1897, he wrote a more comprehensive article on the subject:

"A man, aged 22, was stabbed with a knife in the fourth interspace, three fingerbreadths to the left of the sternal margin. After a period of unconsciousness, which lasted three hours, the patient revived sufficiently to take about 300 paces, when he fell to the ground. He was later found almost lifeless and was taken to the hospital. The first day following the injury the sensorium cleared, and the pulse became stronger and the dyspnea developed and the operation was performed.
An incision 14 cm long was made in the fourth left interspace and fifth rib was divided in the mammary line. The pleura was opened. Blood distended the pericardium and oozed from the stab wound which entered it. The pericardium was opened widely and the blood within it was removed. A wound 1.5 cm long was found in the right ventricle from which there was active bleeding. This was controlled by placing a finger over the wound, but difficulty was experienced in keeping the finger properly in place. There was less bleeding during diastole than during systole. The wound was closed with three silk sutures placed during several diastolic phases. The pulse was immediately improved. After the blood was removed from the pleural and pericardial cavities an iodoform gauze drain was placed in each cavities. The patient recovered and was able to return to work."

The entire text of Rehn's historic article is reproduced in the original language.

In 1902, Harry Sherman, a professor of surgery from the University of California published a review of 34 cases of  cardiac wound repair that were performed between 1896 and 1902 in several countries. In his article, Sherman wrote  "the road to the heart is only 2 or 3 cm, in a direct line, but it has taken surgery nearly 2400 years to travel it."

In 1907, Rehn reported an observational study of 124 cases of cardiac suture with a 40% success rate.

REFERENCES

Johnson SL. The history of cardiac surgery 1896-1955. Baltimore, John Hopkins Press,1970

Sherman HM. Suture of heart wounds. Boston Med Surg J 1902; 46:653-8

Rehn L. Zur chirurgie des herzens and des herzens and des herzbeutels. Zbl Chir 1907; 34:42


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