Archivos Peruanos de Cardiología y Cirugía Cardiovascular Arch Peru Cardiol Cir Cardiovasc. 2021;2(2):77-85. Editorial Cardiology and Cardiovascular Surgery in Peru: A Brief History Breve historia de la Cardiología y Cirugía Cardiovascular en el Perú Bertha Gonzales Álvarez 1,a; Aida Rotta Rotta 1,b; Ofelia Aráoz Tarco 1,c*; Gian Huamán Benancio 2,c ; Vitalia Pisfil Farro 3,c; Daysi Diaz Seijas 3,c; Carlos Pereda-Joh 1,c; Manuel Chacón-Diaz 1,c Received: June 25, 2021 s we commemorate the Bicentennial of Peru’s Independence this year, we cannot fail to Accepted: June 26, 20211 mention aspects of the history of cardiology and cardiovascular surgery in the country Authors’ affiliation 1 Cardiologist. and the contributions that these specialties have made to society. 2 Pediatric cardiologist. A 3 Nurse. a Clínica Padre Luis Tezza, Lima, Perú. Research from pre-Inca times has shown us, that members of the Sechin culture, for example, b Hospital Nacional Cayetano Here- dia, MINSA, Lima, Perú. knew the anatomy of the human body through dissection and vivisection, as reflected in the petroglyphs c Instituto Nacional Cardiovascular INCOR, EsSalud, Lima, Perú. that they left us as legacy, one of them seems to correspond to the representation of the heart, lungs and (1,2) Correspondence diaphragm (Figure 1) . The chronicler Guamán Poma de Ayala, refers in his writings to the knowledge Calle Coronel Zegarra 417, Jesús María, Lima, Perú. of chest pain as a symptom, referred to as “tight heart”, also evoking aspects that could correspond to the (3) E- mail knowledge of cardiovascular risk factors . [email protected] Financial sources The oldest data about the first Peruvian doctors dedicated to the study of the heart go back None to declare to the year 1888, when Dr. Ernesto Odriozola (Figure 2) describes the heart in his doctoral thesis in Disclosures None to declare Paris: «Lesions of the heart following atheroma of the coronaries ». In 1904 he published his “Clinical DOI: 10.47487/apcyccv.v2i2.141 Lessons” with semiological, pathophysiological and clinical data on cases of aortic valve disease, in 1920 he published a case of complete atrio-ventricular block, cited by Dr. Paul White in his work “Heart diseases” as the most severe bradycardia case published in the literature for that date (4). Dr. Julián Arce, professor at Universidad Nacional Mayor de San Marcos (UNMSM) and head of the San Roque ward of the Dos de Mayo Hospital, in 1918 published the first case in Peru of a patient with atrial fibrillation treated successfully with quinidine. Dr. Maximiliano Gonzales would follow the path of the cardiology study in the famous San José ward in Dos de Mayo´s Hospital, where the seed of what would become the Peruvian Figure 1. Sechin petroglyph EsSalud | 77 Cardiology and Cardiovascular Surgery in Peru: A Brief History the San José ward from 1931; Likewise, he was the first Peruvian doctor dedicated exclusively to the practice of cardiology and formed the first cardiology school with doctors Eduardo Perez Aranibar, Aurelio Peralta, Augusto Mispireta, Pedro Moyano, Pedro Roggero, Carlos Guibovich, Roberto Delgado and Marcos Roitman, becoming thus in the first visionary of the creation of a National Institute of Cardiology (1957) (4). Around the year 1940, the scientific spirit of many Peruvian doctors led to the investigation of the physiology of the “Andes people”, so there are important contributions related to cardiac and pulmonary function at high altitude, data recognized worldwide and reflected in research articles such as that on pulmonary circulation at sea level and at high altitude (4). It is known that, in those years, diagnostic cardiac catheterizations were performed as part of the investigation. The teaching of Cardiology within the course of Internal Medicine at the Faculty of Medicine of the University of San Marcos in the 1940s, was based on clinical procedures of the French school, prior to World War II (4). The exploratory arsenal Figure 2. Dr. Ernesto Odriozola included the stethoscope, the aneroid sphygmomanometer, the http://historiamedicinaperuana.blogspot.com/2012/05/ernesto-odriozola- 150-anos-de-su.html fluoroscopy, the chest X-ray in three positions and the Eithoven electrocardiogram, in its three classic leads (4). Therapeutics consisted in the use of digitalis leaf powders, mercurials that were cardiology school was sown, and whose first exponent would used as diuretics, antiarrhythmic drugs such as quinidine, and be Dr. Rafael M. Alzamora Freundt (Figure 3). Dr. Alzamora antihypertensives such as rauwolfia and reserpine (4). acquired the first electrocardiograph in Peru (1921) and took over The hospitals of the Public Charity (Hospital Arzobispo Loayza) and hospitals of Ministerio de Salud (4) were in operation at that time, and many Peruvian cardiologists recently trained abroad began their work in the country, such as Dr. Matías Ferradas at the Arzobispo Loayza Hospital and Dr. Víctor Alzamora Castro at Dos de Mayo, who brought to Peru the electrocardiographic record of precordial derivations, and generalized its use since 1944 (5). Likewise, the classic cardiology schools of Loayza hospital, Dos de Mayo hospital, Military hospital, Naval hospital, Aeronáutic hospital, Socialsecurity worker hospital and San Juan del Callao hospital were stablished, where important figures of Peruvian cardiology are highlighted such as the Doctors Augusto Mispireta, Carlos Roitman, Enrique Arnaez, Andrés Rotta, Carlos Rubio, Teobaldo Pinzas, Matias Ferradas and Jorge Luis de Somocurcio. In 1945 the Cardiology Service of the Hospital del Niño was inaugurated, its first head was Dr. Augusto Mispireta Dibarbout (Figure 4), who together with doctors Guido Cornejo, Carlos Guibovich, Carlos Solís and Carlos Ruíz began the care of the pediatric population with cardiovascular disease. Dr. Ricardo Tole was a pioneer of pediatric Cardiovascular Surgery, since 1945 he performed ligation of the ductus arteriosus, and the first Blalock- Figure 3. Dr. Rafael Alzamora Freundt Taussig anastomosis in 1951, in a patient with tetralogy of Fallot. http://cecraf.blogspot.com/p/jrss05.html Likewise, it is in this hospital where Dr. José Bocanegra and Dr. Jesús Bendezú carried out the first hemodynamic study in 1954. 78 | EsSalud Arch Peru Cardiol Cir Cardiovasc. 2021;2(2):77-85. Figure 5. Dr. Carlos Peschiera Figure 4. Dr. Augusto Mispireta http://repebis.upch.edu.pe/articulos/acta.hered/v49/a29.pdf In the Obrero hospital from the Social Security System, a directed by Dr. Carlos Peschiera (Figure 5), who in 1946 performed Cardiovascular Surgery Service was created at those time and was the first cardiac surgery in Peru (ligation of ductus arteriosus). Figure 6. Sociedad Peruana de Cardiología´s founding act https://sopecard.org/pdf/historia-sociedad-peruana-cardiologia.pdf EsSalud | 79 Cardiology and Cardiovascular Surgery in Peru: A Brief History president, and due to this event, March 12 was considered the Peruvian Cardiology Day years later, by Ministerial Resolution 397-2001 (5, 6). The Department of Cardiology of the Arzobispo Loayza Hospital, with the support of the Public charitable institute and the Faculty of Medicine of the UNMSM, was inaugurated in 1956. Its first head was Dr. Andrés Rotta (Figure 7), together with Drs. Ruiz de Somocurcio and Dr. Pinzas performed electrocardiographic, vectocardiography, phonocardiography, ballistocardiography recordings and cardiac catheterization studies (Figure 8). Dr. Dante Peñaloza (Figure 9) joined the team promoting cardiological research, especially in the study of the heart and circulation in high altitudes (5,6), activities that were carried out at the Institute of Andean Biology from the UNMSM and then at the Altitude Institute of the Cayetano Heredia Peruvian University. In 1953, the first intracardiac surgery was performed at the Hospital Obrero: mitral valvotomy by Dr. Marino Molina Scippa with the assistance of Dr. José Valencia and Justiniano Figure 7. Dr. Andrés Rotta Murphy. The following year, Drs. Molina, Valencia, and Carlos https://medicina.unmsm.edu.pe/index.php/en/home/2013-09-24-08-36- 52/2013-10-02-07-13-20 Alcántara performed the first surgical correction of an interatrial communication. The surgical team formed at this hospital, supported the development of cardiovascular surgery in other In the Inter-American Congress of Cardiology held in La hospitals, for example: Dr. Peschiera at the Dos de Mayo Hospital Habana in 1947, Peru was not represented because it did not have operated the first cases of coarctation of aorta (1956) and Dr. a cardiology society. For this reason, Dr. Rafael Alzamora, together Molina’s team in Loayza Hospital. In 1956, in the Cardiology with Dr. Andrés Rotta and other 22 leading cardiologists of the Service of Dos de Mayo Hospital, the hemodynamic laboratory time, formed the Peruvian Society of Cardiology on March activities began under the charge of Dr. Ricardo Abugattas. 12, 1947 (Figure 6), with the aim of promoting the progress of cardiology, the activity and the formation of the Peruvian The Cardiology Service of Hospital Obrero, was created Cardiology Institute. Dr. Rafael Alzamora Freundt was its first in October 1958, headed by Dr. David Cánepa, who was joined Figure 8. Dr. Andrés Rotta. Andean biology service. Arzobispo Loayza Hospital. 80 | EsSalud Arch Peru Cardiol Cir Cardiovasc. 2021;2(2):77-85. Montesinos (the latter formed at the Cleveland Clinic where Dr. René Favaloro created the surgical technique) (Figure 10). In 1971, electrophysiological studies were carried out for the first with intracavitary recording of the sinus node, atrium, bundle of His and branch potentials, with the help of Dr. Edgar Sowton from the London Institute of Cardiology. Likewise, computerized thermodilution started to be used to determine cardiac output thanks to Dr. Marco Romero, which facilitated the monitoring of patients in the coronary unit and in the postoperative period of cardiac surgery. Numerous studies have been published as a result of these advances, among which are the reports of the first cases of catheterization in patients with myocardial rupture during infarction.