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The following letter by Dr Walter Somerville to Dr Evan Bedford was written 40 years ago. It was recently unearthed by Dr Howard Swanton of the Middlesex Hospital, London.

I had been meaning to have a word with you about one or two points since you came back but I know you have much to catch up on. None of them is urgent but I thought I would put this point now. Sooner or later we will have to take a more active part in pump-oxygenators. They were discussed recently at the Junior Cardiac Club, at which everyone involved in the subject in London attended, including several people who had recently returned from the US. They included Bentall (Hammersmith), Rose (Guy’s), McMillan (St. Thomas’s) and Paneth (Brompton) and others. It is quite clear that at two American centres, at least, V.S.D.s are being closed as routine, and Fallots have the defect repaired and the stenosis removed.

My suggestion is that at this stage we might approach the problem in the way that has been so successful with the A.S.D.s. That is to say we should send an anaesthetist and a surgeon to either the Mayo Clinic or Minneapolis, for say a month, to learn the anaesthetic and surgical techniques as they stand today. It is a fact that Sellick has been devoting some time to trying to work the Lillehei apparatus on dogs. He can spend a half-day a week or less in the laboratory, with little or no surgical assistance. This type of approach to the problem is quite hopeless; it is not even pioneering because the Minneapolis people have passed this point many years ago. At Guy’s, Ross has been working for the past few years on the Lillehei pump-oxygenator with full-time surgical assistance, but as he told us at the J.C.C. his dog survival rate is still very low and the results on humans is so depressing that anyone else but Brock would have had to abandon it. Drew at Westminster told us his results are not much better. Paneth (Brompton) has just returned from spending a year with Lillehei who he says closes V.S.D.s as a routine procedure on humans. Lillehei’s own words are “ . . .the closure of ventricular defects even in the tiniest infants is technically quite easy . . .” (Circulation 1957, p. 634).

Now that the ostium secundum problem has been mastered, it is up to us to remain in the lead with the V.S.D.s, ostium primums and Fallots. Unless we take action soon we shall lose our place, and the way to keep it is to profit by the years of American groundwork and copy the identical techniques used today.

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