Recognition of greatness: "the Jatene operation".

The history of cardiac surgery is associated with great surgeons, and their contributions are usually recognized by having their names attached to the innovation. Such is the case for many instruments (DeBakey forceps, Cosgrove retractor, and others), sutures (Lima suture for off-pump coronary artery bypass, Dubost suture for left ventricular aneurysm), and operations (Rastelli, Mustard, Batista, Bentall, and others). It has occurred to us that one of the greatest contributions in pediatric cardiac surgery of recent times was the ingenious operation first performed more than 30 years ago by Dr Adib Jatene of Brazil to treat transposition of the great arteries (TGA). This operation represents a monumental contribution to the treatment of congenital heart disease. It revolutionized the way that the complex congenital anomaly of TGA was treated and dramatically improved the longterm outcomes of children born with TGA. The magnitude of the contribution is even greater if one considers that in those early days cardiac surgery in infants was not as evolved as it is today. The bravery and courage of a surgeon in deciding to perform a new operation of such technical complexity, never performed before, requiring the delicate coronary transfer in a small child, is immeasurable. One wonders how Dr Jatene developed the idea to perform this operation, and how he elaborated the surgical strategy to perform it in human beings, as at that time an animal model did not to our knowledge exist. Our curiosity on this topic led us to contact Dr Adib Jatene to document this important, ingenious, and historic development. What follows is a verbatim of Dr Jatene’s response to our request: As you know, my training in cardiac surgery was in Brazil, together with Professor E. J. Zerbini, with whom I worked for 11 years. I had the opportunity to participate to the first mitral commissurotomy performed by him in 1951. Our experience was always based on anatomic studies in our laboratory of pathologic anatomy. As it relates to TGA, there were 62 specimens in the laboratory, together with other congenital cardiac lesions, that I frequently examined. After reviewing the literature on TGA, I became convinced that the problem could be solved if the coronary arteries could be transposed, as suggested by Dr. Harold Albert. At this point in my career