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Ahead of his time: Gross’ first successful ligation of a patent ductus arteriosus

The history of interventional cardiology and cardiac surgery is hallmarked by pioneers—Columbuses who sailed into territory as yet unchartered, countering currents of dissent while circumnavigating potential failure. Advancement in the field would not have been possible without the parents whose courageous consent for their children to be the ‘firsts’ benefited the field and indeed later generations. In 2018, we will celebrate the 80th anniversary of the first successful patent ductus arteriosus (PDA) closure by Dr Robert Gross.

PDA was considered an untreatable condition for a long time. Munro, Cutler, Strieder, O’Shaughnessy, Hubbard and Frey—these are names of surgeons who went down in the history of PDA closure. John Munro, a Boston surgeon, was the first physician to speak of the possibility of surgically closing PDA. In his publication in 1907, he strongly advocated ligation of PDA.1–4 Thirty years later, John Strieder, a surgeon in Boston City Hospital, attempted PDA closure on a 22-year-old woman. Success was stymied by anatomical difficulties and the patient’s poor preoperative condition. Only partial PDA closure was feasible, and although it was an apparent initial success the patient died on day 4 postprocedure. The autopsy revealed vegetations from the origin of the duct to the pulmonary valve.4 

Albert Einstein was known to say: “Everyone knows that something cannot be done until someone comes along who doesn’t know that it’s impossible, and he does it.” It was impossible to close PDA and Robert Gross knew that. But he did it, and it was 15 years prior to Inge Edler’s echocardiographic confirmation of cardiac anomalies. In 1938, a 7-year-old girl with PDA was admitted to Boston Children’s Hospital (figure 1). After clinical and chest X-ray evaluations, a decision was made to surgically ligate the PDA. The young chief resident surgeon at Boston Children’s Hospital Robert Gross (33 years old) undertook the task. He faced the dilemmas of diagnostic and …