Discovering a Surgical First: Russell M. Nelson and Tricuspid Valve Annuloplasty
Dr. Russell Nelson's life had brought him into personal acquaintance with the damage to heart valves caused by rheumatic fever. During surgical residency, Nelson and his wife found close friends in Don and Netta Davis, another medical couple in their twenties. Netta developed rheumatic mitral stenosis, which progressed into florid heart failure. As he watched Netta waste away physically and ultimately succumb to the effects of her valve disease, Nelson resolved to commit his professional career to treating such profound heart disease. The experience was perhaps the pivotal moment in diverting Nelson's career from general surgery to cardiac surgery. Nelson's career up through 1960 had afforded him the opportunity of treating such patients, and, by the time he was approached by E. L., a stake patriarch who had an inoperable valve defect, Nelson had accumulated some professional experience with rheumatic heart disease. At the time of this operation, Nelson had performed seventy-three operations in the open field and a total of sixty mitral valve operations—not insignificant numbers for less than five years in the newest of medical fields. However, by today's standards, his surgical experience would be considered rather limited.
Furthermore, Nelson's particular work on conditions relevant to E. L.'s case was even more limited. His open-field operations on the mitral valve, the closest surgical correlate to the tricuspid valve, numbered only eight, and he had performed just two repairs of mitral valve insufficiency. Nelson was hardly embarking on a routine procedure, even if the mitral valve were his only surgical objective. However, targeting a tricuspid valve defect was venturing entirely into the unknown.
During the procedure, Elder Nelson reported,
"a picture came vividly to my mind, showing how stitches could be placed—to make a pleat here and a tuck there—to accomplish the desired objective. I still remember that mental image—complete with dotted lines where sutures should be placed. The repair was completed as diagrammed in my mind. We tested the valve and found the leak to be reduced remarkably. My assistant said, ‘It's a miracle.'
I responded, ‘It's an answer to prayer.'"
One may ask why Nelson never published a report of the new procedure. Despite maintaining detailed surgical records of the case that corroborate the event, Nelson was prevented by several practical barriers from publishing the new repair.
Nelson's first tricuspid annuloplasty carried a rare confluence of personal, professional, and spiritual significance for the young surgeon. It was the realization of a personal commitment he had made while watching a dying friend that came as a uniquely tangible answer to prayer. The operative repair that resulted was a first of its kind correction for a previously untreatable and potentially fatal defect in the heart's tricuspid valve. More than just a novel approach, however, Nelson's annuloplasty technique would prove a remarkably effective solution to the problem of tricuspid regurgitation, one that would anticipate problems with contemporary approaches years before they were appreciated by the surgical community at large.