On 15th April this year, we will remember the 100 year anniversary of one of the most famous Lithuanian medical innovators; a heart surgeon, professor at Vilnius University, and a member of the Lithuanian Academy of Sciences Algimantas Marcinkevičius. To commemorate this prominent scientist and educator, we invite you to remember his biography, his journey and the work he did. These memories and insights are shared by Professor Emeritus Vytautas Sirvydis.
Prof. Giedrius Uždavinys, prof. Algimantas Marcinkevičiu, prof. Vytautas Jonas Sirvydis.
The life and work of Professor Algimantas Marcinkevičius are particularly important to the medical advancements of Lithuania in the 20th century. The most important of these is the creation of a new medical field – modern heart surgery – and its improvement and elevation to the global level.
Fate led the professor to live and work during a difficult period. He was born in the inter-war period in the independent Lithuania, into a family of doctors. His father, Mykolas Marcinkevičius, was a doctor and later a famous professor of internal diseases, and his mother, a nurse, worked on the periphery assisting her husband in Linkuva, Rokiškis, and then later in Panevėžys. The medical environment in the family determined the selection of the specialism by the young Algimantas. Living in the independent Lithuania and the patriotic atmosphere of the family had a great impact on the formation of his views, beliefs and character.
Educated at Panevėžys Gymnasium, famous for its influential teachers, especially in the humanities, formed Algimantas into a Lithuanian patriot with strong views and a desire to serve humanity. He chose medical studies and the medical profession not only to pursue family traditions, but, in addition, to realize his humanitarian ideals; to be able to help a someone in the most difficult moment of life, and to defeat the disease that threatens them.
The great shockwaves in Europe, threatened the young, newly formed and strengthening state of Lithuania, and the future of its people. The violence and terror were paraded as a new ideology, although it clearly opposed common sense and the ideals pursued by young people. Marcinkevičius, like many others, could not accept the new ideology and opposed coercion and cruelty with all his being. Dedication to medical studies, the pursuit of a profession that was humanitarian at its core, and his dedication to helping a neighbour, was his way to partially dissociate from the spreading madness and to create his goals of the future.
His studies at Vilnius University provided Algimantas not only with medical knowledge, but also a history of the university; its past works, the pursuit of cherished ideals and progress, and helped him to withstand the devastating cult of war and post-war violence.
Prof. A. Marcinkevičius in the operating room.
The influence of the eminent Professor Kazys Katilius and Professor Pranas Norkūnas working at the Faculty of Medicine at the time, determined the path chosen by the surgeon and later professor, Algimantas Marcinkevičius. On the completion of his studies, he linked his fate to the work of Professor Pranas Norkūnas. He was his assistant, sharing aspirations for surgical progress. He started conducting experiments in vascular surgery and hypothermia on behalf of Professor Norkūnas. And finally, Professor Norkūnas awarded him the leadership of the cardiovascular surgery laboratory and the general surgery department. This step was decisive for Professor Marcinkevičius, and not only for him. It was important for the advancement and future of Lithuanian medicine and for the training of many young professionals, who brought together a new field of medicine in Lithuania, that of cardiovascular surgery.
Heart surgery is the most recent specialism in surgery and in medicine in general. This is due primarily to the fact that directly handling the heart, and especially the suspension of the heartbeat, is life-threatening. The elimination of that threat required significant progress, not only in medicine but also in other sciences, such as physics, biochemistry, biology and engineering. In Lithuania, the emergence of heart surgery and its progress was prevented by the Second World War; especially the post-war turmoil, the imposition of the iron curtain and the subsequent isolation of Lithuania from the world.
Marcinkevičius started to develop modern open-heart surgery in Lithuania as an experienced surgeon, after 10 years of working together with Professor Norkūnas. He also developed as a scientist, seeking medical progress and achieving a PhD. There was also significant experimentation: he completed experiments in hypothermia and started testing a newly acquired, (rather imperfect) Russian artificial blood circulation machine, to be able to stop the heart during surgery. Although post-war upheavals and atrocities had passed, Lithuania's isolation from the western world, where open heart surgery had already been developed, meant developments were without opportunity to learn lessons from the West. In Moscow and St Petersburg, with the help of English surgeons, these operations had already been taking place. Professor Marcinkevičius drew on the expertise of Evgeny Meshalkin from Moscow who had been his scientific consultant during his PhD research. Professor Meshalkin had been one of the heart surgery pioneers in Moscow, but had been forced to leave due to disagreements with senior administrative commanders and had then continued his heart surgery in Novosibirsk.
In 1964, after a brief series of experiments to test the artificial blood circulation apparatus, Marcinkevičius, along with a group of young surgeons, anesthesiologists, biochemists and physiologists completed a one-month internship at the Institute of Blood Circulation Pathology in Novosibirsk, headed by Professor Meshalkin. Here, Marcinkevičius monitored open heart surgeries, and then continued the experiments in artificial blood circulation started in Vilnius. A significant coincidence was that the laboratory of artificial blood circulation in Novosibirsk was headed by the Lithuanian deportee Jeronimas Stundžia, who shared his knowledge. Later, the two men would continue their work together in Vilnius, carrying out the first open heart surgeries.
14th October 1964 remains the most significant of dates. This is the day when the first successful open-heart surgery in Lithuania was performed, using artificial blood circulation. On that day, with the participation of Meshalkin and Stundžia, a specialist in artificial blood circulation, a defect in the ventricular septum was mended for a 14-year-old girl and the next day – a defect in the atrial septum.
In 1964, the first open heart surgery for Professor Marcinkevičius was the beginning of a long journey. Operations took place more and more frequently, and new methods for diagnosing heart disease were being introduced. More accurate diagnosis and improved performance in operations encouraged the expansion of the range of procedures, which also became increasingly complex. Marcinkevičius, with his young students, carried out congenital heart defect repairing surgeries, introduced prosthetic heart valves, eliminated aortic aneurysms, and initiated aortic coronary bypass surgery. Along with this, blood vessel surgery progressed significantly.
Marcinkevičius selected talented young people, bringing them together, to inspire ideas, medical innovation and progress. They worked day and night. Their work was important for people, and the pursuit of progress in this area of medicine, the most important thing in life to them. It allowed them to partially close themselves off from the rather gloomy Soviet reality. Aspirations of freedom sometimes manifest themselves in the most unexpected ways.
In 1967, medical progress culminated when the South African surgeon Christiaan Barnard announced the first successful heart transplant surgery in the world. This sensational news quickly spread around the globe, and this medical milestone was acknowledged as the most significant world event of the year. Famous European and American heart surgeons rushed to repeat this surgery. Professor Marcinkevičius and his followers were also overwhelmed by this innovation. This rapidly developed into the desire to start and develop organ transplantation in general.
The first heart transplantation in Lithuania (1987).
Intensive experiments began, and Marcinkevičius directed individual groups of young surgeons who experimented with heart, liver and kidney transplantation surgeries. The professor and his students were convinced that experimentation and the pursuit of medical progress was a very patriotic duty. They responded to his frequently proclaimed motto of the old Vilnius medical society “to serve science and the home country”. As with the ideal of freedom, scientific progress has always been the most important goal for humanity. Transplantation of the heart and organs in general, remains one of the most outstanding achievements of medical science, continuing to save thousands of lives. The professor’s way of life – his not belonging to the party, his being undoubtedly in favour of religious freedom, and demonstrating he was a man of free spirit, fascinated and attracted young people.
The post-war period of terror and murder had now passed. Professor Marcinkevičius was in the most creative phase of his life, despite the continuing alien ideological oppression, and complete isolation from the world. He was unable to attend conferences or maintain direct contacts with the most advanced European and American medical centres and surgeons, even medical literature and western journals failed to reach Lithuania. In order to read and learn the world’s news, it was only possible at Moscow’s libraries. This is of course, unbelievable and incomprehensible to our young people today.
Another feature of Marcinkevičius’ era was the poverty of medical supplies at that time and the significant backwardness of medical technical equipment. Partly addressing this problem, Marcinkevičius organized engineering services in the clinic. Together with the Vilnius drill plant, his colleagues created Lithuanian artificial blood circulation systems.
The goal of transplanting a heart had to be delayed, even though, in 1969 more than 200 cardiac transplant experiments were carried out, an immunology laboratory was established, kidney transplantation operations were started, and Professor Marcinkevičius and his co-workers were fully prepared to proceed with the operation. Unfortunately, the then, Minister of Health of the Soviet Union prohibited these surgeries. The wait was 17 years. Only after these surgeries had been carried out in Moscow, was the ban lifted. On 2 September 1987, the professor and colleagues undertook the first heart transplant surgery in Lithuania. This surgery has not yet been carried out in neighbouring countries to the east of Lithuania, excepting in Moscow. In fact, this was the crowning glory of all the work of Professor Marcinkevičius and a supreme achievement, opening a new era of medical progress in Lithuania.
Marcinkevičius was very enthusiastic when Lithuania restored its independence. He believed in the ideals of freedom and saw the progress of medicine. He actively sought the restoration of the Lithuanian doctors’ union in order to unite the efforts of doctors to advance medicine and to raise their role as an active part of society and was elected its first President.
In addition to what Marcinkevičius did for science and medical progress, he was a dedicated doctor, who had prioritized these duties over other work. Days and nights were devoted to this. The patients felt this. They trusted him, believed in his abilities, and his visits were a big celebration. The professor treated the sick not only with surgery and medicines, but also with the words of hope that were equally as important. The patients responded with great love and confidence.
For the future, Marcinkevičius will remain a prominent medical scientist, the developer of heart surgery, who made a significant contribution to the advancement of Lithuanian medicine. He published over 400 scientific articles, gave lectures and presentations in Vilnius, Riga, Moscow and Frankfurt am Main, Kiel, and Mayo and Cleveland clinics. He was a member of the Lithuanian Academy of Sciences, the World Society of Cardiovascular and Thoracic Surgeons, Estonian and Georgian Societies of Surgeons, and was awarded the National Science Prize, the Lithuanian Science Progress Prize and Commander’s Grand Cross of the Oder of the Lithuanian Grand Duke Gediminas
The words of one of the most famous medical managers of the twentieth century, William James Mejo, of the US, are very suitable in summarizing the life and work of Professor Marcinkevičius: “these heroic men whose life work marked epochs in medicine we think of as individuals, but what they accomplished singly was inspiration they gave to the group of men who followed them.”