Historically, cardiac surgery in Korea began to take root after the Korean War. In the 1950s, the number of cardiac surgery cases in Korea began to increase with the introduction of foreign medical literature and the wartime experience. The factors that greatly contributed to the development of cardiac surgery in Korea were the experiences of American Mobile Army Surgical Hospital military surgeons, training at the United States military hospital, and foreign hospital ships during the Korean War. Sung Haing Lee (Fig. 1), who served as the fourth President of the Korean Society for Thoracic and Cardiovascular Surgery from 1974 to 1976, performed the first open heart surgery using hypothermia in Korea. This groundbreaking procedure took place on September 13, 1961, at Kyungpook National University Hospital [1-4].

Figure 1. Sung Haing Lee (1919–2012), who performed the first open heart surgery using hypothermia in Korea.

Sung Haing Lee was born on September 14, 1919, in Changwon, Gyeongsangnam-do. He graduated from Daegu Keisung High School and Severance Union Medical College (now known as Yonsei University College of Medicine) in 1942. Following his graduation, he undertook an internship at DongSan Christian Hospital in the same year. In 1949, Lee was appointed as an Assistant Professor at the Daegu College of Medicine Hospital, which is now known as Kyungpook National University Hospital. Under the mentorship of Professor Pyung-Kan Koh [5], Lee participated in the first pneumonectomy in Korea in May 1949. He also assisted in a variety of other surgical procedures, including thoracoplasty, pneumonectomy, and esophagogastrostomy [3].

With the outbreak of the Korean War on June 25, 1950, all university hospitals in Korea were reorganized into military hospitals. Only Koh and Lee remained at their hospital, as all other surgeons were incorporated into the military. At that time, developed countries such as Denmark, Norway, Sweden, and the United States, sent numerous military medical personnel to treat their soldiers and trained Korean physicians. Both Denmark and the United States dispatched hospital ships to provide medical care and offer short-term training for Korean physicians onboard. Despite these chaotic times, Korean physicians received significant assistance and training in a brief period. In 1952, Lee underwent 2 months of thoracic surgery training on a Danish hospital ship, the Jutlandia [6] (Fig. 2). The hospital ship was outfitted with modern facilities, including well-equipped operating and admission rooms, and the surgical equipment was the most advanced of its time. Here, Lee began his training by observing thoracotomy cases performed under general anesthesia and was deeply impressed by the outcomes. Most of the operations were performed on young soldiers with lung injuries and hemothoraces, who showed remarkable recovery after surgery. For Dr. Lee, this 2-month thoracic surgery training on the hospital ship was a significant turning point in becoming a cardiothoracic surgeon [3].

Figure 2. The Jutlandia was a Danish hospital ship dispatched to Korea during the Korean War. In September 1950, the Danish government decided to contribute to the United Nations’ operations in Korea in the form of humanitarian assistance [6].

After the Korean War, he pursued further training in cardiothoracic surgery. The American Korean Foundation, which was a non-governmental, non-profit organization that nonetheless served the political and capitalist interests of the United States, launched a wide range of projects for the postwar reconstruction of public health infrastructure in Korea [7,8]. Thanks to a scholarship from the American Korean Foundation, Lee was able to go to the United States in 1954 and specialize in cardiothoracic surgery at George Washington University, University of Pittsburgh, and Allegheny General Hospital in Pittsburgh. In 1957, he returned to Korea as an Assistant Professor at Kyungpook National University Hospital [9].

Before the development of cardiopulmonary bypass in the early 1950s, the only way to perform cardiac surgery was through hypothermia. This technique was pioneered by Dr. F. John Lewis in 1953 and Dr. Henry Swan in 1945. Another method, known as cross-circulation, was developed by Dr. C. Walton Lillehei in 1954. This method involved using parents as biological oxygenators for infants suffering from congenital heart diseases. While studying at George Washington University, Lee conducted research on hypothermia techniques under the mentorship of Dr. Brian B. Blades. Upon his return to Korea, he continued his research on open heart surgery using hypothermia, conducting experiments on over 50 dogs. On September 13, 1961, at the age of 42, Lee successfully performed Korea’s first open heart surgery using hypothermia on an 8-year-old boy with an atrial septal defect (Fig. 3). The patient was placed under general anesthesia and immersed in ice water to cool the body surface. Once his body temperature had decreased to 33ºC, he was transferred to the operating table. Upon opening the chest and exposing the heart, the patient’s body temperature continued to decrease, stabilizing at 29ºC. Lee was cognizant of the fact that if the patient’s body temperature fell below 30ºC, it could trigger ventricular fibrillation. Therefore, he carefully maintained the patient’s body temperature around this level. The atrial septal defect was then repaired while the venous return to the heart was blocked [9].

Figure 3. (A) A newspaper article and a picture of Lee with the 8-year-old boy, on whom he performed the first open heart surgery using hypothermia in Korea on September 13, 1961. (B) A reception was held with a special lecture in 1998 to commemorate the first open heart surgery in Korea. The 8-year-old boy, who had grown up to be a healthy man (center), participated in the reception and took a photo with Lee (far right).

Lee also devoted all his efforts to the application of the cardiac catheterization technique as a crucial diagnostic tool for both congenital and acquired heart diseases. During the 1950s and 1960s, cardiac catheterization was at an immature stage in Korea. Lee was training at Allegheny General Hospital in Pittsburgh under the mentorship of Dr. Edward Kent, but the residency program did not include training in cardiac catheterization. Recognizing its significance for open heart surgeries, Lee fervently requested a cardiologist to instruct him in this technique. Fortunately, he was given the opportunity to learn not only cardiac catheterization, but also cardiovascular imaging, cardiac auscultation, and electrocardiography from Dr. Donald Fisher, a cardiologist at Allegheny General Hospital. Once he had mastered these techniques, Lee’s next challenge was to acquire the necessary equipment for cardiac catheterization. The cost of this equipment was between $40,000 and $50,000 at the time, which the hospital in Korea could not afford. Thus, he asked Dr. Fisher to find him the cheapest equipment possible. Dr. Fisher, who had performed the first cardiac catheterization in the United States, helped Lee to assemble a control box that connected the cardiac catheter to an electrocardiogram machine using only $15 worth of electronic components. In addition, Lee gathered used cardiac catheters, which were considered disposable in America but were in high demand in Korea. He brought these catheters, along with the $15 assembled control box, back to Korea. In May 1958, he successfully performed the first cardiac catheterization in Korea on a patient with tetralogy of Fallot [9] (Fig. 4).

Figure 4. (A) Lee and Dr. Donald Fisher assembled a control box to perform cardiac catheterization in Korea. This diagram shows the connection of a control box to an electrocardiogram (ECG) to depict intracardiac pressures as waveforms. (B) The first cardiac catheterization in Korea was measured in a patient with tetralogy of Fallot in May 1958. This is a record of the actual intracardiac pressures measured using the control box connected to an ECG during a cardiac catheterization procedure.

In 1964, Lee founded the Department of Cardiothoracic Surgery at Kyungpook National University School of Medicine. He was also a founding member of the Korean Society for Thoracic and Cardiovascular Surgery, which was established on May 18, 1968. In 1971, he formed the Atlas Club, a group of medical and pharmaceutical students, and served as their advisor, leading medical volunteer activities in villages without hospitals. As a devoted Christian, he served in the position of chairman for both the Daegu YMCA and the National YMCA Federation. He served as the 4th and 12th president of the Korean Society for Thoracic and Cardiovascular Surgery and also as the 18th, 19th, and 20th president of Kyungpook National University Hospital. In 1985, he became the dean of the College of Medicine at Kosin University in Busan. He retired in 1987 [10].

Dr. Lee and his wife, Joon-Hee Park, had 2 sons and 3 daughters. Their eldest son became a general surgeon, while their second son specialized in obstetrics and gynecology. The family’s medical legacy continued into the third generation, with their granddaughters also choosing to become physicians. Dr. Sung-Haing Lee passed away on December 5, 2012, at the age of 93.

Recently I came across the story of Professor Sung Haing Lee by chance. With the vast amount of data available and my hectic life schedule, I was hesitant about whether to read his biography, “1989 Thoracic Surgery Stories” (Fig. 5). However, I eventually made up my mind to open the book. As a Christian, I firmly believe that God has bestowed unique talents upon each of us, and it is my duty to do my best in my calling within the scope of those gifts. Reading Professor Lee’s biography, especially the story of studying at Keisung High School with a full scholarship and his learning about the cardiac catheterization procedure in the United States, deeply moved me. It is not easy to empathize with the stories of older generations, but Professor Lee’s autobiography resonated profoundly with me. I wish I could have achieved at least half of what he achieved. I am grateful to God for guiding me to read his biography and achievements.

Figure 5. Sung Haing Lee’s archives. (A) Lee’s biography, “1989 Thoracic Surgery Stories.” (B) “The first open heart surgery in Korea (retrospect and prospect)” was published on September 12, 1998, at Kyungpook National University Hospital [9].

Author contributions

Conceptualization: HJ, KYP, TYO, WK. Data curation: HJ, KYP, TYO, WK. Investigation: HJ, KYP, TYO, WK. Methodology: HJ, KYP. Project administration: KYP, TYO, WK. Resources: HJ, KYP, TYO, WK. Supervision: KYP. Writing–original draft: HJ. Writing–review & editing: KYP. Approval of final manuscript: all authors.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.