Raymond de Vieussens

Jeremy Parker, MD

Rush University Medical Center in Chicago, Illinois, United States

Raymond de Vieussens, the great French physician and pioneer of anatomic work in neurology and cardiology, was born in the village of Vieussens in Rouvergue (c.1635-1641). His father, a lieutenant colonel in the French army, was possibly a bourgeois of Vigan.1,2 Little is known about Vieussens’ upbringing, except that he financed his own education in philosophy at Rhodez and later completed medical school at the University of Montpellier in 1670. It was in Montpellier that he began his interest in anatomical dissection.3

After graduating from his medical training he was appointed to a position at the Saint Eloi Hospital at Montpellier, a rather prestigious post for such a young physician.2,4He drew the ire of at least one unnamed co-physician who labeled him an “ignoramus and a plagiarist” offering to “treat free of any charge” Vieussens’ patients.4 Regardless of protests, it was at Saint Eloi that Vieussens began compiling records of his time in the morgue. His 500 post-mortem dissections served as the basis of his first great anatomical work, entitled Neurographia universalis.3 Published in 1684, Vieussens work represented the most authoritative anatomic volume on the nervous system up to that time. Vieussens sought to expand and improve upon “the beautiful treatise on the brain and spinal cord of the celebrated Willis” while further describing the peripheral nerves.2

Following his 1684 publication, Vieussens’ fame grew and he earned election into the Academy of Sciences in Paris as well as fellowship in the Royal Society of London. In 1688, Louis XIV called upon Viuessens to be the physician of the royal family, where he eventually attended to Madame de Montepensier—the cousin of the king—until her death in 1693. For his effort, Vieussens was paid one thousand livres a year.5 His salary came with few restrictions, and Vieussens was able to continue his academic pursuits including evaluation of the human lymphatic system and blood vessel anatomy.6

It was in his study of lymphatic and venous drainage that Viuessens first came to prominence for his work on the heart. His 1705 publication Novum vasorum corporis humani systema (“New vessels of the human body”) was a compilation of his vacular and lymphatic work that received widespread praise.2 In 1706, he published a collection of experiments in which he ligated the vena cava above and below the right atrium as well as the pulmonary veins. He then injected a saffron and alcohol mixture into the coronary arteries. He observed that the solution not only filled the coronary veins, but it also appeared to leak into the main ventricles via small “ducti carnosi” which he felt to be in continuity with the coronary anatomy. He published his findings in 1706 as Nouvelles découvertes sur le coeur (“New discoveries of the heart”). These “ducti carnosi” (fleshy ducts) were ultimately named “Thebesian veins” after subsequent work completed by Adam Christian Thebesius just two years after Vieussens’ publication.7,8 This 1706 work also included a description of the valve of the coronary vein known now as Vieussens’ valve—of clinical importance during placement of biventricular pacing leads—as well as a description of a conus branch of the right coronary artery circling around the aorta to the left arterial system providing a source of collateral flow known as Vieussens’ ring.9–11

In 1715—just a year before his death—Vieussens secured a nomination from King Louis to be a “Counsellor of State” and with it an additional 3,000 livres per year. With this funding, Vieussens was able to self-publish his most famous compilation of cardiac anatomy and physiology.4 The work titled Traité nouveau de la structure et des causes du mouvement naturel du coeur (“Treatise on the structure of the heart and the causes of its natural motion”) provided remarkable descriptions of a variety of cardiac diseases, including mitral stenosis and aortic insufficiency.

He describes the story of a 30-year-old druggist by the name of Thomas d’Assis who had voluntarily admitted himself to the St. Eloi hospital at Monpellier under the care of Deidier—the son-in-law of Vieussens and the chief of medicine at the hospital. Vieussens visited d’Assis to assist in the management, and his description of the ailing patient notes that d’Assis was “lying propped up in bed, his head held high; he seemed to have great difficulty in breathing and his heart was troubled by violet palpitation. His pulse appeared very small, feeble, and altogether irregular. His lips were the colour of lead and his eyes sunken; his legs and thighs were swollen, and cold rather than hot.” D’Assis would perish from his condition within the week and Vieussens performed an autopsy finding lung tissue soaked with lymphatic fluid, an enlarged heart with dilated pulmonary veins and excessively dilated atria and right ventricle. The mitral valve apparatus was noted to be narrowed and hardened—as if “bone.” He goes on to describe his hypothesis that “circulation of the blood was embarrassed by the excessive narrowing.” Such embarrassment of flow led to a backup of blood in the pulmonary veins and subsequently the right heart chambers.2,6

In the same text, Vieussens would describe another 30-year-old man with severe aortic insufficiency. The patient’s pulse was “the like of which I have never seen nor hope to see.” At autopsy, Vieussens noted a markedly dilated left ventricle and that the “semi-lunar valves were stretched.” He postulated that with each contraction the aorta “sent back into the left ventricle a part of the blood which it had just received” leading to a violent pulsation of the heart that would later be named “Corrigan’s pulse.”2

Using these clinical and pathologic findings of two patients with end-stage mitral stenosis and end-stage aortic insufficiency, Vieussens was able elucidate an anatomic model for heart disease and failure. Vieussens’ treatise also provided descriptions of the pericardium, the course of the muscular fibers of the heart, the structure of the left ventricle, and the course of the coronary arteries.2

With his passing in 1716, Vieussens left a large legacy of scientific discovery and publications. His pioneering work in anatomic and clinical cardiology served as a foundation for further investigation in the centuries to follow.

References

  1. Dulieu, L. Raymond Vieussens. Monspeliensis Hipoocrates 10, 9–25 (1967).
  2. Podolsky, E. Raymond Vieussens and the affairs of the heart. Med Womans J 57, 32–35 (1950).
  3. Raymond De Vieussens (1641-1715) French neuroanatomist and physician. JAMA 206, 1785–1786 (1968).
  4. Kellet, C. The life and work of Raymond De Vieussens. Annals of Medical History 4, 31–53
  5. Loukas, M, Clarke, P, Tubbs, RS & Kapos, T. Raymond de Vieussens. Anat Sci Int 82, 233–236 (2007).
  6. Kellet, CE Raymond de Vieussens on mitral stenosis. Br Heart J 21, 440–444 (1959).
  7. Wearn, JT The role of the Thebesian veins in the circulation of the heart. J Exp Med 47, 293–315 (1928).
  8. Vergani, F, Morris, CM, Mitchell, P & Duffau, H. Raymond de Vieussens and his contribution to the study of white matter anatomy. J. Neurosurg. 117, 1070–1075 (2012).
  9. O’Leary, EL, Garza, L, Williams, M & McCall, D. Vieussens’ Ring. Circulation 98, 487–488 (1998).
  10. Strohmer, B. Valve of Vieussens: an obstacle for left ventricular lead placement. Can J Cardiol 24, e63 (2008).
  11. Corcoran, SJ, Lawrence, C & McGuire, MA. The valve of Vieussens: an important cause of difficulty in advancing catheters into the cardiac veins. J. Cardiovasc. Electrophysiol. 10, 804–808 (1999).

 


JEREMY PARKER, MD, is a third-year fellow in cardiovascular disease at Rush University Medical Center in Chicago, Illinois. He will be joining a group in South Carolina to practice non-invasive cardiology starting in August, 2013.