This paper looks at the beginnings of cardiac surgery in Kenya with relevant clinical data as well as the overall historical background to various cardiovascular operations which preceded formal establishment of the Thoracic and Cardiovascular Surgical Unit at the Kenyatta National Hospital. Similar activities in other hospitals in Nairobi and elsewhere in Kenya have been excluded. The Unit separated from general surgical wards in January 1973. By the end of 1983, a total of 208 open heart operations had been done by various teams in the Unit. A number of other heart operations were also undertaken. Those done before that decade are also highlighted back to 1950. The many problems that the Unit faced and still faces are also identified in this paper and the dream of making it a Centre of Excellence revisited.