Hearts & Scalpels

When Dr. Horace Smithy, crack young (34) surgeon of the Medical College of South Carolina, first examined his patient, he thought her trip to Charleston had been in vain. Blonde Betty Lee Woolridge was an almost classic example of the wreckage caused when a heart is crippled by rheumatic fever. At 21, Betty Lee weighed only 85 pounds; veins in her neck stood out like whipcords; her abdomen was swollen with a fluid by-product of congestive heart failure. Doctors in her home town of Canton, Ohio had told her she had only a year to live.

But Betty Lee had come to the right doctor. For two years Dr. Smithy, ex-professional baseball player and college (University of Florida) boxer, had been working on a new technique for operating on the heart's valves. He had performed 121 operations on dogs/- in the college laboratories, and had developed two new surgical tricks.

The Technique. First Dr. Smithy designed a new valvulotome, an instrument for cutting valves. Essentially, it is a tube containing a small lancet with a special biting end ; with it he hoped to cut out the scar tissue that forms on the heart valves of many rheumatic fever victims, and blocks their action. Then he developed a way of using procaine (local anesthetic common in dentistry) to control the violent, often fatal spasms that usually plague surgeons who have the courage to operate on the heart. Dr. Smithy was ready for his first operation on a human being when Betty Lee reached Charleston's Roper Hospital.

One day last fortnight, Betty Lee was wheeled into the green and brown operating room. After cutting his way to the heart by conventional surgery, Dr. Smithy injected four cubic centimeters of 2% procaine into the heart muscle at the apex. Then he opened the heart wall, passed his valvulotome into the ventricular chamber, and cut away a segment of the thick tissue blocking the valve. That was the critical point.

Betty Lee's heart kept its steady rhythm; the procaine had done its work. The operation was over in an hour and 35 minutes. The third day the patient sat up in bed; on the fourth, she was walking. By the fifth day her venous blood pressure, almost three times normal before the operation, was within the upper limits of normal. Her abdominal swelling was gone, her color was good, and she joked with visitors.

The Chances. Dr. Smithy's operation on Betty Lee was daring. Surgical annals record only twelve operations on the heart's valves; only two patients lived. Since 1928, no other such operations have been recorded. The type of heart damage Betty Lee suffered is the most common resulting from rheumatic fever, which causes 90% of all heart disease in children, 40% of heart disease at all ages.

Not all patients, Dr. Smithy warned, could benefit from the new operation. The only good candidates are those who are young, suffering from stenosis (narrowing) of the mitral or aortic valves, with no active rheumatic involvement of the heart, and whose general health is good enough to make them reasonable operative risks.

So far, only Dr. Smithy has tried the operation. Some day, some other surgeon, who will need long laboratory training, might operate on Dr. Smithy himself, whose own heart was damaged in childhood by rheumatic fever.

Thirty-year-old Don Fegenbush is one of the oldest "blue babies" known to medicine. Blue babies rarely live beyond twelve unless an operation corrects a congenital defect: a too-small opening in the pulmonary artery that carries blood from the heart to the lungs. One day last week Don decided to risk the operation devised by Johns Hopkins' Surgeon Alfred Blalock (TIME, Dec. 31, 1945).

At his age, he was told by doctors at Los Angeles' Children's Hospital, there was only a 100-to-1 chance that he would live. The three-hour operation was successful. When he left the operating room, Don's bluish complexion was pink. Doctors believe that Fegenbush, never able to take more than ten steps at a time, will be able to leave his wheelchair.

/- Reported, to the American College of Surgeons last September, in a paper written with Dr. Henry P. Deyerle, also of South Carolina Medical College.

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