Surgery in the Heart

From opposite borders of the U.S., two major advances in the delicate art of heart surgery were reported last week. They made a dramatic contrast: in one operation the heart was kept beating during surgery; the other made a point of stopping it.

Bypassing the Heart. A 17-month-old boy at the Cleveland Clinic was the first human subject of the heart-stopping technique. Born with an opening in the septum (wall) between the right and left ventricles, his heart was unable to pump blood efficiently through his body because much of the blood pumped by the left ventricle leaked back through the hole into the right ventricle. The condition was getting worse.

When he was wheeled into the operating theater, the small patient was lost among a task force of 15 doctors and nurses, led by Surgeon Donald B. Effler. Then, building palisades of clamps, scalpels, retractors, forceps, the surgeons opened the boy's chest and inserted tubes in the two great veins carrying used blood to the heart. When they clamped off these veins, they forced the blood out through the tubes, which fed it to a combined pump and oxygenator, the heart-lung machine developed by Cleveland Clinic's Willem Johan Kolff (TIME, Oct. 31). From the machine the blood was fed back into the body through an artery in the chest, bypassing the heart.

If nothing else had been done, the heart would have continued beating during the operation. But after letting the heart beat long enough to empty itself of blood, the doctors injected potassium citrate, which arrested the beat.

This gave the surgeons a "dry field" and a heart at rest. With deft scalpel, Surgeon Effler slit open the flaccid right ventricle, drew the remaining blood from it, and located the opening in the septum. He sutured the sides of the hole together. Then he took the clamp off the aorta and let blood from the artificial heart flow back into nature's heart. The potassium citrate soon washed out and--with no artificial prodding--the heart resumed its normal rhythm even before Effler could finish closing the ventricle wall. Last week, nine weeks after the operation, the youngster was home and hopping.

Since the successful case of the young boy, the Cleveland team has used the "stopped-heart" method in eight more severe cases; two died, apparently not because of the heart arrest but mainly because their condition was desperate before it. The team says conservatively that the principle "has introduced an era of open-heart surgery."

Wires, So to Speak. From Houston came news of a similar and equally daring operation on an adult with an injured heart. The Houston doctors decided that they did not need to stop the beat of an adult's heart already damaged by a blockage in the arteries feeding its muscle (coronary thrombosis or myocardial infarction). Bertram Sommerfield, 49, a Houston businessman, had a heart attack three months ago. One of its incidental effects was to tear a gaping hole in the septum between the ventricles. In adults, this usually is quickly fatal.

Somehow, Sommerfield survived ten weeks with his badly damaged (and somewhat enlarged) heart, then went under the knives of a Baylor College of Medicine team of surgeons headed by Michael E. DeBakey and Denton A. Cooley (TIME, June 29, 1953).

Instead of the Kolff lung, the Houston team used a bubble oxygenator, which pumps oxygen into a column of blood withdrawn from the body. (The methods of taking the blood in and out of the body, and pumping it, are similar in the two techniques.) When Dr. Cooley opened the heart, he found that the hole was the size of a half-dollar--too big to close by simple stitching. It needed a blowout patch. With the heart still beating, but relatively free of blood so that he could see what he was doing, Dr. Cooley took a piece of plastic sponge and stitched it over the hole. Then, as he sewed the outer wall of the heart together, he let blood flow back through it. The blood shut-off had lasted 21 minutes, during which the severely damaged heart had not missed a beat. The whole operation took five hours. Said a Cooley colleague: "This is the ultimate in heart surgery--the achievement we have been waiting for. It is now possible to lay open the fine muscles of the heart--the wires, so to speak--control circulation, patch a blowout and then repair the muscles and restore circulation. We can now repair some of the most serious damage there can be to the adult human heart."

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