Blowout in the Heart

Bent over his drafting board at an Army Engineers' installation in Alexandria, Va., Private Norman L. Hickey, 27, felt a sudden tightening around his chest --"as though someone had been screwing down a metal band around it, and I was shaking like a leaf." He worked on. Next day, too nauseated to eat, Hickey felt the tightness return. He gave up, went on sick call. Doctors, unable to decide what ailed him, even sent him to a fever isolation ward before he ended up in the cardiac clinic of Walter Reed Army Hospital. Because his case was so tricky, the hospital called Presidential Cardiologist Thomas Mattingly for consultation. Colonel Mattingly had the diagnosis in jigtime: a rupture, creating a tunnel between the aorta and the right auricle of the heart.

Hole in the Wall. The aorta is the heart's outlet, through which the left ventricle pumps freshly oxygenated blood to the entire body. A weak spot in the wall of Hickey's aorta had ruptured, blowing a hole in the adjoining wall of the right auricle, which draws in used blood from the veins and sends it on its way to the lungs to be oxygenated. Thus a large proportion of the outgoing blood was being short-circuited, clogging the right side of the heart instead of coursing into the arteries. Hickey's heart was laboring enormously at only 25% efficiency. He was put to bed on a salt-free diet, and dosed with digitalis to boost his heart. That was in January.

Such an accident in the heart is extremely rare. Heretofore, it has nearly always proved fatal. Surgeons considered two operations for stitching up the ruptured valve, decided against them as offering no real hope of success. Then a visiting Swede. Dr. Hans Erik Hanson, suggested plugging the tunnel with a plastic sponge shaped like a long-stemmed golf tee. That was in June.

While Hickey waited at Walter Reed, his ankles and body slowly swelling with accumulating fluid, researchers at the National Institutes of Health began experimenting on 21 dogs. Seldom has a surgical research project been pushed so fast. The dogs stood up well in the tests. The surgeons felt ready for Hickey.

Water in the Bag. At 8:45 a.m. on Aug. 1, attendants wheeled Hickey into an operating room at NIH. The anesthesiologists knocked him out with sodium pentothal, then put him in a double-jacketed plastic bag up to his neck. Through the bag they circulated ice water. When Hickey was chilled enough so that circulation could be almost stopped without fear of damage to his brain, the surgeons opened both his aorta and his heart. Through a slit in the aorta they slipped the stem of the tee-shaped gadget, then worked this down into the heart wall until its head plugged the blowout. After trimming off excess stem, they sewed the plug in place. Then they stitched up the incisions, closed Hickey's chest and let him thaw out.

Last week Hickey lolled on a living-room couch at home, drinking a beer and puffing on a cigarette. Out of the Army with a disability discharge, he was literally a new man. He is going back to finish college, will get into condition meanwhile by taking daytime care of his 2 1/2-year-old son while his wife is at work. "They tell me I'll never be an Olympic star," he said. "But hell, I wasn't an Olympic star before."

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