The Heart That Stopped

From the start it was a race against time, and for a while it seemed that death had won. David Fleming Jr., 6. of New York City's Queens Village, had a coarctation (narrowing) of the aorta at the point where it descends through the chest to carry blood to the abdomen and legs. Doctors in Queens found by X rays that the swelling had ballooned out into a thin-walled aneurysm the size of an orange, transferred the blond youngster to St. Francis Hospital in Roslyn, N.Y. (TIME, Jan. 4, 1954), which specializes in heart conditions.

There, doctors wanted to operate, but they had on hand only six pints of David's uncommon Type O, Rh-negative blood, and expected to need twice as much. As they watched David's condition closely, more X rays early last week showed that the aneurysm was already leaking blood into the chest cavity. In a matter of hours it would burst. Then, unless they could intervene, David would bleed to death within a few minutes. Somehow they had to cut out the diseased seven-inch length of aorta, replace it with a graft. Over TV and radio went appeals for O-negative donors.

Chilled to the Marrow. David was wheeled into surgery. Around him were five surgeons, two cardiologists, an anesthesia team of three, and five nurses. After the first anesthetic he was wrapped in blankets laced with tubes through which chilled antifreeze circulated. His body temperature dropped to 88DEG, which would give the Burgeons extra time if the blood supply to any part of the body was interrupted (the tissues need less blood at low temperatures). Surgeon Edward Braunstein drew a long red line with his scalpel, beginning in front and curving around the back, then opened the chest.

What he saw was worse than expected. The leaked blood had formed a big clot, which was resting against the aneurysm. Dislodging it might make the aneurysm burst. After almost two hours of surgery this is just what happened. It was 6:10 p.m. As blood gushed into David's chest cavity, his heart stopped. Instantly Dr. Raj Mahajan reached across the table, and with both hands began massaging David's heart to keep blood flowing through the nearest (ascending) part of the aorta and its first arterial branches, which supply the oxygen-demanding brain. Simultaneously other surgeons worked fast to put clamps on each side of the ruptured section. (The lower part of the body would have to get along with little or no blood, but its organs and limbs could stand this deprivation better than the brain.) Blood transfusion through David's arm and leg was speeded up.

Enough Blood? At 6:20 there was another setback. The heart's lower chambers began to fibrillate (quiver ineffectually). Once, this would have been a sure prelude to death, but an electric defibrillator, now standard in operating rooms during heart surgery, halted the flutter. Still the heart had no beat. Two surgeons took turns at massage to ease their cramped hands. At 6:50 p.m. the six pints of blood were gone. A surgeon asked: "Is there more blood?" A nurse answered: "In a minute." Donors from miles around had rushed to meet the emergency, and their blood was being tested. The first pints arrived just in time.

At 8 p.m., with David's pupils dilated and fixed--usually a sign of death--the diseased section of aorta was cut out. In its place, Surgeon Braunstein and assistants began stitching in a graft, donated by a man who had died two months earlier, which was then freeze-dried. At 8:55 the stitching was finished. Fourteen pints of blood had been used. There was still no sign of a heartbeat or of life in David's eyes. The clamps were removed. Then the seemingly unbelievable happened. Says Dr. Mahajan, who was still massaging David's heart at the time: "One moment it was a flabby, lifeless organ. Suddenly it swelled alive--strong, firm, and pumping steadily."

It took another hour to close the surgical wound. Within that hour David moved his arms, opened his eyes. This week the boy whose heart stopped for 2 3/4 hours was making a good recovery.

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