Bypassing the Heart

An operation that heart surgeons have long hoped to achieve was reported last week by a Yale University surgeon: a successful method of bypassing the right side of the heart in patients with certain kinds of defects. These may be in the heart itself and in the adjacent great vessels, and of a type that defies repair even when the heart is laid open with the aid of a heart-lung machine. Dr. William W. L. Glenn's case is reported in the New England Journal of Medicine.

Kent Murray, fourth child of a New Canaan, Conn. insurance agent (who doubles nights and weekends as a jazz drummer), had a normal birth but looked alarmingly blue and immediately needed oxygen. Still blue when he went home, he got bluer when he cried. Kent grew normally, but whenever he tried to play tag with other youngsters, he turned blue and gasped for breath. When he was five, doctors at the Grace-New Haven Community Hospital found that his heart had only one ventricle (lower chamber). The result was that freshly oxygenated blood from the lungs was mixed in this chamber with used venous blood and pumped both ways--some back to the lungs, some out through the arteries. Kent also had his aorta and pulmonary artery transposed and had a narrowed valve leading from heart to lungs. With this miserably inefficient arrangement, the boy's heart was overworked, was doomed to fail when he grew older.

A Short Stop. When Kent was born, no way was known to relieve a condition like his. But when he was three, Dr. Glenn's team at Yale School of Medicine began experimental operations with a little black and white mongrel. Of the two great veins carrying blood back to the heart, they tied off the upper one and diverted its flow directly into the pulmonary artery leading to the right lung--thus bypassing the right side of the heart. The dog got along fine. When Kent Murray, now seven, entered the hospital last February, Dr. Glenn was ready to try the technique on a human patient.

Kent's heart stopped soon after the heart sac was cut open, but promptly picked up its beat again on being massaged. Dr. Glenn cut through the right pulmonary artery (see diagram) at its beginning near the ventricle, carried the free end around to a hole, half an inch across, cut in the side of the superior vena cava, and stitched it in, like a plumber's elbow joint. Then he tied off the vein near its normal entrance to the auricle. In this way, 30% to 40% of Kent's venous blood (the proportion carried by the superior vena cava) bypassed the right heart completely, went directly to the lungs for oxygenation, then into the left heart. In the common ventricle it was still mixed with venous blood from the inferior vena cava, but the proportion of well-oxygenated blood was more favorable.

Blue to Pink. Although Kent's heart defects were technically different from those of the "blue babies" saved by Johns

Hopkins' famed Dr. Alfred Blalock and later surgeons, the change seen in him was the same: he turned from blue to pink while still on the operating table. On the sixth day he was walking. Now, five months after the operation, Kent is riding a two-wheeler. His heart, instead of growing bigger but weaker, seems actually to be smaller and stronger. Like the dog that had the same operation 3 1/2 years ago, Kent can run and jump with the rest, no longer turns blue except after truly strenuous exercise.

Dr. Glenn doubts that his team's operation can be used on infants (their blood vessels are too small) and insists that it be tried only on children who meet his rigid standards of selection.

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