X Rays to the Heart

For patients whose hearts have been damaged by a shutdown in a coronary artery, a Manhattan surgeon last week reported "encouraging progress" with a new and bloodless method of increasing the circulation. Dr. Ivan D. Baronofsky, chief surgeon at Mount Sinai Hospital, told the New York Heart Association that his technique involves use of X rays to provoke enlargement or multiplication of small, subsidiary arteries in the heart wall so that they will carry more blood.

Although about a million Americans annually have a first heart attack, which they survive with varying degrees of disability, doctors so far have been baffled in efforts to find a safe and generally applicable way of helping the body to repair the damage. Italian surgeons pioneered with rerouting one or two small arteries from the upper chest to the heart wall. The operation is relatively minor and safe, but most U.S. cardiologists doubt that it does much good, if any. Cleveland's Dr. Claude S. Beck (TIME, March 25, 1957) and Manhattan's Dr. Samuel Thompson (TIME, Nov. 13, 1950) relied on a different principle. If tissues in and around the heart are irritated, they develop an increased blood supply. So these surgeons opened the heart sac and supplied an irritant by dusting with talc or asbestos. Good results have been reported, but the procedure is a major operation, for which many heart patients are too weak.

Focused Beam. Dr. Baronofsky, 42, figured out a way of using irritation, but without the knife. X rays, in properly adjusted doses, cause transient irritation without doing actual damage. Tests with hundreds of dogs showed that survival rates jumped fourfold or better after an artificially simulated heart attack, if the animals were irradiated. Then some were killed, and dissection of their hearts showed that small artery branches had multiplied.

Dr. Baronofsky selected patients who were in no shape to withstand surgery. Working with Surgeon Elliot Senderoff and Radiologist John Boland, he focused an X-ray beam through the chest walls onto the heart muscle itself, in three or more treatments over a two-week period. By now the group has treated 28 patients and seen no ill effects, but encouraging signs that in the human subjects, as in the dogs, small coronary branches have increased and carried a bigger load.

Excluded Placebo. Caution personified, Dr. Baronofsky would make no precise claims for benefit to these patients because none has been observed for longer than a year. It is important, he noted, to rule out the "placebo effect"--many heart patients feel better if they only think that something has been done. Dr. Baronofsky has devised a method, which he would not disclose, to get around this difficulty. He is also comparing irradiated patients with others who have had heart surgery.

How many heart attack victims may be benefited if the radiation technique fulfills its inventors' hopes cannot yet be guessed. Most important is the fact that if it works, it can be done without anesthesia, and by any experienced radiologist in his office.

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