Bird Cage in the Heart

A pretty young Florida housewife who has suffered increasingly severe heart trouble since childhood reported proudly last week that she is now able to fix one meal a day, and hopes soon to go back to her office job. The secret of her progress is embedded in her heart. It is like a miniature bird cage. At the point where the aorta (the body's main artery) begins, surgeons have removed part of nature's valve, which was diseased, and replaced it with an ingenious steel-and-plastic gadget.

Mary Richardson, 32, wife of a Jacksonville truck driver, had blackouts for years before she went to Boston's famed Peter Bent Brigham Hospital in 1958. Doctors found that she had, in severe form, a two-pronged heart defect: because of hardening and scarring (perhaps from rheumatic fever), the aortic valve does not open wide enough to let out a full supply of blood, and at the same time it does not close tight enough to keep blood from sloshing back into the heart and adding to its work load.

Surgeon Dwight E. Harken, 49, operated on Mrs. Richardson to free the valve leaflets. Radical as it was, this surgery gave only temporary relief. Blood still poured back into the heart. What Dr. Harken wanted was an artificial valve. Plastic valves have been developed by Washington's Dr. Charles Hufnagel, but they cannot be placed as close to the heart as surgeons would like, and they click audibly. Dr. Harken went to work with designers and technicians at Davol Rubber Co. in Providence, and they devised what he calls a "caged ball valve."

To laymen, it resembled a double bird cage. A silicone rubber ball, three-fourths of an inch in diameter, is encased in a slim, steel-wire cage in which it can move freely up and down. This in turn is enclosed in a second cage. In a ten-hour operation recently, Surgeon Harken removed one leaflet of Mary Richardson's faltering valve. Into the slit in the aorta wall he stitched a piece of Ivalon sponge, to which the bird-cage valve was attached so that it snuggled into the heart-aorta junction. Mrs. Richardson's tissues grew into the sponge, making a firm union. The outer cage kept tissue from growing into the inner cage, where it could have interfered with the valve ball's movement.

After four weeks, Mary Richardson went home to Jacksonville. She still has discomfort from healing of the huge chest wound, but her heart rarely bothers her. "Sometimes I hear the valve at night," she says. "But I'd rather hear it than not."

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