Posts Tagged ‘Alfred Blalock’

The Gross-Taussig Shunt

March 4, 2010

There was once a heart surgeon who was the acknowledged expert in Pediatric Heart Surgery. Dr. Helen Taussig once approached him asking for advice about re-routing some blood vessels to relieve a Congenital Malformation of the Heart known as Tetralogy of Fallot (ToF).

This surgeon was not Dr. Alfred Blalock.

As I mentioned yesterday, everyone is born with two heart defects: The foramen ovale and the  ductus arteriosus, which is a direct connection between the Pulmonary Artery and the Aortic Arch. It allows blood coming from the Right Ventricle to bypass the lungs, and it closes shortly after birth. If it fails to close it is refered to as a “patent ductus arteriosus” (PDA), and can lead to Congestive Heart Failure.

Robert Gross was born in 1905 and by 1938 was the Chief Resident at Children’s Hospital in Boston.  Children’s Hospital had been experimenting with closing PDAs in animals and was having success, and Gross was eager to try the repair in a human. Being a good Resident, he asked his boss, highly respected Surgeon-in-Chief  Dr. William E. Ladd. Ladd said no – we do not touch the heart.

Not long after that, Dr. Ladd went on vacation. Dr. Gross went to his substitute, Dr. Thomas Lanman, and again asked permission. Lanman gave him the OK, and on August 26, 1938, Dr. Gross closed the PDA of  a little girl named Lorraine Sweeney. Everything went perfectly.

Dr. Ladd came back from vacation, learned what had happened, and fired Dr. Gross.

Gross wasn’t out of work for long – the higher-ups at Boston Children’s thought the surgery was a great thing, and sent Dr. Ladd to rehire Dr. Gross! Rather than holding a grudge against Gross, Ladd came to realize just how good he was and the two teamed up. Working together, the two devised several new heart operations over the years and experimented with valve replacements and a heart lung machine. When Dr. Ladd retired, Dr. Gross was selected to replace him.

In the early 1940′s a young female doctor from Baltimore visited Dr. Gross. Since he was one of the leading Cardiac Surgeons of the time, she discussed with him a theory that she had: Although it was impossible (at the time) to do surgery on the heart, she felt that Tetarology of Fallot (ToF) could be relieved by redirecting some of the major blood vessels.

Gross was intrigued by the idea. When this doctor offered him the chance to actually help develop such an operation, Gross hesitated. She seem to be smart enough, and she did work at Johns Hopkins. They were as prestigious as Boston, and wouldn’t just hire anyone. But there were so few female doctors around no one would take her seriously…. and he turned her down.

So Helen Taussig, M.D., got back on the train and returned to Baltimore. A few years later Alfred Blalock was named Chief of Surgery at Johns Hopkins. Had Gross accepted Taussig’s offer, the first Congenital Heart Surgery could have been named the Gross-Taussig Shunt.

If it had worked. Without Vivian Thomas – who came to Hopkins with Dr. Balock – the operation could have failed and wrecked both of their careers.

Partners of the Heart

November 24, 2009

In honor of Red and Blue Day, what follows is a reprint of an article I wrote for the November 2009 issue of The Right Heart Times, the newsletter of the CHD support group Hypoplastic Right Hearts:

The Blalock-Taussig Shunt (Shunt means “detour”) was the brainchild of one of the most unusual people in medicine: Dr. Helen Taussig. Despite being Dyslexic and slowly losing her hearing after becoming a doctor, Taussig had overcome both disabilities to become the head of the Cardiac unit at the Harriet Lane Home for Invalid Children, located at Johns Hopkins Hospital in Baltimore, Maryland.

While at Harriet Lane she began to study Congenital Heart Defects, especially Tetralogy of Fallot (ToF). ToF children suffered from a combination of four heart defects which led to the mixing of oxygenated blood with unoxygenated blood inside their damaged hearts. This caused them to have Cyanosis (have a bluish tinge to their skin due to poor blood oxygenation), have poor stamina, difficulty feeding and usually die before they reached ten years old.  Despite the fact that these children were breathing hard and deep, they were suffocating – and there was nothing that Dr. Taussig could do about it.

Taussig’s frustration would continue until 1943, when Hopkins hired Dr. Alfred Blalock as the new Chief of Surgery. It wasn’t long after his arrival that Taussig and Blalock had a conversation that would change the world.

Hopkins legend states that Dr. Taussig literally broke into a conversation between Dr. Blalock and her boss, Dr. Edwards Park, and convinced him to attempt a surgical repair of the defect. Blalock reminded her that it was impossible to operate on the heart (at that time it was impossible) but Taussig contended that what she had in mind was not an operation on the heart itself, but moving the blood vessels around to send more blood to the lungs. She had the idea, but since she was not a surgeon she could not act on it.

Little did she know that he already had a partial answer. While studying the effects of shock on the human body, Blalock and his assistant Vivien Thomas had sewn a smaller artery onto the Pulmonary Artery in an attempt to increase blood pressure. Blood pressure had not been affected, but blood flow increased. The challenge now was to recreate the effects of ToF in a dog, perform the arterial connection, and evaluate the results. Swamped with his teaching duties and surgical schedule, Blalock turned the assignment almost completely over to Thomas. An African American with a high school education, Thomas had gotten a job in Blalock’s lab after dropping out of college and had become Blalock’s most able assistant.

Re-creating either the heart defect or the planned repair often proved fatal for the dog, but finally Thomas found the perfect combination and a mutt named Anna survived. The next step was to teach Blalock the procedure. The surgeon had observed the operation several times but had never done it himself; Thomas had done the procedure several hundred times – all on dogs.

On November 29, 1944, the trio tried the new surgery. They may have operated sooner than they wanted to, but young Eileen Saxon’s condition was deteriorating. Although she was 15 months of age, Eileen weighed only nine pounds and was badly cyanotic.

As they were preparing for surgery, Blalock turned to his scrub nurse and quietly asked her to summon Mr. Thomas. Although Thomas had taught him the procedure, he wanted his assistant close by in case there was a problem. Thomas entered the surgical suite and stood behind Blalock, guiding him through the operation and giving advice.

Making a five-inch incision on Eileen’s left side, Blalock clamped and cut her Left Subclavian Artery. The Left Subclavian branches off of the Aorta, travels along the shoulder blade (the Clavicle) and down the left arm. For a visual reference, the Left Subclavian Artery is located almost directly behind a police officer’s badge.
Blalock then placed clamps on the left branch of the Pulmonary Artery and made a small hole in the artery. Gently pulling the Subclavian downward, Blalock sewed the vessel onto the Pulmonary Artery, took a deep breath, and disconnected the clamps.

Eileen’s cyanosis almost instantly faded. “She’s a lovely color now!” Taussig exclaimed. Blalock’s surgical notes are a bit more understated, reporting that “the circulation in the nail beds of the left hand appeared to be fairly good at the completion of the operation.”

Originally known as a “subclavian to pulmonary anastomosis,”the operation was soon renamed the Blalock-Taussig Shunt, after the surgeon who performed it and the doctor who conceived it. Thomas received almost no credit for his part of the procedure during his lifetime.

Survivors of the Blalock-Taussig Shunt often have difficulty getting a pulse or a blood pressure reading in the arm on the shunt side (because of the disconnected Subclavian Artery) and should avoid having injections into that arm. In the late 1970′s the Modified Blalock-Taussig Shunt (MBTS) became popular. The MBTS leaves the Subclavian intact and makes the Subclavian-Pulmonary connection by inserting an artificial tube and avoids the arm problems created by the original Blalock-Taussig.
Eileen Saxon did well for a few months but again became Cyanotic as her shunt failed. She underwent another Blalock-Taussig Shunt (on her right side this time) but passed away just before her third birthday.

Blalock’s surgical team performed almost 200 Shunts in the space of a single calendar year and the operation opened the door for Congenital Cardiac Surgery. He continued to operate until just before his retirement in 1964, and died six months later.

Dr. Helen Taussig became known as “the Mother of Pediatric Cardiology” and had a part in averting the Thalidomide crisis in the early 1960′s. She retired in 1963 but often returned to Hopkins, staying current on the latest Cardiac research and contributing  much of it herself. She was killed in an automobile accident in May of 1986.

Vivien Thomas continued to stand at Blalock’s shoulder and eventually became Director of the Johns Hopkins Hospital Surgical Research Laboratories. He trained many of the surgeons who would become famous for their heart surgery accomplishments and invented many of the procedures that they would use. He received an honorary doctorate in 1976 and retired in 1979. Thomas wrote his autobiography, Partners of the Heart: Vivien Thomas and his work with Alfred Blalock and died in 1985, just before the book was published.

Anna the Dog served as the mascot of the Johns Hopkins Surgical Labs until her death in 1957.

Get the notes!

August 4, 2009

My main task yesterday was to get my information together and fax the Medical Records department at Johns Hopkins. I don’t know what happened to them or where they went, but I have misplaced some of the photocopies of my records that I had gotten from them.

It was rather surprising that I actually got them. I emailed them and asked if records from February of 1967 were still available.  Surprisingly, they said they would look for them! And now I have managed to misplace them! Ain’t life grand?

You really ought to have a copy of your medical records handy, just in case. The more complex of an illness you have, the more useful they will be. I have multiple copies – an 8×10 folder (Which I take with me when I travel and leave somewhere in my room that it will be easily seen), a 3×5 folder in my back pocket, and a copy stored on a USB stick clipped to my belt. If I get taken into an Emergency Department unable to speak, I ‘ve got what I need.

And you have to look through everything and decide what’s important and what is not. I edit mercilessly – that unexplained fever I had in the 5th grade probably isn’t a concern any more, so that report stays at home. This is what I have in my heath folder: my vital statistics, insurance information, who to contact, allergies, information about my defect, corrective surgeries, diagram of my heart, and the last EKG I had. The basic stuff.

What you can also have that is invaluable is your surgical report. Whenever an operation is performed, a careful record is kept of the procedure. Here’s an example: Alfred Blalock’s surgical report of the first Blalock-Taussig shunt. (Page 1; Page 2) Having them is almost like letting that doctor travel back in time and see the original operation – he might have to call for a surgical consult to help him interpret them, but he’ll know exactly what was done during your operation.

Getting your surgical records might be difficult. The older you are, the better the chance they have been stored, filed and lost, and perhaps even disposed of. If you are the parent of a young child, be sure to ask for the surgical notes. The doctor may say, “Sure, no problem!”, or he may have to ask you to sign a form to show that they were transferred legally. You might have to jump through the hoops that the HIPPA law places in your way, but if they can be obtained, get them. Hopefully you’ll never need them, but if you do, they could save your life!

Present at the Creation

April 22, 2009

“In late November 1944 Dr. Blalock did the first Blue Baby operation on Eileen Saxon. I believe Denton Cooley was the Intern. The operation was done in late November just before changing services, and I rotated onto the service as Denton rotated off.

My job was to take care of Eileen. A lot of people, mainly Dr. Blalock and Dr. Taussig, were hovering over her. She didn’t seem to be less blue than she had been before the operation, but Eileen got better over the next few days.

It is interesting how little treatment we had to give back then. There wasn’t really much you could do except put a child in an oxygen tent, which increased the oxygen from 20 percent to 28 percent, obviously not much help. We did not have chest tubes, no intubation during general anesthesia, and none of the other things that are commonly done at the present time. Her operation had been done without an endotracheal tube, only with a mask. Miss Berger, the nurse-anesthetist, did the procedure.” – Dr. Henry T. Bahnson; interview appearing in Pioneers of Cardiac Surgery by William S. Stoney, M.D. Copyright 2008 Vanderbilt University Press, Nashville, Tennessee

Making History

January 6, 2009

Doctor Blalock!

What are you doing out here? Doctor Taussig is beside herself, wondering where you are! Please get in there and get scrubbed up, or she’ll have my hide!

No I don’t know where Mr. Thomas is. Find him? Send him down to the OR? I don’t know about this… Yes, sir, you’re the doctor and I’m just an orderly. I’ll find Mr. Thomas myself! But right now, you need to be in the Scrub Room!

It is November 29, 1944, and YOU are Dr. Alfred Blalock. Eileen Saxon has just been brought into Room 706 for heart surgery… the first such operation ever attempted. If you think you are up to the challenge, CLICK THIS LINK.

Teamwork

November 28, 2008

blalock-thomas1

These two men did pioneer work on blood loss and shock. They developed heart surgery procedures that are still in use. Odds are, you have only heard of one of them.

Vivien Theodore Thomas was born on August 29, 1910 in Lake Providence, Louisiana. After graduating high school in 1929, he planned to attend Tennessee Agricultural and Industrial State Normal School, (Now known as Tennessee State University) with hopes of becoming a doctor.

He had been in school two months when the stock market crashed, causing him to lose his part-time carpentry job. Forced to drop out of college, Thomas still found work as a Lab Assistant at Vanderbilt University Medical School, working for surgeon Dr. Alfred Blalock. Although hired to sweep floors and clean out cages, Vivien Thomas impressed Dr. Blalock with his intelligence. Blalock was so impressed that he trained Thomas to be his Surgical Technician.

Thomas began assisting Blalock in the study of shock during surgery. Shock is caused by a sudden drop in blood flow through the body, and can be fatal. Working together, Blalock and Thomas developed ways to prevent shock from occurring during an operation. By World War II most of their theories were in use, saving the lives of countless injured soldiers.

In 1941, Dr. Blalock was hired by Johns Hopkins Hospital in Baltimore, Maryland, to serve as the hospital’s Chief Surgeon and as a Surgical Professor in the Hopkins Medical School. The doctor asked his trusted assistant to go with him, and Thomas agreed. But while Blalock was responsible for training every surgeon in the school, Thomas had to enter the building through the service entrance. He was also listed on the hospital payroll as a handyman.

The two men respected and trusted each other, but were hardly equal. At one time, Blalock was paid ten times more than Thomas. Often the doctor hired Thomas to serve drinks in his home during a social event. And never was Thomas allowed in the Operating Room.

It was at Johns Hopkins that the two men met Dr. Helen Taussig. Taussig had been hired in 1930 to oversee the Cardiac Clinic of the Harriet Lane Home, (Hopkins’ children’s hospital) and quickly grew interested in “Blue-Baby” diseases.

Usually, blood coming into the heart is routed first to the lungs, where it absorbs oxygen. The oxygen rich blood then goes back to the heart, where it is pumped throughout the body. Blue Babies are born with a badly formed heart or blood vessels that cannot provide enough oxygen to the blood. Their skin has a distinctive blueish tinge, especially in the fingertips. At that time Blue Baby diseases were incurable, and almost all of the patients died very young.

Dr. Taussig approached Dr. Blalock with an idea: if a Blue Baby’s heart couldn’t provide  oxygen to the blood naturally , then why couldn’t a surgeon re-route the major blood vessels? Taussig’s plan was interesting but extremely dangerous. The operation would have to take place near the heart, and heart surgery was so risky it was almost never recommended. Any accidental damage to the heart would have to be repaired within 4 minutes, or the patient died.

Busy with his teaching duties, Blalock asked Vivien Thomas to work out the details of how such an operation could be done. Thomas began by studying medical textbooks, drawings and diagrams of hearts, and even real hearts taken from dead bodies. Then he operated on dogs, intentionally creating Blue Baby hearts in them. Later he would operate again, repairing the heart and making careful notes of everything he did. It was a slow process, learning exactly what had to be done.  Many dogs died, and several of the surgical tools he needed didn’t even exist. Quite often, Thomas would invent them.

X-rays of the patient were another problem. X-ray films provide a good still photograph of the workings of the body. But Taussig preferred to use a fluoroscope. A fluoroscope image is best described as “X-ray TV”– It provided moving images of the interior of the body. If the patient accidentally moved, so did the picture. There was no way to record the fluoroscope image, so the three doctors would have to study their patient’s fluoroscope scans carefully and commit them to memory.

At last they felt they were ready, and Taussig began to search for a proper patient. On November 29, 1944, they operated on a little girl named Eileen. Although fifteen months old, Eileen only weighed nine pounds.

Thomas had planned to be in the observation room, watching the operation. Blalock said no – he felt more comfortable with Thomas close enough to give him advice. In preparation for the operation, Thomas had performed the procedure over 100 times on animals. Blalock had been taught the procedure by Thomas, but had actually done it only once. Breaking all the rules of the time, Thomas entered the operating room and guided  Blalock through the operation.

Eileen’s heart never stopped beating and her blood vessels were only as thick as a  matchstick. After about 90 minutes, Blalock was finished. Everyone held their breath as he removed the last clamp from a blood vessel. After a long pause, Helen Taussig said “Al, the baby’s lips are a glorious pink color.”

Proven to be a success, Blalock’s team performed nearly 300 operations in less than a year. Surgeons came from around the world to study Blalock’s new surgical procedures, only to learn that Thomas was the expert, not Blalock or Taussig. Still, the operation was known as the “Blalock-Taussig Shunt,” named for the surgeon who performed it and the doctor who suggested it.

Blalock retired in 1964 and died four months later. For six years, Thomas continued to teach but took on no major project – almost as if  he were in mourning. But as the 1970′s began, more and more African-Americans were entering the Hopkins Medical School. To them, Vivien Thomas was not just one of their teachers, he became their mentor. And just as he had guided Blalock so many years before, Thomas’ advice and support guided a new generation of doctors through medical school.

Thomas died in 1985, just a few days before his autobiography was published.* Today, Vivien Thomas is almost unknown to the general public. But Dr. Alfred Blalock never forgot him. If someone stood too close to his right shoulder during an operation, Blalock would tell them to back away. “Only Vivien may stand there.”**

* Thomas’ autobiography has been reissued with a new title: Partners of the Heart: Vivien Thomas and his work with Alfred Blalock. A hardback copy of the original title, Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and his work with Alfred Blalock is usually valued at over $100.

** This photo has been identified by Johns Hopkins archivists as being a photo of the third Blalock-Taussig Shunt taken in early 1945. Dr. Helen Taussig normally would have been in the operating room but is not identifable in this photograph.

Red and Blue Pride!

November 24, 2008

Alfred Blalock (Alan Rickman) and Helen Taussig (Mary Stuart Masterson) in HBO's Something the Lord Made

Alfred Blalock (Alan Rickman) and Helen Taussig (Mary Stuart Masterson)

Still from HBO’s Something the Lord Made

Saturday (November 29) is the 64th anniversary of the Blalock-Taussig Shunt. It’s our birthday, and I think we should celebrate.

All of you are not invited over to my house – I don’t think I have a big enough cake – so you’re going to have to party by yourselves. “But wait a moment,” you may say, “my operation wasn’t a Blalock-Taussig. It was a Waterston Shunt, or a Bidirectional Glenn, or the Norwood.”

Doesn’t matter.

Because the Blalock-Taussig operation was the first surgery designed to relieve the effects of a Congenital Heart Defect. Without Dr. Blalock and Dr. Taussig, there is no heart surgery. And without heart surgery… we aren’t here. So it doesn’t matter if you’ve never had the Blalock-Taussig Shunt; if you have a Congenital Heart Defect and have survived an operation, this is your event, too.

To celebrate, I’m wearing Red and Blue on Saturday. I was blue (Cyanotic) and now I’m red… or at least, an acceptable shade of pink. Why don’t you do the same? Ask your friends to wear the colors, also.

I’m also wearing my Adult Congenital Heart Association (ACHA) pin. If you are a member of a CHD support group, make sure you put yours on, too. I’ll lose my ACHA lapel pin in a moment, so I usually leave it attached to my suit jacket; but I’m wearing it Saturday. Wear yours. If you have an extra pin, give it to someone you care about, or who cares about you.

Call every Heart Dad and Heart Mom you know, along with fellow Heart Warriors and get them involved. Let them know what you are doing and why – and tell them to pass the word. 1 in 125 people have a heart defect, let the world know how many of us that there really are!

A Congenital Heart Defect is an “unseen disability” – the general public will never know what we put up with. Instead of whining and complaining, we just want to do the best we can and be happy and productive citizens. We usually don’t draw attention to ourselves… but on Saturday, we need to brag a little!

(Don’t) Follow the Plan

October 28, 2008

First, a quick update on two of our friends: Colby is home! As it says on his blog, he went before the Doctor’s Parole Board and they released him on good behavior. As of this writing Katie is still scheduled for a Glenn Shunt tomorrow. Keep this young lady in your thoughts.

If you are putting together a heart book, a good starting point is a copy of the surgical notes. The surgical notes are written by the surgeon (or one of his assistants) after an operation; basically they are a “play by play” description of the operation. Modern operating rooms can be outfitted with recording equipment; the surgeon describes the operation as he works. A boom microphone above his head picks up his words and the tape is transcribed later. (Modern operating rooms are amazing, a surgeon can pause long enough to say “Please replay the MRI from last Monday” and it will appear on a video screen. Usually there is a computer tech controlling the system, but more and more often the computer can do it automatically!)

Surgical notes are very detailed, as operations have become more and more complex the level of detail in the notes has increased. Alfred Blalock’s notes on the first Blalock-Taussig Shunt are an incredibly short two pages. (Page One, Page Two) In surgical notes being written today, you may read a page and a half before the first incision is made.

Reading the notes are very difficult: they are meant for the official medical records. Normally you won’t receive a copy of them, you will have to ask. If you or your child are still in the hospital, getting them could be as simple as asking “Say doc, can I have a copy of this for my personal health records?” If you’ve recently been released, make an appointment with the surgeon. You’ll probably have a follow up appointment anyway, let him know beforehand that you’d like a copy of the surgical notes… and for him to go over them with you. Surgical notes are written in “Medical Talk”. If you don’t speak Doctor and have a good working knowledge of Anatomy, you’re going to be lost. That’s why you want an expert to review them with you – and who better than the person who performed the procedure? (It would help to give the doctor ample warning and to discuss the notes during a regularly scheduled appointment, even if you have to make an appointment just for the discussion. Extending your “usual” appointment really isn’t fair to his other patients.)

If you had your surgery a long time ago, you will have to contact the hospital where the surgery occurred and request the notes. Be prepared for a wait. You will have to fill out a form to release the records (even though they are your records)… the HIPAA laws require it. And then… be patient. Your records may be stored somewhere away from the hospital, and someone’s got to dig them out. That might take a while.

You really need a copy of all your surgical notes, if you can get them. Surgery is like Chess – everything starts from the same point, and there are a limited number of opening moves. All Bi-directional Glenn Shunts, for example, start the same way. Surgeons are the Grandmasters; they have the ability to think three steps (or more) ahead and they know when it’s time to deviate from the accepted course. You can’t learn this skill by reading a book, it only comes with training, repetition, and an inborn skill. They just know what they need to do next, how it is going to affect the body, and how to react if a crisis develops.

Every surgery is different, because your surgeon is reacting to what he finds inside of you. So even though we may share the same defect and the same surgical procedures, our insides may be totally different. So get those surgical records, having them could save your life!

Documents

October 19, 2008

Holding a copy of Helen Taussig’s book Congenital Malformations of the Heart is almost like holding a copy of scripture. This is where it all began: before publication of this book in 1947, there was almost no understanding of Congenital Heart Defects (CHD). No way to diagnose them. No field of Pediatric Cardiology, barely any heart surgery to speak of. Very few survivors. No groups like The Congenital Heart Information Network (TCHIN), Mended Hearts or the Adult Congenital Heart Association (ACHA). Hardly anything. And certainly no Adventures of a Funky Heart.

I have heard stories of doctors from the late 1940′s and early 1950′s examining their patients with a stethoscope in one hand and Taussig’s book in the other. And finally, instead of telling the worried parents that the situation was hopeless, being able to offer at least a small chance: “They’re making amazing progress with surgical solutions at Johns Hopkins, maybe if we contact them…”

She was years ahead of her time. Taussig wrote an entire chapter concerning a defect she described as “Atresia or marked hypoplasia of the aortic orifice prevents the expulsion of blood from the left ventricle in the normal manner. In such abnormalities the development of the left ventricle is also usually defective.” This defect is almost certainly what we know today as Hypoplastic Left Heart Syndrome (HLHS).

Other records exist that actually predate Congenital Malformations. Alfred Blalock’s surgical notes from the first Congenital Heart Surgery (later known as the Blalock-Taussig Shunt) have been saved and are online. You can read them here. (Page 1 Page 2) And here is a photo of the clamp that Vivien Thomas designed for the surgery.

The first operation occurred on November 29, 1944. Blalock and Taussig wrote a paper about the shunt that was published in the Journal of the American Medical Association on May 19, 1945, that brought the news to the world. (Here’s a drawing from that article). Normally works in medical journals are not noted in the public press, but a medical reporter who was actually a doctor (and not a well informed amateur, as many of them are) read the article. He wrote a short blurb about it that was printed in his paper and picked up by the wire services.

And the people came. At first they went to their local doctors, to find out all they could about this new operation. And then they came to Johns Hopkins Hospital…on the train, in cars, and some of them actually walked, bringing their sick children to the one place that might could help them. Blalock and his team actually performed an estimated 300 heart operations in a single year. The American Weekly printed an article about Taussig, Blalock, and the B-T Shunt in its February 17, 1947 issue and still more people came.

And in late 1947 Congenital Malformations of the Heart was published. The life changing surgery was only designed for Tetralogy of Fallot (ToF) patients, but now there  was a way to figure out exactly what was going on in a defective heart, and with knowledge came a chance.

There is a small section titled “The Plan of the Book” in which Taussig notes how her book is organized. In the second paragraph is this chilling sentence, which was true in 1947: “Although occasionally a patient with one of these malformations may live to adult life, in most instances death occurs before eighteen months of age.*” At the bottom of the page, the footnote reads “*The recent advances in vascular surgery may alter the prognosis in this group of malformations.”

I think Dr Taussig would be thrilled with the results of recent advances in vascular surgery.

Anna saved us all

October 6, 2008

I’m leavin’ in a minivan,

should be back Wednesday night…

Wait a minute, that doesn’t rhyme. I guess my career as a songwriter isn’t going anywhere.

I’m packed for the trip to Atlanta, the laptop is also packed and the batteries are charged, so I should be able to post tomorrow night. Of course, you’ll get a full report once I return home. I’m feeling good and not expecting any problems, though my weight is up a little bit. So the doc may wave his finger in my face. He won’t have to crack the whip too hard; I don’t like for it to be up either. When you have heart failure, your weight creeping up might mean there is a problem brewing. And even if it doesn’t, your heart has to work harder. That’s not good.

First, here are a couple of links that you need to read: Researchers have discovered that a new type of drug can trigger a heart defect in unborn mice. The chemical in question is fairly common, so if you are planning to have children (or more children), clicking these links would be beneficial!

But let’s not get ahead of ourselves; the sky isn’t falling (yet). Taking the results of a research study using unborn mice and saying that we’ve found a way to prevent heart defects is a giant leap, but it is certainly worth continued study.

Is animal research necessary? I have to answer with a resounding “YES!” When he was designing the first congenital heart surgery, Vivien Thomas first had to study the effects of Tetralogy of Fallot (ToF) in a test subject, then figure out a way to correct the defect. Conducting experimental surgery on children with ToF was completely out of the question, so Thomas first had to surgically re-create the defect, then devise a corrective procedure to counter it.

His test subjects were dogs, most of them supplied by the Baltimore City Pound. Thomas is said to have performed heart surgery 200 times or more before Alfred Blalock attempted it on a child, so we must assume that most of those operations were failures. The dogs almost certainly perished.

Finally Thomas figured it out, and not only did the dog (a “mutt” named Anna) survive the procedure that “gave” her a defective heart, she made it through the operation that corrected it. Thomas then taught Blalock the operation (again, on a canine test subject) and on November 29, 1944, with Thomas standing behind him giving him guidence and advice, Blalock performed the first operation designed to relieve a Congenital Heart Defect. (Click this link for a “Who’s Who” in the operating room!) The operation eventually became known as the Blalock-Taussig Shunt. Anna became the mascot of the Johns Hopkins Surgical Lab and lived there until her death in 1957. She even had her portrait hung in the Hospital.

While animal research may be necessary; animal cruelty is not. My personal rule of thumb is “Would I do this to my family pet?” If the answer is no, then that test is not done. (And this standard can be subjective; my dog is not my pet, she is a member of the family. A neighbor who owns hunting dogs does not think of them as his pets, rather they are “tools”. Their main purpose is to do a job: Tracking deer.) So even going by my own rule, Thomas would have never invented cardiac surgery. Because I couldn’t do that to my dog.

So now, all I’ve done is muddied the water! While you are contemplating the fine line between animal research and animal cruelety, carry a couple of doggie biscuts in your pocket and be sure to toss one to a stray. Because if it wasn’t for a mutt named Anna, none of us with a heart defect would be here.


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