Open Heart Surgery

OVER IN THE LOST AND FOUND DEPARTMENT:

I had to go to the doctor’s office for a blood test this morning. Later, my mother asked how it went.

“No problem,” I said. “The only thing unusual that happened was that I found an iPhone in the waiting room.”

“What’s the difference between your phone and an iPhone?” Mom asked.

“About $600!”

I turned it in at the Reception Desk, so if you have misplaced your very cool mobile phone – and it has an 803 area code – call your doctor’s office!

*******

Have you had Open Heart Surgery? Are you sure? Because sometimes, Open Heart Surgery isn’t open heart surgery.

Say what?

It may seem like a little bit of a pet peeve, but seriously, if you are going to speak intelligently about a medical issue, you need to learn the terminology. I am certainly not perfect – it is an Emergency Department, but I am one of the worst about calling it the Emergency Room. I usually manage to type Department, but say Room. (No male wants to go to the ED.) I worked at a museum for ten years but still spell it musuem… thank goodness for Spellcheck!

Open Heart Surgery is one of those phrases that is specific, but has come into common use almost as a verb or descriptive term. Ever ask someone to Xerox something for you? You can’t do that – you can photocopy something, but Xerox had rather you not use their company name as a verb. (Page down to “The Xerox Trademark”.)

Actual, true “Open Heart Surgery” means that an incision was made in the heart – but the term has come to mean all surgical procedures involving the heart. The Blalock-Taussig shunt, for example, was not an open heart surgery. This was the first planned Congenital surgery, and no one knew what would happen if an incision was made in the heart. No one wanted to even get near the heart, just clamp and cut that Subclavian blood vessel we talked about, Dr. Blalock. Clamp the Pulmonary Artery and sew the two together, and get out. So my 2nd operation was not an open heart procedure.

My first one wasn’t supposed to be either the Glenn shunt of that time required sewing the Superior Vena Cava closed, cutting the right branch of the Pulmonary Artery and then sewing that into the Superior Vena Cava. That would deliver blood going through the Vena Cava not to the heart, but shunt it over to the right lung. For a person to live with Tricuspid Atresia, they must have an Atrial Septal Defect (ASD) and a Ventricular Septal Defect (VSD). There are no exceptions – if you don’t have those two holes the blood can’t find a route through the heart and lungs. My ASD was smaller than it should have been, so Dr. Gott performed the Blalock-Hanlon procedure on me. In the Blalock-Hanlon, you cut into the Right Atrium and use a probe or a scalpel to enlarge (or create) an ASD. So even though it wasn’t part of the original plan, I did have Open Heart Surgery.

Dr. Clarence Dennis was the first person to try to use a Heart-Lung machine and perform Open Heart Surgery in April of 1951. Dennis and his team thought they were going to be fixing a simple ASD, but almost as soon as the heart was open they found themselves face-to-face with a severe Heart Defect. Dennis later admitted, “I wasn’t even certain what I was looking at.” They got out quickly and the patient died in Recovery a few hours later.

Dr. John Gibbon was the next person to try Open Heart Surgery, using a Heart-Lung machine of his own design. In the early and mid 1950s all heart lung machines were built as needed and each one of them was different, reflecting the perceived needs of the designer. Pretty much the only thing consistent between all of the machines was the tubing, as a certain beer distributor sold tubing that had a very smooth interior. At one time that company sold to just as many hospitals and individual doctors as they sold to drinking establishments.

Gibbon’s Heart-Lung machine worked and the operation was a success! Positive that he was onto something, Gibbon used the Heart-Lung machine three more times – and failed badly each time, resulting in three deaths. Gibbon was shaken so badly he destroyed his machine, burned the plans, and never operated again.

Dr. Robert Gross, who was operating on children to fix their patent ductus arteriosus (PDA) in 1938, also tried Open Heart Surgery in the 1950’s. His idea didn’t require a Heart-Lung machine at all. Gross’ idea was called the “Arterial Well”, a rubber cone open at both ends. This cone was sewn onto the heart in the area of the needed repair. (The original plan was to use it to repair ASDs, and after that, Gross and his team would have to think about further uses.)

Reaching down into the well, the surgeon made his incision in the heart. The rubber cone would immediately fill with blood, but since it was both wide and tall, it shouldn’t overflow. The surgeon was then supposed to reach down into the blood, find the ASD (by feel!) and sew it up. The incision would then be closed (again, only by touch) and the blood drained off with a small pump. Once the surgeon was satisfied that there were no leaks, the Arterial Well could be removed and the blood replaced by IV.

As you might imagine, that idea didn’t work out very well!

Dr. John Lewis fixed an ASD in 1952. Lewis used Hypothermia  – once sedated, the patient was placed in a large tub of ice. The hypothermia worked, but not for long; the heartbeat was slow enough for surgery for only about 10 minutes. In the room with Dr, Lewis was C. Walton Lillehei, who had some ideas of his own. Lillehei used a cross circulation technique – someone of the same blood type (preferably a close relative) lay on a table next to the patient. Lilllehei would stop the patient’s heart, using the second person as a living Heart-Lung machine! Blood would flow through connections and tubes from the patient to the 2nd person, then back to the patient’s body. Although there was always the possibility that something could go wrong and kill the patient and the volunteer, this setup worked. It wasn’t perfect (most of the patients who passed away died from pneumonia, an all too  common occurance in the early days of heart surgery) but the success rate was more than 50%. Lillehei also had a discussion with Earl Bakken about some kind of electronic device that could regulate a heartbeat. Bakken went home and designed the first pacemaker in his garage – and eventually formed Medtronic! Working with Dr. Richard DeWall, the two developed yet another Heart-Lung machine in 1955. This one worked – and it worked so well that from 1955 until the 1970’s, the Lillehei-DeWall Oxygenator was the top of the line model.

So if you’ve had Open Heart Surgery, take a moment to reflect on all the effort – and lives – it took to get it right.

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5 Responses to “Open Heart Surgery”

  1. ashleyburgess Says:

    I thought that the BT shunt wasn’t open heart, but everyone kept calling it that, so I assumed I was wrong. What about the Glenn and Fontan? They aren’t open heart, are they?

    • Steve Says:

      The B-T is not. My Glenn (the Original Version as done in 1967) is not, the Bidirectional Glenn might be, if you are being a purist. The Superior Vena Cava is cut very close to the point where the Vena Cava enters the heart. (I don’t consider it to be)

      The Fontan depends on which version you are using. The Fontan didn’t give results that the doctors were looking for, so it has been redesigned twice for a total of 3 versions over the years. I should have gotten version 2 (Fontan 2.0!) in 1988 but that operation was called off after I nearly bled out on the table.

  2. carolyn Says:

    Clarry has had the bi-directional glen and the surgeon talked about enlarging the atrial chamber…so I believe he has had OHS. It is always a bit confusing. The surgeon then said something I need to clarify before Clarry’s Fontan; he said that Clarry’s heart would not have to be stopped this time because he managed to enalrge the atrium during the glen operation. I also remember having to work out myself that tricuspid atresia had to have a VSD as well! When I realised I felt a bit stupid….I put this to the cardiologist and I will never forget his reply:”yes of course” with a certain look that said “haven’t you been listening?”. It was so incredibly logical to him. It is hard to ask the right questions when you don’t know anything about the topic. So I have read and read and read just so I know the right questions to ask.

  3. Karen Thurston Chavez Says:

    Another great post, Steve! Oddly, I learned the difference lonnnnng before William came along!

    Matter of fact, I learned the difference between open-heart and closed-heart surgeries at least 15 years ago when my father had open-heart surgery.

    A journalist, scientist, bookworm and genius, my father was a stickler for using the right word and knowing what those right words meant.

    When my older son, Martin, was exactly 1 week old, my father had quadruple bypass and his aortic valve replaced with a mechanical valve (funny how you could hear that thing clicking beneath his skin). Dad was 70 years old, underwent a pneumonectomy (via thoracotomy) when he was 19, and had chronic obstructive pulmonary disease. It was a miracle he survived the deep sedation required for his surgery.

    He learned everything he could about the procedure he was about to undergo. And, true to form, explained it to us kids in minute detail, including outlining the difference between open-heart and closed-heart procedures.

    Cincinnati Children’s has a great explanation of these, too: http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/closed.htm.

    Thanks, Steve!

    KTC

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