Posts Tagged ‘Ballock-Taussig Shunt’

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.

(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!