Taken

A sad note from Dr. Wes:

A nationally renowned cardiologist, best known for his basic research on abnormal heart rhythms and the molecular structure of drugs to treat them, and a pioneer in applying nanotechnology to the study of biomedical problems, Morton F. Arnsdorf, professor emeritus and associate vice chairman of medicine and former section chief of cardiology at the University of Chicago, died June 9 in a motor vehicle accident in Indiana on his way home from work.

No in-depth post for you tonight, as I’m organizing the submitted links for Grand Rounds. See you tomorrow!

Room 706

The first Congenital Heart Surgery occurred on November 29, 1944 in Room 706 of the Harriet Lane Home for Invalid Children, the facility for children at Johns Hopkins Hospital. Located in the East Wing of the 4th floor, most of Hopkins’ early heart operations took place there. While there had been heart surgeries before this (Dr. Robert Gross had been repairing PDAs since 1938) this with the first surgical procedure specifically designed to relieve the effects of a Congenital Heart Defect. The operation was later named the Blalock-Taussig Shunt and is still in use today.

Here is a photo of Room 706 taken February 3, 1945 during the second Blalock-Taussig Shunt. (You can click on this photo and enlarge it) Blalock and his team are hard at work and most of the people who participated in that first operation are in this photograph. Ever wonder who they are, and what happened to them?

The first patient, Eileen Saxon, survived but again became Cyanotic a few months later. A second operation – once again the Blalock-Taussig Shunt, but on the opposite side of the body this time – was performed but Eileen died just a few days before her third birthday. In fact, fourteen of the first seventy patients to undergo the Blalock-Taussig Shunt died as the operating team learned the proper techniques needed for Cardiac Surgery.

Alfred Blalock (Surgeon, leaning over patient): Already head of the Hopkins Surgical Department and a Professor of Surgery, Blalock held those positions until he retired in 1964. He died a few months later.

Vivien Thomas (behind Blalock, face partially obscured by operating room spotlight): Thomas continued in his job as Surgical laboratory Assistant to Dr. Blalock and was later named Director of Surgical Research Laboratories. In 1976 he received an honorary doctorate from Johns Hopkins. Thomas retired in 1979 and died in 1985.

Olive Berger (Nurse Anesthetist, standing at head of table): Miss Berger is in this photograph but did not participate in the November 29 operation.                Anesthesiologist Merel Harmel been on duty that day, and either Harmel or Berger usually worked with Blalock. Miss Berger died in 1981 and her notebooks, currently in the Hopkins Archives, are considered important historical records of the first heart operations.

Denton Cooley (Across Operating Room table from Blalock): Just an intern at the time, Cooley would go on to form the Texas Heart Institute in 1962 and is considered one of the best heart surgeons in the world.

William Longmire (to Blalock’s left): After medical school, Longmire had left the residency program to run his father’s medical practice until the older Longmire recovered. Returning to Hopkins, he was granted a temporary residency and assisted during the first Blalock-Taussig shunt. Feeling he had earned his way back into a regular surgical residency program but having almost nowhere to put him, Dr. Blalock made him the Chief of Plastic Surgery.  Longmire left Hopkins in 1948 to become Chairman of Surgery at UCLA. He continued as Chairman of Surgery until 1976 and passed away in 2003.

Helen Taussig (Not identifiable but most likely in room): Already head of the Cardiac Division of the Harriet Lane Home, the operation would also bring her to prominence. Her 1947 book Congenital Malformations of the Heart (along with a second volume dealing with specific Heart Defects) were the first modern textbooks outlining the diagnosis and treatment of Congenital Heart Defects. Considered the mother of Pediatric Cardiology, Taussig would retire in 1963 but never ceased researching. In addition to her work with young Cardiac Kids, she was instrumental in preventing the use of Thalidomide in pregnant women in the United States. Taussig died in an automobile collision in 1986. The two women at the foot of the table are not Taussig; neither is the woman standing to Denton Cooley’s right. Taussig wore glasses, none of these three women wear them.

Room 706 itself: The Harriet Lane Home for Invalid Children closed in 1972 as the pediatric hospital moved into a more modern building. The old building was torn down in 1974.

The wrong question

The question we should be asking isn’t “Is it right to consolidate centers that offer Congenital Heart Defect (CHD) surgery in favor of larger centers?” but rather, “How do we get a CHD patient that presents at a non-surgical facility to one of the large surgical centers?” This question really has no good answers.

At 11:21 PM last night, a mother delivered a child at a smaller facility that does not offer Congenital Heart Surgery. The child, a five-pound, six-ounce boy, appeared to be showing the signs of Cyanosis. There has been no indication of any potential for cardiac problems noted in the medical records, and the child was immediately evaluated by the Cardiologist on staff.

The Cardiologist noted the presence of several unusual heart sounds, which along with the Cyanosis, lead him to believe that the child may very well have a Congenital Heart Defect. However, he is not sure of the exact diagnosis. For further testing the child needs to go to a facility with advanced imaging equipment, and there are two hospitals that can provide this service: Hospitals A and B. Hospital A has imaging equipment but no Congenital Heart surgeons; Hospital B (304 miles away) has both. The Cardiologist chooses Hospital B – perhaps the easiest decision that will be made all night.

Meanwhile, the parents have been informed that there may be a health issue with their child, and they may need to travel to a larger facility. In a small room with a Hospital Counselor, they discuss their options, which at the moment are largely unknown. In a few moments the Cardiologist enters the room and states that their child may have a serious heart problem but he is not sure. He recommends the child be taken immediately to Hospital B and possible surgery.

Now our questions multiply: Is the infant stable enough to fly? If yes, is the weather suitable for helicopter transport? Is a helicopter available? What kind of medical skills will be needed for the journey? Does the hospital have someone who is qualified to provide that level of care? If not, can someone be found quickly?

Is the mother able to travel? If not, how will the mother travel to Hospital B when she is well enough to travel?

These are the medical questions that need to be answered. Non medical questions could include anything from how will the family arrange for their clothing to be delivered to them at Hospital B, where will they stay, do they require any financial assistance, and what will happen to their vehicle? After all, when they arrived at this hospital, they never expected anything but the miracle of childbirth. Now they have been thrown into a world they do not want to visit, but have been informed that this will be their permanent home.

At 2:13 AM the phone rings in an office of Hospital B. The person who answers the phone knows that the Cardiologist on Call has been discussing a case with a fellow doctor at a small facility and that the child in question is being transported by helicopter. The phone call informs him that the helicopter about fifteen minutes from landing.

In turn, this person calls the Catherization Lab, Hospital Social Services, and Cardiology to relay the news. With great reluctance he calls the number of a home near Hospital B. Apologizing again for waking the family, he tells the woman who answers the phone that the helicopter is near.

The woman represents the local Congenital Heart Defect support group and is a Heart Mom herself, and has volunteered to work with new parents and try to guide them through their first journey into the CHD world. Just before leaving the house she looks into the room where her young daughter sleeps, her personal reminder of why she answers the phone in the middle of the night.

Obviously, this story is fiction – or it may not be, as 1 out of every 125 children are born with a Congenital Heart Defect. Many of them are born at smaller facilities that offer little to no Open Heart Surgery experience, and need to be relocated to “Hospital B” for evaluation and possible surgery. In my opinion, asking if closing smaller facilities in favor of larger, more experienced hospitals is the wrong question. We need to concentrate on smoothing the transition from smaller hospitals to the larger centers where help is more readily available.

C.H.D. in the USA!

Sung to the tune of R.O.C.K. in the USA by John Cougar Mellencamp

They come from the cities

And they come from the smaller towns

From all walks of life

With hearts that go

Crack! Boom! Bam!

Fighting CHD in the U.S.A!

Fighting CHD in the U.S.A!

Fighting CHD in the U.S.A!

Yeah, Yeah!

Fighting for the U.S.A.!

Said goodbye to their families

Said goodbye to their friends

With pipe dreams in their heads

And very little money in their hands

Some are black and some are white

Headin’ to DC to set things right

Solid as a rock with our eyes on the prize

‘Cause we’re gonna be…

Fighting CHD in the U.S.A!

Hey!

Voices from nowhere

And voices from the larger towns

A head full of dreams

Gonna turn the world upside down

There were people with stenosis, pig valves, and Fallot

(They were fightin’!)

Bad aortas, switched vessels, ASDs,  Cardiomyopathy

(They were fightin’!)

Spotlight on the HLHS team

And don’t forget the Funky Heart!

Fighting CHD in the U.S.A!

Fighting CHD in the U.S.A!

Fighting CHD in the U.S.A!

Fighting CHD in the U.S.A!

Fighting for the U.S.A!

HEY!

The Holmes Heart

This is probably the moment when the study of defective hearts began: a day in 1899 when Canadian physician Maude Abbott found an unusual medical specimen and wondered What in the world is this?

Recently named Assistant Curator of the Medical Museum of the McGill University Medical School, Abbott was appalled at what she found. A properly organized Medical Museum was a valuable resource to a medical school of the 19th century. Students could go down to the museum and study preserved organs and cadavers to learn about the workings of the human body. McGill’s facility hardly deserved the title; it was more like a giant linen closet full of surplus body parts.

“Let’s organize and catalog our exhibits,” Abbott suggested. “Find out exactly what we have.” Her boss glanced at the calender on the wall, figured three weeks before his retirement was not the time to begin a major project, and said no. He wasn’t interested, but if Maude wanted to, go right ahead. And that was what Maude Abbott was doing when she found it.

What in the world is this? It was a heart, obviously, but it was unlike any heart she had ever seen. There were two Atriums but only one Ventricle. No, there were two Ventricles, but one was so tiny that she almost missed it. Two valves drained into the same ventricle, leaving the other one isolated.  The specimen container was labeled Ulcerative Endocarditis. That was almost certainly what led to the owners death; experts have speculated that the specimen was a  Cor Triloculare Biatraitum heart, a very rare defect.

No one knew anything about this heart, other than the fact that it was obviously deformed. Abbott thought of someone who might know, Dr. William Osler. Now a major figure at the new Johns Hopkins Hospital in America and one of the world’s most respected doctors, Osler had graduated from McGill. She had met him in Baltimore the year before, perhaps he would answer a letter from someone at his old medical school.

Not only did Osler answer, he seemed to know the item Abbott had asked about.  Osler described the heart and referred to it as the “Holmes Heart” because it had been donated to the museum in 1822 by the Dean of the medical school, Dr. Andrew Holmes. Holmes had also documented the heart in an article that had appeared in the Edinburgh Medical Journal.

Abbott began to search for that issue of the EMJ. Finding a 75 year old medical journal wasn’t easy, but she located one. She was stunned to read that the heart had been removed during the autopsy of a 22 year old man. Someone had lived 22 years with this heart? How?

Since the heart had been “lost” for an unknown amount of time, Abbott revised the article, documented the recovery of the heart, and submitted it to the McGill Medical Journal under her own name.

But she was left with this strange heart and the thought that someone had actually lived to adulthood with it beating inside their body. It must have struggled to produce every beat. Already an noted expert on hearts who had produced a major work on heart murmurs, Abbott decided to study defective hearts in more detail.

And this could have been the starting point of Congenital Cardiology  – a malformed heart floating in a sealed glass container, sitting on a shelf for over 70 years.

Slow it down

Here’s a great blog entry by Ambulance Driver about calming down, taking control, and getting the job done. AD even uses one of my favorite quotes: “Slow is smooth; and smooth is fast.”

Modern medical technology allows doctors to monitor an unborn child – Dr. Milazzo’s presentation at the CHD Symposium was about Fetal Echocardiography – and hopefully the child will develop normally and have a healthy birth. But every so often the doctor has to deliver bad news: There could be a problem with your child’s heart; we need to do some further testing.

It’s a devastating event, but consider yourself (and your child) lucky. There is time to study the problem, figure out what is going on, and come up with a plan of action. When I was born there was no warning: I got here on Tuesday and my doctors realized there was a problem on Friday. I got three days of “normal” – and then things went haywire. But you have time to set your house in order, because you know the storm is coming.

Suddenly, a lot of people are going to become interested in you and your child, trying to figure out exactly what is going on and the best way to deal with it. Right now is the time to become proactive – get involved, learn what your physician’s  current thinking is, and become familiar with their plans. Start studying, learn the medical terms, get educated.

No matter what you are doing, there are always certain steps that must be followed. Everyone has their own variation of a spaghetti recipe, but no matter what it is, you must put the noodles in the pot. Your doctors have studied all the echos and test reports and hopefully they have developed a plan. Learn the plan. Know it as well as your doctors do. Break it down into individual steps if you need to: The first thing we need to do is A. Then we’ll do B. Depending on what the results of B are, we can do either C or D.

Stay cool, and keep your head.

The Great Money Shift

Primary Care Physicians (PCPs) are getting a pay raise! That’s great news, they certainly deserve it. But it’s not new money – we really can’t afford to put much more in the Medicaid/Medicare system – the government is re-shuffling the deck. Increases in one area means cuts in another, and Cardiologists are among those taking the hit this time. The American College of Cardiology… as you can expect, they aren’t happy campers.

But what is the answer? I’m not smart enough to know. I think that whatever the answer is, it’s gonna hurt – and that is the last thing that politicians want to do. But given the choice, I’d rather take some pain now than the hurting thats going to happen when Medicare/Medicaid payments outrun the national economy. We haven’t seen that kind of pain.

The Music of the Heart

An unusual ad campaign by the Zurich Chamber Orchestra reveals something… well, take a look!

This will change Cardiology forever!

Running for our Lives

As previously mentioned, I’ll be in Boulder, Colorado for a few days to support my friends in the Denver Metro Chapter of the Adult Congenital Heart Association (ACHA). They’ll be participating in the Bolder Boulder, a 10 Kilometer (slightly over six miles) road race through the streets of Boulder. We’ll raise money for the ACHA and awareness of Congenital Heart Defect (CHD) survivors. I’m not participating in the race because of my low PulseOx readings, but if I were on the course, I’d be crazy enough to wear a T-Shirt with these words printed on the back:

YOU ARE LOSING TO SOMEONE WHO HAS A HEART DEFECT!

But that probably wouldn’t make us any friends and with my luck, I’d finish last!

Last year, Denver Metro was able to field a team that included seven adults with heart defects, and between them they had undergone twelve heart surgeries. Friends, family and neighbors of the twelve survivors were right out there with them. And there were more Funky Hearts who didn’t participate but were cheering from the sidelines.

More and more children born with a heart defect are growing up; a report from the Bristol Royal Hospital for Children estimates that 1,600 British children with bad hearts become adults each year. Doctors are learning how to control arrhythmia in adults better, and the medical community is beginning to recognize that Adult Congenital Cardiac patients need lifelong care, though for years many of us were “lost in the system.”

If you are in the Boulder area over the Memorial Day weekend, keep your eyes open for ACHA T-shirts, and give us a shout out when you see one! We’ll give a shout right back at ya! We hope to have an awareness table, but I can’t tell you where – we won’t know for certain until the events for the week are finalized. But if you see it, stop by and meet the team!

And maybe you are a Funky Heart who’d like to be part of a national organization that works for you, full of people who have been right where you are. You don’t have to live in the Denver/Boulder area; just click HERE to become a member of the Adult Congenital Heart Association. Membership is free, and the benefits are priceless!

Link, Link, Link your Boat, Gently Down the Stream….

We have a new link in the Blogroll: Congenital Heart Defect Clinical Trials. Clicking this link takes you to a list of the medical studies authorized by the National Institutes of Health (NIH) to study Congenital Heart Defects. The information can be viewed on a map (click the “Results on Map” tab) so you can choose a study taking place near you. By participating in a Clinical Trial, you can be a part of finding a cure for Heart Defects. The list changes often, so there are many opportunities to participate. (Since I’ve set the link to automatically load every study having to do with Congenital Heart Defects, click “Refresh” on your browser after the list loads. That will give you the most up to date listings.) Clicking on an individual Trial takes you to more information about that project and who to get in touch with to participate. Take an active role in fighting CHD by joining a Clinical Trial!

A basic Cardiology skill, but can your doctor do it?

Let’s encourage transplants by turning the system on its head.

Who is the world’s most kissed woman? You’ll never guess! (Hint: The rumor isn’t true)

The brains at MIT thought of this one: Repair a heart by building a scaffold.

Wheelchair backflip! With video!

AND…

Officially, you now have no excuse for not voting!