Posts Tagged ‘Heart Surgery’

Hospital Suspends Heart Surgery Program

March 5, 2010

An alarming story is coming out of Great Britain today, where all pediatric heart surgery at the John Radcliffe Hospital in Oxford has been suspended after the deaths of four children in three months.

All four of the children had Congenital Heart Defects and had been receiving care for some time before their operations. With the unusually high number of deaths, officials at Radcliffe decided to stop everything and review their procedures. The shutdown has affected twenty-six children awaiting surgery, but all are being transferred.

When something like this happens, it is a good idea to review procedures and try to learn if the problem is arising locally. The Health Secretary is obviously concerned, but also notes that heart surgery is “high-risk”. Heart surgery is an exacting science; there is little (if any) room for error…. which is why the President of the Society of Cardiothoracic Surgery has been concerned about the number of specialized surgical units.

“There are 25 to 30 surgeons involved in the whole country. We feel they are spread too thinly across those units. Everyone is working hard to provide a good quality of care but we don’t think it is sustainable.”

While it is quite possible to just have “a run of bad luck” (try explaining that to grieving parents) could overworked surgeons be the root cause of the problem? Or is it a local issue? Radcliffe Hospital has had problems before – an investigation in 2005 found that the death rate after a coronary artery bypass graft was “higher than expected” and there have been previous concerns.

Hopefully this time the investigators will be able to remedy the problem.

Updates on Zeb

March 2, 2010

I’ll be keeping an eye on Zeb during his surgery and updating whenever something comes in. Just keep refreshing this page!

9:19 AM: No word yet. Surgery was scheduled for 8:30 AM.

10:02 AM: Surgery began at 9:15 AM and could take five to seven hours. As of right now Zeb is stable.

2:03 PM: Great News, things have gone VERY fast! Zeb is off the bypass machine already! He was scheduled for the Ross Procedure, but after they got inside and looked around the surgeon was able to do a repair! His parents can’t be any more pleased and they hope to be able to see Zeb soon! (The update came through about an hour ago, but I’ve been out of touch for a little while. So the next update may come even more quickly.)

2:09 PM: The surgeon has been in and spoken to Zeb’s parents. Zeb did very well and they should be able to see him in about 15 to 20 minutes.

4:29 PM: No fresh updates from Zeb. Hopefully “No News is Good News” and his parents have seen him and are having some personal time.

6:34 PM: Zeb is resting comfortably in the recovery unit. He is still on the vent, but doctors are hopeful that the vent can be removed tomorrow. An Echocardiogram was done while still in the operating room and there is no leakage around Zeb’s Aortic Valve. Everyone involved seems to be pleased with his progress!

(Since everything seems to be going well, the 6:34 report will be the last update for the day.)

New way to create an ASD!

February 20, 2010

Here’s a report of a novel procedure that will hopefully come into use soon: creating (or enlarging) an Atrial Septal Defect (ASD) without breaking the skin.

I had a small ASD at the time of my first surgery but it needed to be larger. Back then (1967), ASDs had to be created or enlarged the old fashioned way – with a scapel. This was known as the Blalock-Hanlon Procedure, and it was pretty straightforward: cut into an Atrium, look for the ASD, and enlarge it. If you couldn’t find an ASD, make one.

Surgeons don’t perform the Blalock-Hanlon very often these days. (When I read my operative notes just a few months ago I had never even heard of the Blalock-Hanlon, much less knew that I had one!) Today the majority of ASDs are created by a balloon atrial septostomy, which is done by a catheter.

But this new procedure wouldn’t cut the skin at all. Histotripsy is “tissue liquification by ultrasonic wave” – the same technology they use when your uncle has his gallstones crushed. The suffix “-tripsy” is a Greek word that means “to massage” or “to crush.”

This was a small study of only ten dogs. Ultrasound was used to locate an appropriate point for an ASD and then the defect was created by Histotripsy. In nine out of ten cases, the shockwaves created an ASD, and later examination showed that there was “minimal damage” to surrounding cardiac tissue and no damage to the outside of the heart.There is also evidence that Histotripsy could be used for some cardiac ablations.

Much more research needs to be done before this becomes an accepted procedure, but the initial results are promising!

Funky Heart tells the story of his first surgery

February 13, 2010

This was taped earlier today at the Regional Forum on Congenital Heart Disease.

Heart Moms and Heart Dads

February 13, 2010

This is the text of my presentation to the Broken Hearts of the Big Bend Regional Conference on Congenital Heart Defects. (February 13, 2010, Tallahassee, Florida)

My name is Steve Catoe, and I was born in 1966 with a Congenital Heart Defect known as Tricuspid Atresia. If you are not familiar with that defect, Tricuspid Atresia means that my Tricuspid Valve – which is the door connecting the Right Atrium to the Right Ventricle – does not exist. Because of it, my Right Ventricle is very small and almost cut off from the rest of the heart.

I write a blog named “Adventures of a Funky Heart!”, where I write about growing up with a heart defect, the latest in Congenital Heart research, and news about advances in the field. I try to make it interesting and use a little humor, so hopefully you’ll keep coming back and reading every day. Hopefully I can help you by giving you information about heart defects that you can use – and I try to do it a little bit at a time, so you don’t feel like you are trying to drink directly from a fire hose.

Usually when I get a chance to speak to a group I talk about spreading awareness and I talk about our Cardiac Kids and I talk about adults living with a heart defect, who I call Heart Warriors. I’m scheduled to be on the Adult Survivors Panel too, and I plan to be around for the rest of the day, so if you want to talk to me about anything I’ll be here. But I asked for a little bit of extra time to tell you a story.

I was born on a Tuesday, and on Friday, they started to realize that something wasn’t right. I don’t know if my mother noticed it first, but that was probably the way it happened. Moms know their babies, and they are almost always the first one to pick up on any problem.

So they took me to my pediatrician, who figured out that I had some type of heart problem, but he wasn’t sure what. So he sent me to the nearest hospital that could help me.

The doctors there told my parents that I had Tricuspid Atresia, and they should take me home and love me, because I wouldn’t be here that long. Well my parents didn’t think a whole lot of that statement, and neither did my doctor back home. In fact, he said it was completely unacceptable.

So he found four places that could try a surgical repair: Johns Hopkins, Mayo Clinic, the University of Virginia, and the Texas Heart Institute. Mayo and Texas he threw out because of the travel distance. Virginia, which was his own medical school, he eliminated because he didn’t think they had enough experience. That left us with Johns Hopkins. He called, and things were set up for that summer. My parents would take me to Baltimore, I would be evaluated, and if possible, the Hopkins surgeons would attempt the surgery.

That night all hell broke loose. I went into heart failure, my heart rate shot up to 200 beats per minute, and I was rushed to my local hospital. I was there a week while they tried to get me stabilized; in the meantime, my pediatrician was working the phones, relaying information about me to the Hopkins doctors. They were telling him that I needed to get there as soon as possible.

Dad picked me up at the hospital and drove home to pick up momma, and we immediately left for Baltimore. Remember this occurred in 1967; I-95 hadn’t been completed yet. After driving all day they needed a break, so they stopped at a hotel in Petersburg, Virginia.

They had been asleep about an hour when Momma got up to check on me. She happened to glance out the window and it was snowing as hard as she had ever seen it snow. She woke daddy up, and we were back in the car and moving within a few minutes.

Cars were stuck in the snow all along the roadway, and daddy was stopping every fifteen minutes to wipe the windshield off with an old rag. When they passed through Washington he actually thought about putting me and momma on a train to Baltimore and catching up to us later. It’s a good thing he didn’t, because he found out later that the snow was so bad that the railroad shut down their trains for the night.

Three families were expected by the Children’s Medical Center that day, but we were the only ones who made it. The doctors examined me and then asked my parents for permission to do a Catherization. After the Catherization, the head Cardiologist came out to talk to my parents.

“He is down to hours,” he said. “We need to operate right now.” He added that my odds of surviving the operation were 50-50 but without it I had no chance. My parents had about five minutes to discuss it before they had to decide to risk the surgery or just let me slip away.

I was taken into the operating room at 10:30 that night, and the operation ended about three in the morning. My folks didn’t leave the hospital until they saw me afterwards, so it was almost daybreak when they went to a boardinghouse about a block away.

I have to admit that I begged Karen and the organizing committee for a few moments to speak to you today, almost to the point of embarrassing myself. Because that surgery took place on the night of February 17, 1967 – almost 43 years ago. My parents are just ordinary people; but that night they turned into a Heart Mom and a Heart Dad just like you. And I’m here today because they have always been willing to ask one more question, explore one more option, and go one more mile.

So I wanted to take a few moments and tell you my story, encourage you to hang in there no matter what, and on behalf of all the Cardiac Kids and Heart Warriors, to just say Thank You.

A helpful book!

December 8, 2009

Every now and again I will mention this book, because I think it is so useful and important. I own a copy, but I am not affiliated with the publisher. I’m not earning anything if you choose to purchase this book.

A book that I highly recommend for any heart family is The Illustrated Field Guide to Congenital Heart Disease and Repair. This book is a great guide to Congenital Heart Defects – the book lists 35 seperate defects – and the operations used to correct them. There are also chapters on Echocardiograms, Electrophysiology, common cardiac drugs, and catherizations.

There is a little bit of Doctor-Talk in the text – an experienced patient or heart parent won’t have any difficulty with the terminology, but someone entering the CHD world for the first time may have a little bit of trouble understanding it. This really isn’t a problem, since there are many diagrams – you can see what you may not be able to read!

There are two versions: The pocket sized version is 4 inches by 7.5 inches, small enough to slip into a purse. It’s a little big for your pocket, but a man could carry it between their belt and the small of their back. A wire binding allows the book to lay flat on a table.

The larger version (7 inches by 10.5 inches) has a little bit different content that the smaller version. The Large format contains a section of “abandoned” heart surgeries – the Classic Glenn Shunt and the Waterston Shunt are two examples. Other than that, the two books have the same content.It also has a wire binding.

You can purchase the Guide here. Both versions are available, but do not let the need for a purchase order scare you (or the $200 minimum order for a purchase order, either!) This company sells a lot of items to doctors offices and hospitals, situations where a purchase order is needed. But they also sell retail, and have no problem sending you one copy of anything. Apparently they recognize the fact that there are a lot of non medical people who need information about Heart Defects. (Good for them!)

They also sell The Illustrated Guide to Adult Congenital Heart Disease. A friend tells me this book is very informative, but I have never seen a copy, so I can’t recommend it.

But I have used the CHD Guide, and I highly recommend that book!

New glue makes surgical recovery easier!

December 7, 2009

On of the hardest parts of recovery from heart surgery is the time it take for the sternum (breastbone) to heal. A sneeze feels like a hammer blow to the chest, and even the littlest things are painful – you just don’t believe how many activities involve your chest muscles and breastbone in some way.

I always seemed to be dropping things – the law of gravity is still being enforced, so I would have to bend down and pick up whatever I had dropped. That HURT! I even started keeping my back straight and squatting down (the proper way to pick up a large object without hurting your back) but that didn’t seem to help very much at all. Grabbing an item from the floor still hurt, just not quite as bad. So I got pretty good at grabbing small objects – pencils, forks, etc. – between my toes and lifting it with my foot! Not the most sanitary trick ever invented, but once I got it off the floor I could wash it off. Actually getting down to the object was difficult, so I used that little foot-grab a lot!

There’s a new surgical technique being used in Calgary that can really reduce the pain and recovery time of heart surgery: gluing the breastbone back together. instead of staples and wire, these surgeons are using a new adhesive that is compatible with the human body to seal the breastbone. Patients are reporting less pain and shorter recovery times.

Glues used in wound recovery aren’t new, but it is the first time that this type of wound closure has been tried. Although the number of cases is low (about 20 patients so far) a larger research study using the patented adhesive has just kicked off. With luck the glue will soon be a standard part of surgical recovery!

Computer Assisted Fontan Surgery

December 4, 2009

I just don’t “get” the Fontan. At all.

I was recently asked by a CHD organization to write an article about the Fontan Procedure for their newsletter. I had to turn them down; I had to say that no matter how many diagrams I studied, and how many textbooks I have read, I just don’t see how that operation works. Thankfully there are people who are a lot smarter than I am who know how to explain it, and a few of them understand how to surgically alter a defective heart to make the Fontan work. Thank goodness for that, because if they didn’t, there would be a lot fewer of us around.

I was scheduled for a Fontan in 1988; that surgery went completely wrong and they barely got me off the table. I never got the Fontan, but many others from that time period have needed a Fontan Revision or Fontan Conversion. (After clicking the link, pay close attention to Section V.)

One of the difficulties in understanding lies in the fact that the Fontan has several variations, and is almost “customized” for the patient. Now there is a new computer simulation available to test various versions of the Fontan on a defective heart. The simulation will help determine blood flow patterns to help surgeons choose which variation of the Fontan works best for that patient.

The two researchers who developed the computer simulation have also designed a Y-shaped graft to be used as part of the Fontan. The Y connected will be used to join the Inferior Vena Cava (The major blood vessel leading to the heart from the lower part of the body) to both branches of the Pulmonary Artery, not just the single connection that is used now. According to the Abstract, the Y graft “is expected to be put into clinical use within a few months.” I am not sure if that means it is ready for clinical trials or has passed the trials and is ready for real world use.

Either way, these developments look promising!

Put your Hammer Down

November 28, 2009

“Are you going to take this on, Doctor?” – Dr. Helen Taussig (Mary Stuart Masterson) Something the Lord Made

There’s something that you want to do that is… unusual. Don’t think that there isn’t; we all have that crazy idea every now and again. So what is it? If it’s moral, legal, ethical, and won’t get anyone hurt, perhaps it is time to throw caution to the wind and actually give it a try.

I never dreamed I’d write about living with a heart defect – I mean, I live 5 miles outside of a town of about 400 people. My life is boring; what could I say that wouldn’t put you to sleep?

Then one day my phone rang. I think I scared the person on the other end, since I was really huffing and puffing when I answered it. No problem, I reassured them. I’m doing my walk inside the house today; it is raining cats and dogs out there. What can I do for you?

The Adult Congenital Heart Association (ACHA) was planning a session at the national convention where selected members would stand up and speak about living with a heart defect. Would I like to participate?

That sounded like a lot of fun, and my time limit would be seven minutes. Even I can’t trip myself up in seven minutes, so I accepted. And how in the world had they chosen me? I’m your average dues paying member (ACHA had dues back then, now the organization is FREE to join – a great CHD resource at a fair price!) I don’t rock the boat, and I don’t stand out. I guess my name was just pulled out of a hat.

So I thought about what I wanted to say and got organized, stood up and spoke. I enjoyed it, and the audience did also. Well – no one threw anything! And the hotel that was hosting the meeting was connected to the airport by a walkway. No one picked me up, rushed me down the walkway, and put me on the next plane heading out of town. I took both of those as a good sign.

“I know in every fiber of my being that this is a limb that I want to climb out on.” – Dr. Alfred Blalock (Alan Rickman) Something the Lord Made

Adventures of a Funky Heart! wasn’t my first attempt at writing about my heart problem. I started a blog on a local TV station’s website, named Adventures in Cardiology. That lasted about a week – the only ones who could see it were the people who were registered users of the TV station’s website. And judging from some of the comments that were left on the news stories… well, a few of them couldn’t read!

Adventures in Cardiology wasn’t available, so I needed a new title. And about that same time someone commented “Your heart is just funky and doesn’t follow the usual rules.”

BINGO!

I played it straight for a little while, I really did. Then I started getting comments and emails, and a lot of them were thanking me for writing – they had children with a Congenital Heart Defect, and no one had ever really told them anything about how to raise a child with a ton of energy and a bad heart. So I stopped and really thought about who was visiting the blog and what I wanted/needed to say:

  • Most of my readers were parents of children with heart defects
  • These parents may understand their child’s heart (A percentage of them don’t, not yet. You just can’t learn Cardiology overnight) but they really don’t know what might happen next

So the best thing I could do was be both a teacher and a storyteller – tell stories about growing up with a heart defect (in the middle of nowhere!); try to explain different things about the heart, both normal hearts and defective hearts; emphasize just how normal I am (and a lot of other survivors, too!); and talk about any advances in heart surgery or taking care of CHD Children that I may find.

And keep it light – “go for the funny” if the subject is appropriate. Write so that anyone can understand. eBay is full of textbooks, if parents want to study a textbook, they could find one easily. Reading Funky Heart! is a good indication that a textbook isn’t what you’re looking for.

This is not the career path I would have chosen… it’s better. Because instead of sitting behind a desk pushing paper somewhere, I feel like I am helping out in my own little way. And a lot more people hear my voice when the Funky Heart speaks than when little ol’ Steve says something, and hopefully I’m saying something that you need to hear.

“When I put my hammer and saw down forty years ago and was offered an opportunity to work with a young surgeon, I had no idea that I would be able to make a mark on an institution as prestigious as [Johns Hopkins Hospital].” – Dr. Vivien Thomas (Mos Def) Something the Lord Made

So don’t be afraid to put your hammer down, and walk a different path. Who knows where your journey will take you?

Happy Red and Blue Day;

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.