24 hours at Johns Hopkins

“Because your whole world can change in 24 hours.” – The Paper (1994)

Tuesday, November 28, 1944: Sometime during the evening of the 28th, Dr. Alfred Blalock places a telephone call to the Surgical Laboratory at Johns Hopkins Hospital. His Surgical Assistant, Vivien Thomas, has recently developed a surgical correction for the heart defect known as Tetralogy of Fallot, also known as Blue Baby Syndrome. The two men have planned for Thomas to teach Blalock the steps needed to successfully complete the surgery during an operation on a dog. Blalock has done the operation only once and many more teaching sessions are needed.

Blalock is calling with grim news: Earlier he had asked Thomas about the possibility of operating on 19 month old infant Eileen Saxon. Weighing only nine pounds and often cyanotic, the dusky blue color that gives this malady its name, she is deteriorating rapidly. At the moment she is so cyanotic that she is purple and is struggling for every breath. Dr. Blalock tells Thomas to meet with Elizabeth Sherwood, the operating room supervisor, first thing in the morning. Thomas has invented several surgical tools specifically for this operation and he is to make sure that they are available.

Thomas is stunned and reminds Blalock that he doesn’t know the operation very well. “But if you don’t get ahead of yourself, break it down into smaller and smaller steps as you work, it can be done.” It is one of the familiar sayings Thomas uses when he is teaching proper surgical procedure and for a moment, Blalock feels as if he is the assistant.

After Blalock hangs up, Dr. Helen Taussig orders him home. Blalock protests, but she reminds him that he plans to operate in the morning – an operation that could very well be emergency surgery. The hospital has his telephone number should he be needed during the night. At roughly the same time, Thomas and Blalock leave for their respective homes. Segregation is still prevalent at the time and Thomas leaves by a back entrance; neither man knows the other one has left.

Dr. Taussig spends the night on the ward; Eileen’s parents are also there. Although they don’t know it, this is an ominous sign: in the 1940’s, visiting hours rules were strictly enforced unless a patient was seriously ill.

Wednesday, November 29, 1944: Too nervous to drive, Blalock asks his wife Mary to take him to the hospital. She lets him out of the car in front of the towering Johns Hopkins dome. Dr. Blalock enters the building, walks through the rotunda (rubbing the toe of the Statue of Christ for luck, an old Hopkins tradition) and turns left. From here he exits the building through a side door, walks approximately 50 yards, and into the Harriet Lane Home for Invalid Children. Vivien Thomas enters the Hopkins complex from a side entrance and goes immediately to Elizabeth Sherwood’s office. Miss Sherwood knows nothing about Dr. Blalock’s plan to operate but immediately shows Thomas the selection of items that will be available to Dr. Blalock. Thomas adds custom-made clamps and needles to the collection. These needles are no more than 1/2 inch long. Thomas insists that the clamps and needles not become part of the general operating room supplies – they have been custom made for this operation only.

Blalock and Taussig examine the child and confer. Eileen has not improved during the night, and Taussig concedes that there is nothing else that she can do. She leaves the meeting as Thomas arrives, perhaps to return to Eileen’s bedside or for a quick trip to the Cafeteria. Blalock and Thomas discuss the upcoming operation. They go over some of the more critical steps, and also discuss “routine” points such as where the incision should be made. Thomas informs him that Miss Sherwood has promised that the large operative theatre will be available but needs to know when the operation will begin. Blalock decides that the operation will take place after the morning rounds, unless events dictate otherwise. He leaves to confer with Eileen’s parents and to conduct Rounds. Thomas did not normally participate in Rounds so he would have gone to the Surgical Lab, although he may have gone to his office. He calls Miss Sherwood and informs her of Blalock’s decision.

The operative team convenes in the Scrub Room annex connected to Room 706. Although first chosen at random, the majority of Hopkins’ early heart surgeries will take place here and the room will come to be known as “The Heart Room.” Dr. William Longmire and Dr. Denton Cooley will assist. An unknown person sets up a movie camera pointed at the operating room table; this film still exists in the Johns Hopkins Hospital Archives.

Blalock continues to discuss the upcoming operation with Thomas as he prepares for surgery. Thomas is not scrubbed in and has no intention to – he is not allowed on the Operating Room floor. He will be seated in the raised seats of the theatre, however. Helen Taussig will be in the Operating Room, even though she is not a surgeon. She’ll spend most of her time at the head of the table, monitoring the patient.

A few minutes before Eileen arrives, Blalock quietly asks his scrub nurse to find Thomas and help him get scrubbed in. As expected, Thomas is seated in the bleachers above the OR. Blalock also orders a milk crate and has it placed behind him. Thomas stands on the crate, peering over Blalock’s shoulder at the operative field.

The operation begins with a curving incision near the 4th rib on the child’s left side. With Thomas guiding him, Blalock gently works past the lung and cuts a path to the heart. The heart is small, dark, and obviously struggling. William Longmire later said “I remember watching him open the patient and just thinking it was impossible.”

Blalock works patiently, finding the Left Subclavian Artery and the left branch of the Pulmonary Artery. He places a clamp on the Subclavian to cut off blood flow – using one of the clamps designed by Vivien Thomas for this procedure – and cuts it. He then places two similar clamps on the left branch of the Pulmonary Artery. Making a small opening in the Pulmonary Artery, Blalock uses the tiny needles Thomas has prepared to sew the Subclavian Artery into the Pulmonary Artery. After double checking his work, Blalock removes the clamps. He is unable to feel blood flowing through the new connection.

Legend has it that Helen Taussig said “Al, the child’s lips are a lovely pink color!” The Johns Hopkins online exhibit about the operation states that the anesthesiologist said “The boy’s a lovely color now!” at a later date, during the third operation. Blalock’s operative notes comment that the circulation in the nail beds of Eileen’s left hand “appeared to be fairly good.”

The difficult segments are complete but the operation is far from over. Sulfanilamide (an antibiotic) is introduced into the incision and Blalock begins to close. He sews the soft tissue closed with silk sutures and is finally done. The operation has taken about ninety minutes. (CLICK HERE to perform the Blalock-Taussig Procedure yourself. Read Blalock’s operative notes here:  PAGE 1 PAGE 2)

Eileen is moved to the Recovery Room, where Dr. Henry Bahnson is responsible for her care. As one might expect, Blalock and Taussig look in on her often.  Bahnson’s opinion is that the little girl is still very blue but improves over time. Eileen’s mother comments “When I saw Eileen for the first time, it was like a miracle… I was beside myself with happiness.” Very little is known of Thomas’ movements after the operation. He is seen in Recovery and also in his Lab.

As the sun sets on the city of Baltimore, Eileen remains in critical condition but she is stable. The operation is a success, but in a few months it will fail and she will need another Blalock-Taussig Procedure, this time on her right side. She will die just before her 3rd  birthday.  The doctors determine that the surgery is more suited to an older child whose blood vessels have had a chance to grow. In early 1945 Blalock and Taussig co-authored a medical journal article about the first three procedures. Hundreds of patients would flock to Johns Hopkins Hospital to receive the life-saving surgery, even though the odds were long: an article in the February 17, 1947 issue of The American Weekly noted that 14 of the first 70 patients had died.

But parents noted that 56 of them had lived and were growing up, something that had never happened before. The era of Congenital Cardiac Surgery has begun.

Celebrate Red and Blue Day

“What sort of day was it? A day like all days, filled with those events that alter and illuminate our times…” – You Are There, 1953

November 29, 1944: Dr. Alfred Blalock took one final look into the incision. It looked right… he had been operating for years, surgery shouldn’t make him nervous anymore. But this operation did. He had completed this same surgery on a dog only once, and no one had ever tried it on a human before. Let this work…

“Watch for bleeding,” his assistant reminded him as he started to remove the clamp. Blalock nodded, ready to drop the clamp back into place if the new connection leaked. But not too hard, too much pressure and you crush the Pulmonary Artery; do that and you kill the patient.

His partner, Dr. Helen Taussig, stood near the head of the table. Heart surgery had been her idea, she had just as much riding on this operation as he did. Probably more – she had assured both him and the child’s parents that the theory behind this operation was sound. The little girl’s heart defect caused Cyanosis – she was literally suffocating from lack of oxygen. Taussig’s theory was to reroute a blood vessel to the lung and increase the amount of oxygenated blood available. Blalock’s assistant, Vivien Thomas, had designed the operation and tested it. All three of them had their reputations on the line.

And the irony of it all was if things went bad, he’d probably be the one to suffer least. Blalock was the Chief of Surgery, after all. Taussig was an almost deaf female doctor (who ever heard of such a thing?) and Thomas was a Black man who official job description wasn’t supposed to bring him anywhere near a scalpel, much less doing experimental surgery. If things went wrong, they would be the ones hung out to dry.

So let’s not allow things to go wrong, Blalock thought as he inspected his work again. “I’m removing the clamps,” he finally said.

Reaching into the open wound, he gently touched the new connection. “I can’t feel any flow,” Blalock said, disappointed. After a long pause, Taussig spoke.

“Al, the baby’s lips are a glorious pink color.” Stunned, the surgeon watched as the child’s blue lips slowly turned pink.

Before that day in 1944 heart defects were almost always fatal, usually during the first year of life. Occasionally a child was lucky enough to survive to late childhood or the early teens, but that was only under the best of circumstances. And that “lucky” child had no strength, no energy, and very little Quality of Life. Even after that first surgery (the Blalock-Taussig Shunt)  there was still only one operation, designed to relieve the effects of one heart defect. The odds weren’t good, but CHDers now had a chance. And sometimes one chance is all you need.

CHD Survivors, our families, and our friends celebrate November 29 as Red and Blue Day. Participating in Red and Blue Day is simple – just dress in red and blue clothing. You don’t have to donate any money (though if you choose to, your favorite CHD Support Group would be an excellent choice!) and you don’t have to volunteer to do anything. Simple as can be. If anyone compliments you on your good taste or your color scheme, just be prepared to explain why you chose those colors.

A Heart Defect is an Invisible Disability… many of us don’t even look like we have a health problem. Some of us are Cyanotic, but you have to look really close (and know what you are looking for) to see it. But November 29 is OUR DAY, so wear Red and Blue… and let’s stand out!

A new blog!

Mary Knudson is a health journalist, good enough that she has been a writer for The Baltimore Sun and teaches science and medical writing to grad students at Johns Hopkins University. Her new blog about living with heart failure opens with the sentence:

I got to know something about heart failure the hard way, by having it.

Heart failure affects millions of Americans, including me. The odds are that you (or someone you love) will have to deal with it, eventually. But as grim as it sounds (Oh my God, Heart Failure! My heart has failed!) it is survivable and you can live with it. Mary is – and she’s learned enough that she’s written a book, along with Johns Hopkins Chief Cardiologist. The blog is an offshoot of her book.

The first entry is a story that many Congenital Heart Defect patients and their parents are familiar with: a misdiagnosis and a roller coaster ride to figure out what is really going on. Mary’s heart failure blog is the feature today and will move into the blogroll tomorrow.

Funky Heart tells the story of his first surgery

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

Heart Moms and Heart Dads

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.

What really happened

Back in August I blogged about faxing a HIPPA compliance form to Johns Hopkins Hospital to get some medical records from my 1967 heart surgery. I already had the records, actually, but I had managed to misplace several of them. So I filled out another compliance form and faxed it to the Medical Records office.

Hopkins responded by sending all of my medical records from that first surgery, not just the 12 sheets I already had. I returned to Hopkins several times for check ups until I was about five years old, but none of those records are included. So now instead of 12 sheets, my stack is about an inch thick. This was a lot more information than I expected, and every bit of it is interesting.

I have Catherization reports, – one of which destroys a family legend; I always thought that we arrived at Hopkins at roughly 10:30 PM, but the Cath report says that I was brought into the Cath Lab at 6:16 PM. Daddy says we arrived at Hopkins about 3:30 pm, and the surgery itself began at 10:30 PM.

There are Radiological reports but no X-rays. I wonder if they deteriorate over the years. Possibly they are filed away in a different place, since all my records are copies, most likely made from microfilm.

Quite a few pages of Nurse’s reports (I can – and probably will – make an entire post about those!) and –

Oh my goodness…

The title of the sheet is OPERATING ROOM REPORT. And this is the entire report, not just the summary and the little bits and pieces of my operation that I assume from what I already know.

After the temperature was down to 32 degrees we used inflow stasis and during a three-minute period of inflow stasis dissected a sizable portion of the Atrial Septum.

I was too small for the heart/lung machine, so the surgical team stopped my heart temporarily by hypothermia – They literally put me in ice and cooled me until my heart stopped. During a three minute period of no blood flow doctors cut into my heart and enlarge an Atrial Septal Defect (ASD). For the heart to work (and its owner to survive) blood has to be able to complete the Cardiopulmonary circuit: flow from the body into the heart, move from the heart to the lungs, then back to the heart, and once again out to the body.  Because my normal pathway is blocked my blood “escapes” through an Atrial Septal Defect (ASD), and that earlier Catherization had revealed that my ASD wasn’t quite big enough.

…at the end of this part of the operation we proceeded to prepare the vessels for a right Pulmonary Artery anastomosis after the technique of Glenn.

This is a phrase that I type often and Funky Heart readers are probably tired of seeing: I don’t have the Glenn Procedure that is currently in use. That’s known as the Bi-Directional Glenn, because blood is rerouted to both lungs. I have the original version of the operation, the “Classic Glenn” or sometimes called the Unidirectional Glenn. In my version, the right branch of the Pulmonary Artery is cut and sewn into the Superior Vena Cava, so the majority of my blood flows into my right lung. CLICK HERE to see the best drawing I have ever seen of the Classic Glenn Procedure.

Chest was closed in layers with #00 catgut and skin with Dermalon. The patient tolerated the procedure well.

(Signed)

Vincent Gott, M.D.

Wow. Just…wow.

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.

Get the notes!

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

“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

Everything old is new again

We had been at the University of Alabama at Birmingham (UAB) Hospital for only a few hours, just long enough to be admitted and assigned a room. A nurse and one of the Cardiac Surgical staff were asking us the “usual” admissions questions.

“Do you happen to know what operation you had at Johns Hopkins?” we were asked.

“Yes,” Daddy replied. “It was called the Glenn Shunt.” (We didn’t say the “Classic Glenn Shunt”; the Bidirectional Glenn Shunt had been invented at that time but wasn’t being used much. It wouldn’t become popular until the early 1980’s, and wouldn’t be part of the HLHS repair until the late 1980’s. I had never even heard of the Bidirectional Glenn!)

The Cardiac staffer put down his pen. “The Glenn Shunt… wow. They don’t do that very much any more.”

My eyebrows shot up. The operation that had saved my life was now in the trashbin of history.

“I guess that’s our…” he paused as he thought. “That’s probably the fourth or fifth option. They are pretty hard to take down.”

When you “take down” an operation, you basically undo it. There are times when you have to restore the heart to it’s original configuration (or as close as you can get it) before you attempt another correction. Because the Pulmonary Artery is cut, it’s pretty difficult to unhook it and reconnect it where it is supposed to be.

The true irony of this story wouldn’t be revealed until a week later, when  surgeon Dr. Albert Pacifico cut my Left Subclavian Artery and connected it to the intact branch of the Pulmonary Artery. That’s right – my second operation in 1977 was a repeat of the very first Congenital Heart Surgery:  the Blalock-Taussig Shunt, first done in 1944!

Everything old is new again!