Posts Tagged ‘open heart surgery’

Behind Those Doors

November 21, 2010

Karen Thurston Chavez is Co-Founder of the support group Broken Hearts of the Big Bend (BHBB) and a good friend. We met when I spoke at BHBB’s Congenital Heart Defect Symposium last year and we trade e-mails at least once a week, keeping up with each other and discussing the latest issues affecting the Heart Defect community.

Karen’s blog has a most unusual post you need to read – in September, she was able to shadow her son’s heart surgeon for a day at Shands Children’s Hospital in Gainesville, Florida. But then something she didn’t expect happened:

I figured I would sit in on conferences and consultations he had with families whose children were having, would be having, or just had open-heart surgery to repair their congenital heart defects.  I guessed that I would sit and watch while he handled administrative work. I was right. I did all those things.

I did not think I would step into his operating room.

So I’m sending you over to her blog for today’s post. Karen will help you get scrubbed in and then walk you into the Operating Room as Dr. Mark Bleiweis performs open heart surgery.

SHADOWING MY SON’S HEART SURGEON

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Open Heart Surgery

July 8, 2010

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.

The List

September 14, 2009

Here’s a needed resource for parents of Cardiac Kids: a 36 page booklet listing Pediatric Cardiologists, Congenital Heart Surgeons, and hospitals that provide Open Heart Surgery for children. The listings cover both the United States and Canada and most of the information was updated in October of 2008. (Some was updated later than that)

It’s a downloadable .pdf file published by Congenital Cardiology Today.

The Guardian Angels

September 4, 2009

They were scared to death.

The nurses of the new heart surgery team at Dayton, Ohio’s Good Samaritan Hospital had practiced, studied, and thought they were ready. But still they doubted – they were walking into uncertain waters, and one mistake could cost a a child her life.

So after a sleepless night, most of them stopped by the hospital chapel before reporting to duty. And on Wednesday morning, July 16, 1959, they all assisted in Dayton’s first open heart surgery – a seven hour operation to repair a hole in a 9 year old girl’s heart.

The operation required the services of six doctors, six nurses, and three technicians. The technicians were probably in charge of the new heart-lung machine. The machine was funded, in part, through an unusual source: the proceeds from “High Fever Follies”, a talent show!

The operation was a success, and that original nursing team recently attended a ceremony to mark the 50th anniversary of that first operation. Age has caught up with everyone – the young patient passed away in the year 2000 – and Good Samaritan has changed. The hospital just opened a $31 million dollar facility dedicated to heart care. A heart attack victim being brought into the hospital can be in the Catherization lab having a life saving angioplasty within 90 minutes of arrival.

And Guardian Angels still patrol the halls of “Good Sam” – the decendants of that original group who stopped by the chapel that July morning fifty years ago.

New valve, no surgery!

August 18, 2009

So you need a new heart valve. Oh, boy. I bet you are just looking forward to the prospects of open heart surgery: having your chest split open, the pain when you cough (and if you think coughing hurts, just wait until your first post surgical sneeze!) and spending two to three months recovering. Or maybe you are like me… after all the problems with the scar tissue tearing and nearly bleeding out during my last operation, the docs aren’t going to go back in my chest any time soon. So what now?

The answer used to be “Just do the best you can,” because there were no other options. But now inserting a heart valve via catheterization is becoming more and more common – New York’s Presbyterian Hospital has implanted its 100th heart valve – and they never split anyone’s chest!

Before you pick up the phone and call the hospital, there is one problem – all 100 were done as part of a clinical trial. Most likely, they’ll have to turn you down, because these are tests of new valves carried out under controlled conditions. But every time they implant a valve, hopefully they learn something new. Presbyterian is replacing Aortic valves; a Pulmonary valve replacement was introduced a few weeks ago. It’s new to us, but they have been using it in Europe for some time.

So perhaps one day – not too far into the future – valve replacement by catheter will be the way things are done!