In 1944, Alfred Blalock, at Johns Hopkins, performed palliative
treatment for a child suffering from the cardiac condition known as the
“tetralogy of Fallot,” a cardiac defect where the pulmonary valve is too
constricted, leading to a hypertrophied right ventricle, a hole in the heart
between the right and left ventricles and “overriding of the aorta,” in
which the aorta empties both the right and left ventricles, instead of just
the left ventricle. Simply stated, the constellation of physical defects in
the heart of tetralogy of Fallot patients makes it impossible to adequately
oxygenate the blood, resulting in a “blue baby,” a child whose oxygenation
is so compromised they acquire a bluish hue to their skin. To be curative,
incising the muscular wall of the heart—and looking inside the heart—was
necessary, but no surgeon in the world could conceive of a method of
“opening” the heart without killing the patient. Tetralogy of Fallot was a
death sentence, but Blalock’s work-around palliative surgery did improve
patients’ lives by connecting large vessels on the outside of the heart.
The world’s first “open-heart surgery” was on September 2, 1952, at the
University of Minnesota when F. John Lewis operated on a five-year-old
girl using total-body hypothermia and inflow stasis. This was
accomplished by placing the child in a horse-watering tank full of ice
water in the operating room, cooling her to 82°F and, after surgically
opening the chest, clamping the blood vessels entering the heart (inflow
stasis). A quick operation to close a pathological hole between heart
chambers was performed, and after warming, the child was resuscitated
and survived the operation. More than fifty children with an abnormal
passage between heart chambers were treated in this manner, but concerns
over the ability to properly normalize the heart rhythm while rewarming
led the Minnesota surgeons to consider another way of unlocking the
heart.
Heartened by Lewis’s progress, Dr. John Gibbon at the Jefferson
Medical College in Philadelphia corrected the same cardiac defect in an
eighteen-year-old in 1953, while using an artificial device to oxygenate
the blood. The screen oxygenator, later named the Mayo-Gibbon heart-
lung machine, was large, complex, and expensive, but did achieve success
in the first application. The machine was the size of a hotdog vendor’s
cart, connected to the patient through a series of plastic tubes, whirring the
blood to and from the patient with DeBakey’s roller pump (stay tuned).
Not only did the patient survive the world’s first open-heart operation
marcin
(Marcin)
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