Medical research; Surgery for heart disease, part 1

The following program is produced by the University of Michigan broadcasting service under a grant he made from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters surgery for heart disease the first of three programs on this subject from the series human behavior social and medical research produced by the University of Michigan Broadcasting Service. These programs have been developed from interviews with men and women who have the too often unglamorous job of basic research. Research in medicine the physical sciences social sciences and the behavioral sciences. OK Julie you will hear what may seem like strange or unfamiliar SOG. These are the sounds of the participants office his laboratory or his clinic where the interviews were first recorded. The people you will hear today are Dr. Willis J pot surgeon in chief of The Children's Memorial Hospital in Chicago Dr. John Givens Jr. head of the Department of Surgery of the Jefferson Medical College in Philadelphia and remarks

made by Dr. C. Walton Lillie Hi Professor of Surgery at the University of Minnesota. And my name is Glenn Phillips. Perhaps of all the areas in medicine the one that has undergone the most dramatic changes in the last few years has been surgery on heart disease. Unfortunately it was not possible to record Dr. C. Walton Lilly high. But his answers to specific questions were supplied and his marks would be read for him. In answer to the question what are the chances of a patient living a normal life span after heart surgery he said. In answering that question we should make clear the different types of heart surgery there are in general three types of heart disease namely birth defects of the heart. Secondly those that are acquired through infection which traumatic fever is the most prevalent example. And third those that are related to aging and generally referred to

as arteriosclerotic. Now some of the most brilliant advances in the past few years have been made in the cure of birth defects of the heart that has come about through techniques which of allowed the surgeon to work inside the empty heart for prolonged intervals of time under direct vision to complete the repair of these malformations of birth origin. And in this type of surgery in general the girl that is named for I am very frequent be achieved is a complete cure once for example a hole between the pumping chambers of the heart which is a very serious defect as far as longevity. As soon as such a hole is closed and the heart muscle has had a chance to recover from some of the strain there's every reason to believe that the individual's life expectancy will be completely normal. The same may be true for example in a common form of blue baby malformation so called to trial a G a fellow here once the obstruction at the outlet of the heart

is relieved and the holes in the septum closed and allowed to heal together as they do then the circulation becomes completely normal. The appearance of the child becomes completely normal and there is every reason to believe that he will have in most instances normal life expectancy. In a so-called acquired heart diseases which takes in both those acquired through infection and rheumatic fever principly and those acquired through aging process sees Terrio sclerosis. One can't be as optimistic about complete cures because here we're often dealing with a defect or injury to the heart muscle itself in addition to some malformation of the valve. But that does not mean that a lot cannot be accomplished because in such an individual for example with a leaking valve once that leakage is repaired they're likely and able to experience a very great increase in their ability to do things and to live a normal life even though we wouldn't call their hearts completely normal necessarily.

The second question which doctor a little high answered was what are the general differences between surgery for these various diseases such as congenital heart disease arterial sclerosis coronary heart disease and cardiovascular disease he said. As I've already touched in part upon this in general and obviously there are exceptions but in general surgery for congenital heart disease is frequently completely curative for acquired or rheumatic valve you know heart disease is able to correct the leaking or obstructed valves but the effects that the rheumatic fever are produced on the heart muscle itself namely the scarring may still leave some residual defects in the heart function. Cardiovascular Surgery is generally a puddy attempt in the sense that areas of obstruction due to hardening of the arteries can be removed and that part of the artery replaced with a suitable vascular substitute functions very well for a

number of years since many of these patients are in the more advanced years. It's often possible to give them a functional cure although they still in general show evidence of arteriosclerosis elsewhere in the body as part of surgery for coronary artery disease. We still regarded here as being in the developmental stage. We're not happy or satisfied with the operations we have. We think that considerable improvement is going to occur probably is occurring already in this particular field of surgery. In that regard I think that one of the most important aspects that's been neglected in the past in regard to coronary artery disease is more accurate recognition and diagnosis so often now a pain in the chest with or without some electrocardiogram abnormalities means coronary artery disease. But even if it dies as it often does one has no idea of the extent of the location. So patients cannot be compared either before or after

surgery and that difficulty has been obviated in the past year by the enormous advances that have occurred in coronary artery aggravate namely taking pictures of the blood flow through the coronary arteries with rapid injection of contrast media which mixes with the blood in the flow than can be followed through the arteries showing where the disease is as well as its extent. It's become a very safe form of examination and has added an effective third dimension to the whole problem which I think is going to bring much more order out of what is now a situation it's difficult to assess namely the results of surgery of coronary artery disease. Looking now at some of these specific areas we will begin with congenital heart problems. That is a disease dating from birth or developed in the uterus before birth. I asked Dr Willis Potts what some of the greatest advances had been in this area. Well as a matter of fact you can speak of the recent advances in this because

everything dates back to the beginning when something first could be done for children with congenital heart disease. After all congenital heart disease is as you all know the story of the defects inside the heart with which a child was born. That's what we're talking about isn't it. Well do you know that before nineteen hundred and thirty eight. Nothing could be done for children with congenital heart disease. Well congenital heart disease of course has been wrecked and recognized for many centuries. But there wasn't particular interest in it by cardiologists because. After a diagnosis had been made nothing could be done for the child. A. Cardiologist would see the child

and say yes this child as such and such a defect. And then the youngster would be sent home and when it went into heart failure it would be given Digitalis. And all the parents could do was to sit around and wait for the end. And then something happened. The first ray of light. Came in through a little crack in the door. Let's say. In 1938 when a young fellow by the name of Robert Gross in Boston became interested in the matter of inductors are Curiosus. What is Payton doctors arterials says. Who the hell didn't duck to set theory or was this is a congenital bypass let me say. Every child has it.

Before the baby is born there is an opening between the aorta the main blood vessel of the body and the pulmonary artery because the lungs are not expanded. It's difficult for the tiny fetal heart to pump the blood through the lungs. In fact it can't get through. So nature has provided an escape valve and so that blood goes from the pulmonary artery to the aorta. Now as soon as the baby is born. The pressure in the lungs of course drops. The baby's lungs expand it starts to breathe. And normally this escape route or Peking duck just should close. If it doesn't close and we assume that it stays open in approximately one in. Two to 5000

children it's very difficult to estimate that. If it doesn't close then the blood is shunted from the aorta to the low pressure area no or the lungs and so blood is pumped out of the heart. Goes through the beginning of the order and is shunted over to the lungs and goes through the heart and establishes what we call a vicious cycle. Some of the blood instead of going to the body in other words is shunted back to the lungs. The thing to do for such a child of course seems terribly simple today. It had been tried but unsuccessfully. Previous to 1938. Then Dr. Gross a young fellow at the time in fact in his young 30s decided with some of the other men at Boston that they would try to close this doctors.

They did a lot of experimental work. And finally a child who needed the operation was found and the operation was performed. And fortunately it was successful. Well when this news spread out over the country of course it caused it tremendously in creased interest. In congenital heart disease. No the operation is extremely common it's done in our first class hospitals and the mortality that is the danger of the operation is is very very low. It's one of the safest operations that can be done on the heart from one thousand thirty eight on to the early 40s. Very little was done. And then a tremendous step forward was made by

Dr Blaylock and Tausig. In Baltimore. Would you like to hear that story. Yes I would. To me it's an extremely fascinating one. Well. Dr Blaylock and some of his associates were doing experimental work on dogs trying to produce hardening of the arteries. They assumed that hardening of the arteries was caused by high pressure because people who have high blood pressure get hardening of the arteries sooner than the people who have a normal pressure and eye Turia sclerosis or hardening of the arteries always appears in the arteries. The big vessels and especially in the aorta and it doesn't appear in the pulmonary arteries the vessels that carry the blood to the

lungs where the pressure is low. So you know they've got this very excellent idea. They made a connection between a vessel coming off from the aorta and the pulmonary artery in order to raise the pressure in the pulmonary vessels. So they swung a vessel. From the left front fork of a dog into the pulmonary artery and raised this pressure considerably. A very fine experiment except nothing happened. The dogs didn't get any changes in the vessels. It just didn't do anything. But the dog was getting of course a lot more blood to the lungs. One day Dr. Helen terracing was talking to Dr Blaylock and said you know if you could do

that sort of an operation on our blue babies these children who are cyanotic which means blue you might accomplish something. Well it seemed a reasonable thing to look into. So Dr Blaylock and his group sharpened up the technique on animals and found that this operation could be done relatively safely. And finally came the opportunity to do this on a child who was going to die. A typical little baby lips as blue as grape juice its fingernails blue child able to walk probably a few steps it would have to sit down in other words a perfectly helpless infant. The parents consented. And so this operation was done was done on a number of cases

and the children turned from blue to pink. Now you ask what is the cause of this defect. Why is a child blue and white as more blood have to be sent to the lungs. Well the child is blue for this reason. Normally blood returns from the body into the right side of the heart the right ventricle the right ventricle pumps it to the lungs where it's pure fied. Then the blood returns to the left side of the heart of the left ventricle and from there it is pumped through the aorta through the general circulation. Now the child who is blue. Is blue because blood bypasses the lungs.

The blood comes back from the body in the blood child goes into the right ventricle. But there is an obstruction right at the point where it should shoot out to the lungs through the pulmonary artery. Well if there weren't an escape valve so to speak or hope for escape or the baby would die at birth. But it doesn't because the blue blood which can't get through this constricted area. Caused a not an area to the lungs. Shoots over to the left side through a defect in the wall between the two ventricles. So this blue blood then bypasses the lungs goes to the left side of the heart and is pumped through the general circulation and the child is blue. The degree of obstruction in the heart and the size of the hole

through which the blue blood is shunted to the left side. Determine the degree of blueness or sign gnosis. So to come back now to this story. As I said Dr tussocks said to Dr play like why not try this operation on a child who is blue who has this trouble called Tetralogy of Fallot lol. Why not. Said Dr. Bill a lot. And as I said he proved it improved the operation. Tried it on a child. It was successful. And in that moment when this first article was published of course the entire medical world was electrified with the news that something could be done for these poor unfortunate suffering children. Children gasping for breath and the interest in

cardiology of course zoomed at once because something could be done for these children. It was at the Chicago's Children's Memorial Hospital. But one of the major advances came in congenital heart surgery. Dr. Potts himself was the first to perform a particular operation. But let him explain it. Well here at the hospital at Children's Memorial Hospital we were interested in doing something for very little children. The infants who were very blue. And. So we've perfected a new type of shot. We tapped the aorta and sent the blood directly to the lungs.

This operation was performed. Over and over again by Dr. Sidney spiffed and me and nine thousand nine hundred forty six. And then by a strange coincidence one day some people by the name of Chanel from Waukesha Wisconsin. Brought their 21 month old baby to the hospital and said we heard that you were. Perfecting some kind of an operation to take care of these infants who were blue and helpless. As a matter of fact she was right. They said come to her but the grapevine examined her baby and it was very blue. Normally a child has a blood count of about four or five million. You would I have a blood card of approximately that level this

red blood count was over 10 million. Her blood was so thick and so blue. She was so short of oxygen that she passed out two or three times a day. If she became excited or if she ate too fast she'd be so short of oxygen that she would simply fall over limp in unconsciousness. Why don't we explain to the chanels that we had perfected this operation on animals but the operation had never been done on a human being never anywhere in the world that we couldn't promise or anything but we would try it if she wished. There was a kind of a tough decision for the parents to make as a matter of fact the father kind of put the burden of the decision on the mother. And she finally said Well I know that my daughter died and I

can't live without some help. We were crying while this happened to be on a Wednesday. Thursday was inconvenient so I said the only day we can do it is Friday September 13th. You have any objection to Friday the 13th. She said No I think it'll be our lucky day. So this mother made the decision to every child. Have an operation which had never before been done on a human being takes a lot of courage to make that kind of a decision. Course the decision is easier when you see that the child has no chance. As it is well the operation was done and fortunately it turned out well. She's now 15 years old and a sophomore in high school

and is doing very well. She comes up every year for an examination. This summer she rode twenty two miles on her bicycle. Her mother didn't altogether approve it I might say. But she and another girl just started out and rode twenty two miles. Did you was the doctor a problem or no I didn't approve of it either but I did know one of the about it of course. Oh that's that's overdoing it is too much for a normal kid. A 15 year old kid. Twenty two miles in a bicycle in one day. I think that's overdoing it a little. Well she did it. I don't laugh. She's a wonderful little girl she said I knew mother wouldn't approve so we went. And after we had gone up to Grandma's we called up from there and said Come and get us we're out here in the country at grandma's house twenty two miles away. So they went up together. Parents didn't approve very much but what can you say it was done. Nothing happened to the

child but I think she was overdoing it a bit. DR JOHN Givens Jr. expressed these beliefs about advances in heart surgery. Here is part of the original interview with Dr. Gibbon. Well I suppose the most striking. Recent advances has been the use of an opera out of us to take over the functions of the heart and lungs. So that the heart can be opened without blood loss an operation is performed inside it. No human operation had been done successfully. 20 years ago and these types of operations are being over this country in the world. By no means certainly is the final answer is it heart surgery. Where might for example what are some of your current research problems here at the Jefferson Hospital.

Well it's not the final answer I'm sure but the final answer and almost all diseases prevention. I think we're going to have with us for a long time. Congenital anomalies failures of tissues to develop normally. In utero or other fetuses levered and those will have to. Do salvage operations of this type. Currently here we are still continuing work less hard line machine operations on patients and we're exploring at the moment very deep hypothermia. Like you and. Them are subject so cold. But with all the body processes stop how or what is going on and many places are productive it's going to be or how much

safer or better. And bypassing the heart and lungs with the apparatus while you operate at the moment. We're interested in other applications of the heart lung machine as well a lot is treating cancer with cancer side of drugs in isolated organs or limbs. This work was started by Oscar Creed's versus two lane and he has had some very gratifying results to date as have others. Hypothermia would you explain it just a bit further. I was left a bit high and dry there and I assume most anyone else is a lady. I'm sorry hypothermia merely means reducing the body temperature of the normal temperature. When you do that the heart beats more slowly and

respirations are slower at a second level of calmness the heart stops and respiration stop but how long can the patient be left this way for the hour I have been successful on human operations. Reported just about 8 months ago from England. At these levels a very very low hypothermia for a long time in this country and elsewhere moderate degrees of lowering the body temperature of the new utilized because they cut down the body's requirements for oxygen and during the cold. But these deep levels in which the heart stops have not been used before until this report came out from the end of the bet 8 months ago. They are a part of them from a gun was not successful with animals but he was human beings maybe humans are tougher. That was part of the original interview with Dr. John Givens Jr. at the Jefferson Hospital in

Philadelphia with Dr. Givens we have heard Dr. Willis Potts and quotes from Dr. C. Welton Lilly high as they have discussed surgery for heart disease. Next week you will hear Dr. Denton Cooley of Baylor University and Dr. W. C. C. Lee of Duke University as they discuss hypothermia on the second part of three programs on surgery for heart disease the next program from the series human behavior social and medical research consultant for this program was Dr. Herbert Sloan of the University of Michigan Medical School. Glenn Phillips speaking asking that you join us next week and thanking you for being with us at this time. This program has been produced by the University of Michigan broadcasting service under a grant in aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. This is the NEA E.B. Radio Network.