Medical research; Surgery for heart disease, part 3

The following program is produced by the University of Michigan broadcasting service under a grant of aid from the National Educational Television and Radio Center in cooperation with the National Association of educational broadcasters. Surgery for heart disease the third and last programme 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 the social sciences and the behavioral sciences. Occasionally you will hear what may seem like strange or unfamiliar silence. These are the sounds of the participants office his laboratory or clinic where the interviews were recorded. The people you will hear today are Dr. Denton Cooley of Baylor University Dr. Willis Potts of the Children's Memorial Hospital in Chicago. Dr. John Givens Jr. of the Jefferson Medical College in Philadelphia and remarks from Dr. C.

Walter Lilly high of the University of Minnesota. And my name is Glenn Phillips. Aside from the general running of a hospital all of the major medical centers are equally concerned with basic research. Dr. Denton Cooley tells us something of the research being conducted at Baylor University in surgery. But we have several projects in which we are particularly interested in the department. One of our main interest has been surgery of chronic vascular disease and we are now trying to evaluate or study some of the numerous specimens which we have seen in the surgical operations in order to determine trying to learn something about the pathogenesis or development our arteriosclerosis. Moreover we're trying to. Developed new methods

of expanding the. Field of arterial surgery to not only the main artery of a order but all of the smaller vessels for example would be if we could work out techniques for operating upon the coronary arteries those being one group of vessels which cause a tremendous amount of disability and are responsible for most of the males. And if we could operate on those vessels directly in a manner in which we operate on the other vessels in the body there would be a great. Humanitarians here. Surgeons another field of interest has been developing new techniques of cardiac surgery. We feel that we have. An operation of sorts

for every type of congenital cardiac defect which is even remotely correctable but acquired had not been so. So we're working on development replacement for the heart as one example in many of the acquired diseases. It is well known that it was virtually destroyed. There's no possibility to perform plastic surgery on that. No suitable tissue with which to work. Therefore we feel that it should be removed and a completely new synthetic put in its place. Those are just examples of the areas of research in which we are engaged in the Department of Surgery. We move next to Philadelphia and Dr. John Givens Jr.. I asked him where should the research begin. We take some of

these diseases that stem from the heart perhaps like theatre of the Roses which can affect any artery of the body can and I guess does the research begin there or does it begin with the heart and the heart's function. Now the research into the disease itself functions and how it functions badly when it gets a disease because of the deformed bowels and so over surgery is the research and surgery is not the moment to try to develop some material way of successfully replacing arteries which are diseased with some tatic TUBES TUBES made out of plastic material. Teflon background that type of thing very successfully in patients who have died from a rupture of the weakened Doughtery and intense research has been going on for the past two or three or four years developing a suitable

material to replace heart valves and the problem isn't completely like at the moment. That's a surgical approach to a more fundamental approach for learning what makes the changes develop in arteries. As I've indicated outside my field and probably related to diet some component of the diet. In your work that you run into problems connected right directly with this but my blood pressure. Is just a contributing factor. Yes only high blood pressure is perhaps a little more complex question it isn't just everybody with arterial sclerosis doesn't have high blood pressure and yet they can. Dive from the arterial sclerosis from a heart

failing to function. The average heart attack you know as there's arteriosclerosis the little vessels that supply the muscle of the heart just become choked up with this. I thought I'm with this material chalky like material and the heart can't function without a blood supply. And we again the surgically worked at the with the end result of this heart damage because it doesn't get a blood supply and try to give it a good blood supply. But the main problem is of course to eliminate the disease. I think that we're saying all right a less romantic fever and the end results on the heart of rheumatic fever and childhood. Which we could correct partially by some surgical operations because there is less dramatic fever going to the development of the antibiotic drugs such as penicillin when rheumatic fever is eliminated altogether there will be no hearts later in life that have

been damaged by a magic fever. The second right disease which causes the injury of the heart changes the heart valve so that it doesn't function properly. There's what we call hardening of the arteries of what white public calls hardening of the arteries which use atherosclerosis and laying down material on the heart bows and changes in the last history of the vessel was gone to such an extent that artery blooms out or breaks the heart bowels become so deformed they don't close properly or open properly. This disease is not Lector not. Completely understood and a great deal of research is being carried on in this country and throughout the world but particularly in this country with large support both from the federal government through Institutes of Health and from the American Heart Association. The.

Problem is to find out what component of the diet is responsible for and we think it is a component of the diet which is responsible for these changes developing in the blood vessels. There are certain areas of the world in which the diseases relatively uncommon. So there's an epidemiological approach to it as well as in the experimental approach through different kinds of diets and I'm in Chicago at the Children's Memorial Hospital. Dr. Willis Potts told me of another research goal. What we're interested in is some type of an operation which will correct the deformities inside of the heart. Well in one thousand two hundred fifty five little eye Dr. Little and his associates up in Minneapolis perfected the heart lung machine. You've heard of that. Everybody has heard of the

heart lung machine the artificial heart and the artificial lungs. Well nothing can be done to the defects inside of the heart of course unless the circulation is carried on at the same time. And obviously the heart can't pump blood. If your going to get it that's for sure. So what they did is to perfect a pump which takes the place of the heart and an oxygen eater which takes the place of the lungs. If all of the blood can be all of the impure blood can be taken out of the body and oxygenated and be pumped back in the heart can be bypassed and so the defect inside of the heart can be corrected. You follow me.

Well. That's the way it is today. The children with tetralogy of the lower end with defects between the ventricles and the oracles. Children who have defects inside of the heart know are operated on with the heart lung machine. The little children who are blue don't get along well. This type of surgery but the older children do when Let's just talk about the older children who get along well. Here's the way the thing works during Pete all the blue blood from the body comes back. To the right article and then it goes to the right ventricle and is pumped to the lungs. So in this operation the open heart operation I'm speaking of tubes that are put into the right Oracle and all of the blue

blood is siphoned off from the heart. It is allowed to flow through an oxygen ear the oxygenate or consists of disks which rotate in the blood and pick up a small film of blood oxygen is blown over this and as these films are exposed to the oxygen the red cells pick up the oxygen and the carbon dioxide is thrown off. And after this blood is flowing through the oxygen later then it goes to the pump and the pump now returns it to the body through it which is placed in a branch of the aorta. The order you know is the main circulating vessel in the body and that is done either at the arm or in the growing. So here we are No.

All the blue blood goes to the oxygenate or it's purified and is pumped back into the circulation. The heart has no work to do with talk. So the heart now is is stopped the clamps are placed over the main vessel right at the base of the heart so that no blood can get into the heart. The heart is stopped with some chemical which is injected or with some cold blood which some people use. Now here is a heart which is absolutely quiet. It can be opened and the defects can be closed. Patches can be put on and as soon as you're through the hole in the heart is closed. The chemical is washed out. And believe it or not this heart which has been absolutely quiet without a single beat for 30 40 sometimes as much as 15 minutes will suddenly start to beat and

take over its staff. It's fantastic and it still is fantastic to me to see how that can be done day after day. One patient in another. It really is. In retrospect it's amazing to see what has been a couple in the past 20 years from the earliest beginning to. Extra corporate or circulation as this is called the heart lung machine. It's a very brief span of time certainly in. Man's history or in medical history either one for such great and rapid strides in one particular field isn't it. To me it's fantastic. Many many people of course who worked on this I have mentioned a few who have been the leaders. But one could spend the afternoon naming people from

San Francisco to Portland Maine and all the way to Japan and England and Italy and France and South Africa and Argentina and where not where in universities in hospitals sometimes just in experimental laboratories which have been built. People have gotten. Down to work and have added bits here and there and there and everywhere until this thing is really doing very well. It's not perfected but Medicine that says have been made. Although it was not possible to record Dr. little High's remarks here is what he said about the research at the University of Minnesota. All research during the past several years has been rather intensively concentrated on cardiovascular problems and in several broad areas with the basic goal of improving methods of diagnosis recognition and treatment of heart conditions which constitute serious problems in as much as

the treatment has not always been satisfactory in the past. Amongst those have been the development of artificial replacements for heart valves out of various plastic materials as well as techniques for reconstructing injured valves. We would of course prefer to reconstruct an injured valve that was basically good. But we know that in this type of surgery from time to time one is going to encounter at the time of surgery valves that are so severely destroyed that repair is almost certain to fail and thus artificial prosthetic valves give one a leeway to fall back on that has already begun to produce an improvement or great improvement I should say in this field of surgery. It's been possible to replace both parts or all of the micro valves in the aortic valve placed in animals and now in a few humans to date. Secondly and somewhat related to that these techniques for working on these parts with the heart lung machine in such a way as not to produce any

further even though temporary impairment of the heart's action. One of the most important of these aside from refinements in the heart lung machine which I won't go into has been the use of cardiac arrest brought about by cold blood but is cooled to 5 to 10 degrees centigrade very easily by running it through a coil immersed in melting ice then through the coronary arteries. Which brings about a complete cessation of the heart's action but at the same time the cold temperature with the profusion keeps the heart well oxygenated so that there is no injury to the heart from this cessation of action. The advantage of course of having the still heart is the fact that the surgeon can do more precise work than he could with a beating. It's been a very great help in the several forms of surgery both for acquired heart disease and for the birth defects where the lesion has been severe. Along that same line of thought is the improvement in diagnostic measures namely

the use of the catheter placed in the left side of the heart with rapid injection of contrast media in order to define the function of the heart valves in a much more accurate method. It can be done by listening by pressure measurements and also where it's of interest to actually outline the anatomy of the coronary arteries and locate obstructions and the extent of disease both as a preliminary to surgery and as a means of evaluating the results of surgery when carried out post-operatively. Another interesting outgrowth of the congenital heart surgery has been the development in animals and now application to humans of a new operation for coronary artery disease which is somewhat different in that it has a physiological basis for it. It was noted in operating on the blue babies or patients with heart disease in which the oxygen content of the blood is somewhat lowered. There was an enormous overgrowth of the coronary

arteries. This has been observed time and time again in patients. Thus experiments were carried out in animals and indicated that this was indeed true that by lowering the oxygen content one could bring about a growth in the coronary arteries. In fact this is proved to be the most potent stimulus to the growth of new coronary arteries that we have yet studied in the laboratory. RAZ there are some side effects from lowering oxygen content to a severe degrade it does appear that the gains can be brought about by relatively mild reductions in the oxygen content. And this is now under study. Lastly I might mention a development which is in effect a byproduct of open heart surgery. But it's brought about benefits in other fields as well namely the use of a small fine wire inserted into the heart and connected to an electrical pacemaker. After extensive surgery sometimes we found patients whose heart action was disorganized whereas the

repair was fundamentally complete. The patients sometimes succumb due to the inability of the heart to pump enough blood to do this disk ordination and its action now by inserting the fine wire into the heart. One can bring about a coordinated heartbeat. This is proved of value a non-surgical patients who may have this condition as a result of infection or coronary artery disease or even overdose or sensitivity to certain drugs or medications that are being used for the treatment of heart disease. I also asked Dr. Lee high if he could be given the answer to one or possibly two questions relating to surgery. What would those questions be. He said well if we were to have the good fortune to be able to have the answer to one question that would benefit cardiovascular surgery as well as many other fields of surgery and all of medicine for that matter I believe that a fundamental understanding of tissue transplantation. And why and how.

More precisely how to prevent organ transplants which are technically within the ability of the surgeon in many areas of the body how to prevent those from being destroyed by their recipient host I'm certain that this is an advance that will be forthcoming. But if we could have the answer sooner than later it would certainly represent one of the greatest advances in the history of medicine. Dr. Lee High is not alone in wanting to know more about this subject. Dr. Givens commented one of the things which is of tremendous interest to surgeons and I am sure I'm quite confident that the problem will eventually be liked is that of the transplantation. An organ or a rather complex part of the body from one individual to another. The medical world was quite startled when I

this was successfully done with a kidney several years ago I read about Brigham Hospital in Boston into homologous twins as twins that come from the same mags or the tissues are very much alike and to date only the only successful transplantations. Rather complex organ such as the kidney have been done in a modest way. And. Or in patients with a gamma globulin Leamy or because the goblin's. Tissues which other substances in the blood which work to reject the graft. You put a kidney and I gave you one of my kidneys. You had two badly functioning ones and it was grafted into your body. It would from my kidney would function in your body for a short time secrete

urine and then it would go to pieces. And this there are many facets of this work and surgery but in medicine to try to find out why or how we can stop this rejection phenomenon. Embryonic tissue is less likely to be rejected than add up tissue. And if you get tissue from a newborn child and grafted on the and I don't it's more likely to be accepted. The Soviet Union too has shown interest in transplantation several months ago a Russian surgeon made medical headlines with a transplant of a dog's head to another dog's body. I wondered if this was really a major advance said Dr. Lowell High. I'm afraid that this is a mere propaganda meant over a certain point should be made clear for those who are not familiar with this field. First

technically there is no problem whatsoever for a trained surgeon to transplant many organs of the body heads arms legs kidneys and so on. The problem that prevents this from being of therapeutic value at the present time is that the recipient or the host who receives this organ inevitably destroys the transplanted tissue unless it happens to be an identical twin. There are also a few people who were born without antibodies in their body. They too can accept a transplant from a total stranger with survival. Unfortunately they are quite rare individuals. As a matter of fact until the era of antibiotics most of them died of infection because of their lack of antibodies before they were even recognised. Now the Russians in the field of cardiovascular surgery are far behind. That's my own personal opinion that this has come about not because of any basic lack of capability but rather because they have or their leaders have chosen to concentrate their energies in

fields other than medicine. I also asked Dr. Givens what his reactions were to the Russian announcement. He said Well let me answer the question that's what I was. By service desk a for instance from Moscow I visited this country and came to our problem and. Was about 10 months ago. And here is a very prominent Russian surgeon and I know him and I Russians are Jews and I have a high regard for them. I would not attempt to characterize what happens in this place has been said in things or whether it's a play for this play for that. It's not my business to comment upon about the transplantation of one dog's head to another dog body. This has been done many many years ago and often it was done in this country.

It was early as the first decade in 1900 and this kind of thing has been done for many years and surgical laboratory is the same thing obtains that the permanent take of of the graft doesn't occur in my function for a short period of time. One of the other way of approaching that and this is being worked with total body radiation which kills all the bone and all the bones a body which would that make your blood and then under a place the blood making substance which is the bone with.

From a donor person we have had donors come into this hospital for example and give a rebel to somebody else who has a cancer of the blood which is overed over duplications of certain formed elements in the blood. This is a field which needs a lot further exploration. If you're good get rid of all that. One person's blood making a sow's and given the blood making cells of the person who's going to contribute the organ to him. It's possible that that order might survive under these circumstances. These are the areas in which a great deal of what's being currently carried out in the Russian. Article I didn't

say anything about how they could and they were talking about how they were combating the inevitable rejection of the grafted tissue. This is Ben the third and last program in surgery for heart disease. We heard today Dr. Denton Cooley Dr Willis Potts Dr. John Givens and the comments of Dr. seawall to Lilly high. Next week you will hear Dr. Julius Wilson Dr. Floyd Feldman and Dr. Saul Roy Rosenthal as they discuss tuberculosis on the next program from the series human behavior social and medical research consultant for this program was Dr. Thomas float 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.