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FILE NAME Kent KNT DATE 1956 Apr 7 DOC KNT127 DOCUMENT DESCRIPTION Newspaper Article - Surgery for Damaged Hearts - The Saturday Evening Post > The Saturday Evening POST April 7 1956 ~ 15 Ai . RUSSIA'S UPPER HIGH JINKS By CHARLES W. THAYER HEARTS SURGERY FOR DAMAGED . By STEVEN M. SPENCER ; At Boston's Peter Bent Brigham Hospital Dr. Dwight Harken slits open the constricted mitral valve of a damaged heart This patient's affliction mitral stenosis or narrowing of the valve opening the most common heart condition presently created by surgery They Repair Damaged Hearts Today there is almost no kind of heart defect which surgeons cannot mend with a special knife and sewing needle By Steven M. Spencer Postoperative checkup Dr. Charles Bailey famous Philadelphia heart surgeon finds Robert Ritter - -covering successfully from an operation to correct a leaky mitral valve Dolly Tondo before surgery and with Dr. Hugh Wilson several months afterward Boston specialists saved Dolly's life by patching up a hole in her heart a . a A stenosis operation After the first incisions are made the heart is exposed by pushing aside the lung slitting the pericardial sac and holding it open with several tie sutures Then the surgeon widens the mitral valve with a knife attached to his finger The mitral valve here seen from above controls the passage of blood from one chamber of the heart to another When this valve is constricted center it hinders circulation and restricts a person's activities Surgery permits blood to flow normally again ee STENOTIC MITRAL MITRAL VALVE or centuries doctors hesitated to lay a finger much less a knife or needle upon the hu- man hcart They were afraid their slightest touch would stop its sustaining beat Even such a bold and skillful operator as the great Theodor Billroth of Germany warned in 1889 that the surgeon who would attempt to suture a wound of the heart would lose the respect of his colleagues . A few men did risk censure by sewing up an occasional stab wound in the forbidden organ Beyond that however they dared not go And in 1896 the British physician Stephen Paget concluded that heart surgery elementary as it then was had probably reached the limit set by Nature to all surgery no new method and no new discovery can overcome the natural difficulties that attend a wound of the heart Happily Paget proved to be a poor prophet But his attitude was typical of the mental block which in the opinion of a present pioneer in heart surgery Dr. Dwight E. Harken of Boston helped delay developments on this frontier for nearly half a century Not until the 1940's did the barrier of skepticism and unreasonable fear begin to crumble Scores of soldiers with bullets shell fragments in their hearts forced the surgeon's hand Doctor Harken himself as chief of the first Thoracic Surgical Center in the European Theater located in England extracted such hardware from within or around the hearts of 134 men in 1944 and 1945 without a single fatality Encouraged by success in removing these foreign bodies and in working on the large arteries and veins near the heart in the patent ductus operation of Dr. Robert Gross of Boston and the blue baby operation of Dr. Alfred Blalock of Baltimore moved on to more complicated repair jobs We discovered that the heart wasn't such a mysterious and untouchable thing after all Doctor Harken remarked referring to his own and other operations and that we could enter it do things to it and get out again if we just followed the rules of the game One rule for example was to avoid turning or dislocating the heart from its normal position since such manipulation could twist the great vessels obstruct the outflow of blood and cause dis- turbances in the heartbeat By following the rules as they learned them and by combining caution with a dash of bold- ness the heart surgeons have written one of the most exciting chapters in modern medical history Today there is almost no cardiac de- fect congenital or acquired which they have not corrected with their knife and sewing needle And thousands of men women and children formerly doomed to invalidism or early death are now going merrily about their work and play supported by expertly mended hearts Continued on Page 91 ~ April 7 1966 9 " Continued from Page 89 Marxism which I dare say Marx would have found bewildering . But suppose you've already bought a car given your wife a mink coat built yourself a country villa and insured your accumulated wealth and still you have money rolling in from royalties or com- missions The Soviet Government aters There is always the possibility of a little party at the country house with plenty of liquor and girls And then there are the bars of Moscow If the dreary humdrum life in Russia is so dull that it drives adults to drink it often drives the young people to even stronger solutions The Soviet press is constantly ranting about the excesses of rubles but the Jet Set often has financial reserves into the millions Some of them are orphans or widows of generals who lost their lives in World War II and have pensions amounting to as much as 1000 per family a month But most of the money comes from royalties for musical and literary works or political tracts When for example a leading communist several villas each permanently staffed a with full complement of servants Itis in these villas that much of their social life including takes place on occasion some rather wild orgies The legalization of abortions had no meaning for these spoiled sons of the great always found a doctor ready to perform the illegal operation launches each year a universal state 2 per youth One newspaper even printed a makes a major speech it is often dis- Politically the Jet Set is completely cent loan which will be deducted from gruesome tale of a band six young men tributed in millions of copies From these loyal to the Kremlin leadership Oc- your salary before you even see it Your in search of something more exciting than he gets huge sums in royalties casionally they bemoan the lack of a subscription to the loan is nonnegotiable ^Soviet movie who planned a bank rob- Income taxes are seldom more than 11 strong man to make decisions but they and runs for twenty years during which time it earns 2 per cent interest In the bery One of the boys threatened to snitch and his body was found months later in per cent and inheritance taxes are a flat 10 per cent It is therefore possible for chil- are well aware that they too have prof ited from Stalin's death for that ruthless past you could subscribe as much of your swamp outside Moscow The plot was dren of top leaders to inherit immense old man might at any moment have wiped salary as the party operatives could per- discovered and the boys sent to jail fortunes This enables them to live in the whole lot from the face of the earth suade you to give up But the latter have Though the names of five were published great luxury without lifting a finger At with a single phone call However they now been forbidden to ask for more than in full the name of the sixth was appar- least one such heir owns three country take no part in active politics and regard two weeks of a comrade's salary During my two months Russia I found no one who had not voluntarily subscribed the full two weeks In addition to the 2 per cent there is a 3 per cent loan which is known in local Soviet slang as the gold loan It has a ently too prominent for publication and was not printed In other immorality among the respects and youthis causing headaches to parents government alike In 1936 during m^ Stalin first assignment to Russia had pro- hibited abortions and the sale of contra- houses keeps two apartments in Moscow and has four private cars Asked how many millions he had he replied Damned if I know The Jet Set are a class to themselves They regard the gilded youth of the welldo new and vulgar Not even all themselves as superior to Communist Party activities Pravda is not for us recently oneof them said When it calls . Tito a hero one day a swine the next and a great and good friend the third day that may be for the masses but it's not for us Indeed their belief in communism is lottery feature attached whereby you can ceptives But prohibition in this respect the offspring of the top leaders are ac- the purest lip service Enthusiasm for its win up to 25,000 in one of seven draw- proved no more successful than pro- cepted For example the Jet Set regards teachings does not exist and when some- ings The loan is negotiable and you can hibition of liquorin America Abortions the children of Mikhail Pervukhin mem- one tries to preach to them they simply buy and sell it in unlimited amounts in any bank I asked a bank clerk wby anyone in his right mind would invest in the continued to be performed by unlicensed practitioners resultinign frequent deaths On my current visit contraceptives were ber of Russia's highest ruling body as lowbrow like their father The Jet Set marry almost exclusively within their own epithets ridicule him with A few of the males in the Jet Set are more serious and have studied for the 2 per cent loan when he could buy the 3 being sold at all drugstores including the circle change marital partners with diplomatic service or engineering but for per cent kiosk at Moscow University Last De- bewildering rapidity the rest like the gilded youth they despise You don't understand she said cember the government announced that As for the masses they simply do not their lives are a monotonous round of They are two entirely different things due to the injurious effects of illegal exist for the cream of the cream The parties and boredom Sometimes they en- tewgiyt I One you buy and the other you subscribe abortions their performance would once Jet Set crowd has no contact whatever joy doing bit pieces in the movies This is to But I objected if had 10,000 rubles more be legalized with those who stand in lines Even at the considered quite the thing so long as it's Lm to subscribe or use to buy there was no One of the chief diversions of bored super Moscow Grand Opera House not done for money But the rest of their - question in my capitalistic mind which I'd Soviet youth is to become a suiter where after performances foreign am- time they spend trying to wangle a trip do But we subscribe to the two per cent because we want to help our government known in Soviet slang as stilyag or chaser Their badge is long hair bassadors wait patiently in long lines at the cloakrooms the Jet Set sweeps ahead abroad as the secretary of a delegation or a helper in some sports competition finance our industrial program she ex- ~ plained I dropped the subject narrow trousers odd hats and brightcolored neckties They can be seen any and gets its mink coats and no one raises a murmur The public of Moscow is too anything for a looakt Paris Why does the Kremlin put up with There is one last way you can spend Saturday night walking up and down well trained to object to such antics these new classes which threaten the very your extra income as any parent in the Gorki Street or in the Moskva Hotel Bar Money has no meaning these new structure of communism The answer it world will tell you your children and nearby restaurants The chic among aristocrats They think nothing of stop- seems to me is that the Soviet system de- The old communist tenet that the state them pretend to speak only Latin or Eng- ping at a flower shop on the way to a pends for its very life on its engineers sci- would take over the bringing up of chil- lish They have rechristened the streets party and buying it out for their hostess entists and managers To make sure of dren has long since been discarded and the role of the parent has been empha- and sections of Moscow with such foreign names as Broadway Gorki Street Their current craze is collecting old porcelain Their greatest passion is for their loyalty the Kremlin has bribed them with privileges whichin turn are sized You may find it difficult to buy a car for your son though it is occasionally Piccadilly Circus Theater Square and Brooklyn the area across the Moskva foreign things cars to phonograph records They would give their shirts passed on to the children gilded youth and the Jet Set The price the un- done You however give him a country villa where he can entertain his River from the Kremlin The gilded youth of the well are for a trip abroad In summer the fashionable place for them to go is Carlsbad thinking masosf Soviet workers are pay- ing for their freedom from terror may friends and spend his vacations If he is backward you can provide tutors to help him get into college is a must for by no means the pinnacle of the Soviet social structure Far above them gyrates another galaxy known as the Jet Set in satellite Czechoslovakia Foreigners who have seen Carlsbad since the com- munists took over deplore its decay But well be high But how high a price the communist rulers are payinign sacrificing some of their most basic principles is for the well Finally you can give him These are the children of the very top for the Soviet upper crust it's the ulti- the future alone to tell an allowance Pocket money up to 250 a month is not unusual for children of the communist leaders marshals composers and writers Whereas the gilded youth mate in spa luxury Whereas foreign ambassadors in Mos- Editors Notes communism with its dreams of world conquest here to stay well But what can the children do with their allowances There are movies and the- number in the millions the Jet Set is con- fined to a few score stars The well count their fortunes in the thousands of cow sometimes have country villas to which they bring their servants when they come to stay Jet Set members often have In his third and concluding article of this series in next week's Post Mr. Thayer has an informed and conving ing to answer this question They Repair Damaged Hearts Continued from Page 33 Some have had abnormal openings be- tween the right and left sides of the septal stitched shut Others have had tight valves loosened up or have been equipped with plastic or cartilage baffles to make leaky valves close more tightly In a few patients a gaping valve has been snugged up by a drawstring made of nylon parachute pound cloth or an fish- line Several people are wearing in their aortas at the exit of the heart a plastic ball valve that ticks away like the alarm clock swallowed by Captain Hook's dreaded crocodile The largest number of surgery patients owe their new hold on life to a much simpler but still delicate procedure This is the finger operation or without a designed to widen a mitral valve scarred and constricted by rheumatic fever The valve named be- cause its two leaflets when closed resemble a bishop's hat or miter funnels the blood from the left auricle down into the left ventricle whenceit passes out to the aortic trunkline Mitral stenosis- narrowing of the valve opening the most common heart condition presently treated by surgery And the operation for perfected within the past eight years has been basic to the development of the whole field of intracardiac surgery The procedure is now being carried out by excellent surgeons in many cities of the world and important contributions to the technique have been made by number of them But credit for originating the operation and bringing it to its present high level of safety and usefulness belongs mainly to three men One of them Dr. Horace G. Smithy Jr. of the Medical College of South Carolina died in November 1948 nine months after his first successful operation upon a mitral valve The cause of his death- mitral stenosis The two others are Dr. Charles P. Bailey professor of thoracic surgery at Hahnemann Medical College in Philadelphia and Doctor Harken surgeon at the Peter Bent Brigham Hospital Boston and associate professor of clinical surgery at Harvard As a boy of twelve Doctor Bailey had seen his father die from the effects of mitral stenosis and he determined early ih his medical career to do something about the conditionBoth he and Doctor Harken were bornin 1910 and were in their thirties when they began research on the problem arriving at solutions al- most simultaneously Their first success- operations ful stenosis were per- formed just six days apartin June 1948 Doctor Bailey's on the tenth at Hahne- mann Hospital and Doctor Harken's on the sixteenth at the Boston City Hos- pital Both of the first patients are still living and well Associated with Doctor Bailey at this time were Dr. Robert P. Glover and Dr. Thomas J. E. O'Neill been who have also resporisible for many improvements in surgical methods Doctor Bailey and his associates in- serted the index finger and a slender knife into the heart as the operating instru- ments a modification of a technique de- scribed by a London surgeon H. S. Souttar some years before Souttar had tried it in only one case however Doctor Bailey called his operation a commis- surotomy Doctor Harken in his first operations which he called valvuloplasties employed a punch instru- ment similar to those used by his famous predecessor in this field the late Dr. Elliott Cutler although he later changed to a finger method 92 THE SATURDAY EVENINEGVENING POST The early triumphs of these pioneers were marred by frequent failures A high College of Surgeons meeting in Philadelphia that the over mortality as esti- frustrating their efforts to have a baby A heart hampered by a constricted mitral woman with severe mitral stenosis and there are cases where the husband failing proportion of the patients operated upon in 1948 and 1949 died during or soon after surgery This period of dark discouragement was recalled by Sir Russell C. Brock of London in a speech last year mated from numerous 1955 reports is now down to 5 per cent And the risk of operation is decreasing he added Doctor Harken reports that the figure for all but the very poorest risks consti- valve in some cases the opening is no larger than the head of a match not pump blood through the body fast enough to take care of the woman's own normal activities When it is forced to as to appreciate the seriousness of his wife's condition has left her If there are children she is faced with the problem of providing for them alone Because of her physical disability she may eventually be before an international symposium on tute about a quarter of the entire group sume the additional burden of nourishing forced to place them in foster homes She cardiovascular surgery at Henry Ford is less than 1 per cent which is no higher a developing infant in the womb trouble now feels completely deserted her life Hospital Detroit He and his associates at Guy's Hospital at one point in their development own of mitral surgery had four successive deaths among their than that in the average abdominal operation Indeed the heart may in many instances be safer to operate upon than an inflamed or stone gall bladder frequently ensues Four times the McSweeneys thought they were going to have a baby and four times the young wife lost it before term Their disappointment was ruined Doctor Harken is confident that cardiac surgery can prevent many of these do- women patients Despair stalked before us and every- one's morale was low Sir Russell said " remember saying to my team that we Doctor Harken classifies his mitral- stenosis patients into four groups ranging from those without any significant symp toms Group -for whom surgery is not bitter When Doris became pregnant fifth time her doctor talked her about the possibility of tenninating the pregnancy earlyin its course for the sake of her own mestic tragedies And to his task of repairing damaged hearts be brings not only a sound surgical preparation but an unquenchable enthusiasm and an affec- could do only one of two things up usually recommended the cardiac in- health But the McSweeneys are Cath- tion for his patients which obviously help or go that it was impossible to give valids suffering chronic congestive failure olics Their priest advised them that such in their recovery His sense of humor is up as we were certainly in the right The Group IV The majority of patients ac- action would not have the sanction of the also on tap for those who are tense and only thing therefore that we should do cepted for surgery fall into a middle church In the meantime Doctor Harken worried about the ordeal they face It is was to go on We did continue and had thirty consecutive successful cases While the courage of skillful surgeons Harken classification Group III described by Doctor as having progressive symptoms so handicapping that their had examined Doris and indicated she could probably undergo a stenosis operation even though she was pregnant related that one woman having been treated by various physicians and brought finally to the point of operation looked at was an important factor the courage of activities are significantly and increas- " wouldn't be able to live with my con- him anxiously and said Doctor I'm desperately sick patients was no less es- ingly limited Of his first 500 mitral- science much less my religion she told now in your hands and God's hands sential to the forward march of cardiac surgery patients 342 were in Group III the surgeon if I didn't make one more To which Doctor Harken replied with surgery Doctor Brock remarked at the The surgical mortality among them im- effort at having a baby So if you think a smile Well 1 hope God scrubs Detroit meeting that he felt that the proved steadily over the years from 14 per this operation will help me I'm anxious Before he himself scrubs for the opera- great pressure to aid the development of mitral surgery came not from the cent to less than 3 per cent Since making this analysis of the first 500 Doctor to go through with it In the third month of her pregnancy tion he orders the patient studied thoroughly to make sure her condition is one doctors but from the patients who in Harken has operated upon several hun- Doris McSweeney entered Mt. Auburn which he has a good chance of correcting their frustrated desires to obtain help in Hospital There Doctor Harken per- First come X rays and electrocardio- their disability brooked no interference formed the operation widening the con- grams Then in many cases a fine plastic One who refused to wait for the slow stricted valve to provide a more generous catheter is inserted into the heart cham- uncoiling of medical conservatism and protocol afraid her heart wouldn't last A million years from now flow of blood for herself and her growing infant Her physical condition began to bers via blood vessels in the arm or through a hollow needle in the back to that long is a skinned delicate the world may be filled with improve almost at once Last June at the measure pressures on either side of the de- tured West Indian beauty named Dolly Tondo Her trouble was a septal defect a hole between the right and left auricles rather than mitral stenosis but her story dramatically illustrates Doctor Brock's creatures who will stoutly deny that they ever descended from man AL MCGEE scheduled time she entered the hospital again for the hoped event And on the afternoon of June twenty Doctor Harken picked up the phone in his office to hear a young woman's excited fective valve The pressure readings give a fairly reliable estimate of the size of the valve opening At Peter Bent Brigham by these studies are made Dr. Lewis Dexter and his associates in the research point For years she had tried in her na- and jubilant voice division Once the patient is wheeled into tive city of Port of Spain Trinidad to get Surprise Surprise she shouted the operating room she is in the hands not help for her failing heart Several years ago she journeyed to England only to re- turn disappointed Then her local doctor got in touch with Doctor Harken and ex- changed letters about her case But Mrs. Tondo became impatient with the pace of the mails And one day last dred more and among the last 400 Group III patients there were only two operative deaths a rate of one half of 1 per cent The figures on the poor patients those in Group are less cheerful Doctor Harken and Dr. Laurence B. Ellis eminent Boston cardiologist who It's twins doctor Twins I've really hit the jack pot Today chubby eyed Maureen and Michael McSweeney are among Doctor Harken's prize testimonials to the value of mitral surgery When their mother brings them to his office he picks of one surgeon but of four plus two anesthesiologists and three nurses highly trained team of nine people Doctor Harken starts by marking out the line of the incision a wide are extending from the front of the chest around under the left breast and left shoulder * July she took the money she had earned has supervised the follow analysis of one up in each arm and marches proudly blade Then with quick sure strokes he from sewing lessons left her seven old son with her mother and boarded a these cases point out the journal Circulation that here the operative death around the place to show them off They are not however the only babies whose cuts through the skin fat and muscle His assistants meanwhile tie off or cauterize plane for the United without let- rate which covers those who die on the advent into the world was made easier the bleeding points ting either physician know she was on the way She felt she was dying and that this was her only chance She landed in Florida and took a bus for Boston Three table or fail to rally in the postoperative period has continued to remain at about 25 per cent This emphasizes the desirability of and more certain by an operation on their mother's heart His list includes twenty other women operated upon while they were pregnant with subsequent success- The surgeons expose the heart by pushing aside the lung slitting the pericardial sac and holding it open with several tie sutures Now the heart can be clearly days and nights later she arrived at the Park Square terminal in a state of collapse too ill to call the doctor or the hospital The bus driver made the calls and a taxi rushed her to the Peter Bent Brig- operating upon disease patients before they reach this terminal stage the Boston physicians state although they believe people should not be operated upon unless they are substantially dis ful deliveries One of these had triplets six months after her operation For some unknown reason mitral stenosis affects more women than men and its insidious course can lead to pink and glistening and pulsating Gently without moving it from its normal pos^<tion Doctor Harken explores the organ and its attached great vessels Folded back on the main body of the ham Hospital where she was placed in an oxygen tent and treated for heart failure abled by their disease and unless in spite of medical treatment they are going progressively downhill tragedies more serious than the inability to bear children Although the condition is usually attributed to childhood attacks heart is the earlike auricular appendage the walled tip of the left auricle This is the vestibule through which the surgeon There followed several weeks of study and tests and early in August Doctor Harken and his associates operated They Even though the poor patient may have only three out of four chances of recovering from his operation this can of theumatic often unrecognized at the time may not give its victimn trouble until she is in her twenties or will enter the heart with his index finger to explore and operate upon the valve To prepare for the crucial entry the ap- employed temperature anesthesia hypothermia chilling her body in an ice bath to reduce its metabolic need for be regarded as a worth gamble For as Doctor Harken says they are terminal cases cardiac invalids He calls atten- thirties Then as the obstructed valve interferes with the heart's blood pumping the woman finds herself getting weaker pendage is pinched shut near its base by means of two curved clamps Then string sutures are stitched in place blood This permitted them to close off the vessels to the heart long enough to open the right auricle and stitch shut the hole in the heart's inner partition She was tion to nineteen such patients who were acceptefodr mitral surgery but who at the last moment refused it Seventeen of the nineteen were dead within one year and weaker She cannot walk upstairs without panting for breath She is tired out before her day's housework is scarcely begun Her ankles may swell As the dis- and a finger slit made in the top of the appendage As Doctor Harken slips his index finger into the slit his as- sistants draw the purse strings saugly then placed in a warming bath to bring her temperature back to normal She made a Careful follow studies of the thousands who have survived the operation ease becomes worse the back pressure in the blood vessels leading from the lungs around it meanwhile slowly releasing the clamps The drawstrings keep blood from good albeit slowrecovery and months after the operation left the hospital for a reveal that more than 70 per cent have shown striking improvement This in- into the heart causes fluid or whole blood to seep into the lung's air spaces This is leaking out around the finger and the surgeon proceeds to probe the valve opening convalescent home She has gained thirty- operation three pounds since the Surgery for mitral stenosis is consider risky and . ably less demanding than op- crations to correct septal defects like Dolly Tondo's And as the surgeons learned more about the dynamics and cludes all groups poor risk and good risk although the percentage of good results has naturally been higher in the latter category some- The measure of improvement is some- times dramatic indeed For Mrs. Doris McSweeney a pretty haired young called pulmonary edema or congestion of the lungs It often comes as an acute attack of gasping wheezing and coughing of blood These terrifying episodes are frequently brought on by unusual physical or emotional strain The emotional ramifications of this with his finger tip This young woman has been very sick he remarks She was terribly thin and pale and she couldn't go up three steps without becoming breathless And no wonder The valve opening is quite small than seven tenths of a square pressure relationships of the heart and its Boston housewife it meant the final re- condition Doctor Harken commented centimeter I'd say valves their score with the scalpel im- alization of hopes many times cruelly de- often lead to the break of a marriage He pauses to ask the anesthetist about ene proved Dr. Frank Glenn professor of surgery at Cornell told a recent American ferred She had been one of thousands of women whose heart conditions were and a home For sex relations may be hazardous if not impossible for the the blood pressure Her heart's pretty irritable Continued on Page 94 same se 94 THE SATURDAY EVENING POST Finishing WITH NEW Behr SANDPAPER HANDY PACKS You can bring silky professional finishes on all your home sanding jobs and enjoy every minute of it with Behr Handy Pack sanding sheets Each pack contains an assortment of git sizes ~ from fine to coarse 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T Arcadia Florida You Can Depend On STRON YetGSEAFR ER ANACIN to relieve Won't Upset The Stomach Anacin not only gives stronger faster relief from pain of headache neuritis and neuralgia is also safer Won't upset the stomach and has no bad effects You see Anacin is like a doctor's prescription That is Anocin con- tains not just one but a combination of medically Ingredients proven active Scientific research research has proved no single drug can give such strong yet such safe relief as Anacin Buy Anacin * Tablets today all drug counters Housework's Harder WHEN DOAM PAIN STRIKES ; GETB Liquid corn remover dis- solves even toughest cornst PainHis safe Buy GETS today Continued from Page 92 he adds as it speeds up momentarily We'll go slowly The surgeon is often asked Doesn't this motion of the heart bother you when , you're operating Yes of course it does he replies But I'd be more bothered if it stopped On rare occasions a heart does stop during surgery and then the doctor quickly grasps it in his hand and begins to squeeze it as you'd squeeze a rubber ball manually pumping the blood along stroke after stroke He may have to con- tinue this for an hour or more before an invisible control center called the pace- maker takes over again An electrical pacemaker devised by Dr. Paul M. Zoll gery patients scattered throughout the country Wearing club pin a red heart with a neat seam stitched across the front they call on patients only with the approval of the physician in charge keep their visits short and cheerful resisting the temptation to talk about their own operation in drenched detail Addressing a group of fellow Mended Hearts recently on the fine art of hospital visiting Mrs. M. Stanley Livingston of Belmont Massachusetts said It is sufficient to point out that you can now walk around the block without huffing and puffing whereas before you had to stop twice en route One Mended Heart went out and won a golf tournament after his operation A buttonhole to normal size by taking stitches across either end we As stated at the outset of this article no cardiac defect is beyond the reach of the modern heart surgeon Some give him more trouble than others of course and one of the toughest is the aortic valve It is the exit gate through which the powerful left ventricle discharges its full load of blood to start the journey around the body Blood flows here at higher speed and pressure than anywhere else and the surgeon cannot plunge his finger through a simple slit in the aorta without risk of uncontrollable and fatal bleeding Nor is there any convenient appendage here to serve as an operating vestibule of Boston may be employed although nothing is quite so effective in this particular situation as the human hand In many instances the surgeon can widen the constricted valve with his finger finger fracture the technique is called Doctor Harken opens it part way with his finger in this case and then calls for bis bread valvulotome to complete the task This is a thin flexible blade a quarter of an inch wide with a . wavy edge and a flat shaft He slides the instrument down flat along the surface of his finger without removing the finger from the heart rotates the blade ninety degrees to bring the cutting edge into position and then moves finger and knife as one unit to slit the corners of the valve " think I've given it about a four- New Hampshire housewife took a holiday trip to Pennsylvania with her husband- on a motorcycle To some of those who ask whether they can drive a car after the operation Doctor Harken replies If you drove a car before you can drive again If you didn't you'll have to take driving lessons Walter Abernathy of Lynn Massachusetts a past president of Mended Hearts Inc. was directing a traffic survey for the Massachusetts Department of Public Works the night we looked him up to ask about his operation He had become a candidate for surgery he said not because his mitral valve was too tight but because it had developed a bad leak This incomplete closing of the valve is termed mitral insufficiency So much blood flows The surgeons are so sold on the vesti- bule principle however that they fashion an artificial appendage or cuff and sew it onto the side of the aorta This provides a safe entrance for a finger or in- strument during the stenosis operation Some of the doctors get their wives to make the cuff out of a scrap of nylon or rayon slip Doctor Bailey now prefers to use a piece of pericardium obtained at post mortem and kept in a refrigerator It is a thin rubbery tissue and sewing it to a slit in the aorta while fold of the latter is pinched off with a clampis a slow painstaking bit of needlework But if properly attached it holds firm without leaking while the surgeon manipulates | instrument to cut open the fused valve leaflets centimeter opening now he says This should be a good result . How's her pressure It dropped to eighty the anesthetist Relay But it's going up again . . . backward into the auricle with each heartbeat that the patient suffers from ex- treme weakness as well as lung symptoms For nine months preceding the opcration Mr. Abernathy was a semi The aortic valve that doesn't close properly is still a challenging problem The plastic valve developed by Dr. Charles A. Hufnagel of Washington has been one solution But there are certain Relay now Relay We'll come out . Get ready with the clamps He withdraws his finger enough for the assistants to clamp the lower part of the appendage shut then pulls it out the rest of the way as they close up the slit with the string sutures The pouchlike appendage now considered excess tissue is snipped off just above the clamp and the opening at the base is sewed up permanently Not all operations go off as smoothly as the one just described In many instances the edges of the valve leaflets are encrusted with calcium deposits Extreme care must then be taken lest fragments become dislodged and sweep out of the heart into vessels leading to the brain Here they could cause an embolism and valid unable to walk across the room without leaning on his wife's arm or holding onto the walls and furniture Doctor Harken repaired Mr. Aber nathy's leaky valve in December 1952 by suspending horizontally across the opening a plastic plug two inches long and shaped like a drink bottle This bottle baffic as it is called gave the otherwise gaping lips of the valve something to close on and prevented the hazardous regurgitation of blood A similar technique for plugging leaky valves was devised by Doctor Bailey in Philadelphia Instead of using plastics he carved the plug out of a piece of rib cartilage and covered it with a strip of pericardium He applied this method not only to mitral valves but to the tricuspid- objections to it and other methods are being tried Since this discussion has dealt only with surgery inside the heart we have said nothing about the various operations performed on the outer surface of the organ aimed at increasing the blood supply to cardiac muscle impoverished by coroartery disease A great many methods have been developed over the past twenty years notably by Dr. Claude S. Beck of Cleveland Among them are the grafting of a chest muscle to the heart the attachment of a chest artery to the coro- nary system and the sprinkling of powdered bone or asbestos inside the peri- cardial sac to stimulate richly vascularized adhesions The powdering procedure was suggested for President Eisenhower but temporary or permanent paralysis Therefore when the surgeon's finger warns him of calcifications he immediately orders an assistant to hold the head vessels Pinching these arteries shut for a few sec- onds will usually deflect any fragments into less critical parts of the circulation the corresponding valve in the right side of the heart to the aortic valve Neither Doctor Harken nor Doctor Bailey however has been satisfied with his score on these plugging maneuvers They and other surgeons have been striving for more physiological approaches was voted down by his physicians including Dr. Paul White on the ground that his heart muscle was not so blood starved as to justify such an operation Advances are steadily being made in this field however and the day may come when this commonest of all forms of heart dis- To make sure no paralyzing embolism has occurred the patient as she comes out of the anesthesia is asked to say something and to move each arm and leg The depth of anesthesia by the way is so managed that the patient is just rousing to consciousness as the surgeons finish with the sutures At that strategic moment be- ~ tween sleeping and waking Doctor Harken leans over the table and says You're doing fine It's all over Your heart's fixed You're going to be all right She opens her eyes drowsily smiles and drops back to sleep The nurses specially trained in the care of surgery patients keep up this re- assurance The patient is thus given a good start on the road to psychological . Studying the anatomy of the valves they found that a certain proportion of them fail to close properly because the fibrous ring or base of the valve from which the flaplike leaflets grow out has become stretched and dilated In other words the space is so large that the leaflets can't possibly meet at the middle to close it Doctor Glover and Dr. Julio C. Davila at the Presbyterian Hospital Philadel phia found they could reduce the size of the dilated mitral ring by encircling it with a heavy string suture The drawstring was then pulled together until the valve leaflets met properly The newest method of diminishing the size of a mitral ring is that devised by Dr. Henry T. Nichols an associate of Doctor Bailey's at Hahnemann Hospital case coronary thrombosis may be re- lieved in its more serious forms by sur- gery : The heart surgeons are also looking forward to the time when they will no longer have to do so many of their intra- cardiac operations by the sense of touch These are hidden plays one of them quipped and we would much rather see what we are doing Help in this direction is coming fast from the de- velopers of artificial heart machines According to newly organized American Society for Artificial Internal Organs four heart machines were in use at the time of its first meeting last June Others have come into operation since then With the patient's circulation by- passed through an apparatus that will as well as physical recovery Reassurance before and surgery is also supplied by members of the Mended Hearts Inc. organized at Peter Bent Brigham Hospital and now number- ing more than 1000 recovered heart and Medical College Rather than at- tempting to encircle the entire ring he pinches it together at two opposite points and holds these tucks with heavy eightypound fishline The procedure is similar to reducing a worn and stretched pump and oxygenate the blood the surgeon can work in an open and dry heart for an hour or so at a time Given this advantage the possibilities for recon- structing damaged hearts are almost limitless THE END