The Heart Healers (51 page)

6. An Impossible Dream

Sam Bachner and Dr. Alfredo Trento
. Unlike the other patients and their doctors in this book, these names are not pseudonyms, and none of their identifying personal details are altered.

Surgery for disadvantaged children in other countries
. This was before the time of the Larry King Foundation and other charities that now handle such expenses for a limited number of deserving children each year.

Gibbon’s initial success in animals before World War II.
Gibbon JH. Artificial maintenance of circulation during experimental occlusion of pulmonary artery.
Arch Surg.
1937;34:1105–1131.

John Gibbon’s years at Harvard, service in World War II, and life in Philadelphia
. A wealth of details concerning Gibbon’s life and his first successful surgery (including the patient’s real name) can be found in: Schumaker, Jr, Harris B,
A Dream of the Heart: The Life of John H. Gibbon, Jr., Father of the Heart-Lung Machine.
Santa Barbara, CA: Fithian Press; 1999. And in: Romaine-Davis A.
John Gibbon and His Heart-Lung Machine.
Philadelphia, PA: University of Pennsylvania Press; 1991.

Dennis passes Gibbon in development of the human heart-lung machine.
Dennis C, Spreng DS, Nelson GE, et al. Development of a pump oxygenator to replace the heart and lungs: An apparatus applicable to human patients, and application to one case.
Ann Surg.
1951;134:709. This report of use of a heart-lung machine in a patient preceded Gibbon’s surgery by two years. Without survivors. Dennis temporarily gave up the attempt to use the device in patients.

Oxygenation before Gibbon and Björk.
Adding oxygen to blood had never garnered scientific interest since its discovery by the famed French chemist Antoine Lavoisier. Among those whose academic careers were abruptly cut short, Lavoisier must stand alone. During the French Revolution Robespierre falsely accused Lavoisier of adulterating tobacco, leading to his arrest and beheading on the same day.

The many efforts at developing a heart-lung machine, as recalled by a surgeon who participated in the era.
Stoney WS. Evolution of cardiopulmonary bypass.
Circulation.
June 2, 2009;119(21):2844–2853.

Houston surgeon Michael DeBakey reminiscences
. DeBakey M. John Gibbon and the heart-lung machine: A personal encounter and his import for cardiovascular surgery.
Ann Thorac Surg.
December 2003;76(6):S2188–94.

Gibbon’s modest report of his success.
Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery.
Minn Med.
March 1954;37(3):171–185.

Gibbon’s view of the history of the heart-lung machine.
Gibbon JH Jr. The development of the heart-lung apparatus.
Am J Surg.
1978;135:608–619 and Gibbon JH Jr. The gestation and birth of an idea.
Phila Med.
1963;59:913.

Harken’s view of Gibbon’s withdrawal.
Cooper DKC.
Open Heart: The Radical Surgeons Who Revolutionized Medicine
. New York: Kaplan Publishing; 2010. Harken never hesitated to express his opinion.

The Iceman recalls the emergence of open heart surgery
. Kirklin JW: The middle 1950s and C. Walton Lillehei.
J Thorac Cardiovasc Surg.
1989;98:822.

7. Electrifying Discoveries

Historical account of Claude Beck’s experience in defibrillation.
Sternbach GL, Varon J, Fromm RE. The resuscitation greats: Claude Beck and ventricular defibrillation.
Resuscitation.
2000;44:3–5.

Beck’s manuscript describing resuscitation by defibrillation.
Beck CS, Pritchard WH, Feil HS. Ventricular fibrillation of long duration abolished by electric shock.
JAMA.
December 13, 1947;135(15):985.

Mirowski reports success with the implanted automatic defibrillator.
Mirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings.
N Engl J Med.
1980;303:322.

The history of development of the implantable defibrillator.
Kastor JA. Michel Mirowski and the automatic implantable defibrillator.
Am J Cardiol.
1989;63:977–982. The implantable defibrillator was the ultimate advance in delivering a defibrillation shock to a fibrillating heart. Implanted in a patient’s chest wall, the defibrillator analyzes each ECG complex, and when ventricular fibrillation is detected fires a shock. This was the device that fired in Dick Cheney’s driveway, saving his life.

The history of electrophysiology.
Horowitz LN. Clinical cardiac electrophysiology: history, rationale, and future.
Cardiol Clin.
August 1986;4(3):353–364.

Fabrice Muamba post-hospital video.
www.youtube.com/watch?v=kyySdtYsh6E
.

8. The Heart That Skipped a Beat

Wounded soldier with heart block.
Dr. Eckart’s medical account of this story appears in
Pacing Clin Electrophysiol
2008;31:635–638.

Dr. Paul Zoll recounts the history of his first successful human pacemaker.
Dr. Zoll’s quoted comments are extracted from transcribed interview in: Weisse AB.
Heart to Heart.

“Lies the rub.”
This phrase appears in Shakespeare’s
Hamlet.
The derivation of “rub” is from a term for the spin put on a ball to make it curve. Events also often come at us with spin, rather than straightforwardly.

Dr. Paul Zoll announces the development of his pacemaker.
Zoll PM. Resuscitation of the heart in ventricular standstill by external electric stimulation.
N Engl J Med.
1952;247:768–771.

The relationship of heart rate to longevity.
Levine HJ. Rest heart rate and life expectancy.
J Am Coll Cardiol.
October 1977;30(4):1104–1106.

Slowing heart rate in mice prolongs life.
Several hundred mice were fed normal feed or feed containing digoxin, a drug that slowed their heart rate. The treated mice lived longer than control mice (50% survival 850 vs. 700 days) and had slower heart rates (266 vs. 563 beats/min.). A confounding factor was that the treated mice had a lower body weight and starvation can extend rodent longevity. Coburn AF, Grey RM, Rivera SM. Observations on the relation of heart rate, life span, weight and mineralization in the digoxin-treated A/J mouse.
Johns Hopkins Med J.
1971;128:169–193.

Who designed the first pacemaker? In
1950 Canadian engineer John Hopps and cardiac surgeon Dr. Wilfred Bigelow (he of the freezing groundhogs) built an external pacemaker using a vacuum tube and power from an AC wall socket, which carried a hazard of inducing ventricular fibrillation. In the late 1960s Dr. Bernard Lown introduced direct current (DC) defibrillation in his Boston CCU, during the years of my training at Peter Bent Brigham Hospital.

9. Singed Wings

The career of Earl Bakken.
After his retirement from Medtronic, Bakken built a home in Hawaii, where he now lives. He has given back to society in many ways, one of which is the funding and creation of the modern new North Hawaii Community Hospital for the residents of the big island of Hawaii.

The Lillehei tax evasion debacle.
The story is well told in both of the Lillehei biographies: Miller GW.
King of Hearts
, and Goor DA.
The Genius of C. Walton Lillehei and the True History of Open Heart Surgery
.

Lillehei is ostracized in Minneapolis society
. Lillehei’s biographer reports his personal experience in: Goor DA.
The Genius of C. Walton Lillehei and the True History of Open Heart Surgery.

10. How to Win a Nobel Prize

Forssmann reports his results and departs cardiology for urology.
Forssmann W. Catheterization of the right heart.
Klin Wochenschr.
1929;8:2085. His publication was ignored by most, and belittled by others.

Werner Forssmann recalls his breakthrough heart catheterization with Nurse Ditzen.
Forssmann provides an entertaining description of his experience in Forssmann W.
Experiments on Myself:Memoirs of a Surgeon in Germany.
Trans. H Davies (New York: St. Martin’s Press; 1974): pp. xiv, 352.

The award citation for the 1956 Nobel Prize in Medicine.
The Nobel chronicles. 1956: Werner Forssmann (1904–1979); André Frédéric Cournand (1895–1988); and Dickinson Woodruff Richards Jr (1895–1973).
Lancet.
May 29, 1999;353(9167):1891.

11. One Man’s Disaster Is Another Man’s Breakthrough

Sones and Shirey describe the new technique of coronary angiography.
Sones FM, Shirey EK. Cine coronary arteriography.
Mod Concepts Card Dis.
1962;31:735. Sones was not drawn to writing manuscripts when there were catheterizations to be performed, so there was a substantial gap between his first coronary angiogram and his first description in the scientific literature.

Historical accounts of coronary angiography and coronary angioplasty.
An extensive body of historical information, photos, and videos about angiography and angioplasty is available at
www.ptca.org/archive/bios/sones.htm
.

The life and times of Mason Sones
. A thoroughly colorful description of Sones and his lab is given by his biographers David D. Monagan and David O. Williams in
Journey into the Heart: A Tale of Pioneering Doctors and Their Race to Transform Cardiovascular Medicine
(New York: Gotham; 2007). This superb, eminently readable book served a significant resource for the personal stories and quotes about Sones. The quotes from Sones and Proudfit are taken from this book.

The role of serendipity in medical breakthroughs.
Meyers MA.
Happy Accidents: Serendipity in Modern Medical Breakthrough.
New York: Arcade Publishing; 2007. Sones’s discovery of coronary angiography has a prominent place in Meyers’s entertaining stories of serendipity in medical research.

12. When the Pampas Came to Cleveland

Beck and Vineberg try to revascularize the heart.
Beck CS. The development of a new blood supply to the heart by operation.
Ann Surg.
1935;102:805, and Vineberg AM. Development of an anastomosis between the coronary vessels and a transplanted internal mammary artery.
Can Med Assoc J.
1946;55:117. Neither man’s approach stood the test of time.

René
Favaloro recalls his childhood.
Weisse AB.
Heart to Heart.
Cooper DKC.
Open Heart
.

Favaloro stuns the world with his successful bypass surgery.
Favaloro RG. Saphenous vein autograft replacement of severe segmental coronary artery occlusion.
Ann Thorac Surg.
1968;5:334. At the same time, George Green and others were pursuing bypass surgery using the internal mammary artery. Green GE, Stertzer SH, Reppert EH. Coronary arterial bypass grafts.
Ann Thorac Surg.
1968;5:443.

Favaloro’s idealism in his own words.
Several of René Favaloro’s quoted comments in this chapter are extracted from his transcribed interview in: Weisse AB.
Heart to Heart.

The postoperative management of coronary bypass surgery.
In the mid-1990s with National Institutes of Health (NIH) support, I was one of the principal investigators on the largest-ever angiographic trial on the long-term effects of lowering cholesterol levels in patients after CABG. We compared aggressive lowering of LDL cholesterol (LDL-C) levels (to <100 mg/dl) to the current standard (130 mg/dl). Aggressive statin therapy resulted in a 30% reduction in revascularization procedures and 24% reduction in clinical events during 7.5 years of follow-up. Consequently, long-term cholesterol lowering therapy is now considered mandatory following bypass surgery.