King of Heartsby G. Wayne Miller, Patrick Cullen
This is the story of the surgeon many call the father of open-heart surgery, Dr. C. Walton Lillehei, who, along with colleagues at University Hospital in
Few of the great stories of medicine are as palpably dramatic as the invention of open-heart surgery, yet, until now, no journalist has ever brought all of the thrilling specifics of this triumph to life.
This is the story of the surgeon many call the father of open-heart surgery, Dr. C. Walton Lillehei, who, along with colleagues at University Hospital in Minneapolis and a small band of pioneers elsewhere, accomplished what many experts considered to be an impossible feat: He opened the heart, repaired fatal defects, and made the miraculous routine.
Acclaimed author G. Wayne Miller draws on archival research and exclusive interviews with Lillehei and legendary pioneers such as Michael DeBakey and Christiaan Barnard, taking readers into the lives of these doctors and their patients as they progress toward their landmark achievement. In the tradition of works by Richard Rhodes and Tracy Kidder, King of Hearts tells the story of an important and gripping piece of forgotten science history.
- Blackstone Audio, Inc.
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Lloyd Anderson returned to Minnesota, hoping to forget what he'd seen on the battlefields of Europe, a decade before C. Walton Lillehei attempted what no surgeon had before. Lloyd's wife, Betty, needed to move on, too. A car crash when she was a teen had put Betty in a coma, and she was different when she emerged, high-strung and fretful.
The end of World War Two promised new beginnings. Lloyd the infantryman came home a father; Betty had become pregnant while he was on leave, and their first child, Patricia Lee, had arrived in his absence on April 7, 1945. At forty-six hours, it had been a miserable labor, but mother and daughter had left the hospital apparently healthy. Lloyd got a job in a Minneapolis tractor factory; Betty was home with Baby. With only an ordinary measure of luck, life at last would be sweet.
So maybe it was nothing when the Andersons began to notice that the blood vessels in their daughter's neck pulsated strangely; maybe it was only their imagination that, as Patty grew, her tiny chest seemed to bulge. New parents see the worst in everything. Still, better not to take chances. Betty took Patty, almost two, to the family doctor.
Listening to her heart, the doctor detected a murmur.
Patty deteriorated with astonishing speed after that. She caught frequent colds. She tired easily and experienced great difficulty sleeping. She was abnormally pale and thin-except for that bulge in her chest. That wasn't imagination. That kept getting bigger, as if something inside of Patty were desperate to escape. In June 1947, a cardiologist at a University of Minnesota clinic diagnosed an atrial septal defect, or ASD-a hole in the wall that separates the heart's upper chambers. Cardiac diagnosis was unreliable in the 1940s, but if the doctor was correct, Patty was doomed. There was no fix for an ASD, no way to open the heart and sew up a hole without bleeding the patient to death. Like many of the fifty thousand or so other Americans born every year with such defects, Patty might not reach adulthood. She might not make first grade.
Three years passed.
Doctors put Patty on a low-salt diet and made her eat liver, rich in iron. She was given oxygen and digitalis, an herbal derivative that stimulates the heart-and one of the rare cardiac medications of any kind in those years. She underwent radiation therapy. But nothing worked. Patty's heart kept failing, and as a result, her lungs were also. Stairs exhausted her and she was consumed by thirst. So severe was her torment that she could sleep only by sitting up in bed. Taxed close to the breaking point, her heart was double its normal size. It was, quite literally, ready to burst.
And then the Andersons heard about Dr. Clarence Dennis, a University of Minnesota surgeon. Dennis was senior member of a staff that included such accomplished young doctors as C. Walton Lillehei.
For five years, Dennis had been developing a machine that would temporarily function as a patient's lungs and heart. With it, he hoped to shut off the vessels to a defective heart, open the heart, right its wrongs, then close it back up. Patty's parents listened to Dennis describe how his machine had worked on laboratory dogs. No one could guarantee its success in the human, of course, but Dennis was ready to try. All he lacked was a volunteer.
The Andersons did not answer immediately. For all the fancy language, the situation was brutally simple: Dennis wanted a human guinea pig. He wanted to hook their daughter up to a newfangled machine they'd never seen and, in a room they were forbidden to enter, entrust it with her life.
And yet, the Andersons' only child-their precious Patty-was slipping away. You could see it in her look, already marred by a terrible case of crossed eyes, and in her smile, which seemed forced and weary, as if she had never known joy. She did not play much with other children: she couldn't keep up and Betty was terrified of germs. Patty had been hospitalized three times already in her short life, most recently for a month and a half, including Christmas of 1950. Betty was chain-smoking and drinking coffee in dizzying quantities. Lloyd was revisiting battlefields in his sleep.
Clarence Dennis was born inventive. As a boy, he built a radio, a record player, and a lathe, and he was handy with Model Ts. Fascinated by the concept of free energy, he set out, at his basement workbench, to achieve the impossible. His father said to his mother, The boy doesn't have common sense. He's been working down there for weeks trying to make a perpetual-motion machine! Dennis graduated magna cum laude from Harvard College and earned his M.D. with high honors at Johns Hopkins, then served his internship and residency at Minnesota. Impressed by Owen H. Wangensteen, the chief of surgery, Dennis decided to stay. Dennis was a professor when the chief asked him to join what many held to be surgery's greatest quest.
It was the autumn of 1945, when heart surgery consisted primarily of repair of peripheral structures such as the aorta, the vessel that sends freshly oxygenated blood back into the body. Fixing the worst defects-those inside the heart-would require time, room, and visibility, all of which were then unattainable. To open the living heart was to kill, in a river of blood that ran dry in less than a minute.
Only a handful of surgeons had yet embarked on the quest, and almost without exception they believed the answer would be found in a heart-lung machine: a mechanical apparatus that could sustain the patient's life while blood was detoured past the sick heart. The principle of supporting life by artificial means was not new; for decades, scientists had been able to keep tissue alive outside of the body with the assistance of various contraptions. The most publicized example was a sliver of embryonic chicken heart muscle that the great French surgeon and Nobel laureate Alexis Carrel managed to keep alive, with the help of a machine, for almost thirty years in his laboratory. Among those inspired by Carrel was aviator Charles Lindbergh, whose sister-in-law's heart disease prompted him, in 1929, to approach the French surgeon with the idea of building an artificial heart-an impossibility at that time, as Lindbergh soon learned.
Clarence Dennis's first inspiration was the artificial kidney, invented in Nazi-occupied Holland by the Dutch doctor Willem J. Kolff. Working in secret, Kolff built eight artificial kidneys out of wood, metal, and other materials that he scrounged from industrialist friends. All sixteen of Kolff's early dialysis patients died. "The first patient who truly recovered -- most likely thanks to the artificial kidney-and who otherwise would have died, was number seventeen," Kolff later recalled. "She was a National Socialist, an old woman who most of my countrymen would have been most happy to send off to her final reward." Clarence Dennis thought the guts of Kolff's device (cellulose sausage casing, of all things) might properly oxygenate blood, a fundamental requirement of any heart-lung machine, but his laboratory studies disproved that hypothesis.
So Dennis traveled east to Philadelphia, home of surgeon John H. Gibbon Jr., who'd been working on a heart-lung machine for more than a decade, longer than anyone else. Gibbon was a guarded man, more so as his competition intensified, but in 1945, he welcomed a visitor from the Midwest.
Thank God you want to build one of your own, said Gibbon to Dennis. Now maybe people won't keep telling me I'm crazy!
Dennis returned to Minneapolis with Gibbon's blueprints, which he took to the university's machinists, who tooled and helped assemble the parts. The first tests used cow blood, available free from a slaughterhouse, but Dennis wasn't satisfied with that design, nor with several others. Years passed. Then one night Dennis woke up, literally from a dream, with the idea for another modification. A prototype was built and tested. Dennis was ready to try it on a living being, and because its heart is nearly identical to a human's, he chose a dog. He anesthetized the animal, split its chest, connected it to the machine, and opened its heart for half an hour. That dog lived, but the next thirty or so died.
Dennis made more modifications and ran a new series of tests. Lost dogs outnumbered survivors-because of mistakes, not a flaw in design, Dennis believed. The mistakes were instructive; once identified, they could be prevented. I think we're ready to give this a try, said Dennis to surgeon Richard Varco, his principal partner.
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