|THE FIRST SURVIVORS
OF THE HEART DEFECT CALLED
ATRIAL SEPTAL DEFECT
The heart has two upper chambers called
the right and left atriums. The right and left atriums are
part of the 4 chambers of the heart. Remember the heart
has 4 chambers, the two upper chambers called the atriums
and the two lower chambers called the ventricles.
The upper chambers called the right and
left atriums pass blood down to the lower chambers called
the right and left ventricles. The upper chambers called
the right and left atriums are the holding chambers and
the lower right and left chambers called the ventricles
are the pumping chambers that pump blood with oxygen in
it out to the rest of the body.
A baby born with an atrial septal defect
has a hole in one of the upper chambers of the heart. The
septum is a wall or a partition that separates or divides
the right atrium from the left. An atrial septal defect
can be a small hole, a large hole, many holes in the septum
or the entire wall of the septum can be missing.
If the hole is small enough it may close
on its own. If there are multiple holes or the holes are
very large or the entire septum is missing surgery is required
to fix this and the hole or holes have to be closed by sutures
or by a Dacron patch or an artificial septum.
The history and the discovery of the heart
defect called an atrial septal defect (ASD) is interesting
as is the history of who was the first to close this heart
defect called an atrial septal defect (ASD).
Credit is to be given to the Canadian
Pathologist Dr. Elizabeth Maude Abbott for her Atlas of
Congenital Heart Disease that opened up the field of heart
surgery with her description of heart defects that she gathered
over the years and during her lifetime she was the worlds
greatest authority on congenital heart disease.
From all that I have been able to gather
from journals, medical papers, books written about heart
defects and speaking with many thoracic surgeons and cardio
vascular surgeons as to who was the first to correct this
heart defect there are many names who deserve credit for
Remember that surgeons were trying to
figure out how to close heart defects and no one wanted
to repeat an operation that some one else had already done.
Each wanted to do it their own way with their own technique
and their own materials.
The year 1952 brought another major breakthrough
in surgery for congenital heart defects. This time it is
for the heart defect called an atrial septal defect. There
are many who contributed and did surgery on atrial septal
defects prior to 1952 but there are two major players in
their approach to heart surgery and two major hospitals
in two different cities.
Who is going to be first and did each
know about the other. The two hospitals are Children's Hospital
in Boston and the other is University Hospital in Minnesota.
The surgeon's are Robert Edward Gross and associates from
Boston and Floyd John Lewis and associates Mansur Taufic,
Richard Varco, and Walt Lilehi from Minnesota.
Dr. Gross and associates had been working
in the lab with animals on a way to recreate the heart defect
in animals and then figure out a way to correct it and then
attempt it on people. Gross developed a method to operate
on the heart by inventing a latex rubber well that he would
sew to the outside of the heart.
The well would fill with blood to a certain
level due to venous blood pressure and the blood would be
heparinized to prevent clotting then Dr. Gross would either
close the atrial septal defect by the use of a button, plastic
apparatus or by suture. It came time to see if what he discovered
and worked out in the lab with success with animals could
now be tried on people.
It was the year 1952. Dr. Gross brought
a patient to the operating room on April 3, 1952 at Children's
Hospital in Boston. Her name was Maria Zinni and she had
an atrial septal defect. Dr. Gross operated on this girl
and closed her hole using his atrial well technique and
closed the hole with a button that covered the hole.
After the operation on Maria, Dr. Gross
brought another patient a girl by the name of Diane Kneeland
to the operating room for the same heart defect called an
atrial septal defect closing her hole with a button also.
On April 11,1952 another patient a 3rd
girl name Diane Campagne was brought to the operating room
by Dr. Gross to close her heart defect another atrial septal
defect with a button also. Diane died immediately after
surgery. Dr. Gross's first 2 patients Maria and Diane also
died some time after surgery. This was not very encouraging
to Dr. Gross.
It was still the month of April and Dr.
Gross this time was going to try and close another atrial
septal defect on a patient a young 9year old boy. The boy
named Gerald Soucy was brought to the operating room on
April 15th 1952.
Dr. Gross again using his atrial well
technique closed Geralds atrial septal defect with a plastic
apparatus this time. This method was different from the
first three operations he first tried.
The very next day Dr. Gross brought another
patient to the operating room for another atrial septal
defect. The patient a young girl named Gail Corbett was
operated on and her hole was closed not with a button or
a plastic apparatus but by suture technique. This means
they closed the hole with thread. Another first for Gross
and the first time sutures were used.
On April 26, 1952 Dr. Gross and his associates
brought a young boy named Wesley Rosner to the operating
room to close his atrial septal defect using Dr. Gross's
atrial well technique and also closing the atrial septal
defect with suture technique. The first two patients Gerald
Soucy and Gail Corbett did well. The third patient Wesley
died some time later.
Dr. Gross went on to do many more atrial
septal defects using his atrial well and had great success
with it. Dr. Gross and associates had many visiting surgeons
come to the hospital to be shown the atrial well technique
to close the heart defect called an atrial septal defect
and the visiting surgeons went back to their hospitals and
used Dr. Gross's method with great success. Dr. Gross was
the first to close an atrial septal defect.
Though Dr. Gross could not see the atrial
septal defect hole by direct visual contact because the
collection of blood would rise up in his well he could feel
the size of the hole by touch and had great success with
his surgical technique of closing each of the patients he
operated on with his atrial well technique and suture technique.
Dr. Floyd John Lewis and associates were
next to take on the congenital heart defect known as atrial
septal defects. Dr. Lewis was going to operate on the heart
but had to figure out how to slow the flow of blood in the
heart and the idea was to use hypothermia which is to lower
the temperature of the body, slow the flow of blood in the
heart and back to the heart. Lewis felt there was a better
way to operate on the atrial septal defect and wanted to
actually see the defect with hisown eyes. He had been experimenting
using hypothermia in the lab at the University Hospital
with dogs and other animals.
Lewis and associates also had to create
the heart defect and then figure out how to correct the
defect. Dr. Wangeensteen was the chief and he felt his young
doctors had great ability and gave them free reign to try
things that had not been done before. Richard Varco was
a great influence on Lewis and assisted on his first atrial
We are still in the year 1952 but the month
is September and it is the second day. Dr. Lewis is now
ready to take his research using hypothermia in the lab
from animals to humans. With his associates at his side
and others he brings a 5year old girl to the operating room
of the University Hospital.
Dr. Lewis assisted by surgeons Dr. Richard
Varco and Dr. Walt Lillehei. The patient a female whose
name is Jacquelin Johnson is brought to the operating room.
She is put to sleep with the drug sodium
phenobarbitol that calms the nerves and induces sleep. The
drug given in the proper amount relaxes muscles and prevents
shivering which would cause the body to rewarm and cause
the blood to flow. Her lungs are ventilated using oxygen
squeezed from a rubber bag and delivered through an endotracheal
Jacqueline is wrapped in the rubber blankets
that are filled with water and turned on the apparatus that
controls the temperature of the blankets. Remember the body
temperature is usually 98.6degees Fahrenheit. They needed
to drop the body temperature which in turn slows the flow
of blood and the beating of the heart. They are going to
drop the body temperature to slow the beating of the heart
by half. Normal heart rate for kids is about 100 beats a
minute and kids with heart defects like an atrial septal
defect heart rate can be 120 beats a minute and higher.
The core body temperature will be dropped from 98 degrees
to about 85 degrees. The cold blankets are removed and Dr.
Lewis quickly cuts open her chest.
Using small tourniquets Dr. Lewis and
Varco close off the main veins called the superior vena
cava and the inferior vena cava along with the all important
azygos vein that are the blood vessels that return blood
from the body to the heart.
Dr. Lewis then clamps of the pulmonary
artery that sends blood to the lungs to pick up oxygen and
give off carbon dioxide and the aorta that returns the new
freshly oxygenated blood back to the rest of the body. At
this time blood can neither enter Jacquelin's heart or leave
her heart. The blood in her body was virtually at a standstill
Dr. Lewis cut through the wall of the upper
chamber of the heart called the right atrium and discovered
no blood. Closing the 3 veins worked. Lewis now proceeded
to find the hole in the atrial septal wall. Finding the
hole by direct eye contact was a first. If Jacquelin does
not go into shock or die this will open heart surgery to
a new level.
Keep in mind that if oxygen does not return
to the brain with in 4 minutes brain cells begin to die.
They had opened the heart and the time that lapsed was almost
4 minutes. Dr. Lewis closed the hole in the wall of the
atrial septum with stitches.
To check for leaks he filled the atrium
with saline solution and saw there was a leak. He placed
one more stitch and the hole was completely closed. More
than 4 minutes had passed. The wall of the heart was closed
and the tourniquets on the azygos vein, superior vena cava
and inferior vena cava were released and now blood flowed.
Jacquelin's heart refilled with blood. Dr. Lewis massaged
the heart to help it restart and maintain a normal rhythm.
Dr. Lewis and associates then closed the chest. Then they
had to rewarm her body. They then placed her in a tub of
warm water that Dr. Lewis found in a Sears catalog that
was used by farmers for watering animals.
Later that day Jacquelin awoke and almost
2 weeks later Jacqueline left the hospital to go home. Now
to everyone opening the heart was a reality. Open heart
surgery was now a reality and would open the doors to surgically
correct many heart defects now.
I have not been able to find Jacquelin
Johnson who was Dr. Lewis's patient but I have been told
she is still alive. I have tried contacting her at her old
address but she has moved.
I am still trying to find both of Dr. Gross's
patients Gerald Soucy and Gail Corbett. If I am able to
find them I will ask them to write about their lives.
There are other doctors who operated on
patients for the heart defect called atrial septal defect
before Dr. Gross and Lewis. One is Dr. Charles P. Bailey
who used the heart itself to close the defect in January
of 1952. He also had a patient in August 1952 but she didn't
Others such as Gordon Murray from Toronto
Canada described a method of putting heavy sutures through
the atrial septum and pulling the sutures tightly closing
from front to back to collapse the walls of the defect.
Murray did this on a 12year old girl.
The girl did well. Fourteen months later the girl went for
a heart catheterization and it was discovered that she had
a persistent left to right shunt and pulmonary hypertension.
The surgery could not be called a success.
The shunting means that blood was crossing over from the
left side to the right side of the heart through the hole
in the atrial septum. This technique did not close the defect.
The pulmonary hypertension means too much blood was being
forced in the pulmonary artery.
Many doctors and others have contributed
much to the field of cardiovascular surgery and it is not
my intention to leave anyone out. One of our goals is to
share with you what we have been able to find and let parents
know that long term survival is possible and by sharing
the stories of the first survivors.
Our children who have VATER have many
birth defects and this is why we do the research to give
a door of hope to many parents who have had to open the
door or will be facing the door and will have to open it
and face what is on the other side and those who have not
yet come to the door.