Heart or blood pump. butt hole Bone of the Arm, Hand and  fingers. Kidneys  Ureters  Bladder  Genitals Food pipe, Swallow,  Gullet and Esophagus. Wind pipe, Breathing tube. Bones of the Neck, Back, Spinal cord.







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 this.

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.

Dr. Gross

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.

HYPOTHERMIA 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 septal defect.

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 tube.

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 not moving.

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 survive.

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.



TEF/Vater® International
is a nonprofit organization founded by Greg and Terri Burke after their daughter, Jaclyn, was born with esophageal atresia in 1990.  To those children, born and unborn, with esophageal atresia, tracheo-esophageal fistula, and/or the VATER/VACTERL Association, and to the very special parents and medical staff who love and care for them, this organization is dedicated

 



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