Heart defects are the most common of all birth defects. The birth defect in the heart called a ventricular septal defect is the most common of all defects in the heart. It is estimated that for every 100 babies born one baby will have a heart defect.

The heart defect that is most often seen in babies born with multiple congenital anomalies and the syndrome called VATER have the heart defect called Ventricular septal defect. The heart is made up of many different parts with names such as ventricles, chambers, septums, atriums, valves, arteries, veins, left heart, right heart to name a few.

A ventricle is a small cavity in the heart. The heart has a right ventricle and a left ventricle. Within each ventricle there is a septum. A septum is a partition or a wall that separates the right and left ventricles from each other.

The ventricles are the two lower chambers of the heart that when filled with blood propel and force the blood into the arteries. The right ventricle forces blood into the pulmonary artery and then into the lungs, the left ventricle pumps blood through the aorta into the arteries.

The left ventricle receives blood from the upper chamber of the heart called the left atrium and then pumps it out into the general circulation of the body through the aortic valve. The right ventricle is the cavity in the heart that receives blood from the upper chamber of the heart called the right atrium and pumps it into the lungs by way of the pulmonary artery.

The heart has 4 chambers to it. The two upper chambers are called the atriums and the two lower chambers are called ventricles. The blood flows from the upper chambers of the heart to the lower chambers.

Defects of the heart especially in children and babies have been known for a long time. Even though the heart defects were known the problem was no one knew how to correct them because no one was willing to operate on the heart because it was the seat of the soul sort to speak.

Having a hole in the septum of the ventricle is called a ventricular septal defect. The holes can be large or small and there can be one hole or many holes. The entire septum can also be missing.

Ventricular septal defects are most often closed from the right side approach and occur between or within these 4 main ventricular septal components, 1. atrioventricular (AV) canal, 2. the muscular septum or (sinus septum), 3, the septal band (proximal conal septum or trabecula septomarginalis) and 4. the conal septum ( infundibular septum or parietal band).

The history of the first unsuccessful and successful operation for ventricular septal defects was at the University of Minnesota in 1954. Dr.F. John Lewis and associates Walt Lillehei and Richard Varco and others had success closing an atrial septal defect on September 2, 1952 using hypothermia. Hypothermia is when they drop the core body temperature of the patient to slow blood flow and oxygen to organs of the body. Dr. Walt Lillehei had been working on Ventricular septal defects in the lab for quite some time using cross circulation.

Chief of Surgery Owen Wangensteen at the University of Minnesota was a great chief because he gave free reign to his surgeons to try whatever they could think. After Lewis had successfully closed the Atrial Septal Defect he wanted to close Ventricular Septal Defects. Wangensteen gave permission to Lewis to do the first ones at the University in 1954. Lillehei didn't believe that hypothermia would work on Ventricular Septal defects and told this to his chief Wangensteen. Lillehei couldn't change the chief's mind and he was terribly hurt by this. Lewis was at the hospital longer than Lillehei and had seniority over him.

Lewis brought a patient in to correct a VSD using hypothermia and the diagnosis was wrong. The patient died on the table. His next patient did have a VSD and this patient also died. This devasted Lewis and he gave up. Now it was Lillehei's turn.

Gregory Glidden had a heart defect called a ventricular septal defect. He had a sister who 4 years before he was born died at home in her sleep because no one could fix her heart. Lillehei believed he could correct baby Gregory's heart with cross circulation which he had been doing in his lab on animals. Gregory's parents Lyman and Frances had agreed to let Lillehei try to save their son. They had already lost their daughter LaDonnah who died in 1950 when she was only 13 years old. No one could correct her heart defect 4 years previously called a ventricular septal defect.

The first cross-circulation operation on March 26 1954 on baby Gregory Glidden and father by Dr. Lillehei and associates.

Lillehei was going to use baby Gregory's father Lyman as his cross circulation donor to baby Gregory. Cross circulation is hooking up baby Gregory to tubes that circulate his blood from him to his father and in his father the blood picks up oxygen from the lungs and is passed back to baby Gregory. No one knew if it would work on live humans but they were going to give it a try. It worked on animals in the lab so the next natural step was to try it on people. Both baby Gregory and his father Lyman had the same blood type O positive.

On March 25th 1954 the operation was scheduled for the next day. The chief of surgery Dr. Wangensteen had given the o.k. for Walt to go ahead. On the operating room schedule appeared the name Gregory Glidden and Lyman Glidden for March 26th. The afternoon of March 25th the operating room scheduled was passed out throughout the hospital and the chief of Medicine Dr. Cecil Watson saw what was scheduled. He could not believe it. After all the patients who had died previously who had ventricular septal defects under hypothermia how could anyone think of trying cross circulation.

Watson wanted all patients admitted to the medical ward for diagnosis and they would decide who needed surgery and who didn't. Wangensteen the chief of surgery wanted potential surgery patients admitted to the surgical staff where he ruled. Watson knew the only one who would listen to him was the director of the University Ray M. Amberg and might help him put a stop to this. Watson brought up Lewis and the patients he lost and also doctors Dennis and Gibbon who also lost patients with the heart lung machine.

Watson said that cross-circulation was more menacing than any machine. He said with a machine you may lose one patient, but with cross circulation you could lose two and one who is healthy. That is a 200 percent mortality for one operation. Amberg did not want to get involved. He had faith in Wangensteen and he remembered the publicity it brought the hospital when Lewis operated on a patient with an Atrial Septal Defect.

March 26 1954 baby Gregory is brought to the operating room number 2 at the University of Minnesota. The gas cyclopropane was used to put Gregory to sleep. This gas was hand pumped in by the doctor squeezing a black bag continuously till the operation was over. At 8:45 a.m. the operation began with Lillehei as head surgeon and Varco assistant. They opened the skin and then the chest bones to exposed the heart.

Lillehei said to the others to bring in the boys father Lyman. Mr. Glidden was placed close to his son. Two other doctors Warden and Cohen made a cut into Mr. Glidden's groin on the right side to expose the femoral artery which carries freshly oxygenated blood from the heart and the saphenous vein which returns unoxygenated blood to the heart. (Remember that arteries take oxygenated blood away from the heart and veins bring unoxygenated blood back to the lungs and heart for oxygen). Cannulas were put in place in his groin artery and vein and hooked up to clear plastic beer tubes and to the blood pump.

The exact amount of blood that went from baby Gregory to his dad had to be the exact amount of blood from his dad back to his son. Lillehei cut into Gregory's neck and placed a cannula down into the large blood vessels the superior and inferior vena cava that took depleted blood into the heart. Lillehei took another cannula and placed it in a large artery into the aorta that sends re-oxygenated blood to the body and then connected the cannulas to separated beer hoses that led through the pump to Mr. Glidden. Air was then siphoned out.

Baby Gregory's heart pumped his blood through his body and soon it would pump to his dad. They turned on the pump and blood flowed through the beer tubes and no leakage occurred. Lillehei tied tourniquets around the vena cava and the pulmonary artery that sends blood to the lungs for re-oxygenation.

The blood was now detoured from son to father. Lillehei cut into the heart and felt around and found a hole the size of a dime. 12 stitches and the hole was closed. The tourniquets were released and the blood flowed from baby Gregory's heart. No problems occurred. The heart beat normally and the pulse and blood pressure good. The pump was turned off and they closed Gregory's chest and removed all the tubes. Mr. Glidden had all his tubes removed. Mr. Glidden awoke and asked if his son was o.k. He was. Mr. Glidden had to go back home to go to work.

Later that day Gregory came too and there were no problems. For the first few days he seemed well. His father and sister returned to see him. Then he had a bout of having difficulty breathing. They had to put a tube down his throat because he couldn't breathe. His father and sister left to go back home after he was doing better. He continued to have ups and downs and on April 6, 1954 at 9:15 in the morning baby Gregory died. It is believed he died from pneumonia.

Mr. and Mrs. Glidden were expecting their 12th child that week and got to the hospital a little before 12 noon not knowing their son had died. Lillehei said how sorry he was and the Glidden's thanked him because they knew how hard he tried and that there was no guarantee of success for the operation. This is the beginning of the many trials and errors that families, surgeon's and patient's would go through.

Gregory was the first survivor of the operation for a ventricular septal defect and by his surviving many others would benefit from the operation that cross-circulation would bring to heart surgery. I have spoken to many of baby Gregory's family members and this is the story they have told me. Two of his sisters wrote letters to me about going to the hospital and sent family pictures that I have included. They also gave me a copy of a book about baby Gregory written by a writer G. Miller. There is a picture of the tombstone for baby Gregory and his older sister LaDonnah that has a beautiful memorial to baby Gregory that says, "His Little Heart Changed The World". The next patient that Dr. Lillehei would operate on was in the hospital the same time baby Gregory was. That story next.