Hopkins pioneered 'blue baby' surgery 50 years ago 'I Remember ... Thinking It Was Impossible' Mike Field -------------------------- Staff Writer It was November 29, 1944. While war raged on in Europe and across the Pacific, in a small, sunlit room in Baltimore a new battlefield was about to emerge. There, in Johns Hopkins Hospital room 706 surgeons gathered round the tiny blue body of Eileen Saxon. At 15 months of age, Eileen weighed only a scant nine pounds and was hovering near death. Worse, her condition was deteriorating rapidly. The child's fingers, toes, lips and nose were blue, an indication that a congenital heart defect was preventing enough blood from reaching the lungs to provide sufficient oxygen to the rest of the body. A "blue baby" suffering from a condition known as tetralogy of Fallot, the little girl had an illness known to be fatal. On this day, however, Hopkins doctors were betting they could save the child's life. The surgery room was a buzz of activity as the four-and-a-half hour operation began. Located on the north side of the building's top floor--to provide optimal natural lighting through two large windows positioned behind the surgeon's back-- the operating room was heated by big cast-iron radiators in the winter. In summer, oscillating fans were used to keep patients and surgeons cool. Scalpels, clamps and needles were all standard issue, the sort a surgeon would find useful in performing an appendectomy. Such was the state of surgery in 1944 as the doctors prepared to do what had never previously been attempted: an operation of the heart, in which one of the arteries that normally supplies blood to the arm would be rerouted to the lungs. This so-called shunt would provide enough additional blood, doctors hoped, to turn sickly blue babies a healthy shade of pink. In an era that no longer considers heart transplants miraculous and in which coronary bypass operations are commonplace, it is perhaps difficult to imagine how daring the concept of cardiac surgery once seemed. Almost exactly 100 years ago, British physician Stephen Paget wrote that "surgery of the heart has probably reached the limit set by nature to all surgery. No new method and no new discovery can overcome the natural difficulties that attend a wound of the heart." His opinion reflects the prevailing attitudes of most surgeons and researchers through the end of the 19th and well into the 20th century. The heart, it was thought, was too central, too vital, too complex to permit surgery or other invasive techniques. It would take a team of inordinately skilled physicians, surgeons and diagnosticians to conceive, plan and execute cardiac surgery when there were no books, no models and precious little practical experience on which to build. Fortunately, Hopkins had just such a team in chief surgeon Alfred Blalock, pediatric cardiologist Helen Taussig and lab technician Vivien Thomas. On June 7, the departments of Surgery and Pediatrics at the Medical Institutions will celebrate the 50th anniversary of the first Blalock-Taussig shunt with a day of reminiscences, formal and informal presentations, and a gala dinner in honor of the pioneering operation and of the men and women who made it possible. Featured among the day's events will be a follow-up report on the original shunt patients, analysis of the impact of modern molecular medicine on congenital heart disease and a first-person report on the original procedure by Texas Heart Institute surgeon-in-chief Denton Cooley, who served as an intern on the first and subsequent operations. "I think the operation was the first stage of the successful development of heart surgery," said William Longmire, professor emeritus of surgery and former chairman of the Department of Surgery at UCLA. Longmire served as chief resident at the first and subsequent operations, and later helped establish the first cardiac surgery program at UCLA. "Prior to that there had been some operations on stab wounds to the heart, and some on the pericardium, which is the envelope that surrounds the heart. But this operation ushered in a new era of cardiac surgery." Most new operations take some time before they become standard procedures and enter into common use. But the Blalock-Taussig Shunt, as it came to be known, earned widespread attention almost immediately. "Maybe because it involved a color, or babies or the heart, I don't know," Longmire said. "But it just astounded me how quickly word of this operation spread. I had never seen a tetralogy of Fallot baby before the first operation, and after that we saw many. I would say we performed another eight to 10 operations within the first six months." By the time Alfred Blalock retired in 1964, more than 2,000 children had received the shunt at Hopkins; worldwide, more than 15,000 owe their existence to the life-saving procedure. Many were subsequently able to undergo open heart surgery as new, more sophisticated procedures, developed in the 1950s and '60s, allowed surgeons to more fully correct congenital heart problems. Others lived full lives with their shunts and no additional surgery. Sandra Stoltz underwent the procedure in 1945 at the age of 11. (The term "blue baby" is something of a misnomer, for, depending on the severity of the problem, many infants affected with tetralogy of Fallot lived well into adolescence with the telltale blue lips, toes and fingers; however, their life expectancy was severely limited by the condition.) Now a practicing psychologist in Minneapolis, Stoltz remembers her condition vividly: "I was a blue baby until I was 11, complete with purple toes, nose, fingertips and lips," she wrote in a recent testimonial. "I was often short of breath, had limited energy and occasionally fainted. ... I desperately tried to be normal and longed to keep up with the other kids." After the operation, she said, her life changed forever: "While I remember little of the first year post-op, thereafter I deemed the operation a complete success. I learned to ride a bike, and attended public school for the first time. In high school, I was excused from physical education, but could jitterbug the night away! I joined a sorority, felt popular and considered myself normal at last." "Al Blalock's tenacity was remarkable, and his skill as a surgeon was unsurpassed," said Longmire, recalling the difficulty of operating on the first patient. "The cuff of the vessel visible was a fraction of a millimeter and the incision itself was only four or five inches. I remember watching him open the patient and just thinking it was impossible." Yet in his calm, methodical and careful way, Blalock carefully knit together arteries with a special tiny needle fashioned specifically for this use by Vivien Thomas. Each suture had to be carefully placed to ensure the new connections would seal. At last, with the final suture complete, Blalock removed the awkward "bulldog clamp" used to occlude the subclavian vessel during surgery. The sutures held, and blood began flowing though the improvised shunt. There was a sigh of relief, followed by a startled exclamation from the resident anesthesiologist: "You should see the change in the color of this child's lips!" he said. Members of the team peered over the sheet-draped body to the little girl's head. The icy blue complexion was gone. Now, her lips were red, and in her cheeks they could just start to see the beginning of a healthy pink blush.
Go to Gazette Homepage