Hopkins pioneered 'blue baby' surgery 50 years ago
'I Remember ... Thinking It Was Impossible'

Mike Field
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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.