The Heart Healers (50 page)

Current heart disease and stroke statistics.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al., on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics—2013 Update: A Report from the American Heart Association.
Circulation.
2013;27(1):e6-e245.

President William Clinton’s coronary disease.
The details of Bill Clinton’s medical history can all be found in public records. One source is Timeline: History of Former President Bill Clinton’s heart problems and procedures at
articles.nydailynews.com/2010-02-11/news/27056090_1_quadruple-bypass-surgery-chest-pains-and-shortness-coronary-arteries
and another is
www.doctorzebra.com/prez/z_x42cardiovascular_risk_g.htm
.

1. A Day Like All Days

The mansions of Beverly Hills
. The colossal mansions and grounds were first made famous by Douglas Fairbanks and Mary Pickford when they built Pickfair in 1919. The Roaring Twenties brought movie legends Gloria Swanson, Will Rogers, Charlie Chaplin, Tom Mix, John Barrymore, Buster Keaton, Harold Lloyd, Jack Warner, Clara Bow, Marion Davies, and Rudolph Valentino, each with their own extravagant mansions. Later the deaths of mobster Bugsy Siegel, Marilyn Monroe, and Jayne Mansfield brought unwelcome notoriety.

Cedars-Sinai Medical Center.
The medical complex includes a multi-specialty 958-bed teaching hospital with approximately 2,000 physician staff members, 2,000 volunteers, and 10,000 employees. The teaching program encompasses over 230 principal investigators and 350 trainees in 60 post-graduate medical education programs and 800 research projects. The research program includes centers in cardiology, gastroenterology, neuroscience, immunology, surgery, organ transplantation, biomedical imaging, cancer, genetics, gene therapy, and stem cells. The cardiology program has been ranked in the nation’s top 15 centers since the inception of
U.S. News & World Report
rankings. Cedars Sinai cardiac transplant program has the world’s largest annual number of surgeries. See
en.wikipedia.org/wiki/Cedars-Sinai_Medical_Center
.

The probability of coronary disease.
In the late 1970s one of my brilliant multifaceted fellows, Dr. Howard Staniloff, MD, showed me a pathology book about “false-positive” laboratory chemistries (tests which indicate disease when none is present). We had a mutual epiphany because we were bedeviled by the same problem, false positive and false negative results, in stress testing. My colleague Dr. George Diamond and I created a system for determining the probability of CAD in every patient before and after testing. Around the world, cardiologists adopted the new method. It is still in worldwide use today, known as the Diamond-Forrester classification. I will not give details, but if you are interested, google Diamond-Forrester and you’ll find more than you want to know. The manuscript is: Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease.
N Engl J Med.
June 14, 1979;300(24):1350–1358.

2. “What Man Meant for Evil, God Meant for Good”

Pericardial tamponade throughout history.
A less fortunate victim of a penetrating chest wound in 1898 was the empress of Austria and queen of Hungary, nicknamed Empress Sissi. She was stabbed while boarding a boat, and over several hours developed cardiac tamponade. Her story, along with the history of cardiac tamponade, is told in: Meyer P, Keller P-F, Spodick DH. Empress Sissi and cardiac tamponade: An historical perspective.
Am J Cardiol.
2008;102(9):1278–1280.

Treatment of pericardial tamponade.
The mortality rate for tamponade has changed little in the last century, due largely to the rising proportion of more lethal injuries caused by gunshot wounds. Kang N, Hsee L, Rizoli S, Alison P. Penetrating cardiac injury: Overcoming the limits set by Nature.
Injury.
2009;40:919–927.

Ludwig Rehn publishes his experience.
Rehn L: On penetrating cardiac injuries and cardiac suturing.
Arch Klin Chir.
1897;55:315. On the Internet you will find many sites stating Chicago surgeon Daniel Hale Williams performed the first successful open heart surgery
.
Williams’s surgical procedure, performed in 1893, however, like Rehn’s, involved closure of a wound on the heart’s surface, and was not open heart surgery. Williams did not publish his experience. Nonetheless, Williams’s experience was a first in the United States, and is remarkable because he was an African American operating in the Jim Crow era of the late 1800s.

The early years of cardiac surgery.
Several books recount the events of the early years of cardiac surgery as described in the notes to chapter 14. An excellent shorter version is: Stephenson LW. History of Cardiac Surgery. In: Cohn LH, Edmunds LH Jr, eds.
Cardiac Surgery in the Adult.
New York: McGraw-Hill; 2003:3–29.

War, doctors, and medical advances.
The birth of cardiac surgery was not the German war machine’s first inadvertent contribution to medicine. In World War I, their use of mustard gas against British soldiers near Ypres, Belgium, led to the discovery of one of the first-ever effective anti-cancer drugs, nitrogen mustard. The dislocating experience for physicians in wartime is documented in: Fishbein M.
Doctors at War.
New York: E. P. Dutton; 1945.

Publication of the new surgical technique.
Harken DE. Foreign bodies in, and in relation to, the thoracic blood vessels and heart; techniques for approaching and removing foreign bodies from the chambers of the heart.
Surg Gynecol Obstet.
July 1946;83:117–125.

Paget’s and Billroth’s comments about cardiac surgery.
Stephenson LW, Ruggiero R, eds.
Heart Surgery Classics.
Boston: Adams Publishing Group, 1994. Includes a section entitled, “The Very Beginnings,” with Harken’s allusion to English surgeon Steven Paget’s comment that surgery of the heart had reached its natural limits, taken from: Paget S.
Surgery of the Chest
. London: John Wright; 1896. Theodor Billroth’s comments are the subject of Schober KL: The quotation about the heart: Comments on Theodor Billroth’s attitude towards cardiac surgery.
J Thorac Cardiovasc Surg.
1981;29:131.

Harken’s mentor fails at mitral valve surgery.
Cutler EC, Levine SA. Cardiotomy and valvulotomy for mitral stenosis.
Boston Med Surg J.
1923;188:1023.

Harken’s safety pin.
Harken was a raconteur. Knowing him, a story told at dinner could have been apocryphal, but it was not. Late in his life he reiterated it in a living history that now appears on the Internet in an interview by Dr. W. Gerald Rainer:
www.ctsnet.org/sections/residents/pioneerinterviews/article-1.html
.

Pathologists’ food obsession
. A charming discussion of pathologists’ broader use of kitchen terms in noncardiac organs is found in Patel F. Culinary delights in kitchen pathology.
J Hosp Med.
March 2002;63(3):180–181.

3. A River of Blood

The career of Charles Bailey.
His distinguished surgical career is recalled in a series called
Profiles in Cardiology,
edited by Drs. J. Willis Hurst and W. Bruce Fye. The profile of Bailey is: Weisse AB. Charles Bailey.
Clin Cardiol.
2005;28:208–209.

Bailey’s recollection of his experience in Philadelphia
. Bailey’s comments are extracted from transcribed interviews of sixteen prominent cardiologists of this era, compiled in a superb historical book: Weisse AB,
Heart to Heart: The Twentieth Century Battle against Cardiac Disease: An Oral History.
New Jersey and London: Rutgers University Press; 2002.

How the mitral valve functions.
For a simple ninety-second video of how the valve works, see
www.youtube.com/watch?v=rguztY8aqpk
.

4. The Pain of the Pioneer

“although man meant it for evil, God meant it for good.”
The translation of the Bible varies with the version. The full quote from the 2012 International Standard version is: “As far as you’re concerned, you were planning evil against me, but God intended it for good, planning to bring about the present result so that many people would be preserved alive,” King James Bible (Cambridge Ed.) Genesis 50:20.

Mitral valve surgery before Bailey, Harken, and Brock
. At least two surgeons preceded Harken and Bailey, as told in: Treasure T, Hollman A. The surgery of mitral stenosis 1898–1948: Why did it take 50 years to establish mitral valvotomy?
Ann R Coll Surg Engl.
March 1995;77(2):145–151, and in Gonzalez-Lavin L, Bailey, CP, Harken, DE. The dawn of the modern era of mitral valve surgery.
Ann Thorac Surg.
1992;53:916–919. The English surgeon Dr. Henry Souttar performed successful mitral valve surgery on one fifteen-year-old patient in 1925 but never repeated the procedure, and Harken’s mentor Dr. Elliot Cutler had one patient survive for four years after cutting out part of the mitral valve.

Harken’s recollection of his early experience in the army and in Boston.
Harken DE. The emergence of cardiac surgery. I. Personal recollections of the 1940s and 1950s
. J Thorac Cardiovasc Surg.
1989;98(5 Pt 2):805–813.

5. A Hill of Bones

William Mustard’s surgical career.
In 1976, William Mustard was awarded the title of Officer of the Order of Canada “in recognition of his many achievements in the field of medicine, particularly as a cardiac surgeon of international repute” and in 1995, he was posthumously inducted into the Canadian Medical Hall of Fame.

Bigelow develops hypothermia for cardiac surgery, but does not bring it to clinical application.
Bigelow WG, Callaghan JC, Hopps JA. General hypothermia for experimental intracardiac surgery.
Am J Surg.
1950;132:531–37. Bigelow did not have a surgical practice in which hypothermia was relevant, and so no patients were referred to him.

Lewis reports his success with hypothermia in ASD, but does not successfully pursue alternative methods of open heart surgery.
Lewis FJ, Taufic M. Closure of atrial septal defects with the aid of hypothermia: Experimental accomplishments and the report of one successful case.
Surgery.
1953;33:52.

Lillehei’s surgeries.
Detailed descriptions of all of Lillehei’s surgeries (without patient pseudonyms) and wonderful personal stories are found in: Miller GW.
King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery
. New York: Times Books; 2000. Miller’s book, which involved eight years of research, served as a major source of the information about Lillehei and his patients. Lillehei’s note and the Gittens’ poignant response is taken from this book.

Lillehei reports his success with cross-circulation.
Lillehei CW, Cohen M, Warden HE, et al. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross-circulation.
Surg Gynecol Obstet.
1955;101:446.

University politics.
Thoroughly researched information on Lillehei and his environment is found in: Goor DA.
The Genius of C. Walton Lillehei and the True History of Open Heart Surgery.
New York: Vantage Press; 2007.

Differences in perception.
In
The Portable Atheist,
Philadelphia, PA: Da Capo; 2007, Christopher Hitchens examines the issue of perception: “Owners of dogs will have noticed that, if you provide them with food and water and shelter and affection, they will think you are God. Whereas owners of cats are compelled to realize that, if you provide them with food and water and affection, they draw the conclusion that they are God.”

Lillehei’s perception of historic events.
Rosenberg JC, Lillehei CW. The emergence of cardiac surgery.
Lancet.
1960;80:201–214, and Lillehei CW. The birth of open-heart surgery: Then the golden years.
Cardiovasc Surg.
1994;2(3):308–17.

The fate of cross-circulation.
Lillehei ignored the contradictory mix of adulation and ethical contempt, performing another forty-five cross-circulation procedures in 1954–1955. His in-hospital mortality rate was 38%. On the other hand among those who survived 49% were alive thirty years later. History has judged these results, in the context of that era, to represent success.