Medicine: Chilling Operation

Judith Schmidt was born with a hole in the wall between the right and left sides of her heart. As a result, “used” blood (from which the body had taken the oxygen) was mixed with fresh blood that had just soaked up more oxygen in the lungs. Judith lived her first eleven years as a semi-invalid.

Last month doctors at the Cleveland Clinic sent Judith to Philadelphia’s Hahnemann Hospital. There she was given a general anesthetic and put in an ordinary, kitchen-type freezer 6 ft. long. Doctors and nurses kept watch on her as her temperature began to drop. Surgeon Charles P. Bailey hoped that it would go down to 80°, but after twelve hours it had leveled off at 88°, and he decided to operate.

Dr. Bailey and his colleagues opened Judith’s chest and cut open her heart. With clamps they stopped the blood flow and slowed the heart’s action. Then they sewed a piece of the upper heart sac over the hole (as big as a half dollar) in the partition, closing it completely. As soon as they had stitched up the heart covering again, they gently massaged Judith’s heart and got it beating at a normal rate.

The tricky, dramatic operation had taken only five minutes. At normal body temperature, the heart cannot be stopped more than three minutes without danger of severe damage to the brain. But at lower temperatures the brain needs less oxygen and can get along longer without it. “In this case,” says Dr. Bailey, “I was glad of those extra two minutes.” Judith was “thawed out” slowly. Next morning her temperature was normal, and she greeted her anxious parents with a cheering “Hi, mom! Hi, dad!” Last week Judith flew home to Cleveland. “She’s a normal girl now,” says Dr. Bailey.

The technique for closing an opening in the heart’s septum was standard; what was new was the freezing to slow the circulation and give the surgeons more time. The idea came to the Hahnemann surgeons after years of working on an artificial heart-lung machine. They could not get it to do the whole job of carrying a patient’s circulation and oxygenating his blood. They reasoned that if they could cut down the body’s demand for blood by lowering its temperature, the machine might be adequate. Then it dawned on them: perhaps the low temperature alone would do the trick, without the machine.

The first human patient on whom they operated (after tests on animals) died because her heart drew in air. Judith was Hahnemann’s second patient. A Minneapolis team operated successfully on a five-year-old girl, chilled in a blanket laced with coils containing frigid alcohol. Last week Dr. Bailey did his third operation, chilling a year-old baby in a blanket.

Dr. Bailey does not believe that the technique can be used in mitral-valve operations, or that it will be much good for older patients whose heart muscles are “worn out.” But it gives the surgeon more time and a “dry field” (without blood flow) to operate on young patients whose cases might otherwise be too risky.