Medicine: Coronary Cleaning

If a victim of arteriosclerosis has a shutdown in an easily accessible artery (e.g., thigh or arm), surgeons can cut out the diseased section and splice in a graft, or split the artery lengthwise and scrape out the bottleneck deposit. At a Chicago medical meeting last week, specialists were speculating on what seemed only a possibility—that a similar technique could be used to scrape out the coronary arteries in case of shutdowns in the heart (coronary thrombosis or occlusion). Whereupon Philadelphia’s famed Heart Surgeon Charles P. Bailey rose to report, in effect: “I have just done it.”

This bold pioneering was based on years of study by San Francisco’s Dr. Angelo May, using human cadavers to see whether the bottleneck material could be removed by a simple instrument, and then testing the method on live dogs to see how well they stood the operation. With encouraging answers to both questions, Dr. Bailey got a supply of May curettes: metal tubes, only one-sixteenth of an inch in diameter, nine inches long, with a nick filed halfway through at one end. On Oct. 29 he was ready for his first patient, a man of 51 who had had a severe heart attack in 1953, and now faced lasting invalidism because insufficient blood was reaching his heart muscle.

After elaborate tests had shown that the blood-starved muscle was dependent on flow from a branch of the patient’s left circumflex artery, Dr. Bailey opened the man’s chest, snipped some ribs and put them aside, then slit open the heart sac. He was fortunate in being able to see the site of the 1953 shutdown where the left circumflex was embedded in the heart wall. Near the end of the artery he made a slit: instead of a spurt of blood, as there would have been in a healthy subject, he got a mere trickle. Through this slit Dr. Bailey inserted the business end of the curette and gradually worked it up the artery against the direction of the blood flow until its tip was past the point of the old occlusion. Then he drew it back so that the sharp nicked edge served as a reamer. Out came the diseased material that had clogged the artery. The operation had done its job. The trickle of blood suddenly changed to a spurt.

Dr. Bailey performed the operation again, two days later, on a man of 52 in similar plight. Both patients were expected to leave the hospital this week. After studying them (and others to be operated on soon) for a few months, Dr. Bailey will know whether he has found an effective treatment for some, at least, of the hundreds of thousands who are disabled every year by heart attacks of this type.