Surgery: Transposition Corrected

During the last quarter-century, surgeons have been learning to correct many cases of the innumerable inborn defects of the heart. But one form of heart trouble has defied all their skill and ingenuity. Called total transposition of the great vessels, it is devastating in its effects on the victim. Half the babies born with it die within a month, and only a very few survive to reach a severely handicapped adolescence. But last week a team of Cincinnati surgeons reported to the American Heart Association that they had performed a corrective operation on a girl only ten weeks old. Now, seven months later, she is developing like a normal infant.

Useless Pumping. In transposition, placement of the heart’s outflow pipes is reversed. The aorta, the great artery designed to supply oxygenated blood to the entire body, arises from the right lower chamber (ventricle) of the heart instead of from the left. As a result, it carries used blood back into circulation. The pulmonary artery, designed to carry used blood to the lungs for oxygenation, arises from the left ventricle instead of from the right; as a result, oxygen-enriched blood is pumped uselessly back and forth between lungs and heart.

The University of Cincinnati surgeons, headed by Dr. James A. Helmsworth, did not try to sever the two great vessels and switch them. The job would have been forbiddingly difficult and almost certainly fatal. Instead, the doctors adopted a method devised by Swedish Surgeon Ake Senning: they rearranged the heart’s inflow pipes, which are only half as big and therefore twice as suitable for surgery.

They hooked up the tiny 7-lb. 3-oz. child to a heart-lung machine. Then they took the venae cavae, the two great veins that carry used blood back to the heart, cut them away from their normal position leading into the right upper chamber (auricle) and led them over to the left side. As near simultaneously as possible, the team of surgeons took the pulmonary veins, which carry oxygenated blood from lungs to heart, and severed them from the left auricle. They stitched the venae cavae to the places where the pulmonary veins had entered the left auricle, and stitched the pulmonary veins to the places where the venae cavae had entered the right auricle.

Complete Reversal. When the surgeons’ clamps were removed and the heart-lung machine was shut off, the baby’s heart resumed its job of pumping blood to her body. But now she had a more total transposition than the one that nature had inflicted upon her. All her used, deoxygenated blood flowed through the left side of her heart, and her reoxygenated blood through the right—the exact reverse of normal, but almost as effective.

The Senning-Cincinnati operation is not the answer for all transposition babies. In many such cases there is also a hole in the septum (wall) between the ventricles. For these infants, Dr. Helmsworth suggested different types of surgery. But for those without a septal defect, adding one transposition to another offers the first substantial hope of near-normal life.