these taut, keeping control over the opening in the heart as though it were the mouth of a purse. In this way, Harken was able to access bullets and fragments of shrapnel practically wherever they lay.
In the ten fraught months that followed the Allied invasion of Europe, Harken removed no fewer than 134 missiles from the hearts of wounded soldiers. The pace was relentless and the workload exhausting; Harken and his team would often operate around the clock for days on end, sleeping, on improvised cots, only when the lull in casualties would allow. The demand for thoracic surgery outstripped the supply of adequately qualified surgical teams. Harken would sometimes operate by day and then travel by night, with his scrub team, to lend his thoracic expertise to other hospitals. While the accounts of these surgeries were frightening, filled with stories of massive blood loss and tense moments, among the patients upon whose hearts Harken operated there wasâincrediblyânot a single death.
The effect on Harken of his experiences in Stowell Park was transformative. He had arrived in England optimistic but unsure that cardiac surgery involving the internal structures of the heart might be acceptably performed in humans. He returned to the United States at the end of the war convinced of this fact. And this time the medical profession sat up and took full notice. The documented evidence was unquestionable: The heart was open for conquest. Major Dwight Emary Harkenâs explorations had proved it so.
â
T HE S ECOND W ORLD W AR HAD BEEN bracketed by two awards for advances in antibiotic therapy. In 1939 the Nobel Prize went to German pathologist and bacteriologist Gerhard Domagk for his work in developing commercially available sulfonamide antibiotics, although the Nazi regime forbade him from accepting it. In 1945, Ernst Boris Chain, Howard Florey, and Alexander Fleming received the prize for the discovery of penicillin. These developments would shape the future of cardiac surgery as much as any surgical technique. Bacterial endocarditis, hitherto an unstoppable disease with a nearly 100 percent mortality rate, was suddenly amenable to treatment by the injection of antibiotic drugs. It was no longer the undefeated foe that Harken had so hoped to slay with surgery. But Harkenâs wartime experience had taught him that the heart could be opened and the mechanisms within altered and repaired. He turned his attention instead to problems of the mitral valveâat the time, wild territory where respectable surgeons were loath to venture.
The mitral valve, seen from below as it opens into the left ventricle, has the appearance of a gently smiling fish mouth mounted on a ring of tissue around the size of a half-dollar. The delicately engineered mechanism is designed to allow blood to flow in only one direction, from atrium to ventricle. Without its system of valves, the heart is merely a pump that is as likely to push blood backward as it is to push it forward.
The leaflets of the mitral valve are prone to damage from the childhood affliction of rheumatic fever. Something as simple as a throat infection can lead to widespread inflammation and trigger the immune system to attack the bodyâs own tissues. The resulting damage is akin to friendly fire: Your bodyâs own defenses, unable to distinguish foreign invader from self, wreak havoc, attacking the skin, joints, eyes, and the heart.
When this happens, the mitral valve can become narrowed, and the opening through which blood can flow is reduced. As a consequence, pressure builds up in the left atrium and is transmitted back to the fragile circulation of the lungs. There, exposed to this unusually high pressure, the tissue-thin capillaries can rupture, spilling blood and fluid into the air spaces of the alveoli, causing coughing, breathlessness, and the expectoration of bloodstained sputum.
While rheumatic fever is a disease of childhood, its cardiac
In the ten fraught months that followed the Allied invasion of Europe, Harken removed no fewer than 134 missiles from the hearts of wounded soldiers. The pace was relentless and the workload exhausting; Harken and his team would often operate around the clock for days on end, sleeping, on improvised cots, only when the lull in casualties would allow. The demand for thoracic surgery outstripped the supply of adequately qualified surgical teams. Harken would sometimes operate by day and then travel by night, with his scrub team, to lend his thoracic expertise to other hospitals. While the accounts of these surgeries were frightening, filled with stories of massive blood loss and tense moments, among the patients upon whose hearts Harken operated there wasâincrediblyânot a single death.
The effect on Harken of his experiences in Stowell Park was transformative. He had arrived in England optimistic but unsure that cardiac surgery involving the internal structures of the heart might be acceptably performed in humans. He returned to the United States at the end of the war convinced of this fact. And this time the medical profession sat up and took full notice. The documented evidence was unquestionable: The heart was open for conquest. Major Dwight Emary Harkenâs explorations had proved it so.
â
T HE S ECOND W ORLD W AR HAD BEEN bracketed by two awards for advances in antibiotic therapy. In 1939 the Nobel Prize went to German pathologist and bacteriologist Gerhard Domagk for his work in developing commercially available sulfonamide antibiotics, although the Nazi regime forbade him from accepting it. In 1945, Ernst Boris Chain, Howard Florey, and Alexander Fleming received the prize for the discovery of penicillin. These developments would shape the future of cardiac surgery as much as any surgical technique. Bacterial endocarditis, hitherto an unstoppable disease with a nearly 100 percent mortality rate, was suddenly amenable to treatment by the injection of antibiotic drugs. It was no longer the undefeated foe that Harken had so hoped to slay with surgery. But Harkenâs wartime experience had taught him that the heart could be opened and the mechanisms within altered and repaired. He turned his attention instead to problems of the mitral valveâat the time, wild territory where respectable surgeons were loath to venture.
The mitral valve, seen from below as it opens into the left ventricle, has the appearance of a gently smiling fish mouth mounted on a ring of tissue around the size of a half-dollar. The delicately engineered mechanism is designed to allow blood to flow in only one direction, from atrium to ventricle. Without its system of valves, the heart is merely a pump that is as likely to push blood backward as it is to push it forward.
The leaflets of the mitral valve are prone to damage from the childhood affliction of rheumatic fever. Something as simple as a throat infection can lead to widespread inflammation and trigger the immune system to attack the bodyâs own tissues. The resulting damage is akin to friendly fire: Your bodyâs own defenses, unable to distinguish foreign invader from self, wreak havoc, attacking the skin, joints, eyes, and the heart.
When this happens, the mitral valve can become narrowed, and the opening through which blood can flow is reduced. As a consequence, pressure builds up in the left atrium and is transmitted back to the fragile circulation of the lungs. There, exposed to this unusually high pressure, the tissue-thin capillaries can rupture, spilling blood and fluid into the air spaces of the alveoli, causing coughing, breathlessness, and the expectoration of bloodstained sputum.
While rheumatic fever is a disease of childhood, its cardiac
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