circulation as Mustard had done, why not insert a whole body? Why not connect up the child with a congenital heart defect to his mother or father’s arteries and veins? The child’s blood could circulate through the parent’s lungs, while the surgeon operated on the child’s arrested heart. The beauty of this approach was that it eliminated the need for a complex oxygenation strategy, since oxygenated blood would be in constant supply to the child from the parent’s normal circulation. If it worked, the procedure would be the essence of simplicity. Only a pump and tubing would be required. Had they come up with the perfect method of oxygenating their patient’s blood, by simply mixing it with a compatible living donor?
Lillehei’s group bought beer keg tubing and a $500 roller pump that could compress the tubing without being in contact with the blood. This devastatingly simple apparatus also eliminated the cleaning issue that was bedeviling those trying to develop heart-lung machines. Just throw away the tubing at the end of the surgery; use new tubing at the next surgery. In dogs, they discovered that both the recipient dog with an arrested heart and the donor dog awoke quickly and appeared normal after a half hour of cross-circulation. They took another step. They created an artificial ventricular septal defect (VSD) in dogs. A VSD is an abnormal hole between the left and right ventricles, which are normally completely separated by a solid muscular wall. Early anatomists wonderfully dubbed this wall a septum, a derivation of the Latin word saeptum, which means a fence. A hole in the fence allows the more powerful left ventricle to pump blood into the right ventricle. As with ASD, the added blood floods the lungs. Most children with VSD do not survive to mature adulthood, unless the VSD is very small.
On his operating table, Lillehei set up cross-circulation between a normal dog and one with his artificial VSD; veins to veins; arteries to arteries. During cardiac arrest on cross-circulation, Lillehei found that he could consistently close the canine VSD with sutures in less than twenty minutes. Walt Lillehei was ready to operate on a child.
The newspapers of March 1954 were dominated by a historic moment in science, the explosion on the Marshall Islands’ Bikini Atoll of the fifteen-megaton hydrogen bomb, a thousand times more powerful than the bombs that had leveled Hiroshima and Nagasaki. From my perspective an arguably more important, but less ballyhooed historic event occurred a few weeks later when Walt Lillehei scheduled open heart surgery using cross-circulation at the University of Minnesota Hospital. The donor circulation would be the child’s parent, providing their blood type was compatible. It was just a year and a half after Lewis and Lillehei’s historic beating heart hypothermic surgery had established the feasibility of open heart surgery.
* * *
THE SCHEDULED SURGERY became the University Hospital’s own megaton bomb. Walt Lillehei was ready but the University of Minnesota was not. Lillehei possessed Charles Bailey’s indifference to criticism, Harken’s charm, and both men’s supreme self-confidence, but it was not enough. When word leaked out about Lillehei’s planned human experiment, as with Bailey at Hahnemann, it precipitated a fierce morality play. The drama pitted the university’s two most powerful physicians: Dr. Cecil Watson, chairman of the department of medicine, and Dr. Owen Wangensteen, chief of surgery, against one another. Watson, boiling with righteous moral outrage, felt Lillehei’s proposal was an abomination. Given the complete uncertainty about the outcome, Watson imagined that for the first time in the history of medicine Walt Lillehei had come up with an operation with the potential to kill two people at one sitting … “a 200% mortality rate!” Operating on a terribly sick child is conceivably justified, he argued, but risking the life of a second
Lillehei’s group bought beer keg tubing and a $500 roller pump that could compress the tubing without being in contact with the blood. This devastatingly simple apparatus also eliminated the cleaning issue that was bedeviling those trying to develop heart-lung machines. Just throw away the tubing at the end of the surgery; use new tubing at the next surgery. In dogs, they discovered that both the recipient dog with an arrested heart and the donor dog awoke quickly and appeared normal after a half hour of cross-circulation. They took another step. They created an artificial ventricular septal defect (VSD) in dogs. A VSD is an abnormal hole between the left and right ventricles, which are normally completely separated by a solid muscular wall. Early anatomists wonderfully dubbed this wall a septum, a derivation of the Latin word saeptum, which means a fence. A hole in the fence allows the more powerful left ventricle to pump blood into the right ventricle. As with ASD, the added blood floods the lungs. Most children with VSD do not survive to mature adulthood, unless the VSD is very small.
On his operating table, Lillehei set up cross-circulation between a normal dog and one with his artificial VSD; veins to veins; arteries to arteries. During cardiac arrest on cross-circulation, Lillehei found that he could consistently close the canine VSD with sutures in less than twenty minutes. Walt Lillehei was ready to operate on a child.
The newspapers of March 1954 were dominated by a historic moment in science, the explosion on the Marshall Islands’ Bikini Atoll of the fifteen-megaton hydrogen bomb, a thousand times more powerful than the bombs that had leveled Hiroshima and Nagasaki. From my perspective an arguably more important, but less ballyhooed historic event occurred a few weeks later when Walt Lillehei scheduled open heart surgery using cross-circulation at the University of Minnesota Hospital. The donor circulation would be the child’s parent, providing their blood type was compatible. It was just a year and a half after Lewis and Lillehei’s historic beating heart hypothermic surgery had established the feasibility of open heart surgery.
* * *
THE SCHEDULED SURGERY became the University Hospital’s own megaton bomb. Walt Lillehei was ready but the University of Minnesota was not. Lillehei possessed Charles Bailey’s indifference to criticism, Harken’s charm, and both men’s supreme self-confidence, but it was not enough. When word leaked out about Lillehei’s planned human experiment, as with Bailey at Hahnemann, it precipitated a fierce morality play. The drama pitted the university’s two most powerful physicians: Dr. Cecil Watson, chairman of the department of medicine, and Dr. Owen Wangensteen, chief of surgery, against one another. Watson, boiling with righteous moral outrage, felt Lillehei’s proposal was an abomination. Given the complete uncertainty about the outcome, Watson imagined that for the first time in the history of medicine Walt Lillehei had come up with an operation with the potential to kill two people at one sitting … “a 200% mortality rate!” Operating on a terribly sick child is conceivably justified, he argued, but risking the life of a second
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