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Home , Cardiothoracic surgery, Denton Cooley, William White (academic)

The Practical Guide to Your and Heart ABOUT THE AUTHORS

Larry W. Stephenson, M.D., is the Ford-Webber professor of surgery and chief of the Division of for in , . He is also chief of Cardiothoracic Surgery at the Detroit Medical Center and Harper . Besides having a busy clinical practice, he has authored or co-authored more than 270 scientific articles and book chapters and three medical books. Dr. Stephenson was born in Appleton, Wisconsin, and attended college and at Marquette University in Milwaukee. He completed his general surgical at the University of Alabama, where he also did a cardiovascular research . Next he did his cardio- thoracic surgical residency at the University of Pennsylvania, where he stayed on the faculty. Previously, he was a cardiothoracic at the Children’s Hospital of and at the Hospital of the University of Pennsylvania. While at the University of Pennsylvania, he rose through the faculty ranks to professor of surgery and was awarded the prestigious J. William White Professorship in Surgery. Dr. Stephenson is a retired colonel, U.S. Army Medical Corps, with more than 20 years of service in the U.S. Army Reserves. He has held numerous command positions and was on active duty at Walter Reed Army Medical Center in , D.C., during Operation Desert Storm.

Jeffrey L. Rodengen, president and CEO of Write Stuff Enterprises, Inc., is the author of the acclaimed and award- winning Legend series of coffee-table books. With more than 40 books to his name, he is the country’s foremost biographer of American industry and technology, including comprehensive works on such global organizations as Pfizer, Inc, Scientific Corp., Cessna Aircraft Co., Advanced Micro Devices, Inc., The Stanley Works, Chris-Craft Industries, Inc., and Ashland Inc. Throughout his remarkable career, Jeff has inter- viewed thousands of scientists, CEOs, business and national leaders, and celebrities. Before beginning his career in publish- ing, Rodengen enjoyed a 15-year career in Hollywood as a writ- er, producer and director. He has written or produced nearly 30 films, network television specials (including six for Arnold Schwarzenegger), Las Vegas revues and Broadway pro- ductions. Jeff has degrees in psychology and post-graduate degrees in engineering. He lives in Fort Lauderdale with his wife Karine, award-winning photographer, and their twin children. The Practical Guide to Your Heart and Heart Surgery

Larry W. Stephenson, M.D. with Jeffrey L. Rodengen

Edited by Jon VanZile Design and layout by Sandy Cruz In Remembrance

Write Stuff Enterprises, Inc. 1001 South Andrews Avenue, Second Floor Fort Lauderdale, FL 33316 1-800-900-Book (1-800-900-2665) (954) 462-6657 www.writestuffbooks.com C. Walton Lillehei, M.D., Ph.D. www.stateoftheheartbook.com October 23, 1918–July 5, 1999 Heart Surgery Pioneer Copyright © 1999 by Write Stuff Enterprises, Inc. All rights reserved. No part of this book may be reproduced or trans- “I would like to think that mitted in any form by any means, electronic or mechanical, I’ve left the world of cardiovascular surgery including photocopying and recording, or by any informa- better than when I found it. tion storage or retrieval system, without permission in writ- That would be a suitable epitaph.” ing from the publisher. — C. Walton Lillehei, 1995

Publisher’s Cataloging in Publication Notice to Readers

Rodengen, Jeffrey L. The practice of , medical science State of the heart /Jeffrey L. Rodengen. and medical research is rapidly changing, espe- — 2nd ed. cially as it relates to the heart. Information result- p. cm. ing from medical research, clinical experience Includes bibliographical references and index. and specific circumstances as well as opinions of ISBN 0-945903-26-X — hardbound cover authorities that may differ require that the read- ISBN 0-945903-63-4 — softbound cover er use judgement and other sources when mak- ing any decision based upon the content of State 1. Heart — Diseases — Popular works. of the Heart. 2. Cardiologists — Interviews. I. Title. The publisher and authors have made every effort to ensure that the information contained in RC682.R64 1999 616.1’2 State of the Heart is complete, accurate and in QBI98-928 accord with medical standards at the time of pub- lication. However, neither the publisher, authors nor any other contributor to this publication can Library of Congress warrant, especially in light of the rapid changes in Catalog Card Number 98-61623 medical science, that the material contained is in all respects accurate and complete and they do ISBN 0-945903-26-X Hardbound Cover not take any responsbility for any use or misuse ISBN 0-945903-63-4 Softbound Cover of the information contained herein. The reader is therefore advised to discuss the Completely produced in the information contained in State of the Heart with of America medical authorities and to confirm any informa- 10 9 8 7 6 5 4 3 2 1 tion with other available sources.

iv TABLE OF CONTENTS

Reader’s Tip: The icon denotes a section that is of historical significance in the development of heart surgery.

Foreword by C. Everett Koop, M.D...... x

Acknowledgements ...... xii

Contributors ...... xiv

Chapter One: The Dawn of Open Heart Surgery ...... 16 The Early Days ...... 17 The Heart- Machine ...... 18 The Roller Pump (Dr. Michael DeBakey) ...... 20 The Dodrill Pump ...... 21 Cross-Circulation ...... 21 C. Walton Lillehei’s Legacy ...... 22 John Kirklin’s Heart-Lung Machine ...... 24 Denton Cooley: Inventor and Pioneer Surgeon ...... 28 Nikolay Amosov: Heart Surgeon and Public Servant in the U.S.S.R...... 30

Chapter Two: The Normal Heart ...... 32 The Right Side of the Heart ...... 33 The Heart As a Muscle ...... 34 The Left Side of the Heart ...... 36 Blood Pressure ...... 36 The Blood ...... 37 The Electrical Conduction System ...... 38 The Cardiac Cycle ...... 38 The Coronary Arteries ...... 39 What You Should Know About Your Heart During Pregnancy ...... 40 by Dr. Pamela Gordon

Chapter Three: Staying Healthy ...... 44 Smoking ...... 45 High Blood Pressure ...... 45 High Cholesterol ...... 45 Vitamin E and the Heart ...... 47 Exercise ...... 48 Stress ...... 48 Diabetes ...... 49 Nutrition for a Healthy Heart by Dr. Morrison Bethea ...... 49

v STATE OF THE HEART

Wine, Alcohol, and the Heart by Dr. R. Curtis Ellison ...... 52 Antibiotic Protection for Dental Surgery ...... 57

Chapter Four: Signs and Symptoms of Heart Problems ...... 58 History and Physical Exam ...... 59 Pain ...... 59 Angina Pectoris ...... 60 Heart Attack ...... 61 Difficulty Breathing ...... 61 Coughing Up Blood ...... 62 Fatigue ...... 62 Swelling ...... 62 Pleural Effusion ...... 63 Fainting ...... 64 Vasovagal Fainting and Dizziness ...... 64 Palpitations ...... 65 Skin Color ...... 66 ...... 67 Changes in Vision, Strength & Speech ...... 67 Leg Pain ...... 67 Your Visit to the Cardiologist by Dr. John O’Connell ...... 68

Chapter Five: Diagnosing a Problem ...... 72 Electrocardiogram ...... 73 Exercise Stress Test ...... 73 Ambulatory Electrocardiographic Monitoring ...... 74 ...... 74 Exercise Echocardiogram ...... 75 The Chest X-Ray ...... 76 Chest Computed Tomography ...... 76 Magnetic Resonance Imaging (MRI) ...... 77 Nuclear Tests ...... 77 Pyrophosphate Technetium-99m Scanning ...... 79 MUGA Scan ...... 79 Positron Emission Tomography (PET) ...... 79 Doppler Ultrasonography ...... 80 Blood Tests ...... 80 Arterial and Venous Oxygen Level ...... 81 Cholesterol Level ...... 82 Second Opinions ...... 82

Chapter Six: What Is ? ...... 84 Experimenting on Himself ...... 85 Catheters Today ...... 86 The Coronary Angiogram ...... 87 Therapeutic Cardiac Catheterization ...... 88 How to Choose a Cardiac Surgeon by Dr. Julie Swain ...... 92

Chapter Seven: Heart Problems of Infants and Children ...... 96

vi T ABLE OF CONTENTS

Diagnosing a ...... 99 Ventricular Septal Defect ...... 100 ...... 100 Sir Barratt-Boyes: Opening Heart Surgery Down Under ...... 101 Atrial Septal Defect ...... 102 Coarctation of the ...... 103 Transposition of the Great Arteries ...... 103 ...... 104 ...... 105 Congenital Aortic Stenosis ...... 106 Hypoplastic Left Heart Syndrome ...... 106 Ectopia Cordis ...... 108 Thoracopagus Twins ...... 108

Chapter Eight: and Treatment Options ...... 110 The Coronary Bypass Evolves ...... 112 First Coronary Artery Bypass (Drs. Dudley Johnson and Michael DeBakey) . .114 Coronary Artery Disease Today ...... 116 Coronary Artery Anatomy ...... 116 What Causes Coronary Artery Disease? ...... 116 Symptoms of Coronary Artery Disease ...... 117 Heart Attack & Heart Failure ...... 117 Dissolving Blood Clots During Heart Attacks by Dr. James Marsh ...... 118 Medical Treatment of Coronary Artery Disease ...... 118 Interventional ...... 119 Transmyocardial Laser Revascularization ...... 120 Coronary Bypass Grafting ...... 121 Complications of Heart Attacks Requiring Heart Surgery ...... 121 Left Ventricular Aneurysm ...... 121 Post-Myocardial Infarction Ventricular Septal Defect ...... 122 Replacement for Papillary Muscle Rupture ...... 123 Transmyocardial Laser Revascularization ...... 124 by Drs. Lawrence Cohn and Sary Aranki Women, Race, and Coronary Artery Surgery by Dr. Reneé S. Hartz ...... 126

Chapter Nine: The Coronary Bypass: Operation and Recovery ...... 130 The Choice of Conduits for Coronary Artery Bypass Grafting ...... 132 The Heart Operation ...... 134 Placing the Graft ...... 136 The Postoperative Intensive Care Unit ...... 137 Minimally Invasive Direct Coronary Artery Bypass Surgery ...... 138 Complications from Coronary Bypass Surgery ...... 139 During or After Coronary Artery Bypass Surgery ...... 140 The Postoperative Exercise Stress Test ...... 141 Common Postoperative Complaints ...... 141 Strokes, Carotid Artery Disease, and Coronary Bypass Surgery by Dr. Cary Akins . . .144 Minimally Invasive Coronary Artery Revascularization by Dr. Michael Mack . . .146

Chapter Ten: Problems ...... 148

vii STATE OF THE HEART

Before the Heart-Lung Machine ...... 149 The Advent of the Heart-Lung Machine ...... 151 Albert Starr and the Starr-Edwards Valve ...... 152 Human Valves Used in Other Humans ...... 154 : The Valve Pioneer ...... 154 Alain Carpentier ...... 156 Modern Heart Valve Therapy ...... 156 Prolapsed Mitral Valve ...... 158 Aortic Valve Disease ...... 158 Mitral Valve Disease ...... 160 Tricuspid Valve Disease ...... 161 Pulmonary Valve Disease ...... 163 Heart Valve Surgery Repair Versus Replacement ...... 164 Heart ...... 164 The Heart Valve Operation ...... 166 Robotic Heart Valve Surgery: Is This Reality or Myth? by Dr. Randolph Chitwood . . .168 Minimally Invasive Heart Valve Surgery ...... 172 by Drs. Delos Cosgrove and A. Marc Gillinov Tissue Engineering of Cardiac Valves and Arteries by Dr. John Mayer ...... 174 Diet Pills and Heart Valve Problems by Dr. Larry Stephenson ...... 176

Chapter Eleven: Advanced Heart Failure: Transplants, Heart Assist Devices, and the Future ...... 178 The History of Heart Transplants ...... 179 The First Heart Transplant (Dr. ) ...... 180 The First Successful Heart-Lung Transplant (Dr. Bruce Reitz) ...... 182 Heart and Lung Transplants ...... 182 Heart Transplants ...... 183 Heart Assist and Artificial ...... 185 Intra-Aortic Balloon Pump ...... 185 Adrian Kantrowitz: Intra-Aortic Balloon Pump ...... 185 Early Artificial Hearts ...... 186 Recent Artificial Hearts ...... 187 Denton Cooley ...... 187 The Mechanical Heart (Dr. Willem Kolff) ...... 188 Ventricular Assist Devices ...... 188 Batista Procedure ...... 190 Skeletal Muscle Cardiac Assist ...... 191 and Aortomyoplasty by Dr. Michael Acker ...... 192 Building a Heart Pump from Your Back Muscle by Dr. Charles Bridges ...... 195 State of the Art in Mechanical Heart Assist Devices by Dr. O. Howard Frazier .196 Cardiac Reconstruction for Heart Failure by Dr. Patrick McCarthy ...... 198 Gene Therapy by Dr. Todd Rosengart ...... 199 The Future in Technology by Dr. Stephen Westaby ...... 200 Heart Cell Transplantation for the Failing Heart ...... 202 by Drs. Terrence Yau, Ren-Ke Li, Richard Weisel, and Donald Mickle

Chapter Twelve: Arrhythmias, Pacemakers, and Defibrillators ...... 204 Pacemakers ...... 205

viii T ABLE OF CONTENTS

Heart Pacemakers ...... 206 The First Practical Pacemaker (Earl Bakken) ...... 207 The Single-Chamber Pacemaker ...... 208 Denton Cooley: Building His Own Defibrillator ...... 209 Dual-Chamber Pacemakers ...... 210 Ake Senning and the First Implantable Pacemaker ...... 211 Pacemakers for Atrial Tachyarrhythmias ...... 212 Surgery for Pacemakers ...... 212 Managing Arrhythmias by Drs. Marc Meissner and Randy Lieberman ...... 214 Surgery for the Irregular Heartbeat by Dr. James Cox ...... 218

Chapter Thirteen: Aneurysms and Other Blood Vessel Problems ...... 220 The Development of ...... 222 Dacron: Michael DeBakey’s Surprise Success ...... 222 Thoracic Aortic Aneurysms ...... 223 Catheter or Stent Treatment of Aortic Aneurysms ...... 225 ...... 226 Traumatic Aortic Rupture ...... 227 Atherosclerotic Disease of the Aorta and its Branches ...... 227 Blood Clots in Veins ...... 228 Varicose Veins ...... 229 Stent-Grafts: Avoiding Major Aortic Surgery by Dr. D. Craig Miller ...... 230 Surgery of the Thoracic Aorta by Dr. Nicholas Kouchoukos ...... 233

Chapter Fourteen: Heart Surgery in the Elderly ...... 234 Erectile Dysfunction, Viagra, and Heart Disease by Dr. C.B. Dhabuwala ...... 237

Chapter Fifteen: Recovery After Heart Surgery and A Second Bypass Operation… Will You Need It? When? ...... 242 Transfer from the ICU ...... 243 Discharge Home ...... 243 Surgical Wounds ...... 244 Recovery at Home ...... 244 Recovery from Coronary Bypass Surgery ...... 248 Recovery from Heart Valve Surgery ...... 248 Cardiac Rehabilitation ...... 248 Formal Cardiac Rehabilitation Programs after Heart Surgery or Heart Attacks 249 The Second Bypass Operation: Will I Need It? When? ...... 249 Bypass Grafts Closing ...... 250 The Second Operation ...... 250 You Can Help ...... 251

References for Selected Chapters ...... 252

Common Drugs for Heart Patients ...... 258

Glossary ...... 262

Index ...... 274

ix FOREWORD BY C. EVERETT KOOP, M.D. FORMER SURGEON GENERAL OF THE UNITED STATES

KNEW I WANTED TO BE A DOC- outside the body in the umbilical tor when I was five. I knew I cord, or a hole in the diaphragm and wanted to be a surgeon when I all the internal abdominal organs up Iwas six. At the time, pediatric sur- in the chest where a healthy lung geons didn’t exist — so I couldn’t say I should have developed — often had envisioned working with children mortality rates as high as 95 percent and their families. Later, during my in 1946. It was not at all uncommon training, I wish I could say I had the to have a two-and-a-half–pound or great foresight to recognize that pedi- three pound youngster brought to the atrics was the field needing the most hospital with one of these defects. help. But that’s not the case. We made our contribution to In 1946, I had my mind set to move into the field very quickly. We went from a 95 percent mortality of surgery when my chief, Doctor I.S. Ravdin, rate in 1946 to a 95 percent survival rate for many who was professor and chairman of surgery at the of the most serious conditions in about a decade. University of Pennsylvania and had been a brigadier I’ve always considered this a remarkable accom- general in the U.S. Army Medical Corps during World plishment for a bunch of doctors in a new specialty. War II, asked me if I’d like to be surgeon-in-chief of has followed a similar upward the Children’s Hospital of Philadelphia. I accepted path. Just like pediatric surgery, open heart surgery the job and the requisites that came with it. It required was a thing of the future in the 1940s. There were me to go to Boston Children’s Hospital for training only a few cardiac surgical procedures available: liga- and to give up the practice of adult surgery. Finally, tion of the patent ductus arteriosus, repair of coarcta- he told me that I had to devote my attention to devel- tion of the aorta, and atrial wells to aid in the repair of oping the country’s finest academic training pro- an interatrial septal defect, but many doctors thought gram for child surgery. cardiac conditions were surgically untreatable. When I set out to create this training program, Within a few years, just as my pediatric practice there was no true competition. The closest thing was was gaining momentum, the heart-lung machine pro- the program in Boston run by Dr. William E. Ladd, gressed to the point where open heart surgery became under whom I was supposed to train. Ladd, howev- possible. In fact, at about that time I built a heart- er, retired just before I moved to Boston and had no lung machine that we used successfully in the lab- immediate successor. As a result, I spent about seven oratory with $6,000 of my own money. I had to months working with Dr. Robert E. Gross. make a decision at that time. I had an extraordinar- I learned several important lessons right away. ily busy practice — for some time, I was the only I learned that children cannot be treated as small pediatric surgeon south of Boston and east of adults. They have a different tolerance for surgery, Chicago. I had to decide whether I was going to con- and dealing with their families is a completely dif- tinue what I was doing in pediatric surgery and add ferent matter from dealing with adults. open heart surgery or whether I would just do the car- I also saw that many of the mortal congenital diac surgery. I didn’t believe I could do both and do defects at that time were basically untreatable. them well. I felt that I should continue doing what I These defects — conditions like abdominal organs was doing.

x STATE OF THE HEART

Since then, the field of cardiac surgery has been A federal donor program would help tremendous- up there with the greatest strides in modern medicine. ly with organ procurement. As surgeon general, I Every portion of the heart can be reached, and almost thought we were on the way to developing one. It was any conceivable operation has already been done. It’s an uphill issue on a national level because doctors been a very exciting time, especially when heart trans- usually want donated organs to stay in their area and plantation came along. Consider all the things object to a heart, for instance, traveling across the that can be done today, especially on newborns where country to benefit another patient. We sponsored we can even correct certain defects in utero. workshops on and transplantation Some problems we haven’t thoroughly correct- and brought people in from all over the world who ed are related to the heart’s electrical system, but taught us a great deal. We also funded the start-up of that will come. The research with angiogenesis, which the ACT, the American Council on Transplantation, deals with growing new blood vessels in the heart, is which helped us come to grips with trading organs another frontier yet to be conquered. People say, from one procurement agency in Richmond to anoth- “Oh, you can’t fiddle around with those.” Well, of er in and so forth. course they say that, but they said that 10 years ago I think public awareness may be the problem. I about other things. I’ve learned that you never say, never fail to compliment the press on the fact that “That’s not going to happen.” when AIDS came along, a most complicated disease, Many of the other hurdles we face in medicine are they kept it in the headlines for eight years and made not actual treatment hurdles but due to society and it understandable to the average person. If we had the changing nature of medical care. Transplanta- that kind of effort for transplantation, I think we tion, for instance, is a viable option for thousands of would get state laws that said if you die in an acci- patients, yet that surgery is underutilized. We need to dent, your organs are available for transplantation improve the organ donation program in this country. unless you specifically object or carry a warrant on We’ve got to change our basic approach and reverse you that says, “Do not take my organs.” our thinking in this matter. Currently, we assume that In greater society, I am also concerned about no one wants their organs given for transplantation the way medical care is delivered. The old system unless they had said so before their death. In France, is changing, and I’m concerned that my great doctors assume everybody wants to donate organs grandchildren won’t have as good pediatric surgical unless they specifically object. I’m sure there are some care, for example, as my grandchildren. That may people there who don’t want their organs taken but sound strange, but the same may apply for cardio- never get around to saying no — and some of these vascular surgery. people may have their organs taken. It takes a lot of practice and experience to become But even with this unfortunate consequence, adept at dealing with a three-pound baby and get a lives are saved. It’s terrible to be in a children’s survivor. We may be training too many pediatric sur- hospital and see the kind of emotional stress that geons and pediatric surgical specialists, thus not develops. Two parents will be waiting for a liver, allowing doctors to develop their expertise in a and in comes a child who doctors don’t think is greater volume of cases. In the most complicated going to live. They question how soon the child is operations, there is a danger of producing so many going to die, and which one of the kids is going to that they will never get enough experi- get the liver. The enmities and the hostilities are ence to become as adept as the Denton Cooleys, terrible. Doctors feel defeated by death, and many John Kirklins and the Michael DeBakeys. surgeons are not anxious to talk to those families I’ve been fortunate enough to have experienced about organ donation. a very exciting period in medicine through my that have gone to a donor program, career, and have served as Surgeon General of the with a special health educator acting as the organ United States for eight years. Undoubtedly, in the procurement specialist probably do better. It’s too future, many of the things that people are excited hard for doctors to face the fact that in order to about now, like minimally invasive medicine, will have one patient survive, they’ve got to lose anoth- be tested. In the operating rooms, doctors will suc- er. That’s part of the reason I think it ought to be cessfully attack even more complicated conditions. taken out of doctors’ hands and put in a donor Over the years, I’ve learned to think that almost specialist’s. anything is possible.

xi ACKNOWLEDGEMENTS

HE AUTHORS WOULD LIKE TO THANK THE who reviewed the chapters and made helpful people who contributed to this book. A pro- suggestions, including: Laura Archer, Walter ject of this size involved the creative efforts Frasher, P.A.-C., Jim and Nancy Gram, Phyllis Tof many people, including the artists who provid- Grissom, Donna Hammond, Vicky Hass, P.A.- ed illustrations and photographs. Medical illus- C., Ken Jackson, P.A.-C., Donald Kossick, P.A.- trators Kelly Moore at the University of Miami and C., Thomas McGarry, P.A.-C., Darcy Sibilia, Denis Lee, formerly at the , P.A.-C., Helen Smith, R.N., Jennifer and William provided the color and black and white illustra- Stephenson, Melissa Stuckey, R.N., and Leah and tions, while Bill Loechel and Dr. Frank Shannon Stephen Vartanian. graciously donated additional color illustrations. A special debt of gratitude is also extended Much of the photography is the work of Ben to Carol Stephenson, who reviewed the manuscript True, the staff photographer at Harper Hospital in and provided invaluable support throughout Detroit. We are especially grateful also to Dr. the project. Harris B. Shumacker, Jr., distinguished professor Thanks are also due to the scores of physi- of surgery, emeritus, , himself cians, including cardiologists, cardiothoracic a pioneer and major contributor to the field of surgeons and others, who reviewed this materi- cardiovascular surgery, for generously allowing al in progress and made innumerable contribu- use of numerous photographs from his collection. tions of fact and accuracy. They include: Likewise, in addition to their contributions, Dimitrious Apostolou, M.D., Agustin Arbulu, Stephen Westaby and Earl Bakken graciously M.D., Pierre Atallah, M.D., Frank Baciewicz, M.D., allowed us to use photos from their collections. Joseph Bassett, M.D., Martin Blank, M.D., Gerald Photography and artwork were also obtained Cohen, M.D., Marcelo DiCarli, M.D., Maria Dan, from Medtronic for the pacemaker chapter, St. Jude M.D., Lingareddy Devireddy, M.D., Michael Epstein, Medical, Inc., for pages 153, 156, 159, 160 and 165, M.D., Steven Gellman, M.D., James Glazier, and Sulzer Carbomedics, Inc., for pages 224 and M.D., Gary Goodman, M.D., Narsimha Gottam, M.D., 225. In addition, artwork was kindly donated by Narsingh Gupta, M.D., Richard Harris, M.D., Robert Charles C. Thomas, Publisher, Ltd., Thomas Higgins, M.D., Antoine Khoury, M.D., Ronald Kline, Jefferson University Archives, Scott Memorial M.D., Jay Kozlowski, M.D., Marvin Kronenberg, M.D., Library, the Baylor College of Medicine, W.L. Gore Steven Lavine, M.D., Edward Malinowski, M.D., and Associates, Inc., Rick Bielaczyc, the University David Martin, M.D., Arthur Mcunu, M.D., Hassan of Pennsylvania Medical School and by many of the Nemeh, M.D., John O’Connell, M.D., Samuel Perov, contributors, who opened up their collections for M.D., Katherine Pitone-Lipkin, D.O., Kevin Radecki, our use. M.D., Peter Rossi, M.D., Paul Ruble, M.D., Paul In addition, material for a graph in chapter Sabotka, M.D., Chanderdeep Singh, M.D., Renata seven was adapted from Heart Disease: A Textbook Soulen, M.D., J. Richard Spears, M.D., Joseph of Cardiovascular Medicine, edited by Eugene Talbert, M.D., Mark Taylor, M.D., Deepak Thatai, Braunwald and published by W.B. Saunders. M.D., Gregory Thomas, M.D., Henry Walters, M.D., We would like to thank the members of Dr. Bruce Washington, M.D., Clifford Weldon, M.D., and Stephenson’s staff and his family and friends, Alkis Zingas, M.D.

xii STATE OF THE HEART

Finally, the staff at Write Stuff worked dili- also extended to the editorial, administrative and gently for two years to produce this book. Medical design staff, including Jon VanZile, principal editor; proofreader Ellen Kurek and proofreader Bonnie Alex Lieber, executive editor; and Melody Maysonet, Freeman provided meticulous and accurate proof- associate editor; Sandy Cruz, senior art director; reading, while transcriber Mary Aaron worked Jill Apolinario and Rachelle Donley, art direc- quickly and efficiently to transcribe the many tors; Fred Moll, production manager; Marianne interviews with pioneering heart surgeons. Roberts, office manager; Mike Monahan, direc- Indexer Erika Orloff assembled the comprehen- tor of sales, promotion and advertising; Bonnie sive index. Executive assistants to Mr. Rodengen Bratton, director of marketing; Rafael Santiago, Colleen Azcona and Amanda Fowler scheduled logistics specialist; and Karine Rodengen, pro- interviews and coordinated travel. Thanks are ject coordinator.

xiii CONTRIBUTORS’ LIST

HEART SURGERY PIONEERS Adrian Kantrowitz, M.D. Ake Senning, M.D. Clinical Professor of Surgery Formerly Professor of Surgery and Director Nikolay M. Amosov, M.D. Wayne State University School of Medicine University Surgical Academician Zurich, Switzerland Formerly Director of the Insitute of Formerly Chief, Section of Cardiovascular Surgery Cardiovascular Surgery Albert Starr, M.D. Kiev, Ukraine Sinai Hospital Director Formerly Deputy, Supreme Soviet, U.S.S.R. Detroit, Michigan Heart Institute of St. Vincent Medical Center Portland, Oregon Earl E. Bakken, B.S., E.E. John W. Kirklin, M.D. Founder and Former Chairman of the Board Formerly Professor and Chairman Department of Surgery Formerly Professor and Chief Medtronic, Inc. Division of Cardiopulmonary Surgery Minneapolis, Minnesota University of Alabama Birmingham, Alabama The Oregon Health Sciences University Portland, Oregon Christiaan N. Barnard, M.D., Ph.D. Former Head of the Department of Cardiothoracic Formerly Professor and Chairman, Department of Surgery Surgery University of Capetown and Mayo Foundation Capetown, South Africa Rochester, Minnesota CONTRIBUTING ESSAYISTS

Brian G. Barratt-Boyes, K.B.E., M.B., Ch.M. Willem J. Kolff, Ph.D., M.D. Michael A. Acker, M.D. Professor of Surgery (Hon.) Distinguished Professor of Medicine and Surgery Associate Professor of Surgery Formerly Surgeon-in-Charge University of Utah Division of Cardiothoracic Surgery Cardiothoracic Surgical Unit University of Pennsylvania Greenlane Hospital Formerly Director of Institute for Philadelphia, Pennsylvania Auckland, and Cardiomyoplasty and Aortomyoplasty Director Division of Artificial Organs University of Utah Alain F. Carpentier, M.D., Ph.D. Cary W. Akins, M.D. Salt Lake City, Utah Professor, Université de Paris VI Clinical Professor of Surgery Harvard University Chief, Department of Cardiovascular Surgery and Formerly Scientific Director Artificial Organs Program Hôpital Broussais Cleveland Clinic Foundation Visiting Surgeon Paris, France Cleveland, Massachusetts General Hospital Boston, Massachusetts Denton Cooley, M.D. C. Walton Lillehei, Ph.D., M.D. Strokes, Carotid Arteries and Heart Surgery Surgeon-in-Chief, Heart Institute (deceased July 5, 1999) Chief, Cardiovascular Surgery Professor of Surgery, Emeritus Morrison C. Bethea, M.D. St. Luke’s Episcopal Hospital Clinical Professor of Surgery Minneapolis, Minnesota School of Medicine Clinical Professor of Surgery University of Texas Fomerly Louis Atterbery Stimson Professor of Chief of Thoracic Surgery , Texas Surgery and Chairman, Department of Surgery Memorial Medical Center-Baptist Campus The New York Hospital-Cornell Medical Center New Orleans, Louisiana Michael E. DeBakey, M.D. Nutrition for a Healthy Heart Formerly Chairman, Department of Surgery and Formerly Professor of Surgery formerly Chancellor University of Minnesota Medical School Charles R. Bridges, M.D., D.Sc. Baylor College of Medicine Minneapolis, Minnesota Assistant Professor of Surgery Division of Cardiothoracic Surgery Olga Keith Weiss Professor and Bruce A. Reitz, M.D. Distinguished Professor of Surgery University of Pennsylvania Chairman, Cardiothoracic Surgery, Philadelphia, Pennsylvania Baylor College of Medicine Medical Center Houston, Texas Palo Alto, Building a Heart Pump from Your Back Muscle Wenner Dudley Johnson, M.D. Formerly Cardiac Surgeon-in-Charge, Associate Clinical Professor, Johns Hopkins Hospital Randolph Chitwood, M.D. Department of Cardiothoracic Surgery , Professor and Chairman of Medical College of Wisconsin Department of Surgery Donald Nixon Ross, B.Sc., M.B., Ch.B. School of Medicine Chairman, Department of Cardiovascular Diseases Formerly Director of the Department of Surgery Greenville, North Carolina St. Mary’s Hospital National Heart Hospital Robotic Heart Valve Surgery: Milwaukee, Wisconsin London, England Is This Reality or Fantasy?

xiv STATE OF THE HEART

Sary Aranki, M.D. Nicholas T. Kouchoukos, M.D. John B. O’Connell, M.D. Associate Professor of Surgery Cardiothoracic Surgeon Professor and Chairman Harvard Medical School Missouri Baptist Hospital Department of Medicine Boston, Massachusetts St. Louis, Missouri Wayne State University and -in-Chief Lawrence H. Cohn, M.D. Detroit Medical Center, Professor of Surgery Former Cardiac Surgeon-in-Charge Harvard Medical School Jewish Hospital of St. Louis Detroit, Michigan Boston, Massachusetts Shoenberg Professor of Surgery Your Visit to the Cardiologist and Chief, Cardiothoracic Surgery Washington School of Medicine Brigham and Women’s Hospital St. Louis, Missouri Eric Racine, Pharm.D. Boston, Massachusetts Surgery for the Thoracic Aorta Coordinator, Clinical Services Transmyocardial Laser Revascularization Harper Hospital, Detroit Medical Center Michael Mack, M.D. Adjunct Assistant Professor of Pharmacy James L. Cox, M.D. Wayne State University Assistant Clinical Professor of Surgery Professor and Chairman, Cardiovascular and Clinical Assistant Professor of Pharmacy Thoracic Surgery Surgical Director University of Texas SW Medical School University of Michigan Georgetown University Dallas, Texas Common Drugs for Heart Patients Cardiovascular Institute Minimally Invasive Direct Coronary Artery Bypass Georgetown University Medical Center Surgery — MIDCAB Washington, D.C. Todd Rosengart, M.D. Surgery for the Irregular Heartbeat Associate Professor of Surgery James Marsh, M.D. Cornell University C.B. Dhabuwala, M.D. Professor of Medicine and Chief New York, New York Professor of Division of Gene Therapy for Heart Failure Wayne State University Wayne State University Detroit, Michigan Detroit, Michigan Julie Swain, M.D. Viagra, Male Impotence Dissolving Blood Clots During Heart Attacks Professor of Surgery R. Curtis Ellison, M.D. Gill Heart Institute Professor of Medicine and John Mayer, M.D. University of Kentucky Boston University School of Medicine Professor of Surgery Lexington, Kentucky Boston, Massachusetts Harvard Medical School, and How to Choose a Cardiac Surgeon Wine, Alcohol and Your Heart Senior Associate in Cardiac Surgery Boston Children’s Hospital Stephen Westaby, BSc, M.S., F.R.C.S. O. Howard Frazier, M.D. Boston, Massachusetts Oxford Centre Professor of Surgery Tissue Engineering of Cardiac Valves and Arteries John Radcliffe Hospital University of Texas Oxford University and Surgeon Oxford, Texas Heart Institute Patrick McCarthy, M.D. Houston, Texas Cardiothoracic Surgeon The Future in Artifical Heart Technology Mechanical Heart Assist Devices Cleveland Clinic Foundation Cleveland, Ohio Terrence M. Yau, M.D., M.Sc. A. Marc Gillinov, M.D. The Batista Procedure Assistant Professor Cardiothoracic Surgeon Department of Surgery The Cleveland Clinic Foundation Marc D. Meissner, M.D. Cleveland, Ohio Associate Professor of Toronto, Ontario, and and Cardiac Electrophysiologist and Cardiologist Delos M. Cosgrove, M.D. Ren-Ke Li, M.D., Ph.D. Chief, Cardiothoracic Surgery Detroit Medical Center and Wayne State University Associate Professor The Cleveland Clinic Foundation Detroit, Michigan Department of Surgery Cleveland, Ohio and Minimally Invasive Heart Valve Surgery University of Toronto Randy A. Lieberman, M.D. Toronto, Ontario, Canada Assistant Professor of Internal Medicine Pamela Gordon, M.D., F.A.C.C. and Associate Professor, Internal Medicine Cardiac Electrophysiologist and Cardiologist Donald A.G. Mickle, M.D. Division of Cardiology Detroit Medical Center and Wayne State University Professor Wayne State University Detroit, Michigan Department of Laboratory Medicine and Detroit, Michigan Management of Atrial and Ventricular Arrhythmias University of Toronto What You Should Know About Toronto, Ontario, Canada Your Heart During Pregnancy D. Craig Miller, M.D. and Thelma and Henry Doelger Professor of Renee S. Hartz, M.D. Richard Weisel, M.D. Professor of Cardiothoracic Surgery Cardiovascular Surgery Professor of Surgery Tulane University Stanford University University of Toronto New Orleans, Louisiana Stanford, California Toronto, Ontario, Canada Women and Coronary Artery Surgery Aortic Endovascular Stents Heart Cell Transplantation for the Failing Heart

xv