Sir Barratt Boyes Opening Heart Surgery Down Under

w 7"hile training to become

% \ / a heart surgeon, native New T ▼ Zealander Sir Brian BarrattBoyes had the opportunity to spend two years working at the Mayo Clinic.

"I was assigned to various surgeons," he said. "Dr. John Kirklin was one. He had recently begun there, but he was making a name for himself, and in 1955, began doing open heart surgery with the Gibbon-IBM heart-lung machine. It was a staggering responsibility.

"We went through a very rapid learning curve," Barratt-Boyes said. "Some of it was pretty traumatic, but the results were exceptional. I used to be sent as a spy to Minneapolis to see what Dr. C. Walton Lillehei was doing. I reported what was happening so I saw the cross circulation operations as well, which were very fascinating."

In 1956, he returned to his native New Zealand and entered a kind of creative vacuum. New Zealand was isolated from the medical community. Later, in fact, Barratt-Boyes would be credited with founding modern open heart surgery in the Pacific Rim area.

"If you are working independently and follow your own star and your own ideas, you can sometimes come up with something that wouldn't be the case if you worked in a group, where everybody has their own ideas," Barratt-Boyes said.

It was there that Barratt-Boyes made two contributions to cardiac surgery. In 1962, only a month after Dr. Donald Ross in England, BarrattBoyes performed the world's second successful aortic valve homo-graft implantation. "It worked extremely well, even in the first patient, who was a young girl of about fifteen with endocarditis," Barratt-Boyes said. "She had a successful operation and recovered from her endocarditis. She's now had several children and works outside the home. She is a remarkable person."

After this, Barratt-Boyes, working with surgeons from Japan, helped introduce and popularize open heart surgery in infants by using hypothermia, or lowering the body temperature to protect the brain.

His results with infants, often desperately ill and with complex forms of congenital heart disease, set new world standards. This method was an important stepping stone, and even today most centers use variations of hypothermia techniques in some infants and adult patients.

Brian B. Barratt-Boyes

Homograft:

A donor graft, or piece of tissue, taken from a donor and placed into a recipient of the same species.

Endocarditis:

An infection involving the heart, caused by bacteria or virus.

Fig. 7.3: Patent Ductus Arteriosus:

An abnormality in which a tube connects the pulmonary artery to the aorta, mixing unoxygenated and oxygenated blood. This tube is open during fetal development when the lungs are not needed but is supposed to close after birth.

Fig. 7.4: Atrial Septal Defect:

An abnormal opening in the wall of muscle, or septum, that divides the two filling chambers, or atria, of the heart.

Arteriosus

Pulmonary Artery premature newborns, it can frequently be closed by giving a medicine called in-domethacin, which causes the ductus to constrict and close. This treatment does not always work, however.

The conventional treatment is surgical closure. This is done by opening the chest on the left side and dividing the ductus and oversewing its ends, or closing it with a tie or a metal clip.

There are also catheters that can be threaded through blood vessels to deliver devices that actually plug the ductus. This avoids a surgical incision in the chest. This procedure has advantages and disadvantages that should be discussed with the pediatrician and the pe-diatric cardiologist. Trial tests of these devices are being evaluated by the U.S. Food and Drug Administration (FDA).

With all methods, the chances of surviving the closure procedure are better than 99 percent, and in most cases the patient is cured.

Atrial Septal Defect

An atrial septal defect (ASD) is a hole in the common wall separating the two atria (Fig. 7.4). There are different types of atri-al septal defects. In most cases, they are well tolerated by children and may not be diagnosed until the child is older — and sometimes not even until adulthood.

Once diagnosed, however, most of these should be closed. Depending on the size, the hole can be sewn up. Larger holes may require a patch of pericardial tissue or an artificial material such as Dacron.

If the hole is not repaired, heart failure can develop because much of the blood pumped by the heart is being short-circuited through the lungs instead of being pumped out to the body, meaning the heart has to work harder to pump more blood. Occasionally, pulmonary vascular disease may develop, or blood clots dislodged from veins in the legs may travel through the ASD and lodge in the brain, causing a stroke. In most cases, the risk of the surgery to repair the defect in children is low, and the survival rate is greater than 99 percent. Devices to close ASDs with a catheter are under development and are being tested at some centers.

There is another, more complex atri-al septal defect that may occur with a ventricular septal defect called atrioven-tricular canal defect. The risks associated with the surgical repair of this defect

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