The Heart Healers by James Forrester

of her brief life. She struggled with the routine chores of housewife and mother, as Harken liked to say “preserving her steps like gold pieces.” Surgical relief of her mitral stenosis led to one of the most dramatic changes in quality of life that I have seen in my years of cardiology, a life restored by the ten who had lost theirs to Harken and Bailey’s learning curve. I believe it was then that I first began to wonder if it would ever be possible for me to reconcile the likely sacrifice of the life of individual patient in high-risk research with its uncertain future benefit to society. I will let you grapple with this question and later give the answer I found for myself.
    Within a few weeks of Bailey’s and Harken’s breakthroughs, Russell Brock succeeded with the same “finger fracture” technique for mitral stenosis in London. With the Philadelphia success confirmed in Boston and London, there could be no doubt, as surgeons now restored vitality to thousands of mitral stenosis victims in the prime of their lives. The era of cardiac surgery had been born, midwifed by shrapnel in the hearts of dying young men, a modern echo of the wisdom of Dominican philosopher Saint Thomas Aquinas that “Good can exist without evil, whereas evil cannot exist without good.”
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    BAILEY’S GROUNDBREAKING REVELATION, that mitral stenosis could be “cured” surgically, led to a new question: can the same technique be used on other valves? The surgeons’ new target became the other major valve of the heart, the one between the left ventricle and the aorta, called the aortic valve. When the heart contracts, blood flows into the body’s major blood vessel (the aorta) for transport to all the body’s organs. Like all cardiac valves, the aortic valve is prone to both narrowing (called stenosis) and to failure to close completely (called insufficiency or regurgitation).
    In the autopsy room, Harken found that he could reach the aortic valve by inserting his index finger through a purse-string suture on the external surface of the ventricle just below the aortic valve. The only difference was that his entry point into the heart was the high-pressure left ventricular pumping chamber rather than the low-pressure left atrial blood-collecting chamber. For his first experiment he chose an older lady from the Massachusetts North Shore whose frequent fainting attacks and heart failure suggested she had a very short life ahead of her. He obtained her consent, even after carefully explaining that he had never performed the procedure in aortic stenosis. In reasoning that he could open the stenosed aortic valve using the same method finger-fracture he had with mitral stenosis, Harken overlooked one critical fact. In severe aortic stenosis the pressure within the ventricular chamber, normally 120 mm Hg, can skyrocket to twice that value because the heart has to generate much greater force to eject blood across the severely narrowed aortic valve. Here is Harken’s own description of the horror that ensued: “I exposed the heart; and I put a purse string around the upper portion of the left ventricle; and I made a little stab wound first (and then) insinuated my finger into the ventricle only to discover pressures previously unheard of … I tried to stem this hemorrhage by pulling up on the tourniquet around my finger and it only tore and so I put in two fingers and then three fingers and then more bleeding and four fingers and then the dear lady succumbed.”
    Harken had experienced the uncontrollable fury of the wounded heart that engulfed Charles Bailey in his very first mitral valve surgery. Both men punched a hole in the heart, believing they could control bleeding, desperately applied clamps to control it, lost control within seconds, then stood helpless in the face of exsanguination, facing a task as impossible as stemming the flow from a ruptured fire hydrant. Overwhelmed with his own acute flood of remorse, Harken