The Heart Healers by James Forrester Page B

insertion of an index finger into a beating heart provided a crude method for ripping open a scarred valve, operating on a beating heart from its outside surface (called “closed heart” surgery), it was irrelevant to almost all other structural abnormalities within the heart. A child with a hole between the right and left atria (called an atrial septal defect or ASD), or a hole between the right and left ventricles (ventricular septal defect or VSD) could not be helped, since the surgeon had to place stitches inside the heart. Adults with leaky valves were similarly out of luck. And what about CAD, the most pervasive of cardiac disorders? Although the vessels could be touched on a beating heart as they splayed over the surface of the heart, they were only a few millimeters in diameter and were constantly moving with each heartbeat. The coronary arteries of a beating heart were far beyond the reach of even the steadiest surgical hand.
    The new question seemed like an insurmountable dilemma. Could they see the inside of the heart, lay it open, perform “open heart” surgery? To progress further they needed to operate on a nonbeating heart. But absence of heartbeat was the definition of death. Now they confronted a hopeless situation, a dead end, an impossible challenge. Or so it seemed.

 
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    A HILL OF BONES
An essential aspect of creativity is not being afraid to fail.
EDWIN LAND, INVENTOR OF THE POLAROID CAMERA
    A SURGEON WHO set out to open up the heart [“open heart surgery”] confronted three new problems that seemed insurmountable. First, the heartbeat had to be arrested to allow surgery, then restarted when the repair was complete. Yet while heart was in arrest, blood still had to be pumped throughout the body. Finally, and most daunting, somehow oxygen had to be added to the blood after it passed through the organs of the body.
    At Toronto’s renowned Hospital for Sick Children in 1951, surgeon William Mustard had one of his many original ideas. Outrageous notions came easily to Bill Mustard, who on occasion would dive into a fountain in a tuxedo, or swallow a live goldfish, or demonstrate one-armed push-ups at a formal dinner party. If everyone arched an eyebrow, so be it. Bill Mustard relished being unconventional, offbeat, shocking, doing what no else would do.
    When Mustard contemplated the challenges of open heart surgery, he figured that if he could solve the problem of oxygenating his patient’s blood, he could certainly rig up a pumping system to deliver the blood when he stopped the heartbeat. His hunch was that he knew an efficient, proven oxygenating system: the lungs of a primate. If monkey lungs could be harnessed to oxygenate his patients’ blood, then he could backpedal into open heart surgery with some tubes and a pump. Armed with only intuition, indefatigable William Mustard set out to create his own deus ex machina. He anesthetized four monkeys and excised their lungs. To avoid blood mismatch, he thoroughly flushed the lungs clear of blood, “until they were white.” He then hung the lungs in sealed jars and ventilated them with oxygen. He connected his patient’s venous blood return to a pump, pumped the blood into the monkey lungs, and used an additional set of tubes to return the blood from the lungs to his patient. Voilà! Bill Mustard had created a functioning heart-lung machine. His first patient was a year-and-a-half-old baby with a a hole between the right and left ventricles, called a ventricular septal defect (VSD). Mustard ran into technical difficulties transporting blood from one monkey lung to the next, then into the child’s body and back out to the first monkey lung through the maze of tubings. The baby died on the table.
    Mustard tinkered with his apparatus, and tried again. This time he completed the procedure but the patient died in the recovery area two hours after surgery. Encouraged by his progress—his patient had survived through the surgical procedure on the