Frozen Heart

At an age when most babies are active and curious, Oliver Clark lay motionless in his crib, indifferent to his surroundings and gasping from pneumonia that he could not seem to shake. Oliver's prospects for active toddlerhood hardly improved when doctors discovered his problem: a hole in the wall separating the two ventricles, or pumping chambers, of his heart. Oliver was just a year old. Usually such patients do not undergo conventional open-heart surgery until they are at least two, and in the interim normal development may be seriously retarded. In Oliver's case, a team of surgeons at the University of Chicago's Wyler Children's Hospital used a dramatic technique that involved drastically lowering Oliver's body temperature and briefly stopping his heart. Their success a month ago means a normal life for Oliver and new hope for other infants with similar defects.

The procedure, called deep hypothermia, was first tried in 1951. It did not come into wide use at that time because the development of the heart-lung machine provided a means for keeping the blood circulating while surgery was performed. In infants, however, use of the heart-lung machine throughout an operation raises two serious problems. The device can damage blood cells that an ill baby cannot afford to lose. It also requires several clamps and connections that crowd the already tiny area in which the surgeon works. Therefore hypothermia was revived in Japan in 1964 and at the University of Washington in 1967, and recent follow-up studies on the handful of patients now entering school showed no long-range aftereffects, such as brain damage.

Dr. Robert Replogle at Wyler Children's Hospital thought that Oliver Clark was a good candidate for hypothermia, and the child's family agreed that the risk was worth taking. Preparations for the operation were painstaking. Oliver's body was packed in ice bags and suspended over a tank of cold water. When the infant's temperature had dropped to about 65DEG F. and his heart rate to 24 beats per minute, Replogle injected a potassium solution into the heart. That stopped the heart, leaving Oliver in a condition closely resembling death. With the patient's body functions literally frozen, the surgeon could operate without the risk of heavy bleeding and without the impediment of a pulsating heart muscle.

The surgical part of the five-hour procedure took only 31 minutes and was uncomplicated. Making a tiny incision in the heart, Replogle sewed a dime-sized patch of Dacron cloth over the hole. After the incision was closed, he hooked Oliver up to a heart-lung machine for the first time; it pumped warm blood through his body and washed the potassium out of the heart tissue. The effect was immediate. Oliver's heart began to beat slowly, then gained momentum; within 30 minutes the beat was back to normal.

Replogle, who recently examined Oliver, reports that he is doing "quite well." The doctor believes that the child should eventually be able to do anything -even play football. So, apparently, does Oliver. Says the mother, Mae Clark: "He's trying to walk now. He's just busy, busy, busy."

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