Monday, December 13, 2010

The Blalock-Taussig Shunt

            The Blalock-Taussig shunt or BT Shunt was first performed by renowned heart surgeon Dr. Alfred Blalock on November 29th, 1944.  The procedure is named for him and Dr. Helen Taussig a pediatric cardiologist.  Taussig approached Blalock after being frustrated and powerless to help children with the Blue Baby Syndrome.  The Blue Baby Syndrome gets its name from the blue pallor to the skin of infants and young children who have severe congenital heart defects.  Of the heart defects that cause the blueness, or cyanosis, tetralogy of Fallot is one of the most common.  The blueness comes from the fact that the blood is not as oxygenated as a normal person's blood.  This comes from either complete or partial blockage of blood to the lungs and a mixing of the blood between the two sides of the heart.  The left side of the heart pumps oxygenated blood to the body and the right side pumps blood to the lungs.  The blockage is usually associated with the pulmonary artery, which takes blood from the right side to the lungs, or the pulmonary valve.  The mixing is usually caused by a hole between the ventricles, main pumping chambers.  In cases like tetralogy, the defect causes more blood to pass from the right side of the heart to the left bypassing the lungs, the causes a much lower oxygen presence in the blood than is needed by the body. 


            Taussig noticed that those patients with the Blue Baby Syndrome seemed to survive longer if there was another defect present.  The associated defect is called a patent ductus arteriosis.  Everyone is born with a connection, called the ductus arteriosis, between the aorta, which takes blood to the body, and the pulmonary artery so that the lungs are bypassed when they are not working before birth.  The connected closes usually within a few hours or few days of birth.  Sometimes this connection stays open and causes a mixing of the blood.  In the case of tetralogy of Fallot due to the blockage in the pulmonary artery the blood flow in the ductus to be in the other direction thus sending blood to the lungs.  Taussig believed that there should be a way of reconnection the major arteries to get more blood to the lungs.  At the time Blalock had been working with his lab technician, Vivian Thomas, in procedures associated with shock and the side effect was more blood sent to the lungs.  He believed he could modify that procedure for blue babies.  He brought the problem up with Thomas who began to work on it.

            Thomas had planned to go to medical school when the depression hit and left him penniless.  He sought work and got a job as Blalock's lab assistant.  Blalock noticed the skill Thomas had and Thomas' interest in his surgical notes and books.  Blalock taught Thomas in surgical techniques and Thomas became his lab technician.  In order to test his how a modification of his procedure would work they needed to recreate the condition in lab dogs.  This was Thomas' job.  After some experimentation, Thomas was able to replicate the condition in a lab dog.  He then went on the modify Blalock's shock procedure and was successful.  He had to modify some of the instruments he used so they would work properly for a human patient.  Many of today’s surgical instruments come from what Thomas had originally done.  He then taught the modified procedure to Blalock.  The basic procedure is connecting the left sub-clavien artery, which is an artery that carries blood to the arm, to the left pulmonary artery.  This created an artificial ductus arteriosis.

            When the time Blalock felt confident enough to perform the procedure on a human, the surgery was scheduled.  The first patient was 9 pound baby girl named Eileen with tetralogy of Fallot.  Blalock, a little uncertain, had Thomas brought into the operating theater to observe and guide him during the surgery.  Thomas did direct and observe the surgery from behind Blalock's right shoulder standing on a step stool.  Besides widely opening up the field of cardiac surgery is the fact that the major work on this procedure was done by Thomas, a young black man living during the era of the Jim Crow laws.  If it were not for him I probably would not be here today.  The BT shunt was my second surgery on my heart and allowed me to grow so that the total correction could be done on me.  I was born with tetralogy of Fallot with pulmonary atresia.  My defect caused a total blockage of blood to the lungs but this surgery was one of two that helped keep me alive until the total correction surgery was done.  All of this is possible because of Taussig, Blalock, and especially Thomas.

Here is a scene from Something the Lord Had Made, dramatizing the first attempt of the surgery:

Wednesday, December 8, 2010

LEGO

Along with model building, I have another constructive hobby: LEGO.  One of my earliest sets was a basic set my grandparents gave me but what really started my fascination with LEGO was a set my school classmates gave me when I went in to the hospital for my second surgery when I was 8.  The school asked what would be a good thing to give me while I was in the hospital and my mother suggested LEGO because I would be laying down in a bed recovering from surgery and LEGO is also an educational toy that helps to build creativity.  I also would say it helps with improving problem solving and spatial ability.  I was given another larger basic set.  When  I was recovering in the CICU (cardiac intensive care unit) one of the nurses helped me build something out of the  LEGO set.  Together we build a model of the CICU.  Took us a bit of time but was fun.  This began my interest in the toy.

A few years later I had my total correction surgery and brought my LEGO toys with me.  This surgery caused a much longer stay and recovery and I was grateful for the LEGO toys I had.  Around this time my brother began an interest in LEGO also.  Another few years later we began to have issues with sharing them.  Over the years some pieces got lost and there were not too many left to really do anything with them.  With these issues our mother decided to buy each of us our own set and we were not to share the pieces or make one big collection.  This way we each had our own and could not fight over them any more.  LEGO had created some specialized sets in addition to their Basic Sets.  They offered Castle, Town and Space themed sets.  I collected the Town and Space themed sets and my brother collected all three.  We still did get a basic set or two.

As we each grew our collections we amassed a lot of LEGO elements.  We would created things and sometimes share building tips or designs.  I focused mainly on science fiction based designs: spaceships, space stations, etc.  I would do other stuff too.  I've build a Mad Max era truck, an Airwolf inspired helicopter with design elements from my brother, a home/cabin that was based on a design from LEGO and some amusement park rides.  Most of my better designs are from when I was in high school and college.  I still have a few things together that I build back then, over twenty years ago.

It has now become a tradition that almost every time I go in to the hospital I am given a small LEGO set to keep me occupied.  Without the LEGO sets I'd have to find something else to occupy my mind.  There is TV which gets boring after awhile, reading, music, etc.  I do those things too as well as prayer too.  I also like visitors but people cannot always visit all the time.  So LEGO is great for the alone time I have a lot of.

I still build with LEGO at home but not as much as model building.  I also still collect sets but not as frequently as I did as a child.  Recently I've been collection the Star Wars themed sets.  I don't have all but I have quite a few of them.  I even like going to the LEGO store where you can select individual elements and build up the collection with special pieces.  I am very grateful for LEGO and still will collect and play with them.

Some of my sets and creations

Thursday, December 2, 2010

A Racing Heart.

My previous post was poem I wrote about an event in my life almost two years ago.  It was part of the beginning of a "year of  hell" for me and my family.  In January of 2003, over 6 months after my last heart surgery to replace the pulmonary valve and conduit, I was undergoing a cardiac stress test to see how my heart was functioning.  During the test I gagged on the mouthpiece that was connected to a machine that was measuring my oxygen consumption.  When I gagged my heart rate jumped from about 130 bpm to about 200 bpm.  They stopped the test started taking my blood pressure.  They were getting no reading at all when they were using my left arm.  They then remembered that I had a BT shunt on the left side and the BP readings are not normal in that arm and possibly gone when the heart goes crazy.  They called for a crash cart.  They then tried to get the pressure from my right arm and they were getting normal readings.  After about almost two minutes of this my heart had one of its skipped beats that I usually get and that broke the rhythm.  I went from 220 to 160 in one jump.  They had me sit and not move or do anything and they kept monitoring my heart rate.  They debating keeping me overnight to monitor but since I was doing well and the EKG looked good I went home.

That incident including a similar event that occurred when restarting my heart and a halter monitor showing a few runs of tachycardia (fast heart rate) prompted my doctor to start me on a beta blocker (an anti-arrhythmia drug) and then have an ICD put in.  I have my first ICD put in in July of 2004.  Until January of  2009 I only had about 3-4 shocks from the ICD, all appropriate and all months apart from each other.  At the end of January I was shocked twice in one day.  I was to go to the ER if I had two or more shocks in a 24 hour period.  I went to the ER of a local hospital and they monitored me overnight.  Everything looked okay and they sent me hope and then I saw my regular doctor who takes care of the rhythm.  That doctor said it was probably a fluke.  They see this happend and I may never need another shock again or it might happen again.  There is no way to tell for sure and that is why the ICD is there.

A month later I came home from work and my heart rate was up a bit so I sat down when I got home.  As I sat there the heart rate was not dropping then suddenly it felt like the heart stopped.  That is the only way I could describe it.  A moment or two later I was shocked and then I felt the heart going but the rate was still up.  My wife called for an ambulance and a few minutes later I got another feeling of the heart stopped and then a shock.  I was put in the ambulance and they were switching drivers and I got two more shocks in the ambulance. Turns out the feeling of the heart stopped was the heart actually beating about about 250 to 260 bpm.  I stabilized but the rate was still up over 100 bpm.

Once in the ER it started again.  In about a 10 minute time span I was shocked about 6 more times.  In the middle of this happening the hospital's lullaby went off as it does when a baby is born.  I heart it and thought how TV cliché it was that when one life ends another begins.  After constant requests by my wife that they give me something to calm me down they gave me two drugs to relaxe me.  Shortly after the heart rate went down and stayed down to almost my normal rate.  I spent a week in the hospital that time.  This was what the poem was about.

The rest of the year was a nightmare of shocks and pacing outs.  When the ICD paces you out of a tachycardia it throws an extra beat or two in at a rate faster then the tachycardia.  This disrupts the rhythm which slows it down.  It is similar to what a shock does but with out the kick a shock gives or the full reset of the heart.

Finally after a year, two electro-physiology studies and two ablations (burning out the cells causing the fast rhythms) the tachycardia attacks or tachy storms stopped.  I been tachycardia free for about 11 months.  Now will see what the future will bring.  I still jump every time I feel a skipped or weird beat.  This is something that will be hard to forget or get over but I'm working on it with God's help.  .