November 29th – First human surgery to correct blue baby syndrome

Vivien Thomas' autobiography, Partners of the Heart, tells the story of Blalock and Thomas' journey to treat blue baby syndrome

Vivien Thomas’ autobiography, Partners of the Heart, tells the story of Blalock and Thomas’ journey to treat blue baby syndrome

On this day in 1944 at the Johns Hopkins University, the first surgery was performed to treat patients with blue baby syndrome. Under the leadership of surgeon Alfred Blalock, his surgical assistant Vivien Thomas, and paediatric cardiologist Helen Taussig, the surgery paved the way to future innovations to combat this life-threatening condition.

Due to certain congenital defects of the heart (four anatomical defects in fact, cumulatively called the Tetralogy of Fallot), individuals with blue baby syndrome do not have enough blood that is being delivered from the heart to the lungs to become oxygenated. The defects in the heart disrupt the normal pathway blood undertakes, that is, moving through the heart, then to the lungs, back to the heart and out towards the body. As a consequence, an abnormal amount of deoxygenated blood enters the body’s circulation.

As its name suggests, blue baby syndrome occurs when newborn babies have inadequate oxygenation of blood by the lungs, resulting in a bluish hue to their skin. Contrary to medical diagrams that have used the colour red to symbolize oxygenated blood and the colour blue to symbolize deoxygenated blood, the deoxygenated blood in your body is not actually blue. Your blood is always red, brighter when oxygenated and dark red or maroon when deoxygenated. In fact, the only animals that do have blue blood are molluscs, crustaceans, and horseshoe crabs (the blue blood from the horseshoe crabs has some medical potential, see here: http://www.youtube.com/watch?v=e8KlAmtIu1E. Rather, the blue appearance of deoxygenated blood (e.g. your veins) has something to do with the difference in absorption of blue light and red light through your skin and blood.

Now back to the history. Prior to his work on blue baby syndrome, Dr. Alfred Blalock was a prestigious physician at the Vanderbilt University Hospital. He had done a lot work on the physiological component of shock, and his work has been credited with saving the lives of thousands in WWII. It was while Blalock was at Vanderbilt that he became acquainted with Vivien Thomas. As an African-American lab assistant who did not receive any post-secondary education, Vivien Thomas would prove invaluable to Blalock’s work with blue baby syndrome, developing cardiac surgical techniques and proposing novel solutions to clinical problems.

After being introduced by Dr. Helen Taussig to the problem of blue baby syndrome, Blalock and Thomas tackled the problem based on previous work done on shock. After some experimentation, they proposed joining (anastomosing) the left subclavian artery (an artery just above the heart) to the pulmonary artery, the artery that directs blood from the heart to the lungs. This procedure, later known as the Blalock-Taussig shunt, would allow for increased blood flow to the lungs, allowing for the oxygenation of the blood. On November 29th, 1944 this procedure was performed for the first time on a dying blue baby. As this was the first time the procedure was performed on a human, there was some concern of an adverse outcome for the patient. The baby survived the operation however, and over the next couple days after the surgery, became less blue and recovered from her illness. The procedure was a success.

The entire story of Blalock and Thomas’ work became popularized through an HBO TV movie called Something the Lord Made (2004), starring Alan Rickman as Dr. Alfred Blalock and Mos Def as Vivien Thomas (http://www.imdb.com/title/tt0386792). Besides describing the process by which Blalock and Thomas came to develop their procedure, Something the Lord Made also delves into the racial aspect to this story. Taking place in the American South, the movie addresses the, at times, unequal relationship dynamic between Blalock and Thomas, such that Blalock took credit for many of the medical innovations that Thomas developed. The fact that Thomas’ name was not included in the name for this procedure (the Blalock-Taussig shunt), and that Vivien Thomas received his due credit for his pioneering work only until the 1970s, as seen at the end of Something the Lord Made, is a testament to the racial issues that underlined this story.

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