And Now for Golf

When Betty Vanella was born in 1930, nature seemed to have gone out of its way to do everything wrong in building her heart. The two "great vessels" were hooked up in reverse: the aorta, which is supposed to send oxygenated blood from the left lower chamber out to the body, emerged instead from the right lower chamber; the pulmonary artery, which is supposed to send used venous blood from the right lower chamber to the lungs for oxygenation, was connected where the aorta should have been. To make matters worse, the outflow of blood from the heart through the pulmonary artery was severely restricted by stenosis (narrowing).

Ironically, two more of nature's mistakes kept Betty going. There were two small holes in the septum (wall) between the two upper chambers of her heart, allowing partly oxygenated blood to pass through. And the ductus arteriosus, which supplies a normal and necessary connection between aorta and pulmonary artery during a baby's life in the womb, did not close as it should have after Betty's birth. This also helped to make partly oxygenated blood available to her faltering circulation.

Somehow Betty survived--always short of breath and often blue in the face from oxygen starvation. She finished high school, married, got a real-estate and insurance broker's license and ran her business from a spic-and-span home. After several miscarriages, she raised an adopted daughter. But all the time she was growing steadily weaker. By mid-1965 she had wasted away to 69 Ibs. She did not have strength enough to leave her room.

"Like Being Reborn." Last month Betty Vanella celebrated her 37th birthday at home in San Jose, Calif. She was a robust 104 Ibs. and announced that she was going to take up golf and swimming. Her lips and fingernail beds were a healthy pink, thanks to a full supply of oxygenated blood. "It's like being reborn," she said.

The rebirth had taken place on an operating table in San Francisco's Presbyterian Medical Center just a year before. Diagnostic tests which were made by threading plastic tubes through arm veins and into Betty's heart had revealed most of nature's errors. Even so, Surgeon Frank Gerbode was in for a surprise. When he opened her chest to make connections for routing her circulation through a heart-lung machine, instead of finding two great veins returning used blood to the heart, he discovered an extra vena cava.

After that, says Dr. Gerbode, "it was just a matter of not making any mistakes." It was also a 91-hour marathon for him and his three assistant surgeons. With the heart exposed (see diagram), Dr. Gerbode stripped away part of its outer sac (pericardium) for later use. Next he sewed up the ductus arteriosus where it joined the pulmonary artery. Then, with his patient connected to the heart-lung pump, he set its heat-exchanger to chill Mrs. Vanella's blood to 68DEG F., to reduce the brain's oxygen demands.

Right to Left. Dr. Gerbode widened the pulmonary outflow channel. With the upper heart open, he and his team cut out the wall between the auricles; not only was it defective, but for their surgical plan it was also in the wrong place. They took a three-inch circle of pericardium and sewed that into the upper heart as a kind of baffle so that oxygenated blood from the lungs would flow into the right auricle, drop into the right ventricle and be pumped out through the aorta. This same baffle directed used blood from the venae cavae (Dr. Gerbode closed off the third) into the left auricle, from which it dropped into the left ventricle for pumping to the lungs.

With the surgery finished, Betty had a redesigned heart. The left side was doing the work normally done by the right, and the right was working for the left. Within a month she was at home, rapidly gaining weight and strength. Babies born with their great vessels transposed like Betty's used to be doomed to death in early childhood. Attempts at correction became possible with the advent of the heart pump, but not until 1963 did Toronto's Dr. Wil liam T. Mustard devise the baffle technique employed by Dr. Gerbode, and all previous patients have been young children. So Betty Vanella's survival before surgery and the age at which her heart was repaired so successfully have probably both set medical records.

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