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Little Hearts
Comments () | Published February 2, 2011
Author John Pekkanen and Alexandria resident Bert Ransom, both born with a heart defect, talk about their surgeries 50 years ago and how much medicine has changed. Pekkanen has remained healthy; Ransom underwent a second heart operation in 2009 at Inova Fairfax.

50 Years Later, Two Lucky Men

Elbert “Bert” Ransom Jr. is impossible to dislike. Gregarious and outgoing, Bert welcomes me to his Alexandria townhouse in August 2010. I’ve come to talk with him at the suggestion of Lucas Collazo, who operated on Bert a few months earlier. Bert and I had similar medical experiences growing up. We quickly developed a kinship based on shared experiences that made it seem as if we’d known one another for years.

Born in Jackson, Mississippi, in 1936, Bert is a longtime civil-rights activist who marched alongside Martin Luther King Jr. during the bus boycott in Montgomery. In 1968, he served as city manager of Resurrection City, the tent city on the Mall that stood as a symbol of the Poor People’s Campaign. Author of two books and an accomplished baritone vocalist, Bert lectures worldwide on nonviolence as an agent of social change under the sponsorship of the US State Department.

In late October 2009, as Bert prepared to travel to Ethiopia on a State Department mission, he routinely strapped his blood-pressure cuff around his arm, pumped it up, and was startled by the digital reading.

“My blood pressure was 211 [mmHg], and I was taking blood-pressure medication,” he says. His systolic pressure should have been in the 120 range. Louise, his wife of 43 years, said, “We’re going to the doctor. Now!”

“If you were my dad,” said the cardiologist who examined Ransom that day, “I’d tell you to cancel that trip and not get on that plane. If something happens to you during the flight, there’s nothing anyone can do for you.”

A few days later, Bert went to Inova Fairfax Hospital for an evaluation of his high blood pressure and what he suspected to be the underlying cause: the reemergence of a congenital heart defect that had been operated on in 1959.

Bert’s family had moved to New Orleans, and at the age of 11 he suffered tonsillitis.

“The doctors at Charity Hospital examined me and detected a heart murmur,” he recalls. “They told my parents they would not operate on me until they figured out the cause of the murmur. I felt perfectly fine at the time. I ran around and played sports like the other kids and never felt any effects from my heart condition.”

Bert told people outside his family about his heart condition, but I never did. I thought my condition was a sign of weakness, so it became my secret.

For years, doctors at Charity Hospital kept reevaluating Bert with chest x-rays and stethoscopes, but nothing unraveled the mystery of his murmur and his high blood pressure. Two months after graduating from Xavier College in New Orleans in May 1959, he moved to Chicago—mostly, he says half seriously, to escape working long hours in his father’s dry-cleaning business. He had a degree in music and applied for a job as a music teacher in the Chicago school system.

“I had to undergo a physical exam to be hired, and the doctor who examined me picked up the murmur. When he did, he looked at me and said, ‘We’re not going to be able to hire you. I suggest you see a heart specialist.’ ”

Bert found his way to Dr. Benjamin Kaplan, who called in other cardiologists and heart surgeon Laurence Rubenstein. In August 1959, Bert was diagnosed with a congenital coarctation of the aorta, a narrowing of the aorta between the aortic arch and the descending aorta. A feature of coarctation is high blood pressure, especially in the upper body.

“I’d never heard the word ‘coarctation’ until that moment,” Burt says.

The doctors recommended that he have surgery to repair the defect because the aortic narrowing put additional stress on the left ventricle to pump blood to the body, and in time the left ventricle would fail.

Bert and I were born with heart defects that seemed to be mirror images of each other. His aortic coarctation overtaxed his left ventricle while my pulmonic stenosis overtaxed my right. So in August 1959, at age 22, Bert underwent surgery to repair his defect. I had my operation almost exactly two years later, in August 1961, also at 22.

Bert’s family didn’t want him to have the “experimental” surgery, but Bert realized, as I did, that the defect had to be corrected if he was to live a normal life, and he was willing to take the risk.

Bert had his surgery at Michael Reese Hospital in Chicago at a time when the heart-lung bypass machine was experimental. “They operated on me without the heart-lung machine by completely icing me and getting my body temperature way down,” Bert tells me.

Collazo explains that when the body is cooled and the metabolism is slowed sufficiently, the aorta can be cross-clamped and the body deprived of blood flow for up to 45 minutes without injury to the brain or other organs. It was the best thing available at the time for many heart patients.

Bert survived the surgery, his aorta was repaired, and his blood pressure dropped into a safe zone. We both have memories of waking from the anesthesia and feeling frozen.

Bert shows me his scar, a horizontal slit in his upper left rib cage. I tell him they split my chest open almost from top to bottom and made a horizontal incision along the top as well, opening me up me like a frog in biology lab. It left a large, T-shaped scar.

It took me years to fully accept that my heart had been fixed. Like Bert, I’d been warned many times not to exert myself, not to run too fast or swim too far because I had a “weak” heart. I remember driving myself to an emergency room two years after my surgery because I felt chest discomfort. All tests came out negative, and I later came to believe that my discomfort had been psychosomatic. It took me four or five years to dispel my demons and stop thinking of myself as fragile.

I suspect most people who have suffered serious medical issues don’t easily escape feelings of vulnerability.

Bert’s heart repair held up for 50 years, until 2009, when his energy seemed diminished and then his blood pressure soared.

With Shen assisting, Collazo operated on Bert the day before Thanksgiving 2009. This time, Bert had the benefit of the heart-lung machine and the skills of Collazo, who navigated through the dense scar tissue in Bert’s chest. When he inserted a Dacron tube and sutured it to the aorta to keep the passage open and maintain a steady flow of blood, Collazo found that the repair made 50 years earlier had scarred over and constricted his aorta again. While he had Bert on the table, Collazo also performed a triple-bypass operation on Bert’s coronary arteries.

As we talk in his living room, Bert tells me that when each of his three children was born, the first question he asked the attending doctor related to the child’s heart. We laugh when I tell him I did the same thing when my three were born. Fortunately, all of our kids came into the world with healthy hearts.

Bert and I share the same lasting gratitude for the doctors who gave us futures. He remains in regular contact with his Chicago cardiologist, Dr. Kaplan, now 89.

I tell him I feel blessed to have had as my surgeon Dr. Dwight Harken, an Iowan who was one of the pioneers of open-heart surgery. He became the first surgeon to operate inside the human heart during World War II when he removed shrapnel from the hearts of wounded GIs in Army field hospitals after the D-Day invasion. In a 1944 letter to his wife, Anne, Harken described the first time he invaded a beating human heart:

“For a moment, I stood with my clamp on the fragment that was inside the heart, and the heart was not bleeding. Then, suddenly, with a pop as if a champagne cork had been drawn, the fragment jumped out of the ventricle, forced by the pressure within the chamber. . . . [B]lood poured out in a torrent.”

Harken, a lieutenant colonel in the Army at the time, stemmed the torrent and saved the soldier’s life, as he saved the lives of 134 other GIs who suffered potentially lethal wounds to their hearts. He didn’t lose one of them, and all left the hospital with normal, functioning hearts. The first surgeon to repeat his success in a series of cases, Harken shattered the myth that surgeons couldn’t invade the chambers of the human heart, thereby ushering in the era of open-heart surgery that was to spare my life and the lives of many others.

“The Father of Heart Surgery”

I first met Harken, then chief of thoracic surgery at Boston’s Peter Bent Brigham Hospital and a professor of surgery at Harvard, in the summer of 1961, between my junior and senior years of college. I had been referred to him by my cardiologist in New London, Connecticut, near my family’s home in Old Lyme. He thought the time had come for me to be evaluated for surgery.

My cardiologist had been reluctant to refer me earlier because the heart-lung bypass machine, the technological marvel that revolutionized heart surgery, had problems during its early development in the 1950s. The correct temperature for blood circulated through it hadn’t been established, nor had the speed at which blood should be circulated. As researchers tried to figure these things out, the experimental bypass machines triggered blood clots and other complications that caused serious problems for many heart patients, including death. Because I was in good health, I could wait, and by 1961 my cardiologist believed that the pump-related problems had been overcome.

In our first meeting in his office, Harken, a commanding man who exuded both certainty and humanity, instilled confidence in me. He had fiery red hair and, as I came to learn, a temper to match. When he and his young colleagues listened to my heart murmur and studied my heart with fluoroscopy during my first examination, they made educated guesses as to the source of the whooshing noise in my chest, which one doctor said sounded like “a freight train chugging up a hill.” One camp bet on ventricular-septal defect, the other, including Harken, on pulmonic stenosis.

I’ve wondered if listening to my murmur in those days before modern imaging was like listening outside the closed door of a room where people are talking and trying to understand what they’re saying. In any event, a cardiac catheterization—made more worrisome when I learned that a catheter had broken off inside a heart patient the day before and had to be surgically removed—would be definitive.

The rudiments of cardiac catheterization, a technology now in daily use in hospitals in the United States and elsewhere, had been developed in the 1920s by Werner Forssmann, a German researcher who eventually won the Nobel Prize in medicine for this work. But not until the 1950s was the technology safe and reliable enough for patient use. For me, the timing couldn’t have been better.

Dr. Lewis Dexter, an early champion of cardiac catheterization, performed it at Peter Bent Brigham Hospital while I was fully awake and surrounded by men and women in white coats eagerly observing. Dexter inserted the catheter through a vein in my right arm and, using fluoroscopy to guide him, maneuvered it into my right ventricle, where it triggered rapid ventricular contractions every time it touched my heart wall.

I tensed as my heart bounced in my chest like Ping-Pong balls in a lotto drawing. Dexter kept reassuring me that this was normal, but that did little to allay my mounting panic. I’ll always remember a young woman standing near me who squeezed my foot with her hand, a simple gesture that brought me comfort.

The catheter revealed that the pressure of blood flow from my right ventricle through my pulmonary valve and into my pulmonary artery was very high, confirming pulmonic stenosis. The doctors who guessed right couldn’t have been more pleased if they’d picked the winner of the Kentucky Derby.

After the diagnosis, I talked with Harken and told him I regularly played two or three sets of tennis in an afternoon and swam and played pickup basketball games. I think I purposely led a vigorous life in defiance of my fear of the time bomb I knew was beating in my chest. It was my way of asserting my normalcy, of staring down my approaching mortality.

Harken told me that all that activity had resulted in a 20-percent enlargement of my right ventricle. If I didn’t undergo surgery, he said, my health would deteriorate. By my late twenties, I would experience early heart failure, and he didn’t think I would survive much past 35, if that. “You should have the surgery now when you are healthy because it will be far more risky for you once you begin experiencing problems,” he told me.

That convinced me to gamble on possibly losing a few good years if things went wrong versus the chance of gaining a normal life if I survived. My operation was scheduled for August 7, 1961, four weeks after my initial visit to Boston.

Prior to surgery, a number of people in my town volunteered to donate blood both to prime the pump—a bubble oxygenator entangled in tubes that seemed nearly as big as a Volkswagen—and to replace blood I lost. Today blood “lost” in most heart surgeries can be conserved and given back to the patient. The new heart-lung bypass machines, called membrane oxygenators, are the size of small refrigerators. For children, they require less than half a pint of blood for priming. The new pumps have sophisticated software that makes procedures safer for patients. I’m pretty sure the word “software” didn’t exist at the time of my surgery.

I never dwelled on the idea, but thoughts of death intruded when I returned to the hospital. I didn’t fear death so much as I lamented the things I would miss. I loved Lynn, the woman I’m now married to, and wanted us to have a life together.

As the day drew nearer and my tension mounted, Harken strode into my room every morning with his entourage of white-coated residents, all intimidated by him. He once turned to them and asked: “Doesn’t anyone here know how to make a butterfly bandage?” Then he removed one from me and fashioned a new one while they watched in silence.

He would lean down, squeeze my arm with his meaty hand, and announce in his booming voice: “I’m going to save your life.”

The surgery took eight hours. I remember waking up on the operating table to see a gaggle of blurry faces yelling, “Your heart is fixed!” But mostly I remember thinking I was freezing to death.

I remained in the hospital for five weeks, the first few days in a morphine-induced haze. Today, many kids who undergo heart surgery are home in five days.

Harken did what he promised—repaired my heart—and I have had a long and healthy life with, to this point anyway, no cardiac problems. Even my enlarged right ventricle returned to normal size.

In one of life’s coincidences, when I mention Dwight Harken to Irving Shen, he tells me he did his general cardiac surgical training under Dr. Alden Harken, Dwight’s son, at the University of Colorado from 1996 to 1999 and considers him his mentor.

“Alden is a brilliant surgeon and scientist,” Shen says.

I saw Harken in his Boston office from time to time in the years following my 1961 surgery. He always told me to consider my heart normal and never let myself become a “cardiac cripple.” I followed his advice. I thanked him publicly in the foreword of a book I wrote and mailed him four years before he died in 1993 at age 83.

Harken’s obituary in the New York Times called him “the father of heart surgery” and also credited him with creating intensive-care units for critically ill patients. The most vivid human being I’ve ever known, he has remained in my thoughts these past 50 years—years I would not have had without his genius and vision.

From my weeks of walking the corridors of Inova Fairfax Hospital and observing its pediatric heart program, I realize that the skill, dedication, and compassion of the physicians and the entire cardiac team offer their young patients the same chance at life Dr. Harken gave me.

Just because repairing heart defects in children is more commonplace today, it is no less a miracle.

This article first appeared in the February 2011 issue of The Washingtonian.

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