Watch Online Mending a Broken Heart Skilled surgeons and an ingenious tool work together to repair young hearts. Select text to jump ahead in the clip: When your whole body was no bigger than this and before your mother even realized she was pregnant your heart began to beat even though it was no more than a tiny crooked tube. With luck and a little care and attention it should beat 2½ billion times before it eventually gives out. For many of us, though just as the heart was the first organ to go to work it's also the first to fail us. In the next hour we're going to see some broken hearts get mended and find out how to keep them from breaking too young. We're starting here at Boston's Children's Hospital with a heart that's still an infant's and that only a few years ago might never have grown older. Zachary's heart problem was diagnosed before he was born. WOMAN: We first found out that he had some cardiac issues on a routine ultrasound on February 19, 1998. Basically, his heart looks like it was put together in a kindergarten art class. ALDA: Zach's heart started to go wrong just a few weeks after he was conceived. Instead of forming two main pumping chambers-- one pushing blood to his body, the other to his lungs-- his heart formed only one. He's still alive today because of two operations that have replumbed his heart allowing its single chamber to keep blood flowing throughout his body. MOTHER: That was good! You got it in there! The first surgery he had got him till he was five months old. At that point, we had to have the next surgery or he wouldn't have lived much longer. And that surgery, which he's under right now would probably allow him to live until he was four or five, six or seven years old but not much longer than that because his body's going to outgrow this procedure. And this procedure's going to get him until he's an old man. ALDA: So for the third time in his young life Zach is prepared for open-heart surgery. The operation he's about to have here at Children's Hospital in Boston is called the Fontan procedure. In a normal heart blood that is pumped around the body by the left ventricle arrives back at the right ventricle to be pumped to the lungs. But in Zach's heart, there is no right ventricle. So to get blood to the lungs a new route has to be built-- and that's what the Fontan does-- it creates a tunnel for the returning blood that burrows straight through the heart. Now, a single heartbeat can push blood around the body through the tunnel and on to the lungs. SURGEON: You all set there, Bob? Let's go on. ALDA: The operation begins when a heart-lung machine takes over from Zach's own heart. DOCTOR: Now the heart is stopped right now and is not getting any blood. So that's why we need to move along at this part of the operation. ALDA: Surgeon Richard Jonas has performed scores of Fontan procedures-- perfecting his tailoring as well as his surgical skills. JONAS: Now we're going to shape this Gore-tex patch... ALDA: With Zach's heart cut open Jonas starts to sew the patch of cloth along its inner wall. We've got to think about how this is going to be folded over in a minute. When you fold it over, is that... It's going to make a tunnel, yeah. That's how it becomes a tunnel. Yeah, so this is the bottom end of the tunnel starting to take shape now. ALAN: I can't quite tell why it isn't in the shape of a tunnel when you put it in. Why do you have to sew it into the shape of a tunnel? JONAS: I guess it's not really possible for manufacturers to pre-form something for us since every child is a different shape and size so we really do have to custom-build components to fit into an individual child. It really is sort of tailor-made specifically for a child's situation. Okay, well at this point we're going to make the fenestration. ALDA: With the cloth sewn in place Jonas uses a punch to makes a small hole-- called a fenestration-- in the side of the tunnel. Creating a deliberate leak like this seems strange right now but in the days to come this little hole is to play a critical role in saving Zach's life. But for the moment, there's no hint of trouble. After being stilled for 90 minutes Zach's heart is slowly stirring back to life. JONAS: As the heart starts to get that warm blood it will gradually start to beat. You can see the first blip-- the top line there is the EKG. There's a beat there. There's another one. There's another one. Yep, there we go. ALDA: Twenty minutes later Zach's rebuilt heart is beating vigorously. We're going to be off the heart- lung machine in about a minute. ALDA: Zach's single ventricle is now able to pump blood around his body and through his lungs almost like a normal heart. But it's about to face perhaps its greatest challenge-- getting Zach through the critical few days following surgery. As it turns out his rebuilt heart comes close to being overwhelmed by a simple cold. ALDA: How is Zach doing now? He's had one complication following the surgery which is he developed a lung infection. It's the... And that made it hard for the heart if he hadn't had the fenestration? It makes it hard for blood to go through the lungs and in this adjustment period after the Fontan without the fenestration, he could have gotten very sick. He could have been, oh... stuck on a ventilator for a long time. And we've had children who've had a Fontan operation and this kind of lung infection who have died. So the fenestration... The fenestration was vital. I think so. ( coughing ) ALDA: Zach's cold lingers for days but it never becomes life-threatening thanks to the fenestration. Here's why: His infection is making it hard for blood to flow through his lungs, so hard that his heart may simply have been forced to a halt. But by allowing the backed-up blood to spill out into the heart's main chamber the fenestration is relieving the pressure and allowing his heart to keep pumping. Of course, not all his blood is now going through his lungs so it has a little less oxygen than it should-- it's a little bluer. But right now, that's a small price to pay. MAN: This infection is exactly the kind of situation-- if he didn't have a Fontan fenestration-- would have resulted in a very high mortality rate. It's not unlikely he wouldn't have made it if he didn't have a fenestration. So the fenestration probably saved his life. Now he has lived through this... this cold which could have been fatal, possibly. Now there comes a point where you want to close that hole eventually, right? Why do you need to close the hole? Because children can tolerate being blue pretty well for a period of time. But it's not well tolerated life-long. And so if we left that hole open eventually he would suffer complications from being blue. So that's why you've got to close it and that's why you invented this? ALDA: "This" is a deceptively simple little device that closes holes in hearts without surgery. LOCK: And the whole thing now folds up into something quite small. When I was a kid I used to do amateur magic and that's how you fold flowers that appear out of nowhere. You're kidding. Yeah, the whole bouquet. You just fold it up like that and you could get it into a small space like that. ALDA: The small space in this case is the tip of a catheter. LOCK: That's what goes inside the body. And we thread it up through a vein in the leg and up into the heart, and we watch it under an X ray fluoroscopic machine and we know where the hole is. And let's pretend that this is the hole here. ALDA: Like my magic flowers-- or a tiny umbrella-- the device springs open. LOCK: See it snap? Yeah. Then I pull it back like this pushing it back... like that. Wow. ALDA: This is nine-year-old Josh. He's lived with a fenestration for six years now-- and it's time to close it. The doctor was telling us it's kind of like a fine-tuning-- they got to tune him up before they send him out. ALDA: Josh's blueness is visible in his lips and fingernails. LOCK: The drill in a patient with a Fontan circulation is to give them the best possible circulation for the rest of their life because it's a little bit tenuous-- they only have one ventricle. And what we need to do is to optimize that circulation you know, so that they can be pretty asymptomatic and be very productive citizens into their 40s and 50s and pay taxes. ALDA: Josh's tune-up will all be done through a tiny hole in his groin. Okay, let's take this picture just like this, guys. Inject. ALDA: Injecting a liquid that shows up black on the fluoroscope reveals Josh's blood vessels including the pulmonary artery taking blood to his lungs. LOCK: So you notice the diameter here is probably seven millimeters and it drops to four millimeters and then it goes to nine millimeters. That's not a very severe obstruction-- it's really only mild-- and if he had a normal circulation, we'd ignore it. ALDA: But since Josh's heart already has a hard enough time pumping blood to his lungs Jim Lock plans to use this metal coil-- called a stent-- to open up the constriction. LOCK: He's going to hold this with his beefy fist... so that it don't move. And with my thin, delicate fingers I'm going to push it up. See it there? Coming in... coming in, coming in... Okay. Blow the little balloon up for me. Right, now slowly... ALDA: A balloon inflated within the stent expands it to permanently hold open the route from the heart to the lungs. LOCK: Okay, so this should be very close to perfect. ALDA: Now it's time to close the fenestration. The twin umbrellas are loaded into their catheter and threaded up into Josh's heart. LOCK: Let go of the wire. ALDA: The tunnel and its hole are invisible in this picture but the first umbrella's arms are unfolding on the outside of the hole. LOCK: It's fully open. ALDA: Then the second umbrella is released. LOCK: We're going to take a picture now with all eight arms open-- one on the left side and one on the right side-- and make sure it's in the right place. You ready, guy? Inject. ALDA: Now the tunnel is visible on the left side of the picture. Some blood is leaking past the umbrellas but that's because their cloth mesh is still porous. In the coming months Josh's cells will grow into the mesh, sealing the hole tight. The final act is to release the catheter leaving the umbrellas behind. LOCK: And there it is! NURSE: It's all done, okay? You're in the recovery room. It's all over, all right? ALDA: Josh's blood oxygen-- which for years has been at 70%-- has jumped to the mid-90s. Hey, big guy, how'd you do? ALDA: Just minutes after the procedure and already Josh's lips and nails are pinker. He's pink! For the first time. Look's good-- a little dirty, but good. ( both chuckling ) ALDA: For Josh and his parents nine years of living with his broken heart are almost over. The odds are good that his rebuilt heart will now allow him a normal life. Meanwhile, Zachary is home in Texas having fun. One day, his fenestration will also need closing. The fact that it can be now done with Jim Lock's little folding umbrellas means that, like Josh, a tune-up is all he'll need for his heart to take him into ripe old age. Jim Wenzell flies planes for a living or, at least, he used to before his airline grounded him when he was diagnosed Robot Heart Surgeon Tiny robotic instruments replace doctors' hands and make surgery less invasive. Select text to jump ahead in the clip: with a dangerously narrowed coronary artery. Today he's at the Ohio State University Medical Center where he's about to be operated on by a robot. Jim Wenzell is one of the first patients in the United States to benefit from a technology that promises to revolutionize surgery yet whose origins can be traced back to a now distant war. ( theme from MASH playing ) It was a war that also formed the background for a television series. MASH was set in a mobile army surgical hospital during the conflict in Korea. The real MASH units represented a major breakthrough in battlefield medicine. Before the early 1950s and the helicopter many soldiers wounded in battle didn't survive simply because they couldn't be treated by a trained surgeon quickly enough. Fast-forward to the 21st century as viewed through a promotional video made for the Pentagon's Advanced Research Projects Agency. WOMAN: Med MASH check. ALDA: In the mid-1990s, the goal of a research program aimed at bringing new technology to battlefield medicine was to shorten still further the time between a soldier's being wounded and getting expert medical attention. Five years ago, we visited a mobile surgical unit parked in peaceful Palo Alto, California. If this person had been wounded in the battlefield and he happened to be lucky enough to have a surgeon here... What's wrong with him? ALDA: Jon Bowersox, himself a surgeon was working with a team of scientists and engineers on a way to project his expertise into the battle zone while he remains miles away. BOWERSOX: What it looks like is there's about an inch-long hole in the small intestine. If we didn't treat that, what would happen is the casualty would develop a severe infection and die in a relatively short period of time. So what's needed to take care of this is emergency repair of the intestinal injury. ALDA: These were actually pig intestines from a local butcher's shop. Poised above them was a pair of mechanical hands. What do these things do? How do they... They get right down in the wound? This is the machinery? As you'll see... Why don't we move them into position here if you'd just move our position control. That's this red button? It is. ( machine whirring ) Stop, please. Good. So as you can see, just like the surgeon's hands they're placed right over the site of the wounding and these are instruments that the surgeon normally uses. ALDA: The armored operating room was connected to this tent by a cable. But the plan was for a wireless link so that O. R. and surgeon could be many miles apart. So this is a surgeon's workstation. Instead of being at the patient's side in the normal operating room I put on these polarized glasses that give me 3-D vision. Instead of talking directly to my assistant I put on a pair of stereo headphones. And instead of picking up the actual surgical instrument handles I put my hands in the half of them that are attached to the console. And now it's like being at the patient's side. ALDA: Jon was seeing a 3-D version of the image shown in the monitor that I was watching. How much like the real experience is it when you were over there? Well, I think the most telling thing is every surgeon that's used the system after working with it for about 15 or 20 minutes will move their hand out of the instrument handle and try to push bowel out of the way. It's getting in the way. ALDA: Jon appeared to be as dexterous with the remote instruments as he was with the normal ones-- aided as he would be in a regular operation by a skilled assistant. Jon could see Michelle in a small monitor in his workstation and together they speedily repaired the wound. BOWERSOX: As you can see now, I am able to tie the knots in the suture just as if we were in the actual operating room. So would you like to have a go at this? ALDA: Uh, yeah. Let me try. I can't wait. This is going to be the first time I've ever done this. ALDA: Despite years of doing fake operations in a fictional MASH unit, this was the first time I'd tried anything like the real thing. And you need a pair of glasses. Right, okay. ALDA: Fortunately, it wasn't the real thing. ALDA: Oh, oh, my God! Oh, wait a minute. ( crew laughing ) I'm terribly sorry. I banged into the instrument and jammed it into the guy's intestines. ALDA ( over monitor ): Now, Michelle, control yourself. Snip, snip, okay. MICHELLE ( over monitor ): Alan? You're ruining my image of you as Hawkeye, you know that. ALDA ( over monitor ): I am not a real doctor, I just play one on TV. ( laughing ) ALDA: Now, I need to pick this side up. MICHELLE: Yeah, pick it up, right where you are. Okay. Now... have I got it? Um... Okay. ALDA: Okay... oh, okay, it went through. Do I have too little of it? No, that's just fine. Oh, pull it with this? Yes. Oh, I see, I see, pull it with the right hand, okay. And I can sort of ease this down with the left hand. Grab the tissue. Pull it out. ALDA: I was just one of many visitors to the Pentagon-funded project who got to try it out for themselves. ALDA: There, I did it. Yes, you did great. I made a stitch, but the poor guy-- I mean, he's going to have cramps from that stitch. ALDA: Another visitor to the project in the mid-1990s was an entrepreneur who saw in the system the answer to a surgeon's dream-- the ability to operate right inside a patient with a pair of miniaturized hands-- to project their hands not so much across space as down into the patient's body. And it's this idea that five years later is being tested here at Ohio State University-- as a camera plunges through the chest wall of the coronary bypass patient. MAN: That's the heart beating. And we're looking at the chest wall and there's the artery that we want. The artery... that particular artery runs up underneath the breastbone along the ribs. We plan on using that artery. It's a little blue streak there. ALDA: The plan is to free the artery from the chest wall and sew it onto the patient's coronary artery just beyond the blockage. This approach to coronary bypasses is becoming increasingly common. What's different here is that the job of harvesting the chest artery will be done by a pair of robot hands. While operating, my hands... all that motion will be transferred to this miniature hand, if you will, inside the chest. This is the working end of the system. If you think about it, why do we make big incisions? We're working on small arteries, we're using tiny suture. Because our hands are large-- that's why we make big incisions. And what this system allows us to do is feel like our hands are inside the chest but we haven't made the big incision. The first thing I do is, I take off my shoes. So I'll be using both feet and both hands. So I take off my shoes and then pull up to the screen. You can see that it's binocular vision. We're going to activate this now. ALDA: Randy Wolf's workstation is the commercialized version of the one I checked out five years ago. The controls for moving the instruments are now much more sophisticated. WOLF: When I turn my left hand like this, it does it. When I pinch my fingers together this pinches together. It feels very natural. I pinch, I let go. I turn right, I turn left. Any angle my wrist makes, it makes at the tip. And this is very helpful in sewing vessels, like this. You grab a suture, you can run it like this. I'll give you a more panoramic view. Any wrist motion is replicated. ALDA: As Randy moves his hands at the controls across the operating room, his actions are mirrored by the arms of a robot inside the patient's chest. WOLF: The vessel is in this tissue right here. So I'm very gingerly, or gently, pulling down on it to open that up. And the first rib, the highest rib, is right here. Rib number one... number two here... number three here... number four here. MAN: This is, in simple terms, fun. It's fun because it allows us to do something that we love doing which is heart surgery but allows us to do it in a manner that is creative in a manner that we think is going to benefit the patient by producing less trauma. MICHLER: Okay, we're finished with mobilization. Note the time. So an hour-- exactly an hour and 30 minutes. Okay? All right? Now that's long for us but again, we were working under more unusual circumstances than usual. You didn't say extenuating, did you? ( laughing ) We were working under friendly fire. ALDA: With the chest artery freed the next job is to clip it so that it can be safely severed. Robert Michler inserts the instrument holding the clip. MICHLER: How about right there? ALDA: The clips will seal the artery until it can be sewn to the coronary. MICHLER: We'll give you scissors to divide it. Okay? WOLF: Yep. That looks good, don't you think? Yep. Let's have the scissors back. There it is. See the artery? That tube? So that's what we're going to sew onto the surface of the heart. ALDA: At this point in the operation, the robot's job is over. Right now, the Ohio State team has the F. D.A.'s permission only to harvest the artery with the robot. Sewing it on to the heart still has to be done by hand. In the next phase of the trial even this attachment of the artery to the coronary will be done by the robot. MICHLER: The whole sewing onto the heart took us about ten minutes to perform. So once we have developed the technology with the robot to the point where we can take the artery off of the chest wall in ten or 20 minutes it could shorten this operation dramatically from the several hours to really under an hour. ALDA: As well as being far less traumatic for the patient the robot system could also make a big difference in the way surgeons learn new techniques. Right now, Randy Wolf spends a lot of time on the road training surgeons in the new technology. But that will change. WOLF: Let's say a Japanese surgeon wants to learn this system and they've got their first case, they want me to help them I don't have to fly to Japan. We can go Internet 2, we can bring the image up we can hook up my system to their system and I can mentor them, tele-mentor them while I'm sitting here at Ohio State University in Columbus, Ohio and they may be in Tokyo, Japan. I'll get a lot less frequent-flyer miles but I think I'll live longer. ALDA: The next step for the robot surgeon here at Ohio State is to do a complete coronary bypass operation-- something Randy Wolf has already done with a robot in Germany. Following that, there are still more ambitious possibilities including doing heart surgery inside an unborn child. WOLF: What's exciting to me is it's all imagination. You really need to act like a little kid with this technology and use your imagination, because that's the only limit. ALDA: The Heart Factory In the quest for the most reliable artificial heart, one device offers hope. Select text to jump ahead in the clip: This is the story of a 20-year effort to develop an artificial heart. Luckily, for one of the players in this volleyball game it was an effort that began to hit its stride in the early 1990s. Today the attempt to build a permanent artificial substitute for a failing heart may be on the brink of success. Whoa! That's it! ALDA: Back in 1993, Mike Dorsey's heart was so diseased that he was on the brink of death. DORSEY: I was very sick. If I'd have walked from here to you I'd have been out of breath for that time. You know, I couldn't do nothing. It gets a little frustrating when your wife comes and takes things from you, you know and you can't carry them, you know. She would take them and carry them in for me. I wanted to do it, but just wasn't able to do it. ALDA: Mike Dorsey was rescued from death by a pump implanted under his own heart that helped propel blood around his body. It was almost 12 years earlier that the artificial heart first hit the world's headlines. But Barney Clarke's brave struggle to live and his death after four months cooled the early enthusiasm for his artificial heart-- the Jarvick-7. After a few more unsuccessful implants the device was abandoned. But research on mechanical hearts continued. The most promising were pumps that weren't intended to replace the heart but boost it. One of them was called the Heartmate. The designers of the Heartmate took a novel approach to a major problem of the Jarvick-7: blood clots that would form inside of it and that could kill when they broke off and traveled to the lungs or brain. The Heartmate's interior was roughened so that a thin layer of blood clots over its entire surface and sticks there firmly. Mike Dorsey's problem-- one that he shares with thousands of others each year-- was a weakening of his heart muscles so that the main pumping chamber, the left ventricle could no longer pump blood around his body. Installing the Heartmate begins with cutting a hole in the left ventricle and sewing in a short tube. Then the electric pump itself is implanted in the upper abdomen. Blood flows from the heart through the pump then back to the patient's aorta. By February 1993, Mike Dorsey's heart was near total failure. His doctors estimated he had just hours to live. Only weeks before, the Heartmate had been approved by the Food and Drug