Correction to This Article
A photo caption with the John Kelly¿s Washington column in the Jan. 8 Metro section incorrectly attributed a quotation to cardiologist Michael Slack of Children¿s Hospital. Another cardiologist at the facility, Joshua Kanter, commented that ¿there¿s an elegance¿ to cardiac catheterization.

Plumbing the Secrets of the Heart

Michael Slack, head of the cardiac catheterization labs at Children's Hospital.
Michael Slack, head of the cardiac catheterization labs at Children's Hospital. (By John Kelly -- The Washington Post)
By John Kelly
Monday, January 8, 2007

In the summer of 1929, a 25-year-old German trainee doctor named Werner Forssmann strapped a nurse to an operating table and made medical history. He performed the world's first human cardiac catheterization, threading a tube up a blood vessel until its tip touched a beating heart.

It wasn't nurse Gerda Ditzen's heart Dr. Forssmann plumbed, however, but his own. He'd needed Ditzen for access to the sterile instruments she controlled at their suburban Berlin hospital. After tying her down -- he didn't want her to stop him -- he anaesthetized his left elbow, punched a hole in a vein, sent a catheter on its journey into his right atrium, then ambled down to the X-ray department to make a record of his achievement.

No one had known what would happen when you touched the inside of a heart. Forssmann found out.

I thought of the good German doctor last week when I was in Children's Hospital's cardiac catheterization laboratories. In one lab, Dr. Joshua Kanter treated a baby whose pulmonary veins and arteries had developed improperly. In another, Dr. Michael Slack explored a 6-year-old's heart, its various parts rendered in shades of gray on two computer monitors.

That morning, the Children's cath lab had celebrated a milestone: more than 500 catheterizations performed in 2006. That's big time.

It's become a common procedure across the country -- all those baby boomer angiograms and angioplasties -- but it's never routine in a child. First off, there's the difference in scale. Dr. Slack, director of the center, has performed procedures on babies weighing as little as 30 or so ounces.

"That's about as long as this book," he said in an interview, motioning toward my hardback copy of Werner Forssmann's 1974 autobiography, "Experiments on Myself." (For a while after my heart attack, I became infatuated by what I call "heart porn": books about our most important muscle.)

Because medical devices aren't made for small bodies, Dr. Slack and his team have become experts at adapting adult equipment. Sometimes they use neuroradiology devices, small catheters intended for the narrow vessels of the brain but well suited for a child's tiny veins and arteries.

Then there's the variability of the anatomy. The vast majority of adult patients are treated for coronary artery disease: It's a matter of opening a blocked vessel with a balloon and keeping it open with a stent. Children, however, present a near-infinite range of congenital defects: underdeveloped valves, misconnected chambers, arteries in the wrong place, arteries missing completely.

"Almost every day I do something a little different," Dr. Slack said. "Every patient is like a unique snowflake."

I had to ask: Isn't it sort of icky? I mean, you're in someone's blood vessel, pushing an instrument toward the heart as if it were a hamster in a Habitrail.

"I would say there's an elegance in it," said Dr. Kanter. "To be able to do this kind of thing and do it in this minimally invasive way is a testament to the advancement of medical science."

We've come a long way in 78 years. And what became of Dr. Forssmann? After experimenting on himself, but before his paper on the experience appeared in a medical journal, he moved to a more prestigious hospital. When his paper was finally published, other doctors tried to claim they'd performed the procedure before him. The 25-year-old was considered an upstart and fired. He eventually became a urologist.

He had the last laugh, though. In 1956, he was awarded the Nobel Prize in medicine.

Have a Heart

Where does the human soul reside? That's a question for poets and philosophers. All I know is that when a child is seriously ill, the pain a parent feels settles in the heart. The folks at Children's Hospital try to take that pain away.

They do it by treating anyone who comes through their doors. And they do that thanks to readers such as you. Your tax-deductible donation to our annual fundraising campaign will help pay the medical bills of uninsured kids. We have until Jan. 19 to raise $500,000. So far, we stand at $ 299,783.78. Time's running out, so please consider making a contribution today.

To donate, make a check or money order payable to "Children's Hospital" and mail it to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

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