As he nears his 44th birthday, Eugene Tison says he feels reborn. Tison feels reborn because surgeons at the Washington Hospital Center saved his life three weeks ago in an operation that involved cooling Tison's body down to 60 degrees Fahrenheit and draining it of his entire blood supply.
Tison was literally without blood for 37 minutes while doctors took out a four-inch piece of the artery that carries blood from his heart and replaced it with a Dacron tube. It may have been the first time anywhere in the world that this operation was done on an adult. It certainly was the first time it was done in Washington and almost surely the first time it was done in the United States.
"That's as long as any adult has ever been without blood," said Dr. Luis Mispireta, who with Dr. Jorge Garcia did the 'surgery that kept Tison from death. "That's as cold as any adult has ever been. . . and lived."
The things that happened to help save Tison's life read like chapters in a Frank Slaughter novel.
Tison was near death in Fairfax Hospital when doctors realized he needed open heart surgery. A frantic phone call to the Park Police produced a helicopter that flew him in 20 minutes above rush-hour traffic to Washington Hospital Center where the frequency of open heart operations has reached 10 a week.
Minutes after Tison was put on the operating table his heart stopped. If a person's heart is going to stop the best place in the world for it to stop is on the operating table.
"He had cardiac arrest just as we made our first incision," said Dr. Howard Champion, who headed an emergency team of doctors and nurses able to get Tison's heart beating again, "had he been in an ambulance or still aboard the helicopter he would have been dead."
Eugene Tison is a teltypist in the wire room at the Voice of America where he has worked for three years. He has never suffered from heart disease. He golfs and bowls, which is what he was doing the night of June 1 when he felt a crippling pain that stiffened his jaw and moved swiftly down t his chest.
In less than an hour Tison was in the emergency room at Fairfax Hospital where doctors treated him for what they felt sure was a heart attack. By next, morning, blood tests, and electrocardiogram and an arterlogram where a fluorescent dye floods the artery so photographs can be taken showed that Tison had not suffered a heart attack.
What Tison had suffered was tear in his aorta, the main artery that supplies blood from the heart to the rest of the body. The tear had forced blood between the inner and outer layers of the aorta, separating them and causing blood to flow in two channels of the aorta instead of just one.
Blood kept moving through the two channels out of Tison's aorta into his main coronary artery, producing what doctors call a "dissected artery." The dissection of Tison's coronary artery had reached the upper parts of his legs. His blood pressure had begun to soar as his heart fought to pump blood through two channels instead of one. He was in danger of death from massive internal bleeding.
The only surgery that can correct a dissected artery is open-heart surgery where the heart is stopped and a heart-lung machine is used to oxygenate and pmp the blood. Fairfax Hospital is not equipped for open-heart surgery, which is why Tison was helicoptered to the Hospital Center.
Time was so critical that Fairfax Hospital did the tests that matched Tison's blood with the 10 quarts of blood sent in the helicopter with Tison, who remembers nothing of the next critical hours:
"The only thing I remember," Tison said from his hospital bed the other day, "was the pilot taking off and saying his ETA (estimated time of arrival) was eight to 12 minutes."
The arteriogram done at Fairfax showed that the valve that let blood out of the heart would not close and blood was backing into the left chamber, putting pressure on the heart.
Even as the surgeons cut through chest bone and the fibrous sac that surrounds the heart to relieve some of that pressure Tison's heart stopped beating. The surgeons finished the incision, then drained the blood pressing on the heart and it resumed beating. The procedure took about one minute. Another three minutes and brain damage would have taken place.
Tison's aorta was torn almost 300 degrees around in a spot less than an inch from the heart. The tear was in the inner wall, forcing the outer wall to move away from the inner wall and also forcing two tiny tears in the outer wall. Blood was seeping from both outer tears, threatening massive internal bleeding.
The most pressing order of business now was to repair the tear in the aorta. A clamp was placed about four inches from the heart on the upper part of the aorta. Now that the heart was working againg its task of moving blood up to the brain could now be taken over by the machine.
Sewing the tear was straightforward but as soon as that was done and the clamp removed so that blood could flow again, the surgeons noticed seeping out once more through the blood aortic wall. There was only one reason the bleeding had resumed. The outer walls of the aorta had been so weakened by the events of the last 18 hours that the clamp had torn fresh hole in the wall.
"The outer wall of the aorta now had the consistency of wet tissue papper," Dr. Mispireta said. "We could go back and reclamp another part of the aorta and sew up the new hole but that might produce another fresh tear and we'd be right back where we started. We also knew we had begun to run out of time and parts of the aorta we could repair."
The surgicial fatners in the Tison case were Dr. Mispireta and Dr. Garcia, who had lost a similar case on the operating table some months back. Mispireta and Garcia vowed the next time they had another dissected coronary artery they would attempt radical new surgery.
The radical surgery they were thinking of is what doctors call "profound hypothermia" and "total systemic arrest." What is involves is cooling the body down from its normal 98.6 degrees to about 60 degrees and draining the body of its full supply of blood. Making the body that cold stops just about all body functions, a condition the body can tolerate for about one hour as long as there is no blood in the body.
Surgeons have done this before in newborn infants, whose body parts are so small and close together that there is no other way for surgeons to perform open-heart surgery. Similar operations have been done on adults with blood clots in the chest cavity but never for very long and not at this cold a temperature.
"The danger of doing what we did is damage to the brain." Dr. Mispireta said, "The alternative is losing the patient on the table."
What Mispireta and Garcia did was to circulate cold water and alcohol around the patient's blood as it moved through the heart-lung machine. This cooled the blood, which cooled Tison's body as it passed through. It took about an hour to get the body down to 60 degrees.
When Tison's body temperature was lowered to 60 degrees, his blood was removed. Tison showed no blood pressure, no moving blood supply. The only blood left in Tison was in residual pools attached to surface tissue, whose oxygen was enough to sustain the brain and other vital organs for one hour at 60 degrees. At 60 degrees, most organ come close to stopping. The brain barely ticks over.
With no blood in the body, no clamps were needed to shut off the main artery. The four-inch piece of aorta containing all the tears was removed and a four-inch tube of Dacron fastened to the upper part of the undiseased section of the aorta.
Blood started moving back into Tison at the end of 37 minutes and clamp was put on the Dacron tube. The blood was now being warmed to restore life to the body. In the 50 minutes it took to get Tisons body temperature back to normal the other end of the Darcon tube was sutured to the undiseased lower part of the aorta.
Once the sutures were in place, the heart was started up again and Tison was disconnected from the heart-lung machine. Dopamine hydrochloride was injected into his bloodstream to stimulate his heart beat, then he was given sodium nitroprusside to keep his blood pressure down so there would be no new tears in his artery.
Tison was brought out of "intensive care" after 11 days, during which time his kidneys and lungs needed machines to help because of the shock they had been through in six hours of surgery. He also needed the psychiatric help of Nurse Terry Queen, mostly because he was so weak and confused he thought he was dying.
Tison left the Hospital Centre last Friday for home, still a little confused about why he had been through such torment. His arteries showed no signs of cardiovascular disease byt three holes in his coronary artery almost killed him. Why?
Doctors think that dissected arteries are hereditary, a suspicion borne out by the fact that Tison's father did 43 years ago of what his mother was told was a ruptured blood vessel.
"It sounds as if my father did of the same thing I had," Tison said before leaving the hospital. "I guess 43 years makes all the difference in the world."