Heart Center Lorraine Sweeney

LIke ThisLIke ThisLIke ThisLIke ThisLIke This

Heart Heroes: Lorraine Sweeney and fetal cardiac surgery

When the first fetal cardiac surgery was performed at Boston Children's Hospital in 2001 – entering Jack Miller’s heart through his mother’s abdomen and opening blood flow – the world was stunned. But more than 60 years earlier, another operation was equally game-changing.

It was 1938, a time before heart-lung bypass, when ether and chloroform were only starting to be supplanted by more controllable anesthetics, when tinkering with the heart or even opening the chest were seen as dangerous and taboo.

Tinkering was what Robert E. Gross, chief surgical resident at The Children’s Hospital, liked to do. He was interested in a congenital heart condition known as patent ductus arteriosus, a passageway between the pulmonary artery and the aorta that’s supposed to close after birth — but doesn’t.

During gestation, the fetus gets oxygen from its mother via the umbilical cord, not its lungs, so the role of the ductus is to shunt blood from the pulmonary artery, away from the lungs, and into the aorta. When a newborn takes its first breath, its circulatory system instantly changes: Muscles clamp the ductus shut, allowing blood to circulate to the lungs.

When this doesn’t happen, the baby is left with an abnormal circulation that strains the heart. Oxygen-rich blood that should go to the body re-circulates through the lungs, leading to lung congestion and shortness of breath. In Gross’s time, patients lived, on average, into their 20s; some only to age 7 or 8.

Gross had started his medical training in pathology, and had done autopsies on infants with congenital anomalies, especially those of the heart and great vessels. He was convinced that a patent ductus arteriosus could be closed surgically, and performed successful test operations in dogs.

But William Ladd, Chief of Surgery at Boston Children’s, forbade him to try it in humans: It was simply too risky. Arteries contain blood under great pressure, so even a small mistake could be quickly lethal. Moreover, as recounted by surgeon and cancer pioneer Judah Folkman, who trained under Ladd, the chief feared that opening a child’s chest would cause the lungs to collapse, perhaps fatally.

The 33-year-old Gross, undeterred, waited until Ladd went on vacation, and, in direct defiance of his order, tried his operation on the first suitable patient he encountered:  a 7-year-old Boston girl named Lorraine Sweeney.

Sweeney was weak and “delicate.” She tired easily and her mother could hear a buzzing noise in Lorraine’s chest from several feet away. Gross’s operative notes described it like this:  “Palpating finger placed on the heart disclosed an astounding coarse and very strong thrill which was felt over the entire cardiac musculature…. When the stethoscope was placed on the pulmonic artery there was an almost deafening continuous sound like rushing steam…”

On August 26, 1938, as described in JAMA, Gross made an incision along the third rib space and allowed the left lung to collapse, exposing the heart and its vessels.

“I was scared to death, scared to death,” recalled anesthesia nurse Betty Lank, interviewed in 1999 at the age of 95. Another hospital had already tried the repair, and the patient had died.

Gross closed off Lorraine’s ductus with a temporary clamp. The strange sounds stopped, and over the next three minutes, Lorraine’s diastolic blood pressure rose to normal levels. “Believing that the ductus had not stayed open as a compensatory mechanism for some other cardiac defect, it was decided to ligate it permanently,” Gross wrote. He tied it off with surgical thread.

The postoperative note in Lorraine’s medical chart read: “Condition good. Patient awake immediately, quite restless. Morphine.”

“Then she ran a temperature,” recalled Lank. “We were all worried sick. And then she got over it and I think she was in the hospital nine days.”

“By today’s standards, Dr. Gross performed a relatively simple type of surgery,” said Alexander Nadas, then Children’s cardiologist-in-chief, in an interview in 1988 marking the 50th anniversary of Lorraine’s operation. “He didn’t have to go inside the chambers of the heart to do the job; he just tied off a little tube – simple. Yet, this was the clear-cut beginning of modern heart surgery.”

Ladd, returning from vacation, was furious. Some accounts say Gross was fired, others say he went on strike. He spent several months at his farm in rural Framingham, during which no cardiac surgery was done at Children’s; there simply wasn’t anyone on staff who could treat many of the cases, according to Folkman’s account.

Gross used to say that “a surgeon in an academic department must pull a new rabbit out of the hat every few years.” He went on to other cardiac firsts, successfully treating a vascular ring (in which the windpipe and esophagus are completely encircled and compressed by a “ring” formed by the aorta and/or surrounding blood vessels) and congenital narrowing (coarctation) of the aorta (in parallel with a similar first in Sweden). He was the first surgeon to graft artery tissue from one person into another and to treat a rare defect called aortopulmonary window.

Amazingly, Gross performed these surgical feats with only one working eye. As a child, his father had trained him to develop depth perception by giving him clocks to take apart and reassemble.

By his own account, Gross performed his last ductus operation, number 1,610, in March 1972. Today, Lorraine is a great-grandmother in her 80s. Other of Gross’s patients weren’t so lucky. But it was a time when, in Gross’s view, there wasn’t much to lose: Congenital heart defects almost always proved lethal.

Request an Appointment

If this is a medical emergency, please dial 9-1-1. This form should not be used in an emergency.

Patient Information
Date of Birth:
Contact Information
Appointment Details
Send RequestIf you do not see the specialty you are looking for, please call us at: 617-355-6000.International visitors should call International Health Services at +1-617-355-5209.
Please complete all required fields

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

This department is currently not accepting appointment requests online. Please call us at: 617-355-6000. International +1-617-355-6000.

Thank you.

Your request has been successfully submitted

You will be contacted within 1 business day.

If you have questions or would like more information, please call:

617-355-6000 +1-617-355-6000
close
Find a Doctor
Search by Clinician's Last Name or Specialty:
Select by Location:
Search by First Letter of Clinician's Last Name: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
BrowseSearch
Condition & Treatments
Search for a Condition or Treatment:
Show Items Starting With: *ABCDEFGHIJKLMNOPQRSTUVWXYZ
View allSearch
Locations
  • Heart Center at Boston Children's Hospital

    Thank you, CHOB!!! Gabe is 10. Born with a form of HLHS and DS. In 2003 very few children with this dual dx survived for more than a few years. Dr. Del nido found a way. There are no words to express our gratitude. Never give up hope. Pray for direction.Read More

  • Heart Center at Boston Children's Hospital

    Our son Hayden was born 5/12/14 with undiagnosed Transposition of The Great Arteries. He was transferred to Boston Children's and his team of doctors saved his life. He was very sick leading up to his Arterial Switch and... Read More

  • Heart Center at Boston Children's Hospital

    One year ago our little Jonah went in for open heart surgery. He is now 15 months old and is a happy, healthy little boy. We can't thank Dr. Emani and the rest of the crew from the Heart Center at Boston Children's Hospital enough! Little Jonah thanks you too!Read More

  • Heart Center at Boston Children's Hospital

    Michael has two birthday's every year now; born on April 14, and re-born on June 3, 2011. It's been three years now since his heart surgery at Boston Children's Hospital. Michael is doing incredibly well, even ...Read More

  • Heart Center at Boston Children's Hospital

    You would never know our little heart warrior Reece was just at BCH undergoing his 8th heart cath. Thank you to all the doctors, especially Drs. Lock and Marshall, for making sure our little miracle is always smiling!Read More

Support Boston Children's Heart Center

Contact the Heart Center

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
Close