Friday, January 18, 2013

The Heart of Cape Town Museum – by Gary

On 3 December 1967 cardiac surgeon Dr Christian Barnard entered the history books by performing the world’s first heart transplant.  The operation took place at Cape Town’s Groote Schuur Hospital, and today the suite of rooms where this event unfolded have been turned in to a museum.  Visitors receive a two-hour guided tour including two short films and entry to the actual operating theatres used, set up with life-like manikins and props recreating some of the drama of this historical event.  We really enjoyed the experience and what follows is a quick summary of what we learned.

Barnard, a promising, highly motivated and self directed young doctor, won a scholarship to study surgery in the USA. He went to the University of Minnesota, at the time a world leader in cardiac surgery.  Returning to Cape Town in 1958 with a PhD degree and a bubble oxygenating machine Barnard immediately started work performing and teaching cardiac surgery.  He used surgery to correct a variety of problems, most particularly faulty valves; he having designed an artificial valve that could successfully replace a human one.

The bubble oxygenator that allowed Barnard to start performing heart surgery in Cape Town.  It performs the job of the heart and lungs while the heart is being operated on.

Not all heart problems can be repaired, and for some the only hope of continuing life is a transplant.  In the USA surgeons had already mapped out a draft procedure and there was a race to put it to the test.  Barnard threw his hat in the ring.

Barnard started by testing the procedure on stray dogs collected from the city pound.  You can see the bubble oxygenator in the background.

Here you can see the dog’s sternum has been cut and a special jig applied to prize apart the ribs exposing the heart and lungs (remember it is a model!). Barnard (according to our guide) performed almost 50 successful operations on dogs.

The problems of tissue rejection had still not been properly resolved (a point skirted by our guide) – however Barnard decided it was time to put the procedure to test on humans.  He assembled and placed ‘on call’ a large team and all the necessary equipment. For his first recipient he selected Mr Louis Washkansky.  Washkansky was suffering an inoperable heart condition and was dying.  All he needed now was a donor.  When 25-year old Denise Darvall was declared brain dead, the victim of a drunk driver incident while crossing a busy road near the hospital, the final barrier came down.

Here Barnard is in the first of two operating theatres removing Darvill’s heart.  He is assisted by his brother (also a cardiac surgeon), an anesthetist, various nurses and a crew working to oxygenate the now still heart.

The heart is moved in to the theatre next door where Washkansky has already been ‘preped’, i.e. his chest cavity exposed, his circulation bypassed to the heart/lung machine and his dying heart removed.  

The job of plumbing up his donor heart takes almost five hours. Here Barnard is using a defibrillator to kick start Washkansky’s new heart – it takes a few jolts before it bursts in to life again.

Washkansky is moved in to the ‘intensive care’ ward, (our guide says this is another of Barnard’s many medical innovations) and is soon conscious and cheerful, saying he feels better than he has for years. 

Unfortunately Washkansky had only had eighteen more days to live, falling victim to pneumonia as a result of the drugs being used to suppress his immune system. But Barnard and his team had learnt a great deal.  They went on to perform many more transplants, each one (according to our guide) more successful than the previous.  Heart transplants have apparently now become quite a common procedure with thousands(?) performed every year.

Washkansky’s donor heart, along with his old one, are displayed in jars at the museum.  It seemed goulish, but visitors to the museum are mostly the medical fraternity whom presumably have a technical interest (for instance you can see all of Barnard’s suturing).  The bottled hearts are the only things they ask you not to photograph – so if you want to see them you better go yourself.  We all highly recommend this museum; it is an absolute corker – although with an edge of propaganda.

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