CRIMINAL MISCHIEF 58: Cardiac Surgery During WWII

What Cardiac Condition Could Be Surgically Repaired During WWII?

Q: I write a mystery series set during the Second World War. My question is about heart surgery during that time period. I am planning a future book in which my character’s heart ailment catches up to him, and he undergoes surgery. What specific ailment can I give him? It needs to be something that he could have lived with into his 20s, and then became critical - and also something that could be repaired by new surgical techniques circa 1944. Plus, he needs to have a fairly quick recovery, so he's not out of commission too long. 

A: You actually have several options. Many of them are congenital cardiac problems and in the 1940s many did not live beyond adolescence. Things like transposition of the great vessels or tetralogy of Fallott often resulted in a premature death. However, the best bet for your scenario would be mitral stenosis. This is a narrowing of the mitral valve which lies between the left atrium and the left ventricle. All the blood returning from the lungs enters the left atrium and then crosses this valve into the left ventricle, where it is pumped out to the body. A narrowing of this valve is usually caused by rheumatic fever that occurred during his childhood. It was fairly common in the early twentieth century. It was often undiagnosed because the symptoms of fever, chills, and a sore throat mimic the flu or a common cold. Only later, when cardiac issues appeared, would the accurate diagnosis of earlier rheumatic fever be made.

In rheumatic fever, a throat infection from several stains of streptococci, the same family of bacteria that causes strept throat, results in an immunologic reaction that progresses throughout life. This immunological reaction progressively scars the cardiac valves, particularly the mitral, and this causes the leaflets of the valve to fuse together, narrowing the opening. We call this narrowing stenosis. The symptoms of this are fatigue and shortness of breath. The narrowed valve restricts blood flow into the main pumping chamber – – the left ventricle – – and thus reduces output of blood by the heart. These symptoms are magnified during any type of physical activity. Your character could have done well throughout most of his life, but then in his late 20s or 30s or even 40s could begin developing shortness of breath with activity and progressive fatigue. He would then be diagnosed with mitral stenosis, which was easily done with a stethoscope. 

The original surgery for this was a procedure that we called a finger commissurotomy. That's simply a big word meaning you use your finger to open up a narrowed valve. The surgeon would open the chest and make a small incision in a structure called the left atrial appendage. This is simply a dog ear, if you will, off the left atrium. It is easily visible and accessible once the chest is open. The surgeon would then slide a finger through that opening an extend it down to the valve where he would force his finger through the opening. Basically, he would rip the fused leaflets apart. This would relieve the stenosis, but it could leave the person with mitral insufficiency, also called mitral regurgitation. This is where the valve leaks a small amount of blood backwards with each heartbeat. This is usually minor and tolerated much better than the stenosis. I think mitral stenosis would serve your needs well.