Pioneers of Cardiac Surgery

Judson G. Randolph, MD

Congenital Heart Surgery 197 Judson G. Randolph, MD (b. 1927) When Dr. Ladd left to go on vacation he said to Dr. Gross, “Whatever you do, don’t operate on that little girl with a patent ductus.” — On the first closure of a patent ductus Interviewed February 4, 2004 I was born in Georgia in 1927, and I went to school in Nashville, Tennessee. I graduated from Vanderbilt University and then went to medical school at Vanderbilt, graduating in 1953. I did my internship at the University of Rochester, and then I came back to Vanderbilt briefly while I was waiting for a position to be available for me at the Boston Children’s Hospital. I went to the Boston Children’s Hospital as an assistant resident, and then as a resident at Massachusetts General Hospital. Ultimately, I was chief resident at the Boston Children’s Hospital in 1960 and 1961. I stayed on the faculty there, and during that time I worked with Dr. Robert Gross. Dr. Gross is a great hero of mine, and he was my close associate while I was working in Boston. He was my teacher and was almost like a father figure to me. So first I’d like to talk about Dr. Gross and how he got started in medicine, and about his various interests and contributions. Robert Gross was born in Baltimore on July 2, 1905. He was the son of a piano maker, and his father hoped that Robert would come into the piano-making business when he grew up. When Robert was in high school, his father had him work after school in piano construction, for two reasons. One reason was his hope that Robert would come into the business, but the other concerned Robert’s eye problem. He had trouble with one of his eyes, and his father hoped that working with the fine tools and movements of piano construction would help him learn to adapt to the partial loss of vision in one eye. From that experience Robert Gross became a mechanic. In the second half of the twentieth century, most surgical contributions have been physiological, but Dr. Gross’s contributions were mechanical. He graduated from Harvard Medical School AOA but couldn’t get the surgical internship he wanted, so he went into pathology with Dr. Bert Wolbach. He was a pathology resident at the Brigham and at Children’s Hospital, and ultimately he was the chief resident in pathology at the Brigham, but at the same time he was appointed to the surgical house staff of Elliott Cutler at Harvard and at the Brigham. When he was doing his work in pathology, he kept seeing little children who had died because they had acute bacterial endocarditis involving the ductus arteriosus. He kept looking at the ductus, and the mechanic in him said, “You know, we ought to be able to shut that thing off.” He went to the dog lab and devised a method to divide the ductus. This was in the mid-1930s, and you must remember that we didn’t have endotracheal anesthesia or antibiotics. The heart was a big heaving thing that everybody avoided because they couldn’t get to it or do anything with it. But Dr. Gross worked out a method. It was a bit 198 Pioneers of Cardiac Surgery primitive. He put four hemostats across the ductus, and he put rubber bands around the handles of the hemostats so they wouldn’t spring open, causing unexpected blood loss. It was that primitive. We were still using the rubber bands when I was his resident. Once the four hemostats were on, he would take the two inner hemostats off and transect the ductus. Then he insisted on silk sutures to close the ductus, not just to tie it off. He wanted silk sutures to close the end of the ductus, and that’s how he really began his inquiries into various extracardiac mechanical problems and operations. He discussed this research with Dr. Ladd, his chief at the Children’s Hospital. He thought that maybe this ductus work could go forward clinically, but Dr. Ladd told him that he should stay in the lab, that they weren’t ready to do such a procedure on a patient. Dr. Ladd always took a month off in August for his vacation. While he was gone, Dr. Gross, who at that time was a thirty-three-year-old assistant resident, mind you, not even a chief...