EXPLANATION


Vivien Theodore Thomas was born in New Iberia, Louisiana on August 29, 1910. He and his family later moved to Nashville, Tennessee where his father worked as a master carpenter. In 1929, after working to raise money for college and with plans to study medicine, he enrolled at Tennessee Agricultural and Industrial College. While Thomas dreamed of becoming a doctor, circumstances led to a different fate. His college savings were depleted during the Great Depression, forcing him to withdraw from college.


On February 10, 1930, Thomas walked into the animal lab of a young doctor named Dr. Alfred Blalock to interview for the job of laboratory assistant. In a matter of days, Thomas was administering anesthesia and performing arterial punctures on laboratory dogs. Over the many years at Vanderbilt, Blalock and Thomas worked to compile a massive amount of data pertaining to hemorrhagic and traumatic shock.


After four years as a laboratory assistant, Thomas was promoted to the role of a senior research fellow. Unfortunately, Vanderbilt University classified him only as a janitor which was reflected in his salary. In 1937, Blalock then received an offer for the chairmanship and surgeon-in-chief at Henry Ford Hospital in Detroit. However, the hospital’s policy against hiring blacks would result in rejection of the offer. In 1940, Blalock was offered the surgeon-in-chief position at his alma mater, Johns Hopkins Hospital. Blalock ensured that Thomas was also offered a position. They arrived in Baltimore in 1941, a time when the hospital had segregated restrooms and entrances to the hospital.


Dr. Helen Taussig soon approached Dr. Blalock, inquiring about a surgical remedy for the “blue babies” under her care. She wondered if there was a way to “change the pipes around” and deliver more blood to the lungs. Blalock and Thomas had already done previous work to reroute arterial blood to the lungs. Thomas worked diligently to first reproduce the physiology of Tetralogy of Fallot (TOF) in the canine heart. Once Thomas had created the dog model of hypoxic circulation, he contributed to the concept and methodology of diverting blood from the subclavian artery to the pulmonary artery. Thomas single-handedly performed this procedure on nearly 200 dogs and taught Blalock the delicate vascular procedure. During a time that pre-dated vascular and microvascular surgery, many of the instruments and sutures were designed by Thomas. As Dr. Denton Cooley, who was trained by Thomas stated, “There wasn’t a false move, not a wasted motion, when he operated.” Dr. Blalock and Mr. Thomas were a remarkable combination. Thomas translated Blalock’s concepts into reality, creating entire surgical procedures where none had existed previously. On November 29, 1944, the first blue baby operation was performed by Blalock. Vivien Thomas, high school graduate, son of a carpenter, and grandson of enslaved ancestors, guided one of the greatest surgeons of the 20th century, Dr. Alfred Blalock, through the revolutionary surgical procedure referred to at the time as the Blalock-Taussig shunt (BT shunt). Blalock insisted that Thomas stand by him on a step stool in order that he could guide Blalock through the surgery for he had only performed the procedure once as Thomas’ assistant. It became widely known that while Blalock was operating, the space behind his right shoulder was reserved for Thomas. In 1946, Thomas went on to conceptualize and perform the atrial septectomy to improve circulation in patients with transposed great vessels.


The BT shunt ushered in a new era of pediatric cardiovascular surgery. It was the first pediatric cardiac surgical procedure performed in the United States. The Blalock-Taussig shunt was hailed as a miracle operation and established Johns Hopkins Hospital as the hospital to treat “blue babies” with TOF. When the work was reported in the press and published in the 1945 JAMA article entitled “The Surgical Treatment of the Malformations of the Heart: In Which There is Pulmonary Stenosis or Pulmonary Atresia” by Blalock and Taussig, the name Vivien Thomas was not mentioned anywhere. Thomas’ work was not recognized for the following 30 years. After 37 years at Johns Hopkins, Thomas was finally recognized as a Clinical Instructor and Faculty of the School of Medicine in 1976. Since an Honorary Doctorate of Medicine was not permitted at that time, he was presented with an Honorary Doctorate of Law.


The alliance between Thomas and Blalock was dramatized in the 2004 movie “Something the Lord Made”, which was based on the autobiography of Thomas entitled “Partners of the Heart”. Thomas made a place for himself as a teacher to surgeons at a time when he could not become one himself. He was a surgical pioneer before Johns Hopkins opened its doors to the first African American surgical resident 30 years later, Dr. Levi Watkins. Thomas retired in 1979, battled pancreatic cancer, and was put to rest in 1985.


In operating rooms all over the world, a modified version of the BT shunt is still performed today. While Thomas’ portrait hangs alongside other titans of medicine at Johns Hopkins Hospital, there has been a growing campaign to solidify his contributions with an official name change. In 2003, a proposal to rename the Blalock-Taussig shunt to the Blalock-Thomas-Taussig shunt was published in the journal Pediatric Critical Care Medicine and in 2009, a similar proposal was published in the journal Cardiology in the Young. The idea was again revisited in 2020 at the Society of Thoracic Surgeons Inaugural Vivien T. Thomas Lecture and in a 2022 opinion article published in the JAMA Surgery.


Choice C is the correct answer because Vivien Thomas helped create the Blalock-Taussig shunt. Choice A is not correct. Dr. Daniel Hale Williams was one of the first African American physicians in the Chicago area and one of the first physicians to perform open heart surgery. Choice B is not correct. John Beauregard Johnson was an African American cardiologist and head of the Department of Medicine at Howard University. He pioneered the use of angiography and cardiac catheterization as diagnostic tools. Choice D is not correct as Dr. Levi Watkins Jr. was the first African American cardiac surgery resident at Johns Hopkins Hospital and performed the first implantation of an automatic implantable cardioverter defibrillator.


REFERENCES


The Remarkable Story of Vivien Thomas, the Black Man Who Helped Invent Heart Surgery. Washingtonian. 2020. https://www.washingtonian.com/2020/06/19/the-remarkable-story-of-vivien-thomas-the-black-man-who-helped-invent-heart-surgery. Accessed November 11, 2022.


Blake K, Yancy CW. Change the Name of the Blalock-Taussig Shunt to Blalock-Thomas-Taussig Shunt. JAMA Surg. 2022;157(4):287–288. doi:10.1001/jamasurg.2021.5611


Blalock A., Taussig HB. The Surgical Treatment of Malformations of the Heart: In which There is Pulmonary Stenosis or Pulmonary Atresia. JAMA. 1945;128(3):189-202. doi:10.100/jama.1945.02860200029009


Kiran U, Aggarwal S, Choudhary A, Uma B, Kapoor PM. The Blalock and Taussig Shunt Revisited. Ann Card Anaesth. 2017;20(3):323-330. doi:10.4103/aca.ACA_80_17


Thomas VT. Partners of the Heart : Vivien Thomas and His Work with Alfred Blalock : An Autobiography. Univ. Of Pennsylvania Press; 1998.


Just One More-Vivien Thomas: Remembering a Pioneering Legend. Cardiology Magazine. 2021. https://www.acc.org/latest-in-cardiology/articles/2021/02/01/01/42/just-one-more-vivien-thomas-remembering-a-pioneering-legend. Accessed September 20, 2022.


Brogan TV, Alfieris GM. Has the Time Come to Rename the Blalock-Taussig Shunt? Pediatr Crit Care Med. 2003;4(4):450-453. doi:10.1097/01.PCC.0000090014.95775.


Evans WN. The Blalock-Taussig shunt: The Social History of an Eponym. Cardiol Young. 2009;19(2):119-128. doi:10.1017/S1047951109003631.