Congenital heart disease
Much of what we know about the heart’s anatomy is thanks to former BHF Professor Robert Anderson. He tells Sarah Kidner about his remarkable career.
Before the BHF was set up, only one in five babies born with congenital heart disease saw their first birthday, let alone their first day of school. Sixty-two years later, largely thanks to research, about 4,000 children born with a heart condition experience their first day of school every year.
Former BHF Professor Robert Anderson’s work mapping the anatomy of heart defects and how they develop was instrumental in this.
At the end of the first year, I’d decided anatomy was a nice life, and so I stayed!
Professor Robert Anderson
Professor Anderson stumbled into a career in cardiac morphology (the study of the anatomy of the heart) in the 1960s, having originally planned to study ophthalmology. In 1967, he was working in the anatomy department at the University of Manchester. During that time, he also developed an interest in golf and spent many hours on the golf course honing his swing. He jokes: “At the end of the first year, I’d decided anatomy was a nice life, and so I stayed!”
Research and discovery
His subsequent MD thesis led him to study the anatomic origins of the electrical impulses of the heart. Around that time, a Liverpool colleague asked him to help with an autopsy of a child who had died from an interruption to the heart’s electrical system during surgery. “One of the risks in cardiac surgery is short-circuiting the delicate electrical pathways in the heart, which produces surgical heart block,” Professor Anderson explains. Heart block is when the electrical impulses of the heart are slowed down, delayed or blocked. In some cases, this can occur as a result of heart surgery. “In the Liverpool case, I could see the stitch encircling the pathways and was able to tell the surgeons exactly where they had gone wrong.”
His research sought to clarify the location of electrical pathways due to holes surgeons were finding in the heart as a result of congenital defects.
“I discovered an irregularity relating to a particular type of disease in the congenital work that I was doing,” he says. “In a particular type of hole in the heart, it was always thought that the electrical impulses ran underneath this hole. We showed that the pulses actually ran above it – so the surgeons were taking extreme care in the bottom part of the hole, when they should have been being careful in the top part of the hole. In making cuts in this particular area, the surgeons were often producing heart block and, up until then, they hadn’t known why.”
A travelling fellowship from the Medical Research Council enabled Professor Anderson to go to Amsterdam and share his anatomic expertise with those studying the electrical events occurring during production of the heartbeat. “I formed a close collaboration with a pathologist called Anton Becker that helped expand my knowledge of the anatomy of hearts with congenital defects,” he says. “I continued to work with him for the rest of my career; we made a formidable team.”
In 1999, I moved to Great Ormond Street Hospital and, at the turn of the century, we were losing far fewer young patients.
The experience also helped to secure Professor Anderson a senior research fellowship at the Royal Brompton Hospital, London. “I was working at the cutting edge of developments in the diagnosis and treatment of children with congenital heart disease,” he recalls. “I was in at the deep end working with the cardiologists and the paediatric surgeons, who’d ask me to go into the operating theatre and share my expertise of where best to put stitches, for example.”
The outlook for children with congenital heart conditions has improved greatly since then, something Professor Anderson is proud to have witnessed. “When I first started at Royal Brompton in 1974, 20 per cent of children with tetralogy of Fallot – the ‘blue babies’ – didn’t survive,” he says. “In 1999, I moved to Great Ormond Street Hospital and, at the turn of the century, we were losing far fewer young patients.
“I can’t claim the credit for that,” he stresses. “The stuff I was doing was part of the developmental advances that we were making because we knew better how to diagnose and how to put in the stitches, but the overall advancement was worldwide and being made in all the supplementary disciplines, not least in intensive care.”
Support from the BHF
If I had not been supported by the BHF, all the work I did and all the differences that I made wouldn’t have happened.
Professor Robert Anderson
In 1974, Professor Anderson became BHF Senior Research Fellow at the Cardiothoracic Institute, London, and an honorary consultant at the Royal Brompton Hospital. Five years later, he became the Joseph Levy Professor of Paediatric Cardiac Morphology – again supported by the BHF – and was awarded the BHF Gold Medal for Research in 1984 on the basis of his overall investigations up to that time. “Throughout my career, the British Heart Foundation realised that the work that I was doing was important,” he says. “If I had not been supported by the BHF, all the work I did and all the differences that I made wouldn’t have happened.”