The engineer who fixed his own heart(bbc.co.uk) |
The engineer who fixed his own heart(bbc.co.uk) |
Generally the trend in vascular surgery these days is to less invasive procedures such as a stent graft.
So, hey, points to the BBC for writing an article about something that continues to be interesting instead of something that's "brand new".
I am not that familiar with Marfan's or this case, so I don't know if this device is useful in this case (http://www.medtronic.com/patients/heart-valve-disease/about-...), but there are stent-grafts that also replace the aortic value so that the stent-graft can be used close to the heart, and you can be sure that medical device companies are looking at ways of using stent-grafts in close proximity to the aortic valve without requiring its replacement.
I suspect a lot of kids who lost their basketball dreams in a heart-attack will be lining up for this procedure.
This sounds like a great thing.
The "garden-hose wrap" method described in this article was not mentioned to me, probably because it would have no use on the more important failure, the stretched valve.
However, I was given a clear choice of replacement valve: metal or tissue. Tal Golesworthy presumably would have had the same choice, but the article doesn't mention that there is a choice.
The metal (actually metal frame with a carbon-fiber flap) replacement valve lasts pretty much forever. On the minus side, it sometimes has a harmless, but audible "tick" noise, but its main drawback is that it can be a source of blood clots, hence the need for the lifelong course of blood thinner. Miss a few days and you could have a stroke from a clot.
I opted for the tissue valve, which is taken from a pig (or a cow, if you object to pork products). All its cells removed, leaving only the collagen form, so there's no host-graft immune reaction. It's silent, it doesn't encourage clot formation -- but it doesn't last forever. At some point in the next decade I'll need another one.
The new valve and about 7 inches of new Dacron aortic arch were sewed in. The surgeon commented afterward that my removed aorta "felt very soft" and was "poor quality tissue" and that I was "fortunate" that it hadn't failed.
This leads me to wonder: a common failure mode of the aorta is Aortic Dissection[2] in which the tube delaminates. Rather than bursting, the lining separates from the supporting wall, and high-pressure blood gets between the layers and spreads them, reducing the cross-section of the pipe. (It's reputed to be one of the most painful experiences possible.) My wonder is: while the "hose-wrap" fix described in this article might prevent ruptures, would it be an effective preventative for aortic dissection?
[0]http://en.wikipedia.org/wiki/Annuloaortic_ectasia [1]http://en.wikipedia.org/wiki/Marfan_syndrome [2]http://en.wikipedia.org/wiki/Aortic_dissection
[1] http://www.ucl.ac.uk/operational-research/the_team/TomTreasu...
However, IIRC, Tal's version is based on one that is custom-built to fit the patient, and of course uses more advanced materials.
This is me:
Even if it could measurably reduce the chances for known risk groups, would it really be prudent to perform open-heart surgery on a patient without a current condition?
Tangent: why have humans (animals in general I guess) evolved pain receptors inside their bodies?
(Obviously with the advent of modern medicine, internal pain is useful.)
For one, you can sit still until they heal, and avoid straining them further.
Second, internal pain after eating something bad (e.g rotten or poisonous) for example, helps you avoid eating it again.
Just off the top of my head -- I'm pretty sure there are tons of other cases.
