The engineer who fixed his own heart | Hacker News Reader

The engineer who fixed his own heart

bbc.co.uk

100 pointsdrucken39 comments

Aorta wrapping was actually pioneered in the 1950's, before the graft replacements that the article mentions, but generally the wrapping had a poor result and was abandonded as a technique. (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1802172/pdf/anns...)

Generally the trend in vascular surgery these days is to less invasive procedures such as a stent graft.

And I think the journal article about this particular process is from 2009 ( http://icvts.oxfordjournals.org/content/10/3/360.short ).

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 find it fascinating that such an old procedure has been revisited sucessfully (not completely unheard of in medicine either). Perhaps better materials (now a polymer mesh) than used previously (cellophane wrap!).

Sorry but when you use the term "generally" in a medical context you can be sure the following statement is incorrect. This article is referring to the aortic root which cannot be stinted due to its proximity to the heart.

"Generally" refers to an average trend, not that all examples must follow that trend.

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.

Marfan syndrome makes you tall and lanky, so they actually have to watch for it carefully in highschool basketball teams. The build it gives them makes them a natural at the sport, but the stress of the game combined with the heart weakness caused by Marfan Syndrome can be lethal.

I suspect a lot of kids who lost their basketball dreams in a heart-attack will be lining up for this procedure.

My favourite artist has Marfan Syndrome, Bradford Cox of Deerhunter: http://www.miscmusic.net/wp-content/uploads/2011/09/138.jpg

Tal provided one of my favourite Ted talks on this subject: http://www.ted.com/talks/tal_golesworthy_how_i_repaired_my_o...

For the ones wondering how the device looks like: http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07...

Does the wrapping material dissolve after a while or last for the rest of one's life?

If it dissolved, it would be pointless to have it put in.

To the OP: thanks for posting this. You may have just changed a life very much for the better (not mine, but someone I know quite well).

We need more collaboration between engineers and the field of medicine. I found the comments about the development process and his doctors' opinions of different approaches coming from outside the medical community almost as insightful and interesting as the invention itself.

Sweet, finally a Hacker News post that features an actual engineer!

I wish they went more into detail about the devise itself. I was hoping to see a picture.

IIRC he holds up an example / prototype during his TED talk. HN user renang found this diagram: http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07...

I don't have Marfan's, but I did suffer a ascending aortic dissection in aug 2009. It was repaired with a Dacron stint. (Basically about 3" of my aorta is now artificial.)

This sounds like a great thing.

I have some personal experience with the related problem. At age 60 a gradually increasing "murmur" led to a diagnosis of Aortic Ectasia[0], a stretching of the ring of muscle that is the base for the aortic valve. As the valve widens, the three leaflets overlap less and the valve doesn't seal properly, making the heart less efficient. In addition my ascending aorta, the big arched tube that is the subject of the above article, was stretching in the manner described. These effects can be the result of Marfan Syndrome[1] but I don't have any of the other signs of it, such as long, spidery fingers and toes (fold your thumb across your palm: if the tip of the thumb projects beyond the outside of your palm, you should read up on Marfan).

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

In a word, No. It wouldnt fix the false lumen.

This is me:

http://aorticdissection.com/2011/12/06/jim-thompson-47/

If it has already dissected it's obviously too late. The parent comment asked if it would prevent dissection in those aneurysms that haven't yet dissected which is probably a more complicated question. It would probably depend on the elasticity of the vessel since we don't see dissection exclusively on absurdly dilated aortas. At the very least we can guess that it would help to extend the life of the native artery. Of course only long term monitoring of these patients will give us a somewhat conclusive answer.

It's not always the aneurysm that causes the dissection. Sometimes the dissection causes the aneurysm. The theory is that a plaque tears a he in the surface of the aorta.

(It's reputed to be one of the most painful experiences possible.)

Tangent: why have humans (animals in general I guess) evolved pain receptors inside their bodies?

Because the skin is not the only point that can give information of something going wrong?

Yes, but when you're a caveman or peasant, there's not much you can do about physical trauma to your internal organs. External pain is useful because you can usually take action to stop it.

(Obviously with the advent of modern medicine, internal pain is useful.)

>Yes, but when you're a caveman or peasant, there's not much you can do about physical trauma to your internal organs.

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.

Hm, OK. I'll buy this. I forgot that "doing nothing" is actually something you can do.

> would it be an effective preventative for aortic dissection?

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?

i'm wondering whether the fact that it is in UK is important, ie. wrt. who paid for the [experimental] surgery. As we all know, while coming up with idea is great, an actual implementation faces the issues of resources/money.

UK or not is probably not too important. The surgeon mentioned (Tom Treasure) is at University College London (his surgery is likely based at Guy's Hospital, as mentioned in the OP). This was most likely the beneficiary of a grant for medical innovations, funded by either the NHS or one of the non-profits such as the Wellcome Trust or the British Heart Foundation.

[1] http://www.ucl.ac.uk/operational-research/the_team/TomTreasu...

Having single-payer healthcare is important for this to happen, yes.

Hasn't Tony Stark already done this?

Great title.

am i the only one who was expecting a Tony Stark photo ?

No, I immediately thought of him too haha

I don't know why you were marked down for this. Not marked up maybe but I was going to say the same thing!

Sounds incredibly obvious.

Apparently the basic technique was examined in the '50s: https://news.ycombinator.com/item?id=6770227

However, IIRC, Tal's version is based on one that is custom-built to fit the patient, and of course uses more advanced materials.

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