Oriented to Thoracic Transplant Recipients -- August 2000

HEALING HANDS MADE OF STEEL

By Gina Kolata, The New York Times, Columbus Ohio

The heart operation taking place in the pale-green tiled operating room at the Ohio State University Medical Center was almost eerie. The patient, a 62-year-old man, was anesthetized, swathed with blue drapes and lying face up on a narrow table. But no one was touching him.

Instead, the operation was being performed by a robot, whose three metal arms protruded through pencil-size holes in the man chest. At the ends of the robot arms were tiny metal fingers with rotating wrists, that held a minuscule instrument, a light and a camera. The robot arms and fingers were controlled by Dr Randall K. Wolf sitting at a computer console in a corner of the room about 20 feet away.

This sort of operation, heart surgeons say, is the start of what may be the biggest change in their profession since bypass surgery began nearly 40 years ago. “The reason we make incisions is that we have big hands,” said Wolf the director of minimally invasive cardiac surgery at Ohio State. The robots dainty fingers, no longer than a nail on a pinky, at the end of the long sticks could eliminate that constraint.

Eventually, surgeons believe, most heart surgery will be done by robots whose arms are inserted through pencil-width holes punched in patients chests. Instead of directly peering into a patient body, surgeons will view magnified images of the operation on computer screens. In theory, the doctor would not have to be in the same room, or even the same country, as the patient.

Now, a doctor commonly makes a foot long incision in a patient's chest, saws the breastbone, breaks the ribs to make holes bigger, then uses a heart-lung machine so the heart can be stopped, often at great risk for repair

MICROSURGERY POSSIBLE

While doctors have already been operating through tiny holes in the abdomen to do gall bladder surgery or gynecological surgery, with what is known as lapamscopy, or in the knee, with arthroscopy, or in the chest, with thoracoscopy, these operations involve removing or working with large body structures. They do not involve micro surgery, which involves cutting and sewing minute blood vessels and other tissues.

Doctors discovered that they simply could not perform the delicate movements of microsurgery without making large incisions and putting their hands directly in patients bodies. Robots allow them to get around that restriction. Surgeons say that while there is intense interest in doing heart bypass surgery with robots, the methods also could be used for other kinds of microsurgery, like sewing fallopian tubes, or working on blood vessels in the brain.

Doctors caution, however that robotic surgery has barely begun. The patient at Ohio State was part of a scientific study to determine whether one part of a heart by pass operation — cutting away an artery in the chest to be used to reroute blood around a blockage in a coronary artery — can be done as well with the robot as with a surgeon hands. In this study, the doctors open a small porthole in the patient chest after the robot cuts the artery and use their hands to sew the artery onto the beating heart.

In the meantime, surgeons say, there is a danger in overselling the technique before it can be systematically tested, especially since the work is being supported by two small robot companies that, even surgeons involved acknowledge, have financial pressures to be upbeat and enthusiastic. One, Intuitive Surgical, in Mountain View, is trying to go public. The other, Computer Motion Inc. of Goleta, went public in August 1997.

ROBOTS NOT QUITE READY

Wolf and others stress that today robots are not yet good enough to take over most heart surgery. The machines cost about $1 million and are suitable only for the 15 percent of patients who have just one blocked coronary artery, in the front of their hearts.

At this point, “we have created the world 's most expensive, least applicable procedure,” said Dr. Ralph Damiano Jr., Chief of cardiothoracic surgery at the Milton S. Hershey Medical Center in Hersey Park, Pa., where he does robotic surgery. “We have taken the first steps on a long road.”

Dr Robert E. Michier, who does robotic surgery at Ohio State, where he is chief of cardiothoracic surgery and transplantation, agreed.

“I call this the Model T of the surgical robot technology,” he said. “By no means is this the final answer”

But doctors say, the still primitive technology shows them that robotic surgery has a dazzling potential. “Nobody has ever seen anything like this before,” Wolf said. “It elegant, it beautiful, and it truly awe inspiring.”

Wolf and others who are testing the procedure in the United States have also done it in Germany, where less-stringent government regulations have allowed them to do entire bypasses with robots. So, they say, they know how it can succeed in simple cases.

TOUGH ON THE PATIENT

The promise is that robots will enable heart surgeons to fulfill their longstanding dream of less invasive, less traumatic operations. Bypass surgery is indisputably effective. When surgeons use the mammary artery in the chest to bypass a blockage, the results usually last for a decade. But it is not easy on the patients.

With bypass surgery, surgeons typically saw into the patient’s breastbone and crack open the ribs, making a hole just below the neck to just above the navel. Even worse, surgeons said, are the heart-lung machines, which allow doctors to operate on a still, bloodless heart. The machine’s plastic tubing elicits an inflammatory response and the medications that are used to prevent the blood from clotting in the machine can cause bleeding problems and organ damage.

About 1 percent of patients have strokes and as many as a third have measurable memory loss, including an inability to perform simple mental tasks like calculations and figure recognition. Many patients also suffer depression after bypass surgery with heart-lung machines.

Another way to open a blocked artery is to thread a tiny balloon into the blood vessel and inflate it, pushing the blockage against the artery wall, and then holding the artery open with a stent, a tiny metal cage. But not every blockage can be opened with a balloon, and the method can be less effective than bypass surgery.

Orange County Register, 5/9/00
Contributed by Tx Victor Tenken

 

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Beware of ‘Catch 23’

TALKING BACK TO YOUR DOCTOR WORKS

By Linda Greider

Next time you visit your doctor keep in mind on crucial if little-known rule: catch 23.

The catch works this way: Doctors typically will listen to a patient’s “opening statement” little more than 23 seconds before changing the subject or “redirecting” the talk. That means you, the patient, must talk not only fast, but also compellingly, even knowledgeably, to get his or her attention. That’s important for your doctor to fully grasp what’s bothering you.

Too often doctors don ‘t. In fact, researchers increasingly are finding that one big reason treatments don‘t work — or aren't prescribed at all is because of problems in the way doctors and patients communicate. Or more precisely, fail to communicate. And when communication fails, the results can be disastrous.

Late last year the NationalAcademy of Sciences (NAS) reported that some 7000 patients die every year because of medication errors.

Even more alarming, the NAS found medical errors in hospitals cause between 44,000 and 98,000 deaths every year

Some mistakes can be avoided, experts believe, if doctors and patients do a better job talking to each other.

Medical authorities are coming to the view that patients themselves must be more assertive in the doctor-patient relationship.

Studies show that doctors remember best the cases of assertive patients. Medical outcomes are also likely to be better

“The pattern is very strong, “says Johns Hopkins University behavioral scientist Debra Roter “When you get patients to be more engaged in a visit, they do better in terms of satisfaction, understanding and recall of doctors ' instructions.”

Moreover, she adds, “there’s also a reduction in markers for diseases such as high blood pressure.”

Patients can do some things on their own to improve communication. First, keep in mind that doctors are under growing pressure to see many patients, and may not have time for idle chit-chat, even friendly conversation.

In fact, your doctor may be in a greater hurry than you think. A 1999 report in the Journal of American Medical Association found that doctors in one study “redirected the patient’s opening statement after a mean of 23.1 seconds.”

That means you must get to the point fast. Start before you get to the doctor’s office. Think about how you ‘re feeling, what is bothering you and what you want.

Then write your questions down, and prioritize them. “Bringing in a list of questions is really essential, “says Michele Greene, a researcher on doctor-patient communication at Brooklyn College in New York. “And then [don't] be afraid to ask those questions.”

Make a list of all your medications. The physician may find two prescriptions for the same drug (one a generic and the other a brand name) outdated medicines or medicines that conflict with one another

Make sure you grasp your condition and the risks and benefits of recommended treatments.

In doing your research, experts advise, learn about alternative treatments. Watch out for biases on the part of your doctor An orthopedist, for example, may be more apt to propose surgery for a back or knee problem than, say, a rheumatologist.

One patient who’s glad she sought additional options is Washington writer and editor Elder Wellborn, who some years ago was diagnosed with early-stage breast cancer. She first visited a surgeon who described, among other treatments, surgery.

Then she and her husband visited several oncologists, all of whom proposed chemotherapy, although her disease had not spread to the lymph nodes. “We pushed them hard on what the gain would be,” Wellborn says. “It turned out you’d slightly improve the odds [of remaining disease free], but you’d go through 6 to 12 months of miserable existence.”

“I had to keep reminding myself I had a choice,” she recalls. Although her doctors described alternatives, she says, they pushed her to choose the one they favored.

But Wellborn stuck to her own plan. Ten years later she is healthy.

Wellborn illustrates how patients can succeed in the doctor-patient relationship: She asked questions, looked for options and sought second opinions. She also brought an advocate to her appointments.

Wellborn brought her husband, but experts say your advocate can be anybody you trust, such as a friend or an adult child. The key thing is that an advocate is not under as much stress as the patient, and can act as an extra set of ears or as the patient’s voice.

If you have problems with your doctor, you have a final option: You can fire your physician.

Such action may be justified from time to time. A classic example is the doctor who is habitually late for appointments. Sharon X liked her rheumatologist, for example, because he was caring and thorough.

That he was always late for appointments — usually about an hour— didn’t matter until the hour once lengthened to 90 minutes, making Sharon late for a meeting. When she asked for an explanation he responded that he hadn ‘t even had lunch and that Sharon should “relax. “She never returned.

If you‘re looking for a new doctor; think about the kind of practice that makes you comfortable -- a bustling, multiphysician practice or a smaller, quieter one.

Ask how long it takes to get an appointment, when the doctor is available by phone and how emergency calls are handled.

Don ‘t be afraid to interview doctors before you sign up. It can be worth the cost of the appointment. You'll get a sense of how the office operates.

Marcia Ory, of the National Institute onAging, points out that your relationship with your physician is one that is “negotiated” over time. “It’s a dance,” she says.

AARP February, 2000
Tx Vktor Tenken

(Editor’s Comment: An excellent summary of what’s necessary to get the most out of a doctor’s appointment, both to save the doctor time, but also leave you satisfied that you’ve got all the information you desired. And it’s so true about the “opening waltz”. “Good morning Mr. Marshall, sorry to have kept you waiting, how are you today. “Now if you say, “I’m fine doctor, “you’ll shut down their open mind right there and they start doing the “squiggle” thing with the chart. I often swear that if one were to use only positive phrases such as, “I’m really feeling better, doctor (probably shut them down right there, so test them) and my hearing has improved so much since there’s no blood in my ears.” I’m willing to bet that that kind ofsoft statement would get right by 75% of clinical doctors.)

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College Professor, Heart Recipient, Hopes More

People Will Decide To Be Organ Donors

-By Patrica L. Pastore — Tribune Star

Professor Robert Clouse goes about his duties in the history department of Indiana State University like he’s never had a sick day in his l(fe.

He is a vibrant contributor to society who actively pursues his job with more zeal than many much younger

Clouse, 68, is grateful for every beat of his heart, a heart that was transplanted into his body more than 15 years ago when a virus in his heart muscle nearly killed him.

Clouse first strongly rejected the idea of a transplant. Only after doctors told him he was dying did he agree to be out on a list for a heart. “I’d never known anyone that had a cornea transplant, let alone a major organ,” he said. “Not too many organ recipients survived then.”

Today, his quality of life is good and he’s grateful to those who made the choice to donate a loved one’s organs so he could survive, he said.

I’m a strong advocate of organ transplants, “he said. “I hope more people will donate.” Donating a brain-dead loved one’s organs is one of the toughest decisions family members can make.

Debi Girton, president of the Organ Donation Awareness Council, got involved 26 years ago when she started her nursing career in a critical care unit at a Terre Haute hospital.

“I saw young patients die who were declared brain-dead and whose family agreed to donate the youngster’s organs,” Girton said. “Later; those family members told me they were glad they chose to donate their loved one’s organs. Other families who made a different choice have told me they are sorry they didn 't choose organ donation. Heart, lung and liver transplant recipients pass you on the street everyday, and the other pedestrians have no idea this person’s life was extended by the gift of an organ transplant.

James Crawford, a Terre Haute attorney, is among those who keep making a daily contribution to his community. He too received a heart when his nearly stopped, Twelve years later; he’s still working and enjoying a rich, full life.

“These people and more than 30 others I know wouldn ‘t have had this second chance at life if people hadn ‘t agreed to donate,” Girton said.

Girton’s organization is attempting to reach as many people in the community as possible to help them understand the need for donations and also to show them how transplant patients, much like the Energizer Bunny, just keep giving and giving and giving, she said.

Vigo County high school students are made aware of the importance of organ donations by a presentation Girton makes in health classes. “We are now talking to those kids for an hour about organ procurement and tissue donation, “she said. "I go at it from a medical aspect and take a recipient with me.

Many people don ‘t realize only brain-dead individuals can be organ donors because organs require oxygen, Girton said. She said others who die natural deaths can be tissue donors.

“There is a need for corneas, bone tissue, skin, ligaments and tendons, arteries and veins and human heart valves, “she said. “If human heart valves are used instead of manufactured ones, the patient doesn‘t need blood thinners’

Brian Zindren, R.N., the local coordinator for the Indiana Organ Procurement Organization Inc. (IOPO) works closely with the Organ Donation Awareness Council.

“We are in the recovery business,” he said. “Our job is to obtain organs from families who wish to donate them.”

IOPO statistics indicate that 80 Indiana residents as of March 7, are awaiting heart transplants, 75 lung transplants, 205 liver transplants, 397 kidney transplants and 2.3 pancreas transplants.

Not every donated organ stays in this state, Zindren said. He said the individual with the greatest need and the closest blood and tissue match is given the organ. If the donor’s blood and tissue are a close match to the recipient, the chances for success are increased, he said.

A multiple organ and tissue donor may enhance the lives of up to 50 people, said Girton.

She said an important step in becoming an organ and tissue donor is talking to your family about your decision.

“Donation is not only beneficial for the recipients, it helps the donor‘s family with death by understanding that something positive came from a personal tragedy.”

The Organ Donation Awareness Council also offers support for donor families and recipients.

Dr. Clouse is certainly one of the very first sufferers, ah, readers of UpBeat. He ‘s also among the group of long-term heart recipient readers, with Marjorie Rorabough leading the group with some 22 or 23 years, but who ‘s counting? Ed.

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SangStat To Keep Selling Capsule Form Of SangCy...

NEW YORK (Dow Jones 7/11/00)— SangStat Medical Corp. (SANG) will continue to market the capsule formulation of SangCya, a drug used for the prevention of organ rejection in transplants, Chief Executive Jean-Jacques Bienaime said Tuesday.

On Monday the company voluntarily recalled the liquid version of the drug, a generic version of Novartis’ Neoral, after a study showed that it wasn ‘t equivalent to Neoral.

“This recall has absolutely no impact on the capsule formulation, “Bienaime said in a CNBC interview

SangCya accounts for less that 4% of the company’s revenues, he said. SangStat Medical has two other products on the market.

Bienaime said he doesn ‘t think improvements to date in transplant technology will affect his company’s business. For the foreseeable future, he said, transplant patients will need to take medication on a daily basis to prevent organ rejection. “As a consequence, our business will continue to grow”

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Organ Drug Recall

WASHINGTON (AP 7/11/00) — A generic version of a drug used to prevent organ buns-plant rejection is being recalled because of an unusual problem: Patients may not absorb enough of the “SangCya oral solution” if they swallow it with apple juice.

The Food and Drug Administration announced the nationwide recall of SangCya, a generic version of liquid cyclosporine, on Monday.

The brand-name version, Neoral, isn‘t affected; nor are cyclosporine capsules.

FDA officials urged patients not to alter how they take SangCya until contacting a doctor for advice on switching to another cyclosporine product.

Patients should not panic. Transplant recipients have cyclosporine levels in their blood checked frequently, so people who regularly took SangCya with apple juice would have had their doses increased if doc tors spotted too-low drug levels, said FDA generic drugs chi ef Gary Buehler

It’s the latest controversy over SangCya. Neoral manufacturer Novartis Inc. already has sued the FDA, claiming the government improperly approved the generic drug, and said Monday’s recall bolsters that argument.

SangCya’s instructions suggest patients mix it in apple juice or orange juice to disguise the bad taste. But a study found volunteers who took SangCya mixed in apple juice absorbed about 20 percent to 30 percent less of the drug than people absorb when taking Neoral with apple juice, Buehler said.

Generic drugs are supposed to be equivalent to their brand-name competitors; hence Monday’s recall.

Roche’s Ceilcept Approved For Liver Transplants

Nutley, NJ (Reuters 8/9/00) - Hoffmann La Roche Inc. said Wednesday that it has received marketing clearance from US. federal regulators for expanded use of CellCept to prevent organ rejection in liver transplant patients.

CellCept was originally approved by the U.S. Food and Drug Administration in 1995 for use with cyclosporine and corticosteroids, to prevent organ rejection in kidney transplant patients. The drug is also used in heart transplant patients.

“There are more than 16,000 people on the waiting list for a liver transplant, and numbers are increasing rapidly,” said Dr EddyAnglade, Medical Director; Transplantation, Roche Laboratories. “Having another drug in the liver transplant arsenal is important news for the transplant community.”

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PVCS

Goodbye Nurse — Hello Friend

An Open Letter: What one heart recipient feels about the retirement of his initial Transplant Coordinator.

Dear Joyce,

I have delayed responding to your kind note regarding your new life and semi—retirement situation. I say kind because you were very thoughtful to think of us. My delay was caused by a visit from our daughter-in-law and two granddaughters, while their father is away being “Air Boss” pilot on a Navy Cruiser.

I’ve had eleven and a half years now to assemble my thoughts on transplant patient and staff relationships. I think the overriding factor is the almost unacceptable bonding that occurs between patient and staff over time. I say unacceptable because supposedly the worst thing that a professional medical clinician can allow to happen is establishment of an emotional bond concerning the patient’s well being. Conversely, it is only normal for the patient to try and maintain an informal communication with their following transplant staff, which can make it very difficult for the individual staff person to always maintain a medically honest professional decorum.

Where am I leading, only really to say a rather embellished “Thanks”. Without your self, many other members of your staff, and your team surgeons at the time, I would never even have met the daughter-in-law mentioned above. With your help I was able to see two sons through college and to actually return to work and then retire. Talk about transplantation permitting a return to normal life, there can be no question. Sure there have been some nasty side trips definitely traceable to the required drugs, but that is not an exposure unique to being a transplant recipient.

And most significantly to me, on all of these sometimes very fearful adventures in undesirable medicine, you have been there both formally to assist in getting second opinions and informally as a firm rational information base without any attempt to make situations nicer than reality. Now that type of person and we all know you aren’t the only one, is as close as anyone wants to get to a friend in the medical profession.

Fortunately for myself and for all others, the transplant field seems to draw the cream of professional people. I have been under the care of others since leaving California, who have instilled in me the same high level of confidence and willingness to accept their decisions unquestioningly. However, in the trauma of a heart transplant, particularly when the procedure was as tentative as it was in January of '88, the staff who’s persona are maintained with the highest esteem are those such as yourself, who took the patient from sure death, to close to a “normal” life. At the time most laymen regarded it as a miracle. I know it was not, it was talent and hard work on the part of many people.

I am now approaching old age, so closely that my former concerns about being retransplanted if necessary are not gone, but fading. I can delightedly inform you that retirement is the best of all worlds. As active intellectually and physically as you have been, I’m positive you will open a whole new era of success.

I know that a simple “Thank you” will be more than enough to happily send you on your way. And better for me, I accept with honor and pleasure your offer to “stay in touch” as a friend. As they say, you’ve got it!

Respectfully yours,

Don M.

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Feds Revise Medicare Standards for Transplant Centers

WASHINGTON (AP 8/2/00) — Medical centers that perform heart, liver and lung transplants for only one year can serve Medicare patients under revised federal standards issued Wednesday.

Previously, transplant programs had to perform procedures on patients not entitled to Medicare for two years before applying for government benefits, said Nancy-Ann DeParle, head of the Health Care Financing Administration, the Health and Human Resources agency that administers Medicare.

Recent studies conclude that the num of transplants performed by a center is re important in predicting successful surgeries than the number of years of expe ice, DeParle said in a statement.

Transplant centers still must meet other dicare standards including those con ning patient selection policies, ility resources and survival rates.

Israeli Surgeons Implant Breakthrough Heart Device

By Megan Goldin

Jerusalem (Reuters 7/30/00) - Israeli surgeons said on Sunday they had broken medical ground by implanting an experimental device in a 64-year-old man which could enable people dying of heart failure to live normally without a transplant. Dr Jacob Lavee, head of the transplant unit at Sheba Medical Center near TelAviv, said the battery-powered electric pump weighed about 350 grams and did most of the work of the left ventricle, the heart’s main pump ing chamber

“It’s the first time it has been planted in a human being, “Lavee told Reuters.

He said the device, HeartMate 2, made by Massachusetts-based Thermo Cardio systems Inc, was a smaller and more effective version of the company’s original left ventricle assist device, HeartMate.

The original HeartMate was designed only as a temporary solution while a patient waited for a heart transplant, but the new device — whose price has yet to be set —would be permanent.

“HeartMate 2 is meant to be an alternative to human heart transplants, “Lavee said.

‘If the new technology is proven to be successful, and it will take another year; it has the potential of solving the problem of many thousands of patients waiting for heart transplants around the world,” he added.

LAST CHANCE

The device was installed in the patient, identified only as A.S, during a 14-hour operation Thursday at Sheba Medical Center. Lavee said the man, who was on the verge of dying before the operation, was in critical condition after the procedure.

Initial tests after the surgery showed that HeartMate 2 was working well, he added.

With HeartMate 2, Lavee said, the patient could look forward to a normal lifespan assuming he was able to overcome the damage done to his organs from months of heart failure.

He said that before Thermo Cardiosystems Inc sought the US. Food and Drug Administration ‘s approval for HeartMate 2, it would be tested on other patients who, like A.S., were dying from heart disease and deemed unsuitable for transplants.

The FDA approved HeartMate in 1998 for dying patients waiting for transplants.

A major benefit of HeartMate 2 is that patients do not need to take anti-rejection drugs which often cause organ damage and lower the immune system, making them susceptible to illness.

However, Lavee said patients with HeartMate 2 would need to take aspirin and other anti-clotting medication.

The number of hearts available for transplants is usually a fraction of the number of people waiting for heart donations. In the United State an estimated 15,000 to 20,000 people need heart transplants each year, but there are only enough hearts for about 2,000 people.

Lavee said the problem was particularly severe in Israel, which had a very low rate of heart donations compared with other countries due to religious beliefs that made people less likely to donate organs.

Contributed by Tx David Cannavo

(Unfortunately the patient died about 5 days later “due to causes unrelated to the artificial heart. “Ed.)

Optical Catheter May Permit New Transplant Biopsy Procedure

Vancouver, B. C., (Business Wire 7/13/ 00) — Biomax Technologies Inc. is pleased to announce that it has received an Office Action from the United States patent & Trademark Office that indicates that least 13 claims in its primary US. patent application related to the Company’s Optical Catheter technology will be allowable if the Company makes some minor formal amendments to the claims.

This is an important milestone for Biomax, as it will enable the Company to maintain strong patent protection for its primary product candidate.

In addition, the Company announces that it has completed its final large Animal study using the Optical Catheter. The study involved the in vivo analysis of 8 pigs in corporating anti-rejection therapy. Over 4,100 optical spectra were obtained during 83 biopsy sessions: three to four days before transplant, at the time of transplant, and every three to four days over the next two weeks as anti-rejection therapy was modified.

As with previous studies, the results demonstrated a correlation between autofluorescence response and the degree of rejection as determined by pathological observations. Based on these positive results, the Company has determined that it has obtained sufficient animal data for it to make application to the United States Food & Drug Administration for an Investigational Device Exemption (IDE). The IDE, once obtained, will enable the Company to commence a human clinical trial utilizing the Optical Catheter; which is currently forecast to commence prior to the end of 2000.

The human clinical trial of the Optical Catheter will be led by James B. Young, MD, FACC, Head, Section of Heart Failure and Cardiac Transplant Medicine and Medi cal Director; Kaufman Center For Heart Failure at the Cleveland Clinic Foundation, Cleveland, Ohio. In addition, Howard J. Eisen, MD, FACC, FACP, Medical Direc tor; Heart Transplant and Director of Heart Failure Intensive Care Unit at Temple University School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania will also be a US Investigator The Cleveland Clinic Foundation and Temple University are two of the five largest heart transplant centers in the world. The trial will also be conducted at St. Paul’s Hospital, Vancouver; BC and one other site yet to be determined.

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Gene for Rare Lung Condition Found

WASHINGTON (Reuters 7/27/00) - Several teams of researchers say they have identified a gene involved in primary pulmonary hypertension, a rare but serious lung condition that can kill.

Knowing about the gene did not offer any immediate hope for treatment, but could help scientists understand the condition, which can cause patients to need a lung transplant and which can kill within 5 years, the researchers said.

PPH is characterized by uncontrolled proliferation of cells in the blood vessels of the lungs. They block the vessels, forcing the heart to pump harder and raising blood although a lung transplant or a continuous intravenous dosing of the drug prostacyclin can help.

The researchers found that defects in a single gene, the bone morphogenetic protein receptor!! (BMPR2) gene, were associated with PPH. The gene regulates growth and development of the lung, they reported in two separate reports, published in the journals Nature Genetics and the American Journal of Human Genetics.

“Now that we have pinpointed a gene, we can focus on learning how it works,” Dr Claude Lenfant, director of the National Heart, Lung, and Blood Institute, which funded both studies, said Wednesday in a statement.

“That information should enable us to devise better treatments and perhaps eventually a preventive therapy or cure.”

Women are more at risk of PPH than men and several conditions are associated with its development, including pregnancy, underactive thyroid, the use of oral contraceptives, cocaine, or the banned appetite suppressant drug combination ofphentermine and fenfluramine (phen fen).

New Jarvik 2000 Heart Pump

By Joel Anderson - Associated Press Writer

HOUSTON (AP 7/21/00) — The first person to have a new type of miniature heart pump successfully implanted to keep her blood flowing while doctors searched for a replacement is back home after undergoing a heart transplant.

Lois Spiller; a 52-year-old retired financial analyst, spoke between tears Thursday as she described her joy over her improved health.

“I’m just real happy to be here today” she said. “!just knew I had to come through this after all the support my family and the doc- tors had given me.”

To keep her alive until her transplant, the Jarvik 2000 left ventricular assist device was implanted in Spiller ‘s failing heart on April 10, after her physicians gained approval from the US. Food and Drug Administration to begin clinical trials with the device.

The battery-operated device is about the size of a wine cork and ftts directly into the heart’s left ventricle. When the heart can no longer pump properly, the tiny turbine pushes oxygenated blood throughout the body.

The implantation of the device brings scientists closer to the goal of finding an alternative to a heart transplant. For now, the FDA has approved study of the pump only as a bridge to transplant.

Two other patients with end-stage heart failure have been implanted with the device and are waiting for donor hearts to become available. Another two had the device implanted on an emergency basis; both died shortly after the surgery.

Spiller. whose heart trouble dates back to 1987, had the implant in her enlarged heart for 79 days. She received her heart transplant three weeks ago and was released from the hospital July 11.

Spiller said she is getting around just fine, and has even cooked breakfast and washed dishes since leaving the hospital. Before the artifìcial pump was transplanted, she was so weak that she struggled to even talk.

According to the Texas Heart Institute, about 5 million Americans suffer from heart failure. The ideal therapy is a transplant, but there are only about 2,500 donor hearts available each year About 6,000 patients annually die before receiving a transplant.

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The following article is a hold-over from last month’s UpBeat

New Pacemaker-Like Device Tested

By LAURAN NEERGAARD - AP

WASHINGTON (AP 5/2 WOO) — Jim Kent was the most avid of outdoorsmen, constantly golfing or fishing or hunting. Then a mountain hike left him gasping for air Heart failure, doctors said. Within a few years Kent’s heart was so weak he was housebound and on the waiting list for a transplant.

Almost 5 million Americans have congestive heart failure, where their hearts gradually lose the ability to pump blood. Drugs help many, but those like Kent whose hearts worsen despite medication have few options.

Now scientists are experimenting with a new pacemaker-like device called a "ventricular resynchronizer” that promises to help these struggling hearts beat more normally.

Kent is one of the few Americans to try one — and today the 60-year-old Louisiana man is back on the golf course and off the heart transplant list. Prompted by such early promising results, scientists are hunting 2,000 more heart failure patients for a study to prove how well the experimental treatment, made by Guidant Inc., really works.

“Right now there’s not a lot you can do for these patients,” said Dr Eric Prystowsky, electrophysiology director at St Vincent Hospital in Indianapolis. “This is very exciting.”

Heart failure is not a heart attack Nor does it mean the heart suddenly stops.

Instead, a heart weakened by age, damage from a survived heart attack or some other disease gets flabbier as it struggles to push blood out to the rest of the body. Lacking oxygen, patients feel dizzy or faint. Eventually, they’re pressed even to walk across a room. Their legs swell. Fluid seeps into their lungs, blocking breathing.

Just half of victims survive five years. When medications fail, they have few options.

Enter the ventricular resynchronizer.

It’s basically a souped-up and redesigned pacemaker But it doesn’t speed up a sluggish heartbeat like regular pacemakers do. Heartfailure causes the opposite problem — the struggling heart beats faster to compensate for weakened pumping. And the heart’s two bottom chambers, the ventricles, don ‘t pump together in rhythm like they’re supposed to.

The idea: Resynchronize the right and left ventricles so they pump at the same time, making that pumping more forcefuL Then the heart might not wear itself out pumping so fast.

Doctors thread three separate pacemaker wires, “leads “ that deliver electricity, into a vein near the collarbone. Two leads are popped down to the heart’s right side, just like a routine pacemaker implantation. The breakthrough came when scientists figured out how to put a third lead on the more vulnerable left ventricle, so both sides can be sparked to pump together It’s tricky, requiring threading into just the right spot in a vein lying on the ventricle’s walL

It’s not a cure. But early results are promising, German scientist Dr Angelo Auricchio told a recent meeting of the North American Society of Pacing and Electrophysiology. In a study of 42 severely ill Europeans, a single month’s use of the device improved the heart’s pumping efficiency by 15 percent, and significantly increased patients’ ability to walk Longer use seems to be reducing hospitalizations.

Dr Scott Higgins of Scripps Memorial Hospital in San Diego has implanted 60 Americans with the Guidant device.

The devices long-term impact isn ‘t proven. But Kent , the Port Allen, La., man, calls his implant life-changing. “It’s nothing worse in the world than not being able to breathe ... But right now, nothing’s too strenuous.”

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