
The engineer who fixed his own heart - drucken
http://www.bbc.co.uk/news/health-24524027
======
graeham
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...](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1802172/pdf/annsurg01428-0088.pdf))

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

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

~~~
graeham
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!).

------
Pxtl
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.

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

------
woolywonder
Tal provided one of my favourite Ted talks on this subject:
[http://www.ted.com/talks/tal_golesworthy_how_i_repaired_my_o...](http://www.ted.com/talks/tal_golesworthy_how_i_repaired_my_own_heart.html)

------
renang
For the ones wondering how the device looks like:
[http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07...](http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07E18AED000005DC-926_468x446.jpg)

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

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

------
kposehn
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).

------
Wingman4l7
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.

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

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

~~~
Wingman4l7
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...](http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07E18AED000005DC-926_468x446.jpg)

------
gonzo
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.

------
fernly
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](http://en.wikipedia.org/wiki/Annuloaortic_ectasia)
[1][http://en.wikipedia.org/wiki/Marfan_syndrome](http://en.wikipedia.org/wiki/Marfan_syndrome)
[2][http://en.wikipedia.org/wiki/Aortic_dissection](http://en.wikipedia.org/wiki/Aortic_dissection)

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

This is me:

[http://aorticdissection.com/2011/12/06/jim-
thompson-47/](http://aorticdissection.com/2011/12/06/jim-thompson-47/)

~~~
z3niMAGiNE
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.

~~~
gonzo
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.

------
VladRussian2
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.

~~~
pcrh
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...](http://www.ucl.ac.uk/operational-
research/the_team/TomTreasure)

------
coldtea
Hasn't Tony Stark already done this?

------
mwetz
Great title.

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

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

------
notdrunkatall
Sounds incredibly obvious.

~~~
Wingman4l7
Apparently the basic technique was examined in the '50s:
[https://news.ycombinator.com/item?id=6770227](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.

