Thursday, June 29, 2006
DIABETES ARTICLES. Surgeons elated by heart partient
DIABETES ARTICLES.
Surgeons elated by heart partient
Surgeons who implanted the first self-contained artificial heart on Monday said today that so far the patient's recovery had vastly exceeded their expectations.
The surgeons strongly cautioned that the procedure was an experiment in which a complication could occur at any time because of the patient's severe illness and the complexity of the AbioCor artificial heart that they implanted. But they expressed optimism that their patient, identified only as a man in his 50's, would be able to return to daily activities.
One complication that the surgeons described as ''very minor'' has already occurred; late Monday night, the patient underwent a second operation lasting two hours to stop bleeding caused by one or two loose stitches among the hundreds placed in his chest during the original implant operation. Officials at Jewish Hospital, where the implant was performed, did not mention the problem in Tuesday's announcement of the procedure.
At a news conference today, the surgeons described the patient as a diabetic man in his mid-to-late 50's who was terminally ill with heart failure and who was in dire condition before the implant operation. Another medical center outside the Louisville area had rejected the man as a candidate for a heart transplant because he had significant kidney failure and abnormally high pressure in blood vessels in his lungs, the surgeons said.
But surgeons who implanted his artificial heart say he may eventually be eligible for a heart transplant.
The man had had an 80 percent chance of dying within 30 days because earlier heart attacks had left such extensive scarring that the heart's two pumping chambers were failing badly, they said.
Before the operation, the man's lungs had been drowning from pulmonary edema, a buildup of fluid that occurs in heart failure, said the surgeons, Dr. Laman A. Gray and Dr. Robert D. Dowling, from the University of Louisville. By this morning, the artificial heart, which has been beating about 120 times a minute, had virtually cleared the fluid from his lungs. They said they were surprised that the problem had resolved so quickly.
The man is conscious but sedated, has responded appropriately to commands and recognizes relatives who have been constantly at his side, the doctors said. They said they expected him to resume speaking after doctors removed a breathing tube connected to a mechanical respirator; later they said the tube had been removed.
Dr. Gray said one reason for his optimism was that tests that measure blood levels of creatinine, a substance that reflects kidney function, had shown no deterioration.
The doctors said they hoped to have the man sit in a chair in the next few days. But they said they were reluctant to make predictions about when he might walk and conduct other normal activities because the man's muscles had become so weak in recent weeks as his heart failure worsened and he was forced to use a wheelchair.
''When he came into the hospital, he could only walk a few feet at a time and could not walk down the corridor because he was so weak,'' Dr. Gray said. ''He did not have enough energy to eat'' and digest protein.
Dr. Dowling said his team did not know how long it would take for the man to gain enough strength to resume normal activities if he continued to progress without complications.
The man sought the heart less than two weeks ago, the doctors said.
When he was admitted to Jewish Hospital, the surgeons said, they had to insert a device known as an intra-aortic balloon pump to help his heart pump. They said the man's heart could barely pump enough blood to keep him alive. He was not a good candidate for a ventricular assist device, another type of implanted device that can keep some people with heart failure alive, because of increased blood pressure in his lungs. They said he needed three drugs, which they did not name, to maintain an adequate blood pressure. A standard creatinine blood test was about 3, showing moderately severe kidney failure.
by Laurce K. Altman at New York Times
Surgeons elated by heart partient
Surgeons who implanted the first self-contained artificial heart on Monday said today that so far the patient's recovery had vastly exceeded their expectations.
The surgeons strongly cautioned that the procedure was an experiment in which a complication could occur at any time because of the patient's severe illness and the complexity of the AbioCor artificial heart that they implanted. But they expressed optimism that their patient, identified only as a man in his 50's, would be able to return to daily activities.
One complication that the surgeons described as ''very minor'' has already occurred; late Monday night, the patient underwent a second operation lasting two hours to stop bleeding caused by one or two loose stitches among the hundreds placed in his chest during the original implant operation. Officials at Jewish Hospital, where the implant was performed, did not mention the problem in Tuesday's announcement of the procedure.
At a news conference today, the surgeons described the patient as a diabetic man in his mid-to-late 50's who was terminally ill with heart failure and who was in dire condition before the implant operation. Another medical center outside the Louisville area had rejected the man as a candidate for a heart transplant because he had significant kidney failure and abnormally high pressure in blood vessels in his lungs, the surgeons said.
But surgeons who implanted his artificial heart say he may eventually be eligible for a heart transplant.
The man had had an 80 percent chance of dying within 30 days because earlier heart attacks had left such extensive scarring that the heart's two pumping chambers were failing badly, they said.
Before the operation, the man's lungs had been drowning from pulmonary edema, a buildup of fluid that occurs in heart failure, said the surgeons, Dr. Laman A. Gray and Dr. Robert D. Dowling, from the University of Louisville. By this morning, the artificial heart, which has been beating about 120 times a minute, had virtually cleared the fluid from his lungs. They said they were surprised that the problem had resolved so quickly.
The man is conscious but sedated, has responded appropriately to commands and recognizes relatives who have been constantly at his side, the doctors said. They said they expected him to resume speaking after doctors removed a breathing tube connected to a mechanical respirator; later they said the tube had been removed.
Dr. Gray said one reason for his optimism was that tests that measure blood levels of creatinine, a substance that reflects kidney function, had shown no deterioration.
The doctors said they hoped to have the man sit in a chair in the next few days. But they said they were reluctant to make predictions about when he might walk and conduct other normal activities because the man's muscles had become so weak in recent weeks as his heart failure worsened and he was forced to use a wheelchair.
''When he came into the hospital, he could only walk a few feet at a time and could not walk down the corridor because he was so weak,'' Dr. Gray said. ''He did not have enough energy to eat'' and digest protein.
Dr. Dowling said his team did not know how long it would take for the man to gain enough strength to resume normal activities if he continued to progress without complications.
The man sought the heart less than two weeks ago, the doctors said.
When he was admitted to Jewish Hospital, the surgeons said, they had to insert a device known as an intra-aortic balloon pump to help his heart pump. They said the man's heart could barely pump enough blood to keep him alive. He was not a good candidate for a ventricular assist device, another type of implanted device that can keep some people with heart failure alive, because of increased blood pressure in his lungs. They said he needed three drugs, which they did not name, to maintain an adequate blood pressure. A standard creatinine blood test was about 3, showing moderately severe kidney failure.
by Laurce K. Altman at New York Times
