from Hacker News

The engineer who fixed his own heart

by drucken on 11/20/13, 4:43 PM with 39 comments

• by graeham on 11/20/13, 7:01 PM

  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.

• by Pxtl on 11/20/13, 7:06 PM

  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.

• by woolywonder on 11/20/13, 5:28 PM

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

• by renang on 11/20/13, 7:31 PM

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

• by kposehn on 11/20/13, 9:05 PM

  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).

• by Wingman4l7 on 11/21/13, 4:14 AM

  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.

• by donquichotte on 11/20/13, 7:24 PM

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

• by dmak on 11/20/13, 5:43 PM

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

• by gonzo on 11/21/13, 1:17 AM

  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.

• by fernly on 11/21/13, 1:21 AM

  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

• by VladRussian2 on 11/20/13, 7:37 PM

  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.

• by coldtea on 11/22/13, 12:15 PM

  Hasn't Tony Stark already done this?

• by mwetz on 11/20/13, 7:01 PM

  Great title.

• by blaco on 11/20/13, 6:35 PM

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

• by notdrunkatall on 11/21/13, 1:33 AM

  Sounds incredibly obvious.