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From Heart to Heart

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by

Meenakshi Singhal

on 11 June 2013

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Transcript of From Heart to Heart

While the first kidney transplants occured in the 1950s, many doctors speculated whether people afflicted with cardiovascular diseases could benefit from a completely new heart. However, it was considered such a precious organ that no one wanted to disturb it. History of Cardiology 1628- William Harvey discovers how blood circulates.
1893- Dr. Daniel Hale Williams performs first successful heart surgery on James Cornish, who had a stab wound.
1940s- During WW2, Dr. Dwight Harken removed shrapnel from over 130 soldiers' chests without a single fatality.
1944- Surgeons operate on a blue baby (infants who are weak due to heart defects) and heart surgery becomes more viable.
1950- After studying hibernation in groundhogs, Dr. Bigelow realizes that putting the patient into hypothermia could increase the time available to perform the surgery.
1953- Dr. John Gibbon invents the heart-lung machine, which takes over the role of oxygenating blood so surgeons could effectively operate on a still heart. Introduction On December 3, 1967, the fate of medicine was forever altered. Beating all Odds A Cardiac Conundrum For the following decade, heart transplants took off. Numerous surgeons replicated Dr. Barnard's procedure. Cyclosporine unlocked the door to a transplant revolution- During the 1980-90s, survival rates soared to 80% for a year. Thousands of patients were given new lives. By: Mannu Singhal From Heart to Heart When surgeon Christiaan Barnard performed the first human heart transplant, others were inspired to do the same and improve the method. "A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues." -Dr. Theodor Billroth, 1883 "Like many of the most successful heart surgeons, he thought of the organ as merely a 'primitive pump' - one that demanded respect, but commanded no great mystical power, no soul." Unfortunately, Louis W. passed away after 18 days after contracting double pneumonia. This was due to the powerful immunosuppressant drugs he was given. Meanwhile, a few carried on in their laboratories and experiments on animals, attempting to perfect the techniques they devised before applying them. -Blood and Guts Immunosuppressant Drugs- Medicines that transplant recipients have to take every day to lower their immune system; otherwise, it would recognize the donated organ as a foreign object and try to destroy it. The first heart operation took place on December 3, 1967 in Cape Town, South Africa at Groote Schuur Hospital.
The donor was 25-year old Denise Darvall, who passed away in a car accident.
Louis Washkansky, a 54 year old with heart disease, was the recipient. However, the survival rates were minimal at first: In 1968, over 100 surgeries were conducted and only 10% survived 2 years. Why would that happen? Major histocompatibility antigens (MHC) Proteins found on the surface of nearly every cell of your body; you inherit a few types from both of your parents.
Everyone has their own distinct combination of MHC. There is a huge variety, so the only person you'll probably have a 100% match to is an identical twin.
When the antigens from one person are detected by the T cells (immune cells) from another person (as in the case of a transplant), then the body realizes something isn't right and tries to get rid of the organ.
The same thing happens when you get an infection. Bacteria don't have your unique antigens on them either, so T cells know to get rid of them. "The results, although poor by today's standards, were exceptional when one considers the primitive nature of the immunosuppressive therapy available at the time (basically azathioprine, corticosteroids, and antilymphatic serum)." -Cooper, 603 The first immunosuppressant drugs included azathioprine (Imuran). It works by disrupting the mitosis of T cells. However, azathioprine could take months to start working and increases the risk of blood, skin, and bone cancer. Thanks to his venture, thousands of people today are living longer and healthier lives. In 1976, a Swedish company unearthed a fungus with mysterious properties. "They might suppress the immune system, but the A-Z of nasty things these drugs could also do to the body ranged from the inconvenient to the fatal." From it, they isolated a compound called Cyclosporine A (CsA). It is another, more widely used immunosuppressant drug.
CsA works by stopping an essential molecule (Interleukin-2) that promotes the growth of T cells and immune responses. A T cell is a highly specialized immune cell whose job is to destroy unidentified objects in the body, like donated organs. The Wonder Fungus Small Steps Something from a Single Cell One rapidly advancing area is regenerative medicine, a.k.a. stem cells. These undifferentiated cells can change into any of the 200 cells in your body. Another radical idea is growing entire, functioning organs from them. Currently, scientists have created small patches of cardiac cells that beat rhythmically.
The aim is to make them bigger and have a definite shape as well as be properly vascularized. - Blood and Guts Conclusion While waiting for a transplant, some people receive artificial hearts. Mechanical Hearts LVAD- It's improved survival rates in the majority of recipients.
In the end, scientists are striving to design entire artificial hearts that last a lifetime, therefore eliminating the rejection issue. In the end, we've gotten far since 1967. Today, survival rates for 1 year are >90% and >80% for 5 years as physicians amend their techniques and find better ways to suppress the immune system. Now, 3,000 heart transplants are performed annually on people of all ages and backgrounds.
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