6 ms·

The engineer who fixed his own heart

100 points by drucken 13y ago

woolywonder 13y ago
Tal provided one of my favourite Ted talks on this subject: http://www.ted.com/talks/tal_golesworthy_how_i_repaired_my_own_heart.html http://www.ted.com/talks/tal_golesworthy_how_i_repaired_my_o...
- deleted 13y ago
  [deleted]
  - icegreentea 13y ago
    I think your brother is probably rolling his eyes when he agrees that yes it would be great if we had a cheap and effective universal mass screening tool for cancer. I mean, why would -any- doctor not want that. Why would any cancer researcher not want that. Oh, but it would mean they would lose their funding you say. But in exchange, you get ever-lasting fame. Oh, and you don't have to worry about having probes shoved up your ass, or have bits of your breast cut out for inspection when you get to "that age". I think your supposition ignores a lot of the latent difficulties in the subject area. You could very well rephrase that as "why not try to create a drug that just kills all cancer with minimal side effects as it seems crazy to have to cut someone open and cut it out by hand". The answer to "why haven't we done more" is "because it's hard and we're working on it". Why isn't automatic machine translation any better? Why are natural language interfaces so crappy? Why does my speech to text program make mistakes? Why are we still using steel and concrete? Why don't have we have a room-temperature superconducting power grid? Why do we still have to get our meat from animals on a farm? Why don't we just make a cure for HIV? Why don't we just make a cure for the common cold? Why don't we just have a malaria vaccine (they really are working on this one! It's HARD!)?. The answer to all of these questions is "because it's hard and we're working on it".
    - dmd 13y ago
      Ok, how about "why can't I get vaccinated for Lyme disease?"
dmak 13y ago
I wish they went more into detail about the devise itself. I was hoping to see a picture.
- Wingman4l7 13y ago
  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-1243723-07E18AED000005DC-926_468x446.jpg http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07...
deleted 13y ago
[deleted]
- deleted 13y ago
  [deleted]
blaco 13y ago
am i the only one who was expecting a Tony Stark photo ?
- jonahoffline 13y ago
  No, I immediately thought of him too haha
- chrislomax 13y ago
  I don't know why you were marked down for this. Not marked up maybe but I was going to say the same thing!
graeham 13y ago
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/annsurg01428-0088.pdf 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.
- mherdeg 13y ago
  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 13y ago
    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!).
- 10dpd 13y ago
  Sorry but when you use the term "generally" in a medical context you can be sure the following statement is incorrect. This article is referring to the aortic root which cannot be stinted due to its proximity to the heart.
  - graeham 13y ago
    "Generally" refers to an average trend, not that all examples must follow that trend. I am not that familiar with Marfan's or this case, so I don't know if this device is useful in this case (http://www.medtronic.com/patients/heart-valve-disease/about-surgery/our-heart-valve-products/open-pivot-aortic-valved-graft/ http://www.medtronic.com/patients/heart-valve-disease/about-...), but there are stent-grafts that also replace the aortic value so that the stent-graft can be used close to the heart, and you can be sure that medical device companies are looking at ways of using stent-grafts in close proximity to the aortic valve without requiring its replacement.
mwetz 13y ago
Great title.
Pxtl 13y ago
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 13y ago
  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
donquichotte 13y ago
Sweet, finally a Hacker News post that features an actual engineer!
renang 13y ago
For the ones wondering how the device looks like: http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07E18AED000005DC-926_468x446.jpg http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07...
- tonyplee 13y ago
  Does the wrapping material dissolve after a while or last for the rest of one's life?
  - devb 13y ago
    If it dissolved, it would be pointless to have it put in.
VladRussian2 13y ago
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 13y ago
  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/TomTreasure http://www.ucl.ac.uk/operational-research/the_team/TomTreasu...
- frandroid 13y ago
  Having single-payer healthcare is important for this to happen, yes.
kposehn 13y ago
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).
gonzo 13y ago
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 13y ago
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
notdrunkatall 13y ago
Sounds incredibly obvious.
- Wingman4l7 13y ago
  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.
Wingman4l7 13y ago
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.
coldtea 13y ago
Hasn't Tony Stark already done this?

100 points by drucken 13y ago

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

deleted 13y ago
[deleted]
- icegreentea 13y ago
  I think your brother is probably rolling his eyes when he agrees that yes it would be great if we had a cheap and effective universal mass screening tool for cancer. I mean, why would -any- doctor not want that. Why would any cancer researcher not want that. Oh, but it would mean they would lose their funding you say. But in exchange, you get ever-lasting fame. Oh, and you don't have to worry about having probes shoved up your ass, or have bits of your breast cut out for inspection when you get to "that age". I think your supposition ignores a lot of the latent difficulties in the subject area. You could very well rephrase that as "why not try to create a drug that just kills all cancer with minimal side effects as it seems crazy to have to cut someone open and cut it out by hand". The answer to "why haven't we done more" is "because it's hard and we're working on it". Why isn't automatic machine translation any better? Why are natural language interfaces so crappy? Why does my speech to text program make mistakes? Why are we still using steel and concrete? Why don't have we have a room-temperature superconducting power grid? Why do we still have to get our meat from animals on a farm? Why don't we just make a cure for HIV? Why don't we just make a cure for the common cold? Why don't we just have a malaria vaccine (they really are working on this one! It's HARD!)?. The answer to all of these questions is "because it's hard and we're working on it".
  - dmd 13y ago
    Ok, how about "why can't I get vaccinated for Lyme disease?"

dmak 13y ago

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

Wingman4l7 13y ago
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-1243723-07E18AED000005DC-926_468x446.jpg http://i.dailymail.co.uk/i/pix/2010/01/16/article-1243723-07...

deleted 13y ago

[deleted]

deleted 13y ago
[deleted]

blaco 13y ago

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

jonahoffline 13y ago
No, I immediately thought of him too haha
chrislomax 13y ago
I don't know why you were marked down for this. Not marked up maybe but I was going to say the same thing!

graeham 13y ago

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/annsurg01428-0088.pdf 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.

mherdeg 13y ago
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 13y ago
  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!).
10dpd 13y ago
Sorry but when you use the term "generally" in a medical context you can be sure the following statement is incorrect. This article is referring to the aortic root which cannot be stinted due to its proximity to the heart.
- graeham 13y ago
  "Generally" refers to an average trend, not that all examples must follow that trend. I am not that familiar with Marfan's or this case, so I don't know if this device is useful in this case (http://www.medtronic.com/patients/heart-valve-disease/about-surgery/our-heart-valve-products/open-pivot-aortic-valved-graft/ http://www.medtronic.com/patients/heart-valve-disease/about-...), but there are stent-grafts that also replace the aortic value so that the stent-graft can be used close to the heart, and you can be sure that medical device companies are looking at ways of using stent-grafts in close proximity to the aortic valve without requiring its replacement.

mwetz 13y ago

Great title.

Pxtl 13y ago

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 13y ago
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

donquichotte 13y ago

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

renang 13y ago

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

tonyplee 13y ago
Does the wrapping material dissolve after a while or last for the rest of one's life?
- devb 13y ago
  If it dissolved, it would be pointless to have it put in.

VladRussian2 13y ago

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 13y ago
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/TomTreasure http://www.ucl.ac.uk/operational-research/the_team/TomTreasu...
frandroid 13y ago
Having single-payer healthcare is important for this to happen, yes.

kposehn 13y ago

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).

gonzo 13y ago

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 13y ago

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

notdrunkatall 13y ago

Sounds incredibly obvious.

Wingman4l7 13y ago
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.

Wingman4l7 13y ago

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.

coldtea 13y ago

Hasn't Tony Stark already done this?