As early as 2500 years ago in the Warring States period, "Lie Zi Tang asked articles" has such a record: Que commanded the disciples to treat trauma "poison" the bubble as "poisoned", again with a small iron knife flesh worn shiny, soaked in wine. Then he let Mr. Lu Hu and Zhao Qi infants and two heart patients, drinking "poisoned" and took off his coat back lying wooden bed. Soon, they will lose consciousness, pulse still beating. Que picked up immediately, "scalpel", then cut open their chests, the public Lu Hu and Zhao Qi infant heart exchanged. Both results quickly back to health.
Process This story operational point of view, it seems to fit the transplant surgery and anesthesia procedures. However, the two so easily replaced with the patient's heart, which is impossible at the time that extremely low levels of medical era. So, modern medicine on the heart transplant and how the birth of it?
Nurses black hair was sewn vascular challenge "rejection of the body."
In 1912, French surgeon Karel, the invention of "vascular suture" was awarded the Nobel Prize in Physiology or Medicine. Prior to this, if the wounded were injured aortic rupture, you can only use a tourniquet. Although the blood stopped, but parts of their bodies connected with this was due to the lack of timely replenishment of blood nutrients, muscle necrosis soon. To turn on vascular suture must be carried out, otherwise the wound bleeding, thrombosis, limb necrosis will follow. Karel through constant research and improvement to create a "three-line suture." He put two separate aliquot end of three vessels, butt folded, then very fine needle and suture the blood vessel wall smooth, blood flow. Was no better or fine nylon suture material, Karel used silk nurses hair. Pin is handmade, very fine.
Vascular closure technology has become a basic skill of contemporary surgeon. In 1905, the first use of this Karel invention, a heart transplant to another puppy dog a big neck and neck vascular anastomosis success. Results puppy heart beating continued for nearly two hours, and finally stopped due thrombosis. In 1906, Karel to the Rockefeller Institute, continue to engage in all kinds of organ transplants exploration. Which has done most of the leg and the dog is allogeneic renal transplants. At that time the medical profession generally believe that, as long as the transplanted organs and the body's blood interlinked solve the nutrition problem, this organ can also long-term survival. For example, the dog's legs Karel transplanted into another body, another dog really can be a normal walking. However, less than 40 days, the dog's legs began to piece transplant fester. This "strange phenomenon" is not only to make Karel himself and his colleagues confused, has become plagued by decades unsolved medical profession. In 1933, two American doctors are dogs similar Karel heterotopic heart transplantation experiments, but unfortunately only after the dog survived for eight days. However, due to advances in technology and equipment, they observed a transplanted heart tissue by lymphocytes, monocytes and neutrophils are infiltrated, and often accompanied by edema. They thus bold speculation, after heart transplant recipient survival does not depend on whether the surgical technique itself, is likely to depend on whether they are some biological factors "interference."
Later, doctors further research shows that this hypothesis is correct. It turned out that the transplanted organ from another individual, and as a recipient organism has a natural immunity, it can be identified, attack and destroy the body to enter the "alien" organization. This physiological defense response after surgery showed rejection, a direct result of damage to organ transplants, resulting in graft failure. Therefore, for long-term survival of transplanted organs, it is necessary to do the opposite, to take a variety of means including drug suppression, including "rejection." In 1963, a scholar during orthotopic heart transplantation during experimental dogs during and after the use of immunosuppressive agents, experimental dog survival period is extended to 42 days, provided a successful template.
"The ice has been broken, the route has been opened, the road has been specified." It is time to target the human heart transplant turned! But who is going to do the first "eat crab" warrior it?
Cape Town a triumph "for the heart of man" Decade Birthday
In 1964, Hardy medical team at the University of Mississippi United States, has accumulated eight years of successful experience in animal experiments on the basis of the first to respond to the call of history. They chose receptor is a 68-year-old man with end-stage heart disease, while the donor was originally a healthy human heart. However, due to the rapid deterioration of the patient's condition, the time has not allowed waiting for a donor, so Hardy decided to switch decisive chimpanzee heart transplant in situ. Fengyun heart surgery in support of artificial heart-lung machine under good beat, but because it is too small, can not effectively support the body's blood circulation, so that the patient is removal of the catheter and the artificial heart-lung machine is connected to a half-hour after death a.
3 years later. December 3, 1967, history finally chose another was still unknown thoracic surgeon - Barnard. That day, in the southern tip of Africa Cape Town to Barnard headed the medical team has 30 people involved, for when he was 53 year-old patient Hua Xikan Sharansky was a heart transplant. 10 years, the patient several times due to myocardial infarction and rescue, this time at the brink of death. The donor was a 24-year-old woman died in a traffic accident of a healthy heart. Preoperative oral carried out a variety of drugs, radiation and other local acceptance of prevention "rejection" process. After heart transplant patients from healing quickly, to 12 days have been able to get up activities. But it is a pity, to December 21, a severe pneumonia has claimed the lives of patients. Although patients survived for only 18 days, but this is the world's first human orthotopic heart transplantation surgery, has great historical significance. January 2, 1968, at Barnard, she was encouraged by while they as a dentist named Brian Berg, 46, was a heart transplant. Preoperative patient effort extreme exhaustion, only sleepless night, sitting on the bed struggling to breathe. 3 days after heart transplant surgery, the patient's symptoms disappeared completely, 74 days after he was discharged. The surgery to create a more patient survival for up to 594 days of miracle!
In November 1978, it was the world's longest survival after heart transplantation patients Witte Calabria, in Marseille, France celebrated his new heart beat 10 anniversary. 10 years ago he was 48 years old, due to a serious heart condition forced bedridden. One night in November 1968, he was implanted with 20-year-old youth in the heart of Marin die in a car accident. Since then, not only Werther Doria returned to normal work and life skills, but also cycling, swimming and other sports.
However, we in the great achievements of cardiac transplantation deeply gratified at the same time, it must clearly see that this operation is still facing many challenges. Although the United States to accept a Tony Houseman died in traffic accidents in the 18-year-old young men's heart transplant in August 30, 1978 after until September 6, 2009 until his death, becoming the survival of the world's most - more than 30 years of patient, but in general, so far underwent heart transplant surgery in many patients, the survival rate and quality of life is also not ideal. This was mainly due to rejection. Despite the advent of a variety of immune suppressing drugs, but it is a "double-edged sword" - insufficient dosage, obviously it can not play its due overdose, will weaken the body's resistance to disease and hematopoietic function, so patients prone to infection, and even hasten death. How should scientists face the new challenges of it?
"Double intention" ingenuity good policy "artificial heart" have sprung up everywhere
Barnard who was a doctor, ingenuity proposed a double heart transplant program. He transplanted heart, near to the patient has heart disease, heart and the aorta and each other interconnected. Thus, patients with chest simultaneously two different heart beating heart. Heart transplants are mainly responsible for the delivery of blood to the body of the task, but the blood still flowing through the original heart. Two heart coordination, greatly reducing the burden on the heart sick. In particular, this "double intention" do not worry "rejection." Because once this phenomenon, doctors can remove the heart transplant immediately, and let the patient's own heart sinking, have adequate rest to work again. Accept this "double heart" surgery 19 patients, three years later, there are 14 patients still survived, the survival rate of over 70%.
Of course, in addition to heart transplantation rejection, the donor is a serious lack of doctors also tend to make "make bricks without straw." As a result, doctors have a bold and innovative ideas artificial heart. The first artificial heart full of material, although only 64 hours of continuous work of chest of a patient, while filling the doctors saw the promising new dawn. After decades of efforts, the US scientists finally the dawn of the new century, to overcome this global problem. This artificial heart consists of four parts: heart made of titanium metal body, miniature lithium battery, the computer control system and the external battery pack. The core is the heart of the body, weighing about 900 grams, about the size of an apple, constituted by a micro motor and pump. It is different and the human heart, not four chambers, only the left chamber and the right chamber. First and then left the chamber is connected to the pulmonary veins and arteries, and right chambers respectively connected to the pulmonary artery and vein. The connection between the two chambers is an electric motor and pump. Artificial parts of the heart and blood vessels connected to the interface, there is no valve, only the piston. So, how artificial heart work? First, the right chamber to accept the delivery vein deoxygenated blood from the heart of the middle part of the micro-pump drive belt bubble pressure, blood into the lungs. Next, the blood oxygen the lungs into the left rear of the chamber, and then transported by the pump to the arteries, and to pump blood to the systemic circulation. This process is repeated, the analog implementation of the full functionality of the human heart.
In 2000, the city of Birmingham, England a 68-year-old man with heart disease Peter Horton was taken to hospital, the doctor diagnosed their remaining life is not more than two weeks, but the use of the artificial heart, he not only survived for a full seven years half, but also improves the quality of life. He not only traveled with his wife Diane, and even participated in a 146 km away in charity walk ......
1987, as an emblem like Que, in the second session of the International Transplant Congress held in Washington, DC, has thought-provoking, and more inspiring. Time flies, and fast in the past 30 years, heart transplantation Although there has been a new major breakthrough, but compared with the Que "little things" and "change minds" still far away. Thus, today's physicians are concerned, it is still a long journey, grass horizon ......
(Author: Wang Zhen via "Science 24")
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