of the Heart "
– SHOW 1104
Mending A Broken Heart
The Heart Factory
How's Your Heart?
ALDA This simple little device is going to help save a toddler's
life -- plugging a tiny hole left after the complete rebuilding
of his heart.
ALDA (NARRATION) Zachary has only half a heart.
BARTHOLET And this procedure's going to get him until he's
an old man.
ALDA (NARRATION) A robot surgeon…
ALDA I made a stitch.
ALDA (NARRATION) …now fixes hearts. My heart gets put through
MANNING Squeezing, squeezing, squeezing.
ALDA (NARRATION) And I hold a heart in my hands.
ALDA I can really feel the beating. I'm Alan Alda. Join me
as Scientific American Frontiers explores some Affairs of
A BROKEN HEART
ALDA It was the first part of you that had to go to work.
When your whole body was no bigger than this, and before your
mother even realized she was pregnant, your heart began to
beat -- even though it was no more than a tiny crooked tube.
With luck, and a little care and attention, it should beat
two and a half billion times before it eventually gives out.
For many of us though, just as the heart was the first organ
to go to work, it is also the first to fail us. In the next
hour, we're going to see some broken hearts get mended, and
find out how to keep them from breaking too young. We're starting
here, in Boston's Children's Hospital, with a heart that's
still an infant's -- and that only a few years ago, might
never have grown older.
ALDA (NARRATION) Zachary's heart problem was diagnosed before
he was born.
BARTHOLET We first found out that he had some cardiac issues
on a routine ultrasound. February 19th, 1998.
BARTHOLET Basically, his heart looks like it was put together
in a kindergarten art class.
ALDA (NARRATION) Zach's heart started to go wrong just a few
weeks after he was conceived. Instead of forming two main
pumping chambers -- one pushing blood to his body, the other
to his lungs -- his heart formed only one. He's still alive
today because of two operations that have replumbed his heart,
allowing its single chamber to keep blood flowing throughout
KAREN BARTHOLET Good, you got it in there!
BARTHOLET The first surgery he had got him till he was 5 months
old. At that point we had to have the next surgery or he wouldn't
have lived much longer. And that surgery, which he's under
right now, would probably allow him to live until he was 4
or 5, 6 or 7, years old, but not much longer than that because
his body's going to outgrow this procedure. And this procedure's
going to get him until he's an old man.
ALDA (NARRATION) So for the third time in his young life,
Zach is prepared for open heart surgery. The operation he
is about to have, here at Children's Hospital in Boston, is
called a Fontan procedure. In a normal heart, blood that is
pumped around the body by the left ventricle arrives back
at the right ventricle to be pumped to the lungs. But in Zach's
heart there is no right ventricle. So to get blood to the
lungs a new route has to be built -- and that's what the Fontan
does - it creates a tunnel for the returning blood that burrows
straight through the heart. Now a single heartbeat can push
blood around the body, through the tunnel and on to the lungs.
JONAS You all set there Bob? Let's go on.
ALDA (NARRATION) The operation begins when a heart-lung machine
takes over from Zach's own heart.
JONAS Now the heart is stopped right now and is not getting
any blood. So, that's why we need to move along at this part
of the operation.
ALDA (NARRATION) Surgeon Richard Jonas has performed scores
of Fontan procedures -- perfecting his tailoring as well as
his surgical skills.
JONAS Now we're gonna shape this Gortex patch.
ALDA (NARRATION) With Zach's heart cut open, Jonas starts
to sew the patch of cloth along its inner wall.
JONAS We've got to think about how this is going to be folded
over in a minute.
ALDA When you fold it over, is that…
JONAS It's going to make a tunnel, right.
ALDA That's how it becomes a tunnel. RICHARD JONAS Yeah, this
is the bottom end of the tunnel starting to take shape now.
ALDA I can't quite tell why it isn't in the shape of a tunnel
when you put it in. Why do you have to sew it into the shape
of a tunnel?
JONAS I guess it's not really possible for manufacturers to
perform something. For instance, every child is a different
shape and size so we really do have to custom build components
to fit into an individual child. It really is sort of tailor
made specifically for a child's situation. OK, well at this
point we're going to make the fenestration.
ALDA (NARRATION) With the cloth sewn in place, Jonas uses
a punch to makes a small hole -- called a fenestration --
in the side of the tunnel. Creating a deliberate leak like
this seems strange right now -- but in the days to come, this
little hole is to play a critical role in saving Zach's life.
But for the moment, there's no hint of trouble. After being
stilled for ninety minutes, Zach's heart is slowly stirring
back to life.
JONAS As the heart starts to get that warm blood, it will
gradually start to beat. You can see the first blip. The top
line there is the EKG. There's a beat there -- there's another
one -- there's another one. Yup, there we go.
ALDA (NARRATION) Twenty minutes later, Zach's rebuilt heart
is beating vigorously.
JONAS We're going to be off the heart-lung machine in about
ALDA (NARRATION) Zach's single ventricle is now able to pump
blood around his body and through his lungs almost like a
normal heart. But right now it's facing perhaps its greatest
challenge -- getting Zach through the critical few days following
surgery. As it turns out, his rebuilt heart comes close to
being overwhelmed -- by a simple cold.
ALDA How is Zach doing now?
LANG He's had one complication following the surgery, which
is that he developed a lung infection.
ALDA And that made it hard for the heart, if he hadn't had
LANG It makes it hard for blood to go through the lungs, and
in this adjustment period after the Fontan, without the fenestration
he could have gotten very sick. He could have been, oh, stuck
on a ventilator for a long time, and we've had children who've
had a Fontan operation and this kind of lung infection who
have died. So the fenestration…
ALAN ALDA So the fenestration was vital.
LANG I think so.
ALDA (NARRATION) Zach's cold lingers for days, but never becomes
life threatening -- thanks to the fenestration. Here's why.
His infection is making it hard for blood to flow through
his lungs -- so hard that his heart may simply have been forced
to a halt. But by allowing the backed-up blood to spill out
into the heart's main chamber, the fenestration is relieving
the pressure, and allowing his heart to keep pumping. Of course,
not all his blood is now going through his lungs, so it has
a little less oxygen than it should-- it's a little bluer.
But right now, that's a small price to pay.
LOCK This infection is exactly the kind of situation, if he
didn't have a Fontan fenestration, would have resulted in
a very high mortality rate. It's not unlikely he wouldn't
have made it if he didn't have a Fontan fenestration.
ALDA So the fenestration probably saved his life. Now he's
lived through this cold, which could have been fatal, possibly.
Now there comes a point where you want to close that hole
eventually, right? Why do you want to close the hole?
LOCK Because children can tolerate being blue pretty well
for a period of time. But it's not well tolerated life-long.
And so if we left that hole open, eventually he would suffer
complications from being blue.
ALDA So that's why you've got to close it and that's why you
ALDA (NARRATION) "This" is a deceptively simple little device
that closes holes in hearts without surgery.
LOCK And the whole thing now folds up into something quite
ALDA When I was a kid I used to do amateur magic, and that's
how you fold flowers that appear out of nowhere.
LOCK You're kidding!
ALDA Yeah, a whole bouquet. You just fold it up like that
and you could get it into a small space like this.
ALDA (NARRATION) The small space in this case is the tip of
LOCK That's what goes inside the body. And we thread it up
through a vein in the leg and up into the heart, and we watch
it under an X-ray fluoroscopic machine and we know where the
hole is. And let's pretend that this is the hole here.
ALDA (NARRATION) Like my magic flowers -- or a tiny umbrella
-- the device springs open.
LOCK See it snap? Then I pull it back like this, pushing it
back like that.
ALDA (NARRATION) This is nine year old Josh. He's lived with
a fenestration for six years now -- and it's time to close
DAD The doctor was telling us it's kind of like a fine-tuning.
They have to tune him up before they send him out.
ALDA (NARRATION) Josh's blueness is visible in his lips and
LOCK The drill with a patient with a Fontan circulation is
to give them the best possible circulation for the rest of
their life. Because it's a little bit tenuous. They only have
one ventricle, and what we need to do is to optimize that
circulation so that they can be pretty asymptotic and be very
productive citizens into their 40s and 50s and pay taxes.
ALDA (NARRATION) Josh's tune-up will all be done through a
tiny hole in his groin.
JIM LOCK OK, let's take this picture just like this, guys.
ALDA (NARRATION) Injecting a liquid that shows up black on
the fluoroscope reveals Josh's blood vessels -- including
the pulmonary artery taking blood to his lungs.
LOCK So you notice the diameter here is probably 7mm, and
it drops to 4mm and then it goes to 9mm. That's not a very
severe obstruction, it's really only mild, and if he had a
normal circulation we'd ignore it.
ALDA (NARRATION) But since Josh's heart already has a hard
enough time pumping blood to his lungs, Jim Lock plans to
use this metal coil -- called a stent -- to open up the constriction.
LOCK He's going to hold this with his beefy fist so that it
don't move. And with my thin delicate fingers I'm going to
push it up. See it there? Coming in, coming in, coming in.
OK. Blow the little balloon up for me. Right now, slowly.
ALDA (NARRATION) A balloon inflated within the stent expands
it to permanently hold open the route from the heart to the
LOCK OK, so this should be very close to perfect.
ALDA (NARRATION) Now it's time to close the fenestration.
The twin umbrellas are loaded into their catheter and threaded
up into Josh's heart. The tunnel and its hole are invisible
in this picture, but the first umbrella's arms are unfolding
on the outside of the hole.
LOCK It's fully open.
ALAN ALDA (NARRATION) Then the second umbrella is released.
LOCK We're going to take a picture now with all eight arms
open, one on the left side and one on the right side and make
sure it's in the right place. Ready guys? Inject.
ALDA (NARRATION) Now the tunnel is visible on the left side
of the picture. Some blood is leaking past the umbrellas,
but that's because their cloth mesh is still porous. In the
coming months, Josh's cells will grow into the mesh, sealing
the hole tight. The final act is to release the catheter,
leaving the umbrellas behind.
LOCK And there it is.
It's all done, okay? You're in the recovery room. It's all
ALDA (NARRATION) Josh's blood oxygen, which for years as been
at 70 percent, has jumped to the mid nineties.
DAD Hey big guy, how'd you do?
ALDA (NARRATION) Just minutes after the procedure, and already
Josh's lips and nails are pinker.
He's pink! DAD He's pink. For the first time.
Look's good. Little dirty, but good.
ALDA (NARRATION) For Josh and his parents, nine years of living
with his broken heart are almost over. The odds are good that
his rebuilt heart will now allow him a normal life. Meanwhile,
Zachary is home in Texas, having fun. One day, his fenestration
will also need closing. The fact that it can be now done with
Jim Lock's little folding umbrellas means that, like Josh,
a tune-up is all he'll need for his heart to take him into
ripe old age.
ALDA (NARRATION) Jim Wenzell flies planes for a living…. NURSE
ALDA (NARRATION) Or at least, he used to, before his airline
grounded him when he was diagnosed with a dangerously narrowed
coronary artery. Today he's at the Ohio State University Medical
Center, where he's about to be operated on by a robot. Jim
Wenzell is one of the first patients in the United States
to benefit from a technology that promises to revolutionize
surgery -- yet whose origins can be traced back to a now distant
war. It was a war that also formed the background for a television
series. MASH was set in a Mobile Army Surgical Hospital during
the conflict in Korea. The real MASH units represented a major
breakthrough in battlefield medicine. Before the early 1950's
- and the helicopter - many soldiers wounded in battle didn't
survive simply because they couldn't be treated by a trained
surgeon quickly enough. Fast forward to the 21st century,
as viewed through a promotional video made for the Pentagon's
Advanced Research Projects Agency. In the mid 1990s, the goal
of a research program aimed at bringing new technology to
battlefield medicine was to shorten still further the time
between a soldier's being wounded and getting expert medical
ALDA So you drive this out…
ALDA (NARRATION) Five years ago, we visited a mobile surgical
unit parked in peaceful Palo Alto, California.
ALDA If this person had been wounded in the battlefield and
he happened to be lucky enough to have a surgeon here, what's
wrong with him?
ALDA (NARRATION) Jon Bowersox, himself a surgeon, was working
with a team of scientists and engineers on a way to project
his expertise into the battlezone while he remains miles away.
JON BOWERSOX What it looks like is there is about an inch
long hole in the small intestine. If we didn't treat that,
what would happen is the casualty would develop a severe infection
and die in a relatively short period of time. So what's needed
to take care of this is emergency repair of the intestinal
ALDA (NARRATION) These were actually pig intestines from a
local butcher's shop. Poised above them was a pair of mechanical
ALDA What do these things do? They get right down in the wound?
This is the machinery?
BOWERSOX As you see, why don't we move them into position
here if you just move our position control.
ALDA That's this red button?
BOWERSOX It is. Stop please. Good, Good. So as you can see,
just like the surgeon's hands, they're placed right over the
site of the wounding and these are instruments the surgeon
ALDA (NARRATION) The armored operating room was connected
to this tent by a cable. But the plan was for a wireless link
so that OR and surgeon could be many miles apart.
BOWERSOX So this is a surgeon's workstation, instead of being
at the patient's side in the normal operating room. I put
on these polarized glasses that give me 3-D vision. Instead
of talking directly to my assistant, I put on a pair of stereo
headphones, and instead of picking up the actual surgical
instrument handles, I put my hands, into the halves of the
instruments that are attached to the console. And now, it's
like being at the patient's side.
ALDA (NARRATION) Jon was seeing a 3-D version of theimage
shown in the monitor that I was watching.
ALAN ALDA How much like the real experience is it when you
were over there?
BOWERSOX Well, I think the most telling thing is that every
surgeon that has used the system, after working with it for
about 15 or 20 minutes, will move their hand out of the instrument
handles and try to push bowel out of the way, it's getting
in the way.
ALDA (NARRATION) Jon appeared to be as dexterous with the
remote instruments as he was with the normal ones, aided -
as he would be in a regular operation - by a skilled assistant.
Jon could see Michelle in a small monitor in his workstation,
and together they speedily repaired the wound.
BOWERSOX As you can see now, I am able to tie the knots in
the suture just as if we were in the actual operating room.
So, would you like to have a go at this?
ALDA Ah, yea. Let me try. I can't wait. This is the going
to be the first time I've ever done this.
ALDA (NARRATION) Despite years of doing fake operations in
a fictional MASH unit, this was the first time I'd tried anything
like the real thing. Fortunately, it wasn't the real thing.
ALDA Oh, oh my God! Oh wait a minute. I'm terribly sorry,
I banged into the instrument and jammed it into the guy's
intestines. Wait a minute. Michelle, control yourself. Snip,
Alan, you're ruining my image of you as Hawkeye, you know
ALDA I am not a real doctor, I just play one on TV. Now, I
need to pick this side up.
MICHELLE Yea. Pick it up. Right where you are. Okay.
ALDA Okay, Oh it went through.
ALDA Do I have too little of it?
No, that's just fine.
ALDA Oh, pull it with this?
ALDA Oh, I see, I see, pull it with the right hand. Okay.
And I can sort of ease this down with the left hand. Grab
the tissue. Okay.
Pull it out.
ALDA (NARRATION) I was just one of many visitors to the Pentagon
funded project who got to try it out for themselves.
ALDA There I got it. Look at that.
MICHELLE Yes, you did great.
ALDA I made a stitch. But the poor guy. I mean he's gonna
have cramps from that stitch.
ALDA (NARRATION) Another visitor to the project in the mid
1990s was an entrepreneur who saw in the system the answer
to a surgeon's dream -- the ability to operate right inside
a patient with a pair of miniaturized hands -- to project
their hands not so much across space as down into the patient's
body. And it's this idea that five years later is being tested
here at Ohio State University -- as a camera plunges through
the chest wall of the coronary by-pass patient.
WOLF That's the heart beating. And we're looking at the chest
wall and there's the artery we want. The artery… That particular
artery runs up underneath the breastbone under the ribs. We
plan on using that artery. It's a little blue streak there.
ALDA (NARRATION) The plan is to free the artery from the chest
wall and sew it on to the patient's coronary artery just beyond
the blockage. This approach to coronary bypasses is becoming
increasingly common. What's different here is that the job
of harvesting the chest artery will be done by a pair of robot
WOLF While operating, my hands, all that motion will be transferred
to this miniature hand if you will inside the chest. This
is the working end of the system. If you think about it, why
do we make big incisions? We're working on small arteries,
we're using tiny suture. Because our hands are large. That's
why we make big incisions. And what this system allows us
to do is feel like our hands are inside the chest but we haven't
made the big incision. The first thing I do is, I take off
my shoes. So, I'll be using both feet and both hands. So I
take off my shoes and then pull up to the screen. You can
see it's binocular vision. We're going to activate this now.
ALDA (NARRATION) Randy Wolf's workstation is the commercialized
version of the one I checked out five years ago. The controls
for moving the instruments are now much more sophisticated.
WOLF When I turn my left hand like this, it does it. When
I pinch my fingers together this pinches together. It feels
very natural. I pinch, I let go. I turn right, I turn left.
Any angle my wrist makes, it make at the tip. And this is
very helpful in sewing vessels, like this. You grab a suture,
you can run it like this. I'll give you a more panoramic view.
Any wrist motion is replicated.
ALDA (NARRATION) As Randy moves his hands at the controls,
across the operating room his actions are mirrored by the
arms of a robot inside the patient's chest.
WOLF The vessel is in this tissue right here. So I'm very
gingerly, or gently, pulling down on it to open that up. And
the first rib, the highest rib is right here. Rib number 1,
number 2 here, number 3 here, number 4 here.
MICHLER This is in simple terms, fun. It's fun because it
allows us to do something that we love doing, which is heart
surgery, but allows us to do it in a manner that is creative,
in a manner the we think is going to benefit the patient by
producing less trauma. OK, we're finished with mobilization.
Note the time. So an hour, exactly an hour and thirty minutes.
OK? All right? Now that's long for us, but again, we were
working under more unusual circumstances that usual.
WOLF You didn't say extenuating, did you?
MICHLER We were working under friendly fire.
ALDA (NARRATION) With the chest artery freed, the next job
is to clip it so that it can be safely severed. Robert Michler
inserts the instrument holding the clip.
MICHLER How about right there? Maybe up a little bit?
WOLF That's fine right there.
MICHLER We'll give you scissors to divide it.
ALDA (NARRATION) The clips will seal the artery until it can
be sewn to the coronary.
MICHLER That looks good, don't you think?
RANDALL WOLF Yup.
MICHLER Let's have the scissors back.
WOLF There it is.
MICHLER See the artery? That tube? So that's what we're going
to sew to the surface of the heart.
ALDA (NARRATION) At this point in the operation, the robot's
job is over. The Ohio State team is in the final stages of
an FDA trial in which they have permission only to harvest
the artery with the robot. Sewing it on to the heart still
has to be done by hand. In the next phase of the trial, even
this attachment of the artery to the coronary will be done
by the robot.
MICHLER The whole sewing on to the heart took us about ten
minutes to perform. So once we have developed the technology
with the robot to the point where we can take the artery off
the chest wall in ten or twenty minutes, it could shorten
this operation dramatically from several hours to really under
ALDA (NARRATION) As well as being far less traumatic for the
patient, the robot system could also make a big difference
in the way surgeons learn new techniques. Right now Randy
Wolf spends a lot of time on the road, training surgeons in
the new technology. But that will change.
WOLF If a Japanese surgeon wants to learn this system and
they've got their first case and they want me to help them,
I don't have to fly to Japan. We can go Internet 2, we can
bring the image up, we can hook up my system to their system,
I can mentor them, telementor them, while I'm sitting here
at Ohio State University in Columbus Ohio and they may be
in Tokyo, Japan. I'll get a lot less frequent flyer miles
but I think I'll live longer.
ALDA (NARRATION) The next step for the robot surgeon here
at Ohio State is to do a complete coronary by-pass operation
-- something Randy Wolf has already done with a robot in Germany.
Following that there are still more ambitious possibilities
-- including doing heart surgery inside an unborn child.
WOLF What's exciting to me is that it's all imagination. You
really need to act like a little kid with this technology
and use your imagination, because that's the only limit.
ALDA (NARRATION) This is the story of a 20-year effort to
develop an artificial heart -- an effort that, luckily for
one of the players in this volleyball game, it was an effort
that began to hit its stride in the early 1990s. Today the
attempt to build a permanent artificial substitute for a failing
heart may be on the brink of success. Back in 1993, Mike Dorsey's
heart was so diseased that he was on the brink of death.
DORSEY I was very sick. I'd walk from here to you, and I'd
been out of breath for that time. I couldn't do nothing. It
gets a little frustrating when your wife comes and takes things
from you, you know, and you can't carry them, you know, she
would take them and carry them in for me. I wanted to do it,
but just wasn't able to do it.
ALDA (NARRATION) Mike Dorsey was rescued from death by a pump
implanted under his own heart that helped propel blood around
his body. It was almost 12 years earlier that the artificial
heart first hit the world's headlines. But Barney Clarke's
brave struggle to live, and his death after 4 months, cooled
the early enthusiasm for his artificial heart - the Jarvick
7. After a few more unsuccessful implants, the device was
abandoned. But research on mechanical hearts continued. The
most promising were pumps that weren't intended to replace
the heart, but boost it. One of them was called the Heartmate.
The designers of the Heartmate took a novel approach to a
major problem of the Jarvick 7 - blood clots that would form
inside of it, and that could kill when they broke off and
traveled to the lungs or brain. The Heartmate's interior was
roughened so that a thin layer of blood clots over its entire
surface, and sticks there firmly. Mike Dorsey's problem -
one that he shares with thousands of others each year - was
a weakening of his heart muscles so that the main pumping
chamber - the left ventricle - could no longer pump blood
around his body. Installing the Heartmate begins with cutting
a hole in the left ventricle and sewing in a short tube. Then
the electric pump itself is implanted in the upper abdomen.
Blood flows from the heart, through the pump, then back to
the patient's aorta. By February 1993, Mike Dorsey's heart
was near total failure. His doctors estimated he had just
hours to live. Only weeks before, the Heartmate had been approved
by the Food and Drug Administration for use at Fairfax Hospital
in Virginia to keep a dying patient alive until a heart transplant
could be found. The operation began with sewing into Mike's
left ventricle the tube that connected with the pump. Then
the Heartmate itself was slid into place. The connection was
made between the pump and the heart it will assist. Finally,
the pump's outflow tube was plumbed into Mike's aorta. The
pump was switched on. And at this point, no one knew for how
long it would need to keep pumping.
LEFRAK Right now this device is approved by the Federal Drug
Administration as a bridging device, that is as a temporary
bridge to help a otherwise dying patient to make it to heart
transplantation. We're hoping that its long-term role will
be much greater than that, and that actually serve as a substitute
for heart transplantation patient.
ALDA (NARRATION) Powered by batteries and controlled by a
small computer at Mike's waist, the Heartmate clearly had
the potential to be an alternative to heart transplantation.
Seven months after the operation, it was still working fine
- and Mike was still waiting for a transplant. The hospital
exercise room had become only too familiar.
DORSEY It's not really me, I'd rather be moving where I have
a destination to go to, instead of standing in one spot, looking
at the same old scenery. This is the battery charger here,
in order to be more mobile, take two batteries, these, just
connect the power source from here.
ALDA (NARRATION) That's the alarm that went off if there was
ever a problem.
MIKE DORSEY There's only one way they fit in. You just drop
them into the pouch like this, fold the flap down. Now I'm
ready for travelling.
ALDA (NARRATION) Mike's travelling was confined to the hospital
- where he'd become a familiar figure. NURSE Hello Michael.
MIKE DORSEY Transplant Center.
ALDA (NARRATION) To pass the time and make himself useful,
Mike helped out in the transplant center. He became an invaluable
source of knowledge, advice and reassurance for other heart
patients - especially those who might also need transplants.
DORSEY I've been here since January 27th.
MAN Six months, seven months, already.
Have you been out yet, been outside the hospital?
MIKE DORSEY Haven't left the grounds.
DORSEY I've threatened to, but I haven't left yet. The staff,
the nurses and everything have been great, but it's almost
like being in prison. I mean you gotta ask permission to do
this and do that. You know. I can't just go outside my door,
outside and get a breath of fresh air, without asking first,
and stuff like that. It's the little things you miss in life.
LEFRAK He was desperately ill, and dying when we put the device
in. The unit has allowed him to recover, so that he feels
well, perfectly well now, completely different then when he
entered the hospital. And of course, he feels that he shouldn't
be in the hospital.
ALDA (NARRATION) But the care and maintenance of the systems
that keep Mike alive meant that leaving the hospital, even
for a short trip - was a very big deal. A lot of things could
have gone wrong.
DORSEY This tube down here is for the vent line so the, allows
the pump to breath, in and out. It circles around, up here,
and this little sock on here filters it. And you can feel
the air coming in and out.
ALDA (NARRATION) The pump sucked air in and out with every
beat. And if the air tube became blocked the pump would slow
and eventually stop.
DORSEY So one night I had rolled over on this side, and it
had got kinked over like that, and I'm looking at the screen
up here, and the numbers start dropping down, and I'm wondering
what's going on, and all of a sudden the alarm went off. And
you know as soon as I sat up the alarm stopped.
ALDA (NARRATION) But the air tube could also be a lifeline
-- offering the hope of at least a brief break from the hospital.
This hand pump could be connected to Mike's air tube, and
would keep the Heartmate pumping blood even if its power supply
or computer control failed -- which is what happened unexpectedly
during a routine check.
How are you feeling Mike?
ALDA (NARRATION) During the 5 or 6 minutes it took to figure
out the problem -- a loose connection -- Mike's artificial
heart was kept beating with the hand pump.
DORSEY Oh, just another day here I guess, to me.
ALDA (NARRATION) As long as the hand pump went everywhere
he went, Mike had at least partial freedom, and he was able
to stroll the hospital grounds. Mike was one of the first
of what has become several hundred patients whose lives have
been extended by the Heartmate while on the waiting list for
a human heart.
DORSEY You gotta look at it both ways, unfortunately somebody's
gotta pass away in order for you to have a donor. You know,
and, I'm not gonna wish that on anybody, but at the same time
I would like to be transplanted and released too.
ALAN ALDA (NARRATION) Mike's first taste of freedom came with
a short trip with his family -- along with plenty of medical
back up. Too cumbersome to itself be a permanent solution,
the Heartmate was an important bridge not only for those like
Mike awaiting human hearts, but also to the future of mechanical
alternatives. Mike got his heart transplant only three weeks
after this trip -- and seven years later, he's still alive
and well. Meanwhile, the Heartmate itself has been reborn
-- and it is now small and efficient enough that it could
soon be a practical alternative to heart transplantation.
Like its predecessor, however, the Heartmate II is designed
to assist a failing heart -- not substitute for it. But these
chambers are incubating a device that is intended not just
to help a heart, but to replace it entirely. We visited the
factory where mechanical hearts are being manufactured by
the hundred justa few weeks before the first one was scheduled
to be implanted in a human patient. The Abiomed artificial
heart is modeled on the human one, with two main pumping chambers
and valves to control blood flow.
ALDA As the blood goes through there it pushes its way through
but it can't come back the other way, right?
ALDA Can that be relied on, after it pumps thousands of times
after you pass through, after it flexes thousands of times,
to maintain that same resiliency?
DAVID LEDERMAN The answer is yes, and it's not thousands of
times. It's approximately one hundred thousand times per day.
ALDA Oh boy.
DAVID LEDERMAN Which is close to forty million times per year.
ALDA Forty million times. You can flex this material forty
LEDERMAN Without it breaking.
ALAN ALDA Not only breaking, but just weakening and softening
and fluttering and that kind of thing.
ALDA So this is where you test the valves.
LEDERMAN Yes. This is where…We have many valves under test.
And we test them under very severe conditions and at an accelerated
rate so we can demonstrate twenty years equivalency in one
ALDA (NARRATION) Just like its rival, the Heartmate, the Abiomed
heart is designed to avoid the danger of blood clots forming
inside. But while the Heartmate has a deliberately roughened
interior surface, the Abiomed heart aims to be completely
smooth and seamless. Clotting is also avoided by swirling
the blood -- simulated here by a suspension of fish scales
-- so that it doesn't pool anywhere inside the pump. But it's
not until I get to hold the heart while it's pumping that
I really appreciate how powerful it has to be to substitute
for a human heart.
ALDA I can really feel the beating. Now interestingly, when
you see a heart pumping, the outside of the heart is going
like that, you see the motion on the outside. Here all the
motion is inside this device. I've held this heart long enough,
Would you mind holding that for a day or so?
So right now I'm going to take away the skin.
ALAN ALDA (NARRATION) This is a CT scan of a potential patient.
Converted to computer graphics, the patient's body can be
stripped of its major organs -- including most of the diseased
heart. Then a technician at Abiomed can insert a virtual artificial
heart into the virtual patient, helping the surgeon plan how
best to fit the heart to the real patient during the operation.
The Abiomed heart gets its power from rechargeable batteries
that transmit their energy through the skin -- avoiding the
tubes and wires that so plagued Mike Dorsey seven years ago.
As well as being tested in tanks here at Abiomed, the entire
system -- heart and power supply -- has been implanted in
LEDERMAN Through our telephone lines we are dialing in to
one of our implanted cows, somewhere in the United States.
This one happens to be in Kentucky.
ALDA And it's standing near a window? What does that mean?
DAVID LEDERMAN It means there are several cows and one happens
to be near the window. So we are monitoring….
ALDA So it's literally near the window.
LEDERMAN We haven't given them a name yet, so….
ALDA Now this is fascinating. So you're going to see now information
coming in from a particular cow whose using one of these artificial
hearts. And there it is.
ALDA (NARRATION) Similar real time data from the artificial
heart will also be gathered from the first human patients.
ALDA How do they get a signal that's something's going wrong?
They're having dinner and all of a sudden they get a phone
call from you saying, lie down immediately. What happens?
LEDERMAN My first comment to you with regard to that question
is wouldn't it be nice if we could do that with our natural
ALDA Yeah, it would be.
LEDERMAN It would be very nice if we could have remote monitoring
of hearts if anything goes wrong we would have an alert that
tells us, gee, we can fix it, get to the hospital. Now how
do you do that? We have cell phone technology so the patient
has a cell phone. Now we can call the patient and say you
the output of your heart is not quite what we think it ought
to be so why don't you come back to the hospital?
ALDA (NARRATION) During our filming, Abiomed was already manufacturing
hearts ready for implantation -- and was opening a new plant
to scale up production further. Meanwhile, five medical teams
in hospitals around the country are on standby, awaiting only
approval from the FDA, before one of the teams implants the
first of these hearts in a human patient.
ALDA Are you going to be extending a lot of people's lives
because now they'll be able to have an artificial heart?
LEDERMAN We hope yes. The fact is that two thousand years
ago the average life span was 30 years, and a hundred years
ago the average life span was 47 years and today the average
life span is 75 years. And there are a large number of people
who reach 75 and beyond who are neurologically intact, who
are very productive, and the only thing that's wrong is a
hip, which we replace, or a muscle like the heart, which we
should be able to replace. And there is no reason why the
end o f life should come prematurely. And it doesn't matter
what the age. You can be 80 or 90, if you are productive you
should be able to live longer.
ALDA (NARRATION) Twenty miles west of Boston is a town whose
chief claim to fame was once that it housed the world's first
shopping mall. But today it can claim another honor-- that
collectively its inhabitants have saved more lives, running
perhaps into the millions -- than any other group of ordinary
citizens in the world. The town is Framingham. Just over fifty
years ago, five thousand of its people signed up for what
became known as the Framingham Heart Study. Year after year,
those five thousand have allowed themselves to be hooked up
to machines that monitored anything and everything that might
conceivably have a connection with heart disease. Over the
years, they've even recruited a few guests.
LEVY Your blood pressure and heart rate are normal, they're
responding in a very normal way to exercise. You look extremely
comfortable and are not having any symptoms. There are some
people who we put through here that do develop symptoms even
during this minor amount of effort.
ALDA (NARRATION) The data from all those thousands upon thousands
of tests are stashed away in the basement. Here are the medical
records of both the original five thousand participants as
well as the records of a second generation -- another five
thousand who are the sons and daughters of the first volunteers.
ALDA You can find the very first person who was a participant
in the study?
ALDA Ha, this is like a James Bond movie.
LEVY This is participant number 001.
ALDA How old was this person when the study began?
DAN LEVY She was about 30 when the study began, and she died
about 30 years after that. We're able by going back to look
at the relationship between blood pressure or cholesterol
or smoking habit and risk for developing cardiovascular disease
ALDA How often did she come in for a round of tests?
LEVY The original 5000 participants were brought back every
two years. In fact right now we're in the midst of our 25th
cycle of exams on the original study participants. And in
fact 80% of our original participants have died. Twenty per
cent though are still alive.
JOSEPH PAVIA I was only 39. I was working for ------ the car
dealer. But I was raising my children, she and I, Lorraine.
ALDA You were only 32 when it started?
PAVIA We've been going over 50 years now.
PAVIA Yeah, been going over 50 years.
PAVIA And we've been going every two years, for exams. ALAN
ALDA And has that been a bother for you?
PAVIA No it's great. I love it.
PAVIA You get used to it.
PAVIA You get a $500 exam for nothing.
PAVIA You know what he says, I feel great when I go in there
and they always find something.
ALDA (NARRATION) We're having lunch with the Pavia family.
From them and the others in the study we've learned most of
what we know about the risk factors for heart disease -- things
like high blood pressure, cholesterol, smoking. Indeed, the
very term "risk factors" comes from the Framingham study.
CASTELLI Half the men and women watching this program are
going to die from some kind of a vascular disease in the United
ALDA (NARRATION) Bill Castelli ran the Heart Program for over
15 years, from 1979 to 1995.
CASTELLI The average person who's, you know, at a risk to
get a heart attack feels fine until the day they actually
get the heart attack, and then they learn too late.
ALDA Well I guess that's what so important about having figured
out that there are such things as risk factors. Because the
risk factors are the ones that can tell you before you ever
have a sign that you have a problem.
CASTELLI That's right. See if the motors going good, you're
not going to look under the hood.
LEHMAN Mr. Alda. I'm going to tell you about this test. I'm
going to inflate this blood pressure cuff for five minutes….
ALDA (NARRATION) The Heart Study is always on the look out
for new and better predictors of trouble ahead. One of the
latest candidate tests has Birgitta Lehman checking out the
springiness of the artery in my arm -- a process which appears
to involve first putting my arm to sleep by choking off its
ALDA Why do you put that cloth here, to help my arm go to
sleep, what is it?
BIRGITTA LEHMAN Somehow it reminds people that they shouldn't
move it because they feel if they start moving their fingers
they feel that they are moving it because it has a towel effect.
Just my own invention.
ALDA Very good. A little thing like that, you see, a simple
invention like that will save millions of lives eventually.
LEHMAN So let me find your brachial artery. There, you have
a beautiful artery, you don't see any bumps or any white stuff.
It's just as clear and smooth as I ever seen it. I'm going
to inflate the cuff now on your arm. It's going to be very,
very tight and it happens very, very suddenly. Right now.
Was that sudden enough?
ALAN ALDA That was pretty sudden, yeah.
ALDA (NARRATION) After five minutes of pins and needles…
LEHMAN I'm going to release the cuff. You hear that? That's
a great return, that's a great blood flow. It was like opening
up a dam when I released the cuff, and the blood was just
rushing forward. With very thick arteries, there's almost
no change. There's almost no change. It takes so long for
these stiff, stiff arteries to bounce open, it maybe takes
them two to three minutes. So I don't get that psssh…, psssh…
ALDA (NARRATION) Another test being explored in the Framingham
Heart Study is a little more elaborate. But its goal is the
same -- to find early warning signs of cardiovascular disease
long before there are any symptoms. This magnetic resonance
machine is at Beth Israel Deaconess Medical Center in Boston.
Happily, they provide music.
We are going to start your first scan. It lasts for about
OK Mr. Alda, take a breath in, blow it out and hold it, don't
ALDA (NARRATION) While I hold my breath the machine is making
snapshots of my heart and chest. By taking pictures repeatedly
as the heart is at different points of its beat, over time
the computer can build up a movie of the heart in motion.
MANNING First we have good news. Everything looks very normal.
ALAN ALDA What do you mean, first you have good news? Is there
going to be bad news latter?
MANNING No, no, everything looks very good. These are some
images we first took of your heart. And this is your breastbone.
We have your heart contracting right here. And this is the
front part of your heart. You can see it's contracting vigorously,
and the heart is the gray part and the blood inside your heart
is this white cavity right here. And you can see that all
the walls, this is the bottom part of your heart, are contracting
vigorously, squeezing, squeezing, squeezing. That all looks
very good. These are some images…
ALDA (NARRATION) It was fun seeing my heart beating. But the
real goal of the test is to get an image of my aorta, the
big artery that carries blood from my heart to the lower half
of my body.
WARREN MANNING This is your aorta, it's a nice black tube.
And you can see that thin white line surrounding the aorta
is normal vessel wall. We don't see any plaque. Looks very
ALAN ALDA My aorta looks so good I'm going to start sending
it out instead of an 8 by 10. It's really nice
MANNING We can give you a picture if you like.
ALDA Yeah, that'll be great, you know, because I believe its
what's inside that counts, you know.
ALDA (NARRATION) In contrast to my impeccable aorta, this
one has a visible build up of plaque -- which while it's unlikely
to cause problems itself could be a warning sign that plaque
is building up in more vulnerable blood vessels -- like the
coronary arteries of the heart itself.
ALDA When the day comes that we'll use this for screening
the whole population, if that day comes, not only will you
be able to tell me I'm liable to develop symptoms soon, but
you can use this picture to actually design a drug therapy
that's just right for me?
MANNING That's our long-term hope. For example, today we know
that if your cholesterol is high, that we could treat you.
We should treat all people with high cholesterol. But it may
be that we find from studies like the one going on in Framingham
that if your cholesterol is high, but you don't have any plaque
on your MR, that we don't have to be as aggressive. Just diet
therapy alone without taking pills is sufficient. Similarly
we know that some people with low cholesterol still have heart
attacks, still have strokes. It may be that those people actually
have plaques in the aorta, and it's not the cholesterol we
should be monitoring but actually the plaques themselves.
ALDA (NARRATION) In an even more ambitious project, Warren
Manning -- as well as many other researchers -- is working
on an MR technique to visualize directly the coronary arteries
ALDA So what do you think, do you think some day this is going
to be so predictive that we'll be crazy if we don't regularly
get an MRI?
MANNING I hope so. I think at some point people will blow
out the birthday candles when they reach 40 or 50 and say
it's time to have a screening MR. That day is not here today,
but I believe it will be here in the future.
ALDA (NARRATION) Bill Castelli, who headed the Heart Study
for over 15 years, now runs a clinic to motivate people to
change their risk factors. It turns out that his simplest
advice is also advice most of us don't want to hear.
BILL CASTELLI Most Americans would do OK if they just got
the portion sizes down. I mean, I go to France a lot. The
French, you say, oh, they eat such rich foods…
ALDA But they give you such little teeny portions.
CASTELLI Yeah, you go to dinner in France and you think it's
the hors d'oevres. It's the whole meal.
ALDA That's right. That's why I stay away from France. You
ever go to Italy, now ah ha…
CASTELLI That's a little better.
ALDA (NARRATION) For over 50 years, the Pavia family and their
neighbors in Framingham have helped write the rules for avoiding
heart disease. As it enters its second half-century -- and
begins recruiting a third generation -- the Framingham Heart
Study will be refining those rules to the point where we'll
each know precisely our risks for heart disease. Then -- it
is as now, but more so -- it will be up to us.