Solving the Mysteries of Heart Disease
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congestive heart failure
author’s father and, 107–110
condition of heart following heart attack and, 257–258, 261–262, 264, 274–275, 280
diastolic dysfunction and, 395–413
following treatment for heart attack, 110–123, 142–144
heart dilation and. see dilation, heart
ineffectivenes of common treatment, 259–260
leaking heart valve and, 377–379
medical community acceptance of new procedure, 277–278
motion of heart and, 255–257
prevalence of, 267–268
prevention of, 268–273
structure of heart and, 250–252, 500
systolic dysfunction and, 395
continuous electrical current, for ventrical fibrillation, 55–57
controlled re-oxygenation, 165–166, 168. see also oxygen
controlled reperfusion, 78–94, 103, 111, 121, 123–125, 128, 130–132, 137–139, 142, 159, 165–166, 177, 179–203, 180, 182, 185–186, 189, 205–208, 210, 212, 214, 217, 227–236, 260–261, 266–267
Cook, Theodore, 460
Cooley, Denton, 76, 78, 82
coronary artery bypass, 9, 61, 71, 74, 89, 97, 107, 113–114, 259, 291, 301, 411–412, 510
Coumadin, 240–242
Cox, Jim, vii, 242, 331–332, 385, 388–389, 392, 472, 477, 491
Craig, Richard, 392–393
crystalloid cardioplegia, 70, 84, 86, 99, 101–102
crystalloid cardioplegia devices, 99–100, 102
Cushing, Harvey, 30–31
cyanosis. see “blue babies”
D
da Vinci, Leonardo, 310, 335–336, 338–339, 373, 460
de Cervantes, Miguel de, 193–194
de Oliviera, Sergio, 280
“dead” heart muscle. see also scarring, following heart attack
determination of, 124–125
ectopic heart beat and, 125–126
reception of research findings, 132–133, 136–146
research into, 127–131
restoration of, 33, 57–58, 115–118, 121–124, 133–136
decompression (venting), 59–60, 130–131, 137
deep hypothermia, 74
defibrillators, 172–175
demand, oxygen, 45–46, 52, 54–55, 57, 59–60, 129–131
dentistry, author’s early studies in, 17–18
depression, author’s, 245–254
diastolic dysfunction, 395–413, 447–449
Diastolic Pressure Time Index / Systolic Pressure Time Index, 46–47, 59
dilation, heart, 107, 109, 113, 121, 123, 257, 263, 265–266, 268–274, 280, 291, 329, 347–349, 360–368, 370, 372, 374–379, 391, 395–396, 408, 420–421, 444, 484, 491–492, 500, 506, 511
“dinergy,” 465
dissolved oxygen. see also oxygen
DNA, double helix structure of, 346
Doczi, Gyorgy, 373, 453, 457–458, 465
Dor, Vincent, 252, 261–266, 269, 272–277, 279–280, 282, 291, 349, 364–365
Dyson, Chuck, 71–72
E
Earl Bakken Award, 237–238
ectopic heart beat, 125–126
Einstein, Albert, 5, 53, 174, 305, 334–335, 340, 355, 492, 503, 511
ejection fraction, 114–115, 347, 395–396, 398
electrical system of heart, 331, 347, 388–389, 432, 442–445, 449, 460, 469–486, 489–491
electrocardiogram (EKG), 467, 470–474
electro-physiologists, 331, 470–472, 484, 487–489
elliptical shape of heart, 252, 257, 261–264, 268–269, 272–273, 275, 280, 366, 370–371, 375–376, 378–380. see also surgical ventricular restoration
endoventricular circular patch plasty (EVCPP) operation. see surgical ventricular restoration
entroventricular tricular circular patch plasty. see surgical ventricular restoration
Erasistratus, 310, 353–354
excitation-contraction coupling, 471, 479, 481, 492
F
Fibonacci, 338–340, 346
finger tips, spiral patterns on, 340
Firor, Warfield, 29–31
Follette, David, 79–82, 88
Fontan, Francis, 279, 284–285, 291, 356
forward, backward delivery of cardioplegia, 96–100
Freddie Award, 392–393
G
Galen, 212, 256, 310–311, 353–354, 402–403, 405
Galileo, 511
geometry of heart, 112–123, 251–252, 257–258, 261–273, 279, 362–364, 377, 500. see also helical structure of heart
Gibbon, John, 25, 158
Glass, Phillip, 133
glucose, in blood reflow, 131
glutamate, oxygen metabolism and, 94–96, 127
golden section, 338–339, 346, 453, 458, 461–462, 464–465
Gorlin, Richard, 364
H
Harvey, William, 256, 263, 309–311, 318, 353–354, 356, 385, 392–394, 403, 430
Heart and Helix video, 384–394
heart attacks
change in heart shape following, 112–113, 257–273
condition of heart following, 109–111, 257–264
heart dilation following. see dilation, heart
heart scarring following. see scarring, following heart attack
one artery closed, another open, 177–179
restoring functioning following, 123–143, 145–146
Heart Failure with Normal Ejection Fraction (HFNEF). see diastolic dysfunction
heart transplants, 276, 348
heart-lung machine, 10–12, 25–28, 33–34, 54, 60–61, 64, 85, 87, 129–130, 135, 143, 148–150, 158–169, 179–183, 186–189, 200–202, 205, 212, 244, 249–251
Hegar, 428, 449
helical fibers, 324, 335, 429
helical structure of heart, 312–332, 335–357, 360–380, 371, 383–384, 395, 397, 399–402, 404, 406–408, 411, 413, 428–429, 431–435, 448–449, 453, 455–456, 460, 465, 472–474, 478, 485, 505–506
helical ventricular myocardial band (HVMB). see helical structure of heart
helix, of heart, 312–313, 316–317, 319, 321–322, 324, 326–327, 329, 333, 346–347, 350, 355, 361, 371, 373, 383, 387, 391, 395, 399–400, 404, 428, 431, 433, 448–449, 456, 464–465, 469, 473, 476, 485
Helix and the Heart lecture, 332, 347–357, 381, 384–394, 451, 460
Henry, Andy, 386
heparin, 77
Heymans, Corneille, 40
Hippocrates, 111–112
Hoffman, Julien I.E., 39–42, 45, 47, 52, 59, 128, 136, 213, 219, 221
Hottenrott, Christof, 56
hyperoxia, 161, 163–166. see also oxygen
hypothermia, 78, 81, 90–91
I
Ignarro, Lou, 410
Ihnken, Kai, 168
Ilbawi, Michel, 167–168
imaging community, 307
Impressionism, 341
infant cardiac surgery, right ventricular failure during, 440–441
interdependence, 17, 21
intermittent aortic clamping, 60, 69, 73, 89–90. see also aortic clamping
intermittent ischemia, 89, 107
ischemic reperfusion injury, 122, 194, 234–235. see also reperfusion injury
“isovolumic relaxation interval,” 404. see also suction, diastolic dysfunction and
J
Jatene, Adib, 264, 272, 277, 364
Johns Hopkins Hospital, 25–31, 33, 47, 51, 59, 103, 151–158, 172, 177, 494
Johnson, Spencer, 141
Jude, James, 172
K
Karmazyn, Morris, 409
Kawata, Nobi, 134, 136
Kirklin, John, 73–78, 82, 103, 166–167, 284–285, 408
Koehler, 100
Kouchoukos, Nick, 280
Kouwenhoven, William, 172
Kron, Irv, 280
L
lactic acid, reperfusion and, 79
Langer, Glenn, 80
Lazar, Harold,
93–95
Lazarus Syndrome. see “sudden death”
leaking heart valve, 377–379, 445–446
learning, drive for, 21–22
left bundle branch block, 487
left ventrical assist devices, right ventricular function and, 441–442
Lenfant, Claude, 292
Levitt, Zelig, 2–3, 105–106
lidocaine, in cardioplegiac solution, 70–72
Lillehei, C. Walton, 137
limb ischemia, 226–229
liver transplants, 225, 234–236
Longmire, William, 31–32, 49–50, 156, 222, 236
Longmire Club, 236
Longmire Legacy Award, 236
Longmire Surgical Society Dinner, 236
Loop, Floyd (Fred), 101–102, 280, 301
low blood pressure, septum and, 446–447
Lower, Richard, 312–313, 317, 335
Lowry, Doug, 415–416
lung transplantation, 231–234
Lycus, 354
M
Maloney, James, 49–52, 62–65, 81, 84–85, 92, 237
Malpighi, Marcello, 393
Mayo Clinic, The, 25, 166
Melrose, Denis, 69–70
Menicanti, Lorenzo, 279–280, 282, 291–292
Merkowitz, Jenny, 417, 423
Methodist Hospital, 284
Meyer, Willy, 140
Michelangelo, 497
microspheres, 41–44, 47, 53–54, 85, 128
mitochondria, disruption to, 125, 127–128, 130, 132, 135
Monaco conference, 260–261
Monet, Claude, 341–342, 357
Morita, Kiyozo, 168–169
multi-dose cardioplegia, 86–87
Murica, Spain, meeting in, 313
muscle fiber orientation, 272, 315, 319, 321–325, 328, 335, 347, 361–362, 364, 367, 387, 391, 428–429, 432–433, 435, 442, 470–471
muscle salvage, 264
myocardia infarction. see heart attacks
myocardial protection, 69–88, 92, 96, 101–102, 119–120, 129, 249, 285, 438–440
N
Nanda, Navin, 393–394
National Institutes of Health (NIH), 160, 187, 215–216, 247, 282, 291–292
Nelson, Roy, 86
Nembutal, 211
Newton, Isaac, 305
normal functioning of heart, 112–113
normoxia, 162. see also oxygen
O
Offer, Lowell, 386
Ohio State University, 18, 196
Okamoto, Fumiyuki, 129
ontogeny, 481
open heart surgery
blue babies and, 164–166
damage to heart muscle during, 41–47, 51–67, 69–89, 92, 120
early period of, 25
oxygen level during, 161
oxygen
“blue babies” and, 4, 26, 32, 147–156, 158–159, 161–169
brain and, 209–211. see also brain, preventing damage to
historical role in surgery, 150–153
level of, 160–162
oxygen metabolism and, 92–95, 97–98
oxygen tension and, 160
P
P wave, 470–471
pacemakers, 119, 237, 347, 443–444, 470–471, 474–492
Pacopexy procedure, 375–377
Paglia, Don, 494–495, 498, 501, 504
patch procedure. see Pacopexy procedure
patent ductus arteriosus, 152–153
pathologists, 307
Patz, Arnold, 160–162
phylogeny, 387, 481
Pomar, Jose, 313
potassium, in reperfusion, 70, 81–82, 103, 129
Purkinje, Jan Evangelista, 478
purkinje fibers, 477–482, 485
Pythagoras, 338, 346, 453, 461–462
Q
QRS wave, 470–472, 483, 487
R
reactive oxygen species (ROS), 161
Rehn, Ludwig, 308
Rembrant (Rembrandt van Rijn), 499–500
remote muscle, 114, 116–121, 135, 142, 177, 180, 251, 259, 262–263, 267, 269, 280, 362, 364, 367, 371
Renoir, Pierre-Auguste, 498
re-operations, 244
reperfusion injury, 121–123, 166–167, 194, 198, 201, 225, 231, 234–235, 408, 410, 438, 449, 499
reperfusion pressure, 131
Research Medical Industries, 99
residents, overseeing, 221–223
RESTORE group, 287–303, 348–349, 359, 371, 391, 395
right ventricle function, 427–428, 430–431, 433, 435, 438
Rodewald, Georg, 65–67, 69–70, 88
Rose, Eric, 280
Rose, Mike, 11
Rosenkranz, Eliot, 96
S
Saleh Saleh, 434
Salerno, Tomas, 365–366
Sallin, Edward, 361–362, 364
salvaged muscle, 264
scarring, following heart attack, 244, 251–252, 257–259, 261–268, 270, 274, 276–277, 280–281, 283, 286, 293–294, 297–298, 302, 349, 351, 362, 364–368, 371–372, 375, 378, 423, 478
Semmelweis, Ignaz Philipp, 5, 19–20, 510
Senec, 313, 335
septal anterior ventricular exclusion (SAVE) procedure, 375–377
septum
AV node in, 477
cardiac valve surgery and, 444–446
damage during open-heart surgery, 436–439
diastolic dysfunction and, 447–449
ignorance of functioning of, 427–429, 449–450
infant cardiac surgery and, 440–441
injury during open-heart surgery, 436–444
left ventrical assist devices and, 441–442
low blood pressure and, 446–447
pacemakers and, 442–444
right ventricular function and, 430–439, 446
septum bundle and, 485
Shiley, Inc., 99
Shumway, Norman, 78
silent heart attacks, 107, 109
Siler, William, 288
site selection process, 374–376
Sjostrand, Fritiof, 126–128, 132
Something the Lord Made, 153
spectators, vs. experimenters, 82–83
spherical shape, of injured heart, 116, 257–258, 263–265, 267–272, 275, 277, 290, 303, 347–349, 360–368, 371, 375, 378–379, 389, 422–423, 432, 500
Stanley, Al, 288
Starling, Ernest, 63–64
Stonehenge, 451–468
stroke, author’s, 241–245
strokes, 205, 213–214, 217–218
structure, function of heart, 305–308, 321–327, 329, 347–348, 361, 364, 383, 388, 397, 428, 430, 436, 444, 447. see also helical structure of heart
Stussy, Jan, 498, 500–501
Styron, William, 245–246, 253–254
suction
cardiac, 447, 449
diastolic dysfunction and, 398–413, 447, 449
“sudden death,” 10–14, 171–185, 189, 192–203, 205–218, 267, 290–291, 377–378, 483, 491–492
Suma, Hisa, 280, 371–376
Surgeon General Award, 392–393
Surgical Treatment of Ischemic Congestive Heart Failure (STICH) trial, 291–303, 348, 378–379, 412– 413
surgical ventricular restoration, 264–282, 288, 290, 293–295, 297, 299, 366–368, 371–372, 375–377, 395, 421, 492
Sutton, Willie, 484, 487
systolic dysfunction, 395
T
T wave, 470–472
Taussig, Helen, 151–156, 158
teachers, role of, 219–225
temperature, cardioplegia and, 78, 81, 90–92, 96
temperature, sudden death and, 185–186, 188
terminal contraction. see limb ischemia
tetralogy of Fallot (TOF), 151, 158
THAM buffer, 79
Thomas, Vivien, 153–154, 163
Thompson, Morton, 19
Tillisch, Jan, 126
Torrent-Guasp, Francisco “Paco,” 313–323, 3
28, 331–332, 342, 345, 351–352, 360, 364, 371, 373, 381–394, 419–420, 428, 432, 449, 469, 471–472, 474, 478, 481
Toscanini, Arturo, 503–504
translational surgical research, 37–38
triphenyl tetrazolium chloride (TTC) stains, 125
twisting and uncoiling motion of heart, 112–113, 256–257, 262–263, 269–275, 280, 288, 308–312, 324, 326, 345–346, 353, 361, 386, 389, 398, 400–401, 404–408, 411, 420–424, 432–433, 441–443, 465, 469–470, 472–476, 479–480, 483–484, 486–487, 489–492, 494, 510
Tyson, Neil de-Grasse, 146
U
University of Alabama, 166, 288
University of California, Los Angeles, 31–33, 49–53, 61–62, 65, 69, 71, 76, 84, 89–90, 97, 107, 133–136, 138, 168, 214–215, 221–223, 227, 231, 233–237, 240, 246, 273–276, 494, 498
University of Cincinnati College of Medicine, 20
University of Illinois Hospital in Chicago, 229
University of Virginia, 284
“untwisting,” of heart muscle, 404–405
unwitnessed arrest, 192–194, 197, 199–201, 205–218
Urell, Herb, 18
V
valve ventricular approach, 378–379. see also Batista Procedure
Vanderbilt University, 152
ventricular fibrillation, 9–10, 53–59, 64, 81–82, 171, 177, 179–181, 184
Vesalius, 311, 392
Vesalius Group, 384–385
Vietnam Wet Lung, 34–36
Vinten-Johansen, Jake, 133
vortex, at tip of heart, 317, 320–321, 324, 335, 337, 340, 429, 456, 463
W
Wechsler, Andy, 356
white blood cell filters, 168, 232–233
Wiggers, Carl, 476, 487
witnessed arrests, 174, 192, 194–195, 199, 218
wrap, right ventricular free wall, 429–433, 435, 441, 447, 449, 473
Wright, Frank Lloyd, 169
Wright-Patterson Air Force Base, 34
Wyman, Elyse, 501, 504
ABOUT THE AUTHOR
Gerald D. Buckberg is a Distinguished Professor of Cardiac Surgery at UCLA’s David Geffen School of Medicine. He is the recipient of the 2007 American Association for Thoracic Surgery Scientific Achievement Award, the highest honor the Association bestows, and his groundbreaking achievements have been lauded with international recognition. His early research led to the landmark discovery of blood cardioplegia (a method that safely stops the heart during surgery), which has dramatically increased the safety of open heart operations. The procedure is currently used by over 85% of surgeons in the United States and 75% of surgeons worldwide. Over 25 million patients have benefitted from the technique.
Dr. Buckberg did residency training at Johns Hopkins Hospital and UCLA, received Cardiothoracic training at UCLA Medical Center, and did research training at the Cardiovascular Institute at the University of California, San Francisco. A member of multiple surgical societies, including the American Association of Thoracic Surgery, American Surgical Association, and the Society of Thoracic Surgeons, his teams have developed new treatments for acute myocardial infarction (heart attacks) that save and restore healthy function and avoid the development of congestive heart failure that often follows heart attacks.