It’s a kind of magic (the science kind)…

 Well, operation done – I have a funky new valve and a bit of a sore groin.  I was in hospital for 28, sleepless, hot, hours and unconscious for about 4 of them.  


While the insertion points for the three catheters I had in me in at the same time heal it’s a case of taking it easy, let my body get over the various manipulations (sore throat, the impact of the still there frozen shoulder) and the simple lack of sleep from stress and some noisy neighbours on the day ward I was on. 

There’s really not a lot else to say… I went in, did the usual pre-op checks, had a chat with the interventionist, had a chat with the anaesthetist, signed the all-important consent forms (kids – that’s when you know you’re an adult; parents, that’s when you know your kid is in charge), was wheeled across to a hybrid cath lab… laid down, bit of banter with the team and the next thing I knew I was waking up, sore and not actually knowing whether the funky valve had fitted me… 

 

It had, so I had the delights of groggily trying to sleep through one of the hottest days, and nights, in UK history… ok, the second hottest and hottest night in UK history.  With a couple of very scared, very loud coronary event patients trying to compare notes with each other and letting their loved ones know what was going in a lot of detail. 

 

Two huge recommendations – noise cancelling headphones and a neckband fan… helped keep me as close to sane as I normally am! 

Mrs Jiminy was brilliant as ever; from sorting out the transportation and accommodation (my bed was sorted, she had the fun of the Travelodge) to the provision of much needed ice filled bottles of juice… She yet again was my shield, and my prop… 

So, a bit of a boring blog… apart from being a nerd I’ve spent a bit of time looking into the magic… and it’s like a Marvel movie. 

Picture the scene, 1929, a young German doctor has an idea… why can’t you put a small catheter in a vein and follow it back to the heart.  His head of department says you can’t do that!  So he convinces a nurse to help him, lets her prep the theatre, straps her to the operating table leading her to think she’s getting the procedure done on her… then proceeds to put a catheter in his own arm, and then released her and they both went to the x-ray team and guided the catheter into the right side of his heart. 

So via a couple of twists and turns, he was sacked, became a urologist, a member of the Nazi party, a POW, a lumberjack, and then back to being a doctor.  His write up of his slightly odd approach to developing a new technique was picked up by some American doctors who publicised it, refined the technique and in 1956 was awarded the Noble Prize for Physiology and Medicine… The full story is here: https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.4960150715 with the wiki version here https://en.wikipedia.org/wiki/Werner_Forssmann and  the presentation speech for the Nobel prize https://www.nobelprize.org/prizes/medicine/1956/ceremony-speech/. 

Still with me?  Yup cardiac catheterisations were invented by a rogue German scientist who tied his helpful nurse down and then walked to the X-ray department to prove it!!!  I think I’ve seen that movie… 

For ten years measurements were taken and drugs administered directly into the heart, and then someone, I like to think at a kiddies birthday party, had the thought… Coronary heart disease has a component when arteries close up… could we blow up a balloon to widen the tubing up?  The answer is yes, but some of them collapse back in quickly… so then the idea of scaffolding, or a stent was thought up… The timeline has been kindly set out here: https://academic.oup.com/bmb/article/106/1/193/321394 . 

Throw in then ability to measure and manipulate the electrical pathways in the heart… by a special breed of magicians known as electrophysiologists and things were ticking along nicely. 

But there was a growing need for something extra… Operations on the pesky kids with congenital heart disease were becoming more and more successful, and the kids were growing up, some of us were even getting jobs, having kids… but relatively often we needed new heart valves; and full open-heart surgery isn’t something anyone particularly wants, let alone wants more than once.  So, another German cardiologist had a bright idea, and tried to put a valve in a stent… lots of hoops were jumped through and the fairly well-known Medtronic Melody valve was created https://www.medtronic.com/us-en/patients/treatments-therapies/transcatheter-pulmonary-valve-therapy/melody.html … That was back in 2000… 

 

Now, here’s the thing.  Not all patients are suitable for transcatheter procedures – their veins may not go the correct way, their heart anatomy may mean the catheters can’t get around the corners or the surgical work back when they were kids means things won’t fit… or as I found out last year my tubes were too big for anything that Liverpool had.  Which is why I went to Leeds, to see a man with a bigger valve… and a much bigger funkier valve… 

The story of the development of this branch of magic now becomes one of undoubted genius coupled with population size and economics.  With a population of 1.4 Billion, and c17 millions births a year… and assuming a 1 in 100 birth rate of congenital heart kids, that’s a hell of a lot of potential patients for a new bigger pulmonary valves.  

I don’t know enough about the reason why a balloon stent device isn’t big enough for the likes of me to explain it - but it means I’ve got a nickel-titanium memory-metal double flared end valve in me.  Of course, being the hottest day of the year my valve needs to cooled under ice to let it be compressed to fit into quite a large catheter. 

This is it https://www.venusmedtech.com/index.php/list-45 it should be good for 5 – 10 years, by which point hopefully there’ll be another entry in the madcap progress of science! 

 

So what happens for those who can’t get their valves via a catheter… Well, if they’re like Seb who I’ve met, and met his Mum and Dad a couple of times normally while running the GNR, it’s the skills and science of open heart surgery.  Seb, being Seb, took it in his stride and has been inducted as an Avenger…



If Seb is the Avenger, then I may just have to be old school https://youtu.be/0CPJ-AbCsT8

 

TTFN

 

Paul

 

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