Transcript File - Djinni`s Educational Portfolio

My eleven year old son Isaac was born with several birth defects, his heart is the
most serious of all defects. His heart defects include, Hypoplastic Right Ventricle,
with Dextrocardia, Pulmonary Stenosis, VSD, and Tricuspid Valve Regurgitation.
Isaac has already endured three heart surgeries. Someday in the future Isaac and
I may be faced with the decision to have Isaac undergo treatment to repair his
leaky tricuspid valve, or possibly have him listed for a heart transplant. At this
time there are only a few options available for treating Isaac’s heart issues since
he is still a child. Isaac’s cardiologist currently believes that fixing Isaac’s leaky
tricuspid valve is not worth the risk of repairing unless it becomes more severe.
The more choices that are offered to Isaac as a patient, allows Isaac more control
of his own health and quality of life. As I have been looking into various options
heart patients like Isaac have, I believe stem cell heart therapies, are a better
alternative than standard heart therapies.
• Biological Pacemaker from Pig Heart
• Stem Cell Injection
• Ghost Heart
Often people associate heart problems with adults.
A c c o r d i n g t o t h e A m e r i c a n H e a r t A s s o c i a t i o n , “A n
estimated minimum of 32,000 infants are expected to
be affected each year in the United States. Of these,
an approximate 25%, or 2.4 per 1,000 live births,
r e q u i r e i n v a s i v e t r e a t m e n t i n t h e f i r s t y e a r o f l i f e .”
Congenital Heart Defects are the most common birth
defect. Currently standard heart therapies are the
most common procedures for adults and children.
(“Statistical Fact Sheet on Congenital Cardiovascular
Defects”2013 Update, American Heart Association )
Pick, Adam. “Pacemaker Heart Valve Surgery,” Illustration, Nov 8, 2010.
http://www.heart-valve-surgery.com/heart-surgeryblog/2010/11/08/pacemaker-maze-procedure-after-heart-valve
Pros
• A regular heartbeat
• Living a more active lifestyle.
• The battery can last up to 15
years.
• The surgery is minimally invasive.
• Most patients only need an
overnight stay at the hospital.
• Many patients return to their
normal activities within a few
days of surgery.
Cons
• The average battery life is
approximately 6-7 years.
• Other devices such as
microwaves, cell phones and MP3
players, can interfere with its
operation.
• The wires can become broken or
dislodged.
• The patient may need to avoid
contact sports.
• Some medical equipment can
interfere, such as MRI’s and
Electro cauterization used in
surgery to control bleeding.
“Pacemakers” National Heart, Lung and Blood Institute
Stent
“Restenosis of a Stent-Widened Coronary Artery.” Figure A shows
the coronary arteries located on the surface of the heart. Figure B
shows a stent-widened artery with normal blood flow. The inset
image shows a cross-section of the stent-widened artery. In figure
C, tissue grows through and around the stent over time. This
causes a partial blockage of the artery and abnormal blood flow.
The inset image shows a cross-section of the tissue growth around
the stent. http://www.nhlbi.nih.gov/health/healthtopics/topics/stents/printall-index.html
The Heart, Lung and Blood Institute
describes a stent as either a metal coil,
or a mesh tube made out of fabric or
metal. The purpose of a stent is to
improve blood flow through an artery,
by widening the narrow or blocked
areas. Stents can also strengthen weak
areas of an artery. Some stents have
medication on them that is released
continuously to prevent blockage. Stents
are placed surgically through a catheter
in the groin or neck. Risks include
bleeding at the site of insertion,
infection, the dye can cause an allergic
reaction and/or damage to the kidneys
(“What is a Stent?”).
• Increase in oxygen saturation.
• Improved energy for patient.
• Lowers the risk of stoke and heart
attack.
• May require changes in lifestyle
such as diet, exercise and
smoking cessation.
• Blood Thinners will be required
for most patients.
• May develop blood clots around
stent if blood thinners are not
used.
• Risk of damage to artery.
• Risk of bleeding during or after
surgery.
• Dyes used during procedure can
cause an allergic reaction.
The Heart and Vascular Institute at John Hopkins
Medicine explains how the Tricuspid valve can
become damaged from a variety of causes such as
pulmonary stenosis or an enlarged heart ventricle.
According to Dr. Patrick McCarthy a tricuspid valve
surgeon from Northwestern Medicine, a leaky
tricuspid valve gradually develops heart failure. The
disease is quiet at first, but over time the patient
develops heart failure.” The tricuspid valve is
usually treated when symptoms become severe,
due to the high risks associated with surgically
repairing the valve. Cardiologists at Cleveland
Clinic state that an annuloplasty ring is most
common surgical approach for tricuspid valve
regurgitation (“Surgical Management Tricuspid
Valve Repair”).
Illustrations courtesy of Cleveland clinic
http://my.clevelandclinic.org/heart/services/surgery/tricuspid-valve-surgery.aspx
Pros
• It can prevent further heart
damage.
• Since a patients own tissue is
used, there is no rejection.
• Better survival rates than
mechanical valve replacement.
• Improved quality of life.
• Live a more active lifestyle.
Cons
• It is a open heart surgery, which
means the patients heart has to
be stopped during surgery and
placed on a heart-lung bypass
machine.
• Open Heart surgery is a very
major surgery with many risks.
http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/treatments/valve_tricuspid.html
http://www.heart-valve-surgery.com/heart-surgery-blog/2013/11/05/tricuspid-disease-dr-patrick-mccarthy/
http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Problem-Tricuspid-Valve-Regurgitation_UCM_450617_Article.jsp
http://my.clevelandclinic.org/heart/disorders/valve/tricuspid.aspx
Heart Transplant
The University of Southern California Keck
School of Medicine explains that when a
patient is in congestive heart failure, they may
be listed on the list for a heart transplant.
When a donor with a matching organ dies, the
patient is contacted and the transplant
process begins. The new heart surgically
replaces the existing heart with the donor
heart within a few hours (“Patients Guide to
Heart Transplant Surgery” ).
Pros
• Quality of life can improve.
• Patient can enjoy an active
lifestyle.
• Some patients have very few side
effects.
• The new heart can allow a patient
to feel better than ever before.
• The heart of a deceased donor
continues to beat inside the
recipient until the heart fails, or
the patient dies allowing the
grieving family to hear the
heartbeat.
Cons
• Someone else has to die in order
for the patient to live.
• Patients need to take
immunosuppressant drugs to
reduce chance of heart rejection.
• Immunosuppressant's can
increase the odds of cancer.
• The side effects from the various
prescriptions can greatly affect
the quality of life for a patient.
• Most Insurance companies do not
pay for the heart to be harvested
from the donor and transported.
“Patients Guide to Heart Transplant Surgery” The University of Southern California Keck School of Medicine
“Heart Transplant Education Manual” Children’s Hospital of Philadelphia, Cardiac Center
Cons continued
• The cost to harvest and transport
is usually over $25,000, which
must be paid in advance.
• The patient usually has to make
some extreme lifestyle changes.
• Some of the prescriptions
required, lower the bodies ability
to fight off infection and disease.
• Biopsies of the heart are a
standard procedure each time a
transplant patient has symptoms
of possible rejection.
• The high cost of the prescriptions
required are not always covered
by insurance.
“Patients Guide to Heart Transplant Surgery” The University of Southern California Keck School of Medicine
“Heart Transplant Education Manual” Children’s Hospital of Philadelphia, Cardiac Center
The National Institute on Aging defines Comfort Care as a compassionate,
end of life stage of medical care. It caters to the needs of the patients,
mental and emotional needs, as well as physical comfort. It is a personal
way to live the end of an individuals life. The health care providers can
give medicine for pain, or oxygen to help breathing. A patient may need
counseling or other therapy such as music or massage, to deal with end of
life issues (“End of life: Helping With Comfort and Care, Providing Comfort
at the End of Life).
As research progresses, gradually stem cell therapies will
increase. Adults are usually the first humans to be involved
with clinical trials. Currently I could not find any stem cell
heart therapies being done on children. However, there is a
possibility stem cell therapy will be available for children in
the future, although it is very difficult to predict at this
time. Due to the main fact that much of the stem cell heart
therapies are in the early stages of development, It is not
possible to list all of the Pros and Cons for the research
which currently has not been tested on humans.
On December 16,2012, researchers at the Cedars-Sinai Heart
Institute in Los Angeles, California, announced a new replacement
for the electronic pacemaker in humans. Researchers discovered a
way to create a “Biological Pacemaker, ”using gene therapy. The
researchers used very small section of a pig heart smaller than the
size of a pea, created a ”sino-atrial node,” which acts as the group of
neurons normally serving as the natural pacemaker of the heart.
They injected a new gene called TBX18 into the pig heart, converting
ordinary heart cells into specialized cell which changed the heart
cells into a new pacemaker. Pigs were used in the study due to
similar shape and size of human hearts. After approximately two
days of the treatment, the pigs hearts were already much stronger
than the group of pigs untreated. In approximately three years,
researchers hope to begin trials in humans, although results can be
different. These new “biological pacemakers,” could replace the
mechanical ones in humans in the future (“Ordinary Heart Cells Become
"Biological Pacemakers" with Injection of a Single Gene”)
Dr. Doris Taylor, Director of Regenerative
Medicine at Texas Heart Institute has been
working with pig hearts to find a better
alternative to the traditional Heart Transplant.
Dr. Taylor and her team of researchers
discovered that cells can be washed away from
a donor pig heart, creating a framework for a
new heart. This framework can be injected
with hundred of millions of stem cells from the
patient needing the transplant, and after a
period of several days A new heart beats,
ready for a transplant. Dr. Taylor states that
due to a patients own stem cells being used,
there is no chance for rejection, which
eliminates the need for biopsies and
immunosuppressant drugs after the transplant
(“Ghost Heart, a Framework for Growing New Human
Hearts”).
“Ghost Heart” Photo. Courtesy of Dr. Doris Taylor. Texas Heart
Institute. http://www.stemcellcite.com/stemcell/texas-heart-institute
PBS NOVA Video that inspired me to do this research.
(Length 13:35 min)
https://www.youtube.com/watch?v=jLs8DeHVkec
Dr. Amit Patel discusses Stem Cell Therapy. Photo is courtesy of kannadigaworld.com
In a set of online videos at University of Utah Health Care, cardiovascular
Center Dr. Amit Patel discusses the human stem cell trials going on
currently in cardiology at the University of Utah Hospital. The patients
involved in the trials are generally experiencing cardiomyopathy , or
congestive heart failure. Dr. Patel says that stem cell therapy is sometimes
a patients last hope, since they do not meet the criteria for a heart
transplant. Dr. Patel explains how only about two tablespoons of stem
cell blood is collected from the patient for the stem cell treatment. A
patients own stem cells are injected into the heart, allowing the patients
own stem cells to heal the damaged heart. He explains that the healing
process is much quicker than other standard heart procedures and very
little risk to the patient. (“Heart Stem Cell Therapy”).
Pros
• Using a patients own cells
eliminates the possibility of
rejection.
• No need for the
immunosuppressant drugs.
• Quicker recovery time
• No waiting on a transplant
list for a perfect match.
• Fewer medications required.
Cons
• There is always criteria for a
patient to be a candidate for
any heart therapy.
• This therapy will be available
for adults only for an
undetermined length of time.
• Many children needing a new
heart will die before this is
available .
•Stem Cells come from a patients own body, eliminating rejection of the
foreign object implanted such as a mechanical device or a transplanted
organ or part.
•Stem Cells allow the body to heal itself.
•Stem Cells are more of a natural way of healing.
•Recovery from stem cell heart therapy is usually quicker.
•Less chance of repeating a surgical procedure.
•No stress from waiting for the perfect organ.
•Less guilt about someone dying in order to save my childs life.
•No need to raise a large sum of money to pay for some of the transplant
costs.
•Less likely for my son to need a heart biopsy.
•Stem Cell therapy is much less invasive.
As I reflect upon the many alternatives available in standard and stem cell
heart therapies, I realize that if stem cell therapy is not available when my
son Isaac is in heart failure, I will possibly choose comfort care. Comfort
Care is a difficult choice in some ways, although it is comforting to know
that it can be a beautiful way to bring closure at the end of a long journey.
I am also prepared to travel to another hospital where Isaac will get the
best care for his individual needs. The decision will be Isaac’s ultimately,
he will decide what he feels is best along with consideration from his
doctors, parents, siblings and his personal feelings. Whether Isaac ever
needs any of these treatments or not, the information is valuable to the
heart community we belong to. Many children can be saved through the
research and developments in standard heart therapies as well as stem
cell research. Health care is as unique as the individuals who use it. I
know Isaac well enough to know that if the opportunity arises for stem
cells to have a chance to heal Isaac, we will consider it with great thought
and consideration.
Works Cited
•
•
•
•
•
•
•
•
•
•
•
“End of life: Helping With Comfort and Care, Providing Comfort at the End of Life,” National Institute on
Aging. U.S. Department of Health and Human Services, 19 May. 2014. Web. 30 July. 2014
“Heart Transplant Education Manual” Children’s Hospital of Philadelphia, Cardiac Center. Web 30 July.
2014.
“Ordinary Heart Cells Become "Biological Pacemakers" with Injection of a Single Gene,” Cedars-Sinai
Institute. 8 Jan. 2013. Web. 30 July. 2014.
“Patients Guide to Heart Transplant Surgery” University of Southern California Keck School of Medicine,
Web 30 July. 2014
Suchetka, Diane, The Plain Dealer, “Ghost Heart, a Framework for Growing New Human Hearts, could be
answer for thousands waiting for a new heart.” Texas Heart Institute, Stem Cell Cite. 19 Aug. 2012. Web 30
July. 2014
“Tricuspid Valve Surgery,” John Hopkins Medicine, Heart and Vascular Institute. Web. 30 July. 2014.
“What are the Risks of Having a Stent?” National Heart ,and Blood Institute, U.S. Department of Health
and Human Services, 17 Dec. 2013. Web. 30 July. 2014.
“What are the Risks of Pacemaker Surgery?” National Heart, Lung and Blood Institute. U.S. Department of
Health and Human Services, 28 Feb. 2012. Web. 30 July. 2014.
“What is a Pacemaker?” National Heart ,Lung and Blood Institute. U.S. Department of Health and Human
Services, 28 Feb. 2012 Web. 30 July 2014.
“What is a Stent?” National Heart ,and Blood Institute, U.S. Department of Health and Human Services, 17
Dec. 2013. Web. 30 July. 2014.
“Heart Stem Cell Therapy,” University of Utah Health Care, Cardiovascular Center.