Faculty Bibliography

The second event took place on Nov. 11, when Robert Tools, the first recipient of a self-contained artificial heart -- a total heart, not just an assist pump -- had a major stroke that may have been caused by the device. Tools' heart had been removed and replaced with a pump called the AbioCor on July 2. Now, his prognosis is uncertain. The assist device is intended to help those with failure of one of the heart's two pumping chambers, or ventricles. The devices are most commonly used to aid the left ventricle, which pumps oxygen- rich blood to the body, and less often to assist the right ventricle, which pumps blood to the lungs to pick up oxygen. Assist devices are too large for two to fit into a patient with failure of both ventricles. A number of assist devices are marketed for temporary use as a 'bridge to transplant' to keep a patient alive long enough to wait for a donor heart. People have lived as long as four years with an assist device before a donor heart became available. Occasionally, the devices have been removed after a few months because patients' hearts recovered well enough to pump on their own

The puzzle is how Mrs. [Otillie W. Lundgren], a woman in her 90's who lived alone, walked with a cane and had limited contact with the world outside her home could have come down with inhalation anthrax. Anthrax has been rare in Connecticut; since 1950, the state has reported just one case, and that was the skin form involving a male mill worker in Glenville in 1968. Mrs. Lundgren's strain of anthrax matches that of the other 18 confirmed cases, said Tom Skinner, a C.D.C. spokesman. It will be later this week before scientists learn whether spores were present in her home, which investigators tested Tuesday. The medical detectives are also looking for evidence of contamination in her mail. On Monday, as Mrs. Lundgren's condition deteriorated rapidly, her chest X-ray became abnormal, but it did not show the characteristic widening of the mediastinum, the space between the lungs that is typically expanded by swollen lymph nodes when they are infected with anthrax, Dr. [Kenneth Dobuler] said. The hospital notified the health department, which performed additional tests to identify the microbe as B. anthracis

The stroke was caused by a blood clot that may have come from Mr. Tools's artificial heart, the AbioCor, which is manufactured by Abiomed Inc. The bleeding, in turn, may have been a consequence of the stroke; it is not unusual for some bleeding to occur into a clot-damaged area of the brain a few days after a good-sized stroke. Before undergoing the implant on July 2, Mr. Tools had been on the brink of death with end-stage heart failure, and had been given little chance of surviving more than 30 days. Until the stroke, his recovery far exceeded expectations, Dr. [Laman A. Gray Jr.] said. Mr. Tools had gone on trips from the hospital to restaurants, and Dr. Gray and his partner, Dr. Robert D. Dowling, had expressed hope that he might go to his home in Franklin, Ky., for Christmas. Dr. Gray said his team has had difficulty in using anticoagulant drugs to prevent formation of a blood clot in the device. Clots can break off and be carried by the blood to lodge in the brain and cause a stroke. The doctors had to reduce the amount of anticoagulant drugs because Mr. Tools suffered several episodes of bleeding from the stomach and nose at the site of a feeding tube. The bleeding was severe enough to require repeated transfusions. Mr. Tools received four transfusions shortly after the stroke last week, but none since, Dr. Gray said

The stroke was caused by a blood clot that may have come from Tools' artificial heart, called the AbioCor and manufactured by Abiomed Inc. The bleeding, in turn, may have been a consequence of the stroke. It is not unusual for some bleeding to occur into a clot- damaged area of the brain a few days after a stroke

Nevertheless, [Eric A. Rose] said the device was not a cure for heart failure, and that it involved a complication rate 2.35 times higher than that for drugs in the study. The complications included serious infections, bleeding and mechanical malfunctions such as motor failure, kinking of the tubes and worn bearings. However, Rose said that the rate of complications is expected to fall with modifications of the device. Assist pumps may eliminate the need for some transplants, and so may help alleviate the serious shortage of donor hearts for transplant. Permanent assist pumps would also eliminate the risks of the immune-suppressing drugs that transplant recipients need to prevent rejection of the donated heart. Rose said that if the Food and Drug Administration approved assist pumps for permanent use, he expected treatment of end-stage heart failure eventually to resemble that of end-stage kidney failure. 'It is premature to say that VADs are as good a treatment now as dialysis, but you could envision that over time' they will become so, he said

The other event took place on Nov. 11, when Robert Tools, the first recipient of a self-contained artificial heart -- a total heart, not just an assist pump -- had a major stroke that may have been caused by the device. Mr. Tools's heart had been removed and replaced with a pump called the AbioCor at Jewish Hospital in Louisville, Ky., on July 2. The assist device is intended to help those with failure of one of the heart's two pumping chambers, or ventricles. The devices are most commonly used to aid the left ventricle, which pumps oxygen-rich blood to the body, and less often to assist the right ventricle, which pumps blood to the lungs to pick up oxygen. Assist devices are too large for two to fit into a patient with failure of both ventricles. A number of assist devices are marketed for temporary use as a ''bridge to transplant'' to keep patients alive while they wait for donor hearts. People have lived as long as four years with an assist device before a donor heart became available. Occasionally, the devices have been removed after a few months because patients' hearts recovered enough to pump on their own

For 130 days, Robert Tools's recovery as the first of five recipients of a self-contained artificial heart was faster and less eventful than his doctors at Jewish Hospital..

Nevertheless, [Eric Rose] said the device is not a cure for heart failure, and that it involves a complication rate 2.35 times higher than that for drugs in the study. The complications include serious infections, bleeding and mechanical malfunctions like motor failure, kinking of the tubes and worn bearings. However, Rose said that the rate of complications is expected to fall with modifications of the device. One tube drains blood from the ventricle into the device, which pumps the blood to the aorta to nourish the body. Most assist pumps help the left ventricle, the heart's main pumping chamber. Photo: Carol Halebian, New York Times / Dr. Eric Rose displays an implantable mechanical pumps that assists a failing heart. Once thought of as a stopgap until a transplant could be done, the devices are now being viewed as a permanent solution that may change the treatment of heart failure. ; Photo: Carol Halebian, New York Times / Implantable pumps might save 50,000 to 100,000 lives a year, according to a landmark study. ;

The study tested a powerful cholesterol-lowering drug, simvastatin, or Zocor, that belongs to the class known as statins. It was the first scientifically controlled trial to include large numbers of women, elderly people, diabetics and people with average or below-average cholesterol, the lead investigator, Dr. Rory Collins of Oxford University, said today at a meeting of the American Heart Association here. Dr. [Sidney Smith], Dr. Collins and other experts advised men and women of all ages, regardless of their cholesterol level, to discuss statin therapy with their doctors if they are diabetic or have had a heart attack, stroke, angioplasty, coronary bypass surgery, narrowed arteries in the legs or neck or the type of chest pain known as angina. The study involved 20,536 patients in 69 hospitals in England. The participants were divided into four groups. One received both simvastatin and vitamins. A second received only a placebo simvastatin and placebo vitamins. A third group received simvastatin and a placebo vitamin. The fourth group received vitamins and a placebo simvastatin

Mr. Tools's condition improved significantly on Monday as he regained some ability to move his right leg, Dr. [Laman A. Gray Jr.] said in an interview. But Mr. Tools still could not move his right arm or speak yesterday, said Dr. Gray, who returned early to Louisville from the meeting of the American Heart Association in Anaheim, Calif