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The man who is living with the first fully implantable artificial heart talked with his family on Wednesday night during nine hours when a breathing tube in his windpipe was removed and he was disconnected from a mechanical ventilator, his doctors said here today. Reconnecting the man to the ventilator ''was not an unexpected occurrence for any patient'' in the man's condition because patients with heart failure may need ventilator support for short intervals in recovery from major surgery, a hospital spokeswoman said. The man knew he was dying and sought the artificial heart after he was rejected as a candidate for a heart transplant at a medical center outside of the Louisville area, his doctors said. The man raised the idea of the experimental artificial heart with his cardiologist, who agreed that it was his only option and referred him to Jewish Hospital

Reconnecting the man to the ventilator was not unexpected, because patients with heart failure may need ventilator support during recovery from major surgery, a hospital spokeswoman said. The doctors plan to leave the man on the mechanical respirator through the weekend to give him a chance to rest and to give his body time to begin a healing process that would take weeks

At a news conference Wednesday, the surgeons described the patient as a diabetic man in his mid- to late 50s who was terminally ill with heart failure and who was in 'dire' condition before the implant operation. Another medical center outside the Louisville area had rejected him as a candidate for a heart transplant because he had significant kidney failure and abnormally high pressure in blood vessels in his lungs, the surgeons said

The surgeons strongly cautioned that the procedure is an experiment in which a complication can occur at any time because of the patient's severe illness and the complexity of the AbioCor artificial heart they implanted. But they expressed optimism that their patient, identified only as a man in his 50s, would be able to return to daily activities. He might even eventually be eligible for a heart transplant, they said. At a news conference Wednesday, the surgeons described the patient as a diabetic man in his mid- to late 50s who was terminally ill with heart failure and who was in 'dire' condition before the implant operation. Another medical center outside the Louisville area had rejected the man as a candidate for a heart transplant because he had significant kidney failure and abnormally high pressure in blood vessels in his lungs, the surgeons said. Before the operation, the man's lungs had been drowning from pulmonary edema, a buildup of fluid that occurs in heart failure, said the surgeons, Dr. Laman Gray and Dr. Robert Dowling, who are from the University of Louisville. By Wednesday morning, the artificial heart, which has been beating about 120 times a minute since the operation, had virtually cleared the fluid from his lungs. They said they were surprised that the problem had been resolved so quickly

The new, totally implantable artificial heart, called the AbioCor, is made by Abiomed of Danvers, Mass. It is battery powered and has no wires or tubes leading outside the body. After the Louisville team, headed by Dr. Laman Gray and Dr. Robert Dowling, removed most of the patient's diseased heart, they attached the Abiomed device to remnants of the two upper chambers, the left and right atria, and to the aorta, the main artery to the body. The operation was one the surgeons had practiced many times on animals, as the FDA had required of any surgical team that participated in the experiment. Among the 700,000 Americans who die from heart failure each year, an estimated 125,000 would be candidates for an implanted artificial heart, [David Lederman] said. Although heart transplants are extending the lives of many patients, there are 4,231 people on the transplant list in the United States, and only about 2,000 hearts become available in a year, according to the United Network for Organ Sharing, which coordinates transplants. Those who do not receive transplants usually die waiting

The surgeons strongly cautioned that the procedure was an experiment in which a complication could occur at any time because of the patient's severe illness and the complexity of the AbioCor artificial heart that they implanted. But they expressed optimism that their patient, identified only as a man in his 50s, would be able to return to daily activities. He might even eventually be eligible for a heart transplant, they said. Before the operation, the man's lungs had been drowning from pulmonary edema, a build-up of fluid that occurs in heart failure, said the surgeons, Dr. Laman A. Gray and Dr. Robert D. Dowling, who are from the University of Louisville. By yesterday morning, the artificial heart, which has been beating about 120 times a minute since the operation, had virtually cleared the fluid from his lungs. They said they were surprised that this problem had been resolved so quickly

Dr. [David M. Lederman] said the Food and Drug Administration gave the company permission in January to implant its artificial heart in up to five patients at any of five hospitals in Boston, Houston, Los Angeles, Louisville and Philadelphia. To protect patient confidentiality, Abiomed officials said they would delay disclosure for up to 30 days after the first human implantation of the AbioCor. The five participants in the F.D.A.-approved experiment must be at least 18 years old and of large enough build to accommodate the grapefruit-size plastic and metal device in the chest. There is no upper limit on age. Such individuals must have failure of both ventricles, the bottom pumping chambers of the heart. They must also have failed all standard therapies and not be eligible for a heart transplant. The researchers did not specify the reasons for that requirement. However, if a recipient of the AbioCor survives long enough and recovers enough to become a candidate for a transplant, nothing ''rules out a heart transplant,'' said Dr. O. H. Frazier, a heart surgeon at the Texas Heart Institute in Houston, one of the F.D.A.-approved centers to implant the AbioCor. Dr. Lederman said that aerospace engineers helped design and develop the AbioCor by using newer microchips and software that were not available to researchers who developed earlier models. The engineers hope that they have learned how to avoid complications like infections and stroke-producing blood clots that plagued the Jarvik-7 heart experiments. William J. Schroeder of Jasper, Ind., lived the longest, for 620 days, on a Jarvik heart, before he died in August 1986. But he suffered a debilitating stroke soon after receiving his artificial heart

Johns Hopkins officials have questioned whether F.D.A. approval was required for the asthma study. Nonetheless, they said they had temporarily halted any studies involving drugs the agency had not approved for experimental use until they consult with the agency. The F.D.A. licensed hexamethonium as a pill for treatment of high blood pressure in the 1950's, but the manufacturer withdrew it from the market in the 1970's after new laws required that drugs meet both safety and effectiveness standards instead of the earlier standard of safety, said Dr. David Lepay, an F.D.A. official. The F.D.A. said that when the first volunteer in the asthma study developed a persistent cough two days after inhaling hexamethonium on April 23, Dr. [Alkis Togias]'s team at Johns Hopkins failed to notify the university's institutional review board. The cough lasted from April 25 to May 3, the F.D.A. said

One thing few doctors considered was the possibility of new infectious agents. We had been taught, quite arrogantly, that virtually all diseases were known; it was just that many things were unknown about them. In fact, an editorial in The New England Journal of Medicine in December 1981 on possible causes of AIDS omitted the whole idea that AIDS might be caused by a previously unknown infectious agent. In Zambia, I hid in the back of a car to escape an angry crowd that did not want journalists reporting on the disease in their country. Earlier, I had tried to interview the country's president, Kenneth Kaunda, about AIDS. His press secretary refused, screaming that reporters only wanted to blame Africa for unleashing the disease on the world when, in his opinion, Americans had brought the disease to Africa. Years later, Mr. Kaunda talked about losing a son to AIDS and the cost of delayed recognition of the AIDS problem. By now, I have written more than 500 articles about AIDS. Tens of millions of sons and daughters are infected, and millions more are AIDS orphans. Last week's special session on AIDS at the United Nations was the first time the General Assembly ever met to address any health issue, and there was a growing realization that the joining of scientific skill and political will holds the best promise for controlling a disease that was unknown until 20 years ago