• Short Summary

    SURGEONS ARE STILL ARGUING ABOUT WHETHER THE RECENT HEART TRANSPLANT OPERATIONS IN SOUTH AFRICA AND THE UNITED STATES WERE PREMATURE, AS ONLY ONE OF THE FIVE PATIENTS, DR.

  • Description

    1.
    SV PAN, SV, STV (3 SHOTS) SURGEON AT TABLE - HEART-LUNG MACHINE - SURGICAL INSTRUMENTS ON TABLE
    0.15

    2.
    SCU DR LONGMORE SPEAKING (SOF) "WE ARE GOING TO TRY... FACETS OF THE PROCEDURE"
    1.19

    3.
    ZOOM IN SURGEON REMOVING ORGANS FROM RECIPIENT CAVITY - SCU HEART-LUNG MACHINE PAN UP TO GUAGE
    1.44

    4.
    ZOOM IN AND OUT, HEART AND LUNGS OF DONOR IN PLASTIC BAG (SOF THROUGHOUT) BEGINS: "THIS IS THE HEART-LUNG PREPARATION ...
    3.39

    5.
    ZOOMS, DONOR HEART AND LUNGS PLACED IN RECIPIENT CAVITY (SOF THROUGHOUT) ENDS: "... THROUGH THE LUNGS AND ITSELF"
    6.20

    6.
    SCU PAN HEART-LUNG MACHINE - ZOOM OUT SURGEON STITCHES DONOR HEART TO RECIPIENT - CU GUAGE ON MACHINE
    6.58

    7.
    ZOOM OUT SURGEON LIFTS HEART AND POINTS OUT FINAL STAGES OF STITCHING (SOF) "NOW I'LL JUST DEMONSTRATE......SHOW YOU THAT STAGE OF THE PROCEDURE"
    8.18

    8.
    SCU SURGEON DISCONNECTS PIPES OF HEART-LUNG MACHINE
    8.48

    9.
    ZOOM OUT SURGEON MAKES FINAL STITCHES, POINTS OUT JUNCTIONS AND HEART WORKING (SOF) "THE DONATED HEART ..... PUT IN THE CHEST DRAIN"
    10.01


    "WE'RE GOING TO STAY AND SHOW YOU ONE OF THE MANY METHODS WHICH MIGHT BE APPLICABLE IN HUMAN HEART SURGERY TO TRANSPLANTING THE HEART AND, AS WE'RE GOING TO SHOW YOU TODAY, POSSIBLY THE HEART AND THE LUNGS AS WELL. THIS IS A METHOD THAT WE USE BECAUSE IT IS QUITE A SIMPLE METHOD FOR TRANSPLANTING......TRANSPORTING A HEART AND KEEPING IT ALIVE DURING THE TRANSPORT PERIOD. THIS EXPERIMENT WILL BE DONE IN AN ANIMAL, AND MANY OF THE LESSONS WHICH ARE LEARNT HERE HAVE ALREADY BEEN APPLIED IN THE CLINICAL FIELD IN HEART TRANSPLANTATION, AND WE HOPE AT SOME FUTURE DATE IN HEART-LUNG TRANSPLANTATION.



    "NATURALLY, SOME OF THE PARTS OF THE PROCEDURE ARE NOT QUITE AS SOPHISTICATED AS THEY WOULD BE IN HUMAN SURGERY, BUT THESE EXPERIMENTS ARE AIMED AT LEARNING CERTAIN THINGS EACH TIME, SO THAT THERE'S A GRADUAL ACCUMULATION OF KNOWLEDGE IN VARIOUS AREAS, IMMUNOLOGICALLY, SURGICALLY, TECHNICALLY AND IN MANY OTHER FACETS OF THE PROCEDURE."



    "THIS IS THE HEART-LUNG PREPARATION, WHICH DR. HALL IS VENTILATING WITH OXYGEN WITH A SIMPLE T-PIECE. I'LL DEMONSTRATE TO YOU HERE: SEE THE HEART BEATING JUST BY MY THUMB THERE. THAT'S THE LEFT VENTRICLE OF THE HEART, AND THAT'S THE RIGHT VENTRICLE, WITH THE CORONARY ARTERY DOWN THE FRONT. THE LUNGS ARE BEING INFLATED HERE BY DR. HALL, AND THIS IS THE METHOD WE USE TO STORE AND PRESERVE AND TRANSPORT THE HEART. WITH THIS SIMPLE APPARATUS WE CAN TAKE THE HEART BY CAR AROUND TOWN FROM PLACE TO PLACE.



    "THIS CLAMP, WHICH YOU CAN SEE HERE, IS ONE THE DONOR AORTA WHICH WILL BE JOINED DURING THE PROCEDURE TO THE RECIPIENT AORTA IN THIS AREA HERE. THAT'S THE FIRST PART, AND PERHAPS THE MOST DIFFICULT PART, OF THE PROCEDURE WE HAVE TO DO. AS SOON AS THAT JUNCTION IS MADE, WE DON'T HAVE TO WORRY ABOUT VENTILATING THE HEART ANY LONGER, BECAUSE THE HEART-LUNG MACHINE, WHICH IS CONNECTED THROUGH THESE VARIOUS PIPES, WILL SUPPORT THE HEART AS WELL AS THE RECIPIENT WHOSE HEART AND LUNGS HAVE BEEN REMOVED.



    "AS SOON AS WE HAVE THE AORTA JOINED, WE'LL JOIN THE RIGHT UPPER COLLECTING CHAMBER OF THE HEART TO THE RIGHT UPPER COLLECTING CHAMBER OF THE RECIPIENT. AND YOU'LL NOTICE THAT WE'VE LEFT THE WHOLE OF THIS CHAMBER IN THE RECIPIENT IN A SIMILAR WAY TO THE PEOPLE WHO JUST TRANSPLANT THE PUMPING CHAMBERS, OR VENTRICLES ALONE. AND THIS IS IMPORTANT, BECAUSE THE NERVOUS CONTROL OF THE HEART, AND THE RATE CONTROL OF THE HEART, AND ALL ITS REFLEXES, ARE CONCENTRATED ON A SMALL AREA HERE, KNOWN AS THE SINUS NODE. AND THAT IS THE PACEMAKER OF THE HEART, WHICH ORGANISES ITS RATE RESPONSES TO EMOTION AND EXERCISE AND ALL THAT SORT OF THING. YOU CAN SEE THAT THIS HEART IS IMMERSED IN A FLUID WHICH IS SPECIALLY DESIGNED TO NOURISH IT AND KEEP IT WARM WHILE THE SPECIMEN IS BEING TRANSPORTED.



    "WE'RE NOW REMOVING THE SPECIMEN FROM THE PLASTICS BAG OF DIALYSING FLUID. YOU CAN SEE IT BETTER NOW, IN MY HAND, STILL BEATING - THE RIGHT LUNG, YOU'LL NOTICE, IN A SEPARATE PLASTIC BAG WHICH IS MORE CONVENIENT FOR US WHILE WE PASS THE LUNG BEHIND THE RECIPIENT'S HEART AND PUT IT IN THE CORRECT PLACE IN THE RECIPIENT ANIMAL. YOU CAN SEE THAT THE HEART IS STILL BEATING QUITE HAPPILY HERE, AND WERE WE TO MEASURE THE PRESSURES IN THE VARIOUS CHAMBERS OF THE HEART, THEY WOULD BE RELATIVELY NORMAL.



    "NOW WE'RE GOING TO SLIP THE HEART INTO THE RECIPIENT'S CHEST HERE, AND AT THIS STAGE THE PROCEDURE'S A LITTLE TRICKY, AND WILL PROBABLY APPEAR SOMEWHAT CONFUSED TO YOU, BECAUSE WE HAVE TO TRY AND GET THE RIGHT LUNG HERE THROUGH A RATHER SMALL HOLE INTO THE RIGHT SIDE OF THE CHEST WITHOUT DAMAGING IT IN ANY WAY, SO IT HAS TO BE DONE WITH CONSIDERABLE CARE.



    "NOW WE TAKE OFF THE PLASTIC BAG, WE TAKE OFF THE PLASTIC BAG HERE, WHICH WAS COVERING THE RIGHT LUNG, SO THAT THE NOW LIBERATED RIGHT LUNG CAN BE INFLATED BY THE ANAESTHETIST IN ITS NEW HOME. (COULD YOU GIVE THAT A BLOW, BOB, JUST TO DEMONSTRATE - A GOOD ONE!) RIGHT, NOW WE'RE GOING TO REMOVE THE ANAESTHETIST'S TUBE FOR A MOMENT AND PASS THE WINDPIPE OF THE DONOR INTO THE RIGHT SIDE OF THE CHEST, WHERE IT ACTUALLY BELONGS, AND WE'LL NEED A TAPE IN A SECOND, AND WE PASS THAT THROUGH IN THE SAME REGION AS THE LUNG HAS BEEN THROUGH SO THAT.... (AND THE TUBE AGAIN, PLEASE).... AND THE HEART IS STILL BEATING, AND WE'RE IN A LITTLE BIT OF A HURRY NOW, BECAUSE WE WANT TO GET THE SPECIMEN VENTILATED AGAIN AS QUICKLY AS POSSIBLE. (TAPE, PLEASE - WILL YOU HOLD THE CLAMP FOR ME, NURSE - THANK YOU). AS SOON AS THIS IS TAPED INTO PLACE, WE CAN TURN OUR ATTENTION TO JOINING THE AORTA, OR THE MAIN VESSEL OUT OF THE HEART, AND THERE'S NO LONGER ANY URGENCY TO THE PROCEDURE BECAUSE THE ANAESTHETIST CAN CONTINUE TO VENTILATE - (YES, PLEASE) - THE SPECIMEN, AND THE HEART IS STILL CIRCULATING BLOOD THROUGH THE LUNGS AND ITSELF."



    "NOW I'LL JUST DEMONSTRATE A FEW THINGS AT THIS STAGE: HERE, ON THE TOP OF MY FINGER, YOU CAN SEE THAT WE HAVE JOINED THE MAIN VESSEL OF THE RECIPIENT TO THE MAIN VESSEL FROM THE DONOR HEART. AND THE DONOR HEART IS DOWN IN HERE - I'LL LIFT IT UP FOR YOU TO SEE - STILL BEATING STRONGLY, BUT IT'S NOW RECEIVING BLOOD THROUGH ITS CORONARY ARTERIES HERE FROM THE HEART-LUNG MACHINE. AND I DON'T KNOW HOW WELL YOU CAN SEE IT FROM WHERE YOU ARE, BUT ONE OF ITS OWN VESSELS HERE CAN PROBABLY BE SEEN BLEEDING FROM THE AREA, A LITTLE TINY FOUNTAIN OF BLOOD THERE AGAINST THE HANDLE OF THE FORCES. THAT SHOWS THE SORT OF PRESSURE WHICH IS PERFUSING THE VESSELS OF THE HEART.



    "NOW WE'VE STARTED TO MAKE THE SECOND LITTLE JUNCTIONS HERE BETWEEN THE SIDE WALL OF THE UPPER RIGHT COLLECTIONS CHAMBER OF THE DONOR HEART - (CAN YOU HOLD THAT, JAMES, PLEASE?) - AND THE UPPER RIGHT CHAMBER OF THE RECIPIENT HEART HERE, AND WE'VE COMPLETED THE BACK ROW OF THE STITCHES, WHERE I AM POINTING WITH THE SCISSORS THERE, AND WE NOW JUST HAVE TO JOIN THE FRONT WALL HERE TO THE FRONT WALL THERE, AND THIS JUNCTION IS NOW COMPLETE, AND ALL WE'RE LEFT TO JOIN IS THE WINDPIPE OVER HERE, AND THEN THE HEART WILL TAKE OVER, AND WE'LL SHOW YOU THAT STAGE OF THE PROCEDURE."



    "THE DONATED HEART AND LUNGS - ARE NOW COMPLETELY ON THEIR OWN WITH NO ASSISTANCE AT ALL. (ARTERIAL PLEASE. GIVE 25 OF BLOOD, WILL YOU?).



    "NOW I'M GOING TO LIFT UP THE DONATED HEART, JUST TO SHOW YOU ALL THE VARIOUS JUNCTIONS. HERE IS THE JUNCTION BETWEEN THE TWO MAIN AORTAE, HERE. I'LL LIFT UP THE RIGHT LUNG IN THIS REGION, AND SHOW YOU THE JUNCTION BETWEEN THE TWO AORTAE THERE, AND I'LL LIFT UP THE BULK OF THE HEART SO THAT YOU CAN SEE IT BEATING. I DON'T KEEP IT UP TOO LONG, BECAUSE ITS BAD FOR THE BLOOD PRESSURE, AND YOU CAN SEE THE DONATED HEART BEATING THERE. I'LL PUT IT BACK WHERE IT BELONGS. (INFLATE A LITTLE HARDER, BOB. 125 OVER 90). WELL, YOU CAN HEAR THAT THE BLOOD PRESSURE IS 125 OVER 90, AND THE VENOUS PRESSURE IS 5, WHICH IS WITHIN NORMAL LIMITS FOR AN ANIMAL OF THIS TYPE AND SIZE.



    "ALL THAT REMAINS NOW IS TO CLOSE THE CHEST AND PUT IN THE CHEST DRAIN."




    Initials JH/V/WS/PF



    Script is copyright Reuters Limited. All rights reserved

    Background: SURGEONS ARE STILL ARGUING ABOUT WHETHER THE RECENT HEART TRANSPLANT OPERATIONS IN SOUTH AFRICA AND THE UNITED STATES WERE PREMATURE, AS ONLY ONE OF THE FIVE PATIENTS, DR. PHILIP BLAIBERG, HAS SURVIVED. SOME SAY THAT MORE EXPERIMENTAL WORK SHOULD HAVE BEEN DONE ON ANIMALS BEFORE A TRANSPLANT TO A HUMAN RECIPIENT WAS RISKED. BUT THE SURGEONS WHO DID THE OPERATIONS, PROFESSOR CHRISTIAN BARNARD IN SOUTH AFRICA, AND DR. NORMAN SHUMWAY IN NEW YORK, HAVE SAID THEY WOULD TRY AGAIN IF SUITABLE CIRCUMSTANCES OCCURRED, BECAUSE THE DEATHS HAD ARISEN FROM OTHER COMPLICATIONS, NOT FROM THE FAILURE OF THE TRANSPLANTED HEART ITSELF.

    IN THE MEANTIME, EXPERIMENTAL WORK IS CONTINUING. THIS FILM SHOWS ONE SUCH OPERATION, PERFORMED ON AN ANIMAL. IT INVOLVES THE TRANSPLANT OF A HEART AND LUNGS TOGETHER, AND IS PERFORMED BY DR. DONALD LONGMORE, CONSULTANT PHYSIOLOGIST AT THE NATIONAL HEART HOSPITAL IN LONDON. BEFORE STARTING THE OPERATION, DR. LONGMORE EXPLAINS WHAT HE IS SETTING OUT TO DO:
    THE FIRST STAGE SHOWN ON FILM IS A SHORTENED SEQUENCE OF THE PREPARATIONS OF THE RECIPIENT PATIENT TO RECEIVE THE NEW HEART AND LUNGS: THE REMOVAL OF ITS OWN UNWANTED ORGANS. BEFORE THIS IS ONE, THE PATIENT IS CONNECTED TO A HEART-LUNG MACHINE, WHICH KEEPS THE CIRCULATION AND OXYGEN SUPPLY GOING DURING THE OPERATION.

    DR. LONGMORE THEN SHOWS THE NEW HEART WHICH HE IS ABOUT TO INSERT INTO THE PATIENT'S BODY. IT IS KEPT IN A SPECIAL FLUID IN A PLASTIC BAG, AND IS BEATING QUITE NATURALLY, WITHOUT ARTIFICIAL STIMULUS.

    FILM THEN SHOWS THE MACHINE STILL BY-PASSING THE PATIENT'S HEART AND KEEPING THE CIRCULATION GOING WHILE THE SURGEON BEGINS JOINING UP THE AORTA. DR. LONGMORE EXPLAIN WHILE HE WAS WORKING THAT A YEAR AGO A MAJOR DISCOVERY WAS MADE IN HOLLAND ABOUT THE CLASSIFICATION OF TYPES OF TISSUE. THIS MEANT THAT A PATIENTS CAN BE GIVEN TISSUE MATCHING HIS OWN, WHICH HIS BODY IS THEREFORE LESS LIKELY TO REJECT. WITHOUT THIS TISSUE TYPING, REJECTION COULD ONLY BE CHECKED BY LARGE DOSES OF DRUGS, WHICH AT THE SAME TIME LOWERED THE PATIENT'S RESISTANCE TO INFECTION.

    THE NEXT STAGE OF THE OPERATION DESCRIBED BY DR. LONGMORE IS AFTER THE AORTA HAS BEEN JOINED, THE JOINING UP OF THE HEART'S COLLECTING CHAMBERS:
    WHEN THE WINDPIPE IS RECONNECTED, THE OPERATION IS ALMOST OVER. THE PATIENT HAS THE WHOLE CIRCUIT FOR BLOOD AND OXYGEN RE-ESTABLISHED, READY TO TAKE OVER FROM THE ARTIFICIAL CIRCUIT THROUGH THE HEART-LUNG MACHINE. ALL THAT REMAINS THEN IS TO DISCONNECT THE TUBES LEADING TO THE MACHINE.

    THE WHOLE OPERATION TAKES ABOUT THREE HOUSE. DR. LONGMORE DESCRIBES THE CLOSING STAGES:

  • Tags

  • Data

    Film ID:
    VLVA8KURUO5J4DZ7N4WQ22GAHF03G
    Media URN:
    VLVA8KURUO5J4DZ7N4WQ22GAHF03G
    Group:
    Reuters - Source to be Verified
    Archive:
    Reuters
    Issue Date:
    02/02/1968
    Sound:
    Unknown
    HD Format:
    Available on request
    Stock:
    Black & White
    Duration:
    00:10:01:00
    Time in/Out:
    /
    Canister:
    N/A

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