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Mending Broken Hearts

As heart disease reaches epidemic proportions worldwide, researchers are moving away from the old “clogged-pipes” model to search for triggers lurking in our genes.

/2007/02/hearts/img/gallery.1.1.jpg /2007/02/hearts/img/gal_tnail.1.1.jpg Photograph by Robert Clark Ready for Transplant A human heart destined for transplant lies cradled in a TransMedics Organ Care System. The device can keep a heart warm and beating—and viable for many hours longer than the conventional method for handling donor hearts: immersion in a saline solution and packing in ice. http://pictopia.com/perl/ptp/natgeo?photo_name=1037753 /2007/02/hearts/img/gallery.1.2.jpg /2007/02/hearts/img/gal_tnail.1.2.jpg Photograph by Robert Clark Comforted by the Thump Danuel Allen lived 54 days with an artificial heart implanted in his chest. He was comforted by the thump, says Sharon, his wife, who could hear the heart beating from across the room. A couple of weeks after this photo was taken Allen received a transplanted human heart, but he died from an infection within months. /2007/02/hearts/img/gallery.1.3.jpg /2007/02/hearts/img/gal_tnail.1.3.jpg Photograph by Robert Clark; Photographed at MÃ¼tter Museum Heart Handiwork Getting a good look at the condition of a live human heart was once impossible without invasive surgery. The organ shown here is, in fact, a museum specimen. http://pictopia.com/perl/ptp/natgeo?photo_name=1037731 /2007/02/hearts/img/gallery.1.4.jpg /2007/02/hearts/img/gal_tnail.1.4.jpg Image by Toshiba America Medical Systems, Inc. Scanning for Trouble Dramatic advances in computed tomography now provide detailed scans in ten scalpel-free seconds. This image of a heart beating in a human chest reveals a narrowed artery—potential trouble. /2007/02/hearts/img/gallery.1.5.jpg /2007/02/hearts/img/gal_tnail.1.5.jpg Photograph by Robert Clark; Model by Gunther von Hagens Internal Plumbing More than 60,000 miles (97,000 kilometers) of arteries, veins, and capillaries in an adult body pulsate to a muscular rhythm—100,000 heartbeats a day. Scientists once viewed the cardiovascular system as a pump and a lot of pipes; now they increasingly focus on the molecular level. /2007/02/hearts/img/gallery.1.6.jpg /2007/02/hearts/img/gal_tnail.1.6.jpg Photograph by Robert Clark; Family portrait courtesy Don Steffensen Mutant Gene Holding a photograph of their parents, six Steffensen children—JoAnn, Marvin, Jeanette, Betty, Donald, and Cecil—once confronted a disturbing question: Why have members of their family suffered from an unusually high rate of heart disease for generations? A few years ago, DNA tests revealed that stricken family members share a mutant gene called MEF2A,]]> which produces a protein that appears to make arterial walls more likely to rupture. /2007/02/hearts/img/gallery.1.7.jpg /2007/02/hearts/img/gal_tnail.1.7.jpg Photograph by Robert Clark; Family portrait courtesy Don Steffensen All in the Family Don Steffensen holds a 60-year-old portrait of his mother, father, and siblings. He and most of his siblings tested positive for a mutation in the MEF2A]]> gene, which may be linked to heart disease. In fact, all have had various heart problems. But doctors agree that genes alone can't forecast the future. Diet and exercise are still crucial. /2007/02/hearts/img/gallery.1.8.jpg /2007/02/hearts/img/gal_tnail.1.8.jpg Photograph by Robert Clark Tale of the Tape In Mississippi's Jackson Medical Mall, nurse Cora Champion measures the waistline of Charlie Brown, a participant in the Jackson Heart Study. The study examines why the rate of cardiovascular disease is so high among African Americans. "Participating in this program reminded me of the importance of a good diet and exercise to live a long, healthy life," says Brown. "Now I go to the gym two or three times a week." /2007/02/hearts/img/gallery.1.9.jpg /2007/02/hearts/img/gal_tnail.1.9.jpg Photograph by Robert Clark High Praise When the Jackson Heart Study Choir sings gospel tunes, they witness to an observation made by the study, based in Jackson, Mississippi: Spiritual activity is associated with lower blood pressure (high blood pressure is a risk factor for heart disease). /2007/02/hearts/img/gallery.1.10.jpg /2007/02/hearts/img/gal_tnail.1.10.jpg Photograph by Robert Clark Looking to Help Of the more than 6,500 participants in the Jackson Heart Study, this family trio spans two generations—Tomp Liddell, center; his daughter, Emma Jean Liddell, right; and her cousin Seneca Turner. The study is exploring the role hypertension, diabetes, and other health problems play in the unusually high level of cardiovascular disease among African Americans. "We have to move from speculation to science—and to an intervention that works," says Dr. Herman Taylor, a cardiologist and director of the study. "Good intentions won't solve this epidemic." /2007/02/hearts/img/gallery.1.11.jpg /2007/02/hearts/img/gal_tnail.1.11.jpg Image by Alan Herman and North Memorial Medical Center, Minneapolis, MN Picturing Heart Disease An angiogram, top, reveals an abrupt closure—referred to as a "widow maker"—in a critical coronary artery. This technique uses a catheter, dye, and x-rays to navigate and study blood vessels. In a second angiogram, bottom, after a stent has been inserted, blood flow is restored. /2007/02/hearts/img/gallery.1.12.jpg /2007/02/hearts/img/gal_tnail.1.12.jpg Photographs by Robert Clark (center), and Yasuhiro Honda and Paul Yock, Stanford University School of Medicine (left and right) Getting the Blood Flowing With intravascular ultrasound, doctors are able to examine the inside of a vessel in cross section (left and right). Plaque (yellow) constricts blood flow (red). Once a stent (center) has been inserted and the wall propped open, blood flows more freely. Says Dr. Paul Yock of Stanford University: "Ultrasound helps us completely expand the stents so they have a better chance of staying open." http://pictopia.com/perl/ptp/natgeo?photo_name=1037748 /2007/02/hearts/img/gallery.1.13.jpg /2007/02/hearts/img/gal_tnail.1.13.jpg Photograph by Robert Clark A Change of Heart This polyurethane heart can keep critically ill cardiac patients alive while they await a donated human heart. Once the device is surgically implanted, its attached plastic tubes run through the patient's skin to a battery-powered pneumatic pump. Despite the cost—$106,000—the demand is strong. Some 3,000 people await heart transplants in the U.S., but only about 2,100 donor hearts are available each year. While boosting the supply of artificial hearts is a relatively simple technical hurdle, increasing the supply of human hearts is more challenging. Who will be tomorrow's donors? That question lingers for a patient in Germany, who recently received a CardioWest artificial heart like this one. /2007/02/hearts/img/gallery.1.14.jpg /2007/02/hearts/img/gal_tnail.1.14.jpg Photograph by Robert Clark Installing a New Pump At the Berlin Heart Institute in Germany, 62-year-old Siegfried Streiter endures four hours of surgery—from first incision to final sutures and bandages—to get his artificial heart. The device will not only keep him alive, says Dr. Roland Hetzer, chief surgeon; its strong, steady pulse might also help clear the chronic congestion in his lung vessels. "A transplanted human heart would have failed immediately," says Hetzer. /2007/02/hearts/img/gallery.1.15.jpg /2007/02/hearts/img/gal_tnail.1.15.jpg Photograph by Robert Clark A Healing Hand Days after open-heart surgery, Lawrence Silberman tries to relax as massage therapist Kathleen Ullmann administers craniosacral therapy. With her gentle touch and extraordinarily sensitive fingertips, Ullmann promotes a state of deep relaxation and facilitates the flow of fluids that surround the brain and spinal cord, which can improve the functioning of the central nervous system. Meditation and yoga also help cardiac patients recover from surgery. /2007/02/hearts/img/gallery.1.16.jpg /2007/02/hearts/img/gal_tnail.1.16.jpg Photograph by Robert Clark Second Chance After suffering a massive heart attack that caused severe cardiac damage, athlete Bill Wohl almost died. An artificial heart kept him alive for five months. After that, Wohl received a heart transplant. Sitting in his living room, Wohl holds a photograph of the donor—the late Brady Michaels, who died in a freak accident while working on a reality TV show. "I'm so blessed," says Wohl. "There's no way I should be alive." /2007/02/hearts/img/gallery.1.17.jpg /2007/02/hearts/img/gal_tnail.1.17.jpg Photograph by Robert Clark Enjoying Life Four months after receiving his artificial heart, Siegfried Streiter often gets out and about—but not without the rolling power pack that keeps the heart beating. The equipment beeps at him periodically, says Streiter, but he's not complaining. "The good news is, I'm alive."