← Autodidact Archive · Original Dissent · Gabrielle
Thread ID: 20470 | Posts: 1 | Started: 2005-10-01
2005-10-01 01:13 | User Profile
[img]http://images.thetimes.co.uk/TGD/picture/0,,231594,00.jpg[/img]
Leonardo's drawing, with the mitral valve at the front of the heart, provided a 'eureka moment' for Francis Wells
HIS drawings, diagrams and maps have excited and inspired us for half a millennium. Now once more Leonardo da Vinci has proved that he was far ahead of his time — and ours. A leading heart and lung specialist has been inspired by anatomical discoveries made by Leonardo 500 years ago to change the way he conducts certain operations. Francis Wells, consultant cardiac surgeon at Papworth Hospital in Cambridge, said yesterday that he had had a “eureka moment” as he pored over drawings and notes by the artist in the Royal Collection at Windsor Castle.
Mr Wells was studying Leonardo’s intricate observations of all the individual components of the heart — the way the valves open and close, the expansion and contraction of the muscles and the flow of blood in and out. The revelatory moment came as he looked at the artist’s exploration of how the blood flow affects the closure mechanism of the mitral valve, which controls the direction of blood. Leonardo showed an extraordinary understanding of the mechanism of the valve closure and the integrity of the valve structure. Until now, repairs involved narrowing the diameter of the valve, which in turn restricted the flow of blood.
With Leonardo’s understanding of the importance of the opening and closing phases of the valve, Mr Wells has worked out how to restore the valve’s normal and full variability in opening and closing properly.
“That has been a big step forward,” he said. “We hadn’t thought carefully enough about the importance of the opening phase of the valve on normal heart function to allow extremes of exercise. Leonardo worked it out in the 1500s. This has brought about a significant change in the surgical approach to this valve which I hope will influence other surgeons in the world.”
He added: “What Leonardo was saying about the shape of the valve is important. It means we can repair this valve in a better way. The knowledge that he demonstrated 500 years ago has been lying fallow ever since.” Mr Wells has returned the mitral valve towards its normal functional state — not simply a corrected state — in operations on 80 patients so far.
“It’s a complete rethink of the way we do the mitral valve operation,” he said.
Each patient has reported a dramatic improvement and an increase in their exercise tolerance, he said. “The mitral repair does enhance people’s quality of life to that degree. It allows a dramatic improvement in clinical status,” he said.
Operations on the mitral valve are particularly complex. The valve, one of four within the heart, is like a door that opens and closes. In closing, the valve stops blood going the wrong way. In opening, it allows the heart to fill with blood.
The valve has two openings, flaps of tissue that arise from a circular orifice in the heart. The flaps fold in and out like butterfly wings.
If it stops functioning properly, the limited amount of blood flowing through the heart is also limited in reaching the rest of the body. The flaps then become like swing doors that open both ways and the valve starts to leak, leaving the heart unable to push itself to the normal extremes.
The patient quickly becomes breathless and drained of energy with the slightest exertion. Until now, surgeons have narrowed the diameter of the valve by removing a square portion of one of the flaps. Now, by closing the gaps on each side of the prolapsing flap and cutting out the excess tissue in a V-shape, he can make the valve competent again.
He said: “Before, people have tended to do what they were taught. They didn’t look at the normal function of the valve. Now patients have ended up with a valve that works like the one God gave them.”
Mr Wells and Leonardo feature in The Secret Of Drawing, which begins on BBC Two on October 8.
[url]http://www.timesonline.co.uk/article/0,,2-1801070,00.html[/url]