The first heart transplant in the world. Who was the first to transplant a human heart? Religious Heart Transplant

Who is Dmitri Ivanovich Mendeleev? March 4th, 2014

Pro Dmitri Ivanovich Mendeleev (1834-1907) short article writing is harder than a thick book. In so many areas of science (and not only in chemistry), he distinguished himself by making first-class discoveries!

But it would be a mistake to think that the life of D.I. Mendeleev was a kind of triumphal march from victory to victory. Most likely the opposite. Everything was difficult for him.

Dmitry Ivanovich was born in the city of Tobolsk. He was the last, seventeenth, child in the family, and the eighth of the surviving children. He studied, as it was then said, "for copper money." His mother, Maria Dmitrievna, after the death of her father, Ivan Pavlovich, managed alone with a large family and fed her. In the possession of her family was a glass factory, her mother took the place of the manager at this factory. This was the source of income.

When Dmitry Ivanovich graduated from the Tobolsk gymnasium, his mother left forever her native Siberia and moved to Moscow with her son and youngest daughter.

There are many legends about D.I. Mendeleev, which most often turn out to be fiction. One of these inventions: Dmitry Ivanovich did not shine with knowledge and did not pass entrance exams to university. In fact, graduates of the gymnasium entered the university without exams. But the university is only in its own educational district. Tobolsk belonged to the Kazan educational district. Therefore, D.I. Mendeleev could only enter Kazan University. But it seemed inconvenient for the mother to settle in Kazan. Relatives lived in Moscow, including the mother's brother, whose help, as she hoped, would allow her son to enter an unacceptable university. Did not work out. And only after three years of worries and troubles, in 1850, D.I. Mendeleev became a student of the Faculty of Physics and Mathematics of the Main Pedagogical Institute in St. Petersburg. So Dmitry Ivanovich did not graduate from universities.

After graduating from the Pedagogical Institute, D.I. Mendeleev worked for two years in the south of Russia as a teacher, first at the Simferopol male gymnasium, and then at the Richelieu gymnasium in Odessa. In 1856 he brilliantly defended his master's thesis in chemistry. From 1857 to 1890, D.I. Mendeleev taught chemistry and chemical technology at Petersburg University. In memory of this, one of the lines of Vasilyevsky Island, which passed next to the building of St. Petersburg University, is called Mendeleevskaya.

Dmitry Ivanovich's trip on a two-year scientific mission to Germany, to Heidelberg University, was very fruitful. He went on a business trip on the recommendation of the famous chemist A.A. Voskresensky in 1859 and worked in Heidelberg until 1861. In the photographs of that time, the twenty-five-year-old scientist is already with a beard. But youth is youth. During his stay in Heidelberg, Dmitry Ivanovich had an affair with an actress. From this novel a child was born, for the maintenance of which Mendeleev sent money, although he was not completely sure of his paternity.

Another one of the legends about D.I. Mendeleev. Returning to Russia from Germany, in 1865 he defended his doctoral dissertation under the cheerful title "On the combination of alcohol with water." But this dissertation did not at all reveal that the strength of vodka should be forty degrees. What fortress should and can be vodka, they knew almost a hundred years before. D.I.Mendeleev's doctoral dissertation marked the beginning of one of the sections of physical chemistry that was then emerging, the theory of solutions. Why exactly solutions of water and alcohol interested the scientist? Because when mixing water and alcohol, the volume of the resulting solution is significantly less than the sum of the volumes of the components. This is because small water molecules are nested inside larger alcohol molecules, forming a "tight stack".

Returning to Russia in 1861, D.I. Mendeleev taught at St. Petersburg University and several others. educational institutions capital Cities. In the same 1861, his outstanding textbook "Organic Chemistry" was published.

The main discovery of Dmitry Ivanovich, the periodic system chemical elements, also arose largely as a result of pedagogical activity and works on writing the most important textbook "Fundamentals of Chemistry".

Inorganic chemistry deals with a wide variety of elements. In fact, each element has its own chemistry. Should students take dozens of specific chemistry courses, each on a specific element?

On the other hand, chemists have long noticed the similarity of various elements: lithium, sodium and potassium, iron, nickel and cobalt, inert (or, as they were also called, noble) gases ... But before the discovery of D.I. Mendeleev, all these were observations on empirical level. Mendeleev discovered the periodicity of property changes in all known elements. And he indicated places for elements not yet open. The discovery of new elements had to wait several years. The first of these, gallium, was discovered in 1875, five years after the publication of the famous periodic table, the second, scandium, in 1879. This was partly the reason that D.I. Mendeleev did not become an academician. In 1880, he was nominated to the academician, but the members of the Academy of Sciences swamped the scientist: there are no discoveries in chemistry. Many considered the periodic system not a scientific discovery, but methodical method. Or would you like to count...

In 1869, an article by D.I. Mendeleev “The experience of a system of elements based on their atomic weight and chemical similarity” appears. By the way, it was reported at the first meeting of the newly created Russian Chemical Society. In 1871, a revised article "The Periodic Law for the Chemical Elements" appeared, which outlined this outstanding discovery.

And again - a legend. They say that D.I. Mendeleev dreamed of the Periodic Law in a dream. The scientist himself told about this to several friends. This is a bit like the story of an apple falling on I. Newton's head, which allegedly prompted him to discover the law of universal gravitation, which was actually invented by the great mockingbird Voltaire. On the other hand, why not? The solution to a problem, if you think hard about it, sometimes comes at the most unexpected moments and for the most unexpected reasons.

The interests of D.I. Mendeleev are surprisingly diverse and in any field he achieved serious results. Among other things, he laid the foundation for scientific metrology. Engaged in petrochemistry and oil refining. He revealed the secret of nitroglycerin gunpowder, which the French began to produce. He participated in the creation of the first Tomsk University in Siberia and almost became its rector. flew on hot-air balloon. Even engaged scientific research spiritualism.

All in all, amazing person and an amazing scientist, whom Russia has full right be proud.

Biography of Mendeleev is complete interesting facts, which are often little known to the common man in the street.

Dmitry Ivanovich was born in the family of the director of the Tobolsk gymnasium, Iv. P. Mendeleev and M. Dm. Kornilyeva, daughter of a poor Siberian landowner, January 27 (February 8), 1834. He was the 17th son (according to another version - 14), but the mother did everything possible so that her "last child" received a good education.

Childhood and upbringing

IN short biography Mendeleev Dmitry Ivanovich says that the future scientist spent part of his life in Siberia, where the Decembrists were exiled at the same time. The Mendeleev family was familiar with I. Pushchin, A. M. Muravyov, P. N. Svistunov, M. A. Fonvizin.

The formation of Dmitry Ivanovich's life views was also influenced by his uncle, mother's brother, Vasily Dmitrievich Korniliev, who was familiar with outstanding representatives of the world of art and science of his time. Perhaps in his uncle's house, Dmitry Ivanovich could meet N. Gogol, F. Glinka, M. Pogodin and even Sergei Lvovich and Alexander Sergeevich Pushkin.

Information has been preserved that one of Dmitry Ivanovich's teachers at the gymnasium was the later famous poet P. Ershov (the author of the famous "Humpbacked Horse").

The future scientist received his higher education in St. Petersburg, at the Main Pedagogical Institute. His mother did everything to enroll her son in the first year of this educational institution.

Family and Children

Mendeleev was married twice. The first wife, Fiza Leshcheva, was the stepdaughter of P. Ershov, and the second, Anna Popova, was 26 years younger than the scientist. From two marriages, 7 children were born. One of his daughters, Lyubov Mendeleeva, was the wife of the famous Silver Age Russian poet A. Blok.

Scientific activity

In 1855, Mendeleev graduated from the institute (with a gold medal) and began teaching. At first he worked at the Simferopol gymnasium (where he met N.I. Pirogov), then at the Richelieu Lyceum in Odessa. In 1856 he defended his dissertation and received a master's degree in chemistry.

From 1857 to 1890 he worked at the Imperial St. Petersburg University at the Department of Chemistry.

From 1859 to 1860 he taught and worked in Germany, at the University of Heidelberg, where he met such scientists as R. Bunsen, J. Gibbson.

Since 1872, after receiving the title of professor, he taught at the St. Petersburg Institute of Technology, Nikolaev Engineering School, as well as at the Institute of Communications. Since 1876 he was a corresponding member of the Academy of Sciences.

Discovery of the Periodic Law

Scientists discovered and formulated one of the fundamental laws of nature - the periodic law of chemical elements. It should be noted that Mendeleev worked on his system from 1869 to 1900 and was never completely satisfied with his work.

Final years and death

IN last years In his lifetime, Mendeleev did a lot to open the first university in Siberia, founded the Main Chamber of Weights and Measures, contributed to the opening of the Polytechnic Institute in Kyiv, created the first Russian Empire Chemical Society.

The scientist died in 1907, at the age of 72. He was buried in one of the cemeteries of St. Petersburg.

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P ervoy successful transplant the organ that Barnard performed was a kidney transplant in October 1967. Winged successful result and absolutely confident in a successful outcome and more serious transplants, Barnard is looking for a patient who agrees to a heart transplant.

We didn't have to wait long - the 54-year-old Polish emigrant, doomed to inevitable death, Luis Waszkanski, gladly accepts the professor's offer to go down in history and become the first patient with a transplanted heart.

Photo: Barnard and Washkansky

D he had no other chance to survive - his heart muscle was so severely affected. All that was left was to wait donor heart, and Washkansky received it from 25-year-old Denis Ann Derval, who died during a severe car accident. The heartbroken father (who lost his wife in this accident) agreed to the transplant.

And now - half past two on the third of December 1967, both operational teams simultaneously begin work. First in the first operating room was removed diseased heart Washkansky, after this, Barnard removes the donor's heart in two minutes and transfers it to the next room. Another three hours of painstaking work on implanting a new heart, and at half past five the transplanted heart began to beat!

And the next morning, Barnard woke up famous - leading newspapers around the world reported in unison about the feat of the South Farican surgeon. But this was not what interested him, but how the patient's body would behave in relation to an organ, albeit vital for him, but still completely alien. After all, the reaction of rejection, which in human body all foreign bodies, both artificial and biological, very often nullifies the work of even the most skilled surgeon. Fortunately, Washkansky's body turned out to be quite "loyal", and the transplanted heart continued to work. And so good that a few days after the operation he was allowed to get out of bed and even take pictures.

Photo: Barnard, December 5, 1967

TO Unfortunately, the trouble came from a completely different direction - powerful doses of immunosuppressants weakened the patient's immunity so much that a few days after the operation he caught a severe pneumonia, from which he could not recover. 18 days - exactly how long the first human heart in the history of a transplanted human heart beat.

Barnard continued to work despite criticism and setbacks. And already the second heart transplantation was crowned with an undoubted success - the patient lived with a new heart for 19 months!..

Photo: Barnard with Grace Kelly. August 8, 1968

B arnard considered the Soviet surgeon Vladimir Demikhov (1916-1998) his teacher all his life. Professor Vladimir Onopriev in his book of memoirs “Live according to the mind and conscience” writes:

“I found out what a grateful student Christian Bernard turned out to be. On the eve of that world's first heart transplant operation, he calls Demikhov across half the globe. Arriving (already after the famous operation) once again in Moscow, looking around the ranks of the meeting officials and exclaimed:
“I'm sorry, but I don't see my teacher here, Mr. Demikhov. Where is he?"

The meeting officials looked at each other in bewilderment: who is this? Thank God, someone remembered, they had to get out: Mr. Demikhov did not come because of the extraordinary employment at the Institute of Emergency Medicine named after. Sklifosovsky. The guest immediately expressed a desire to immediately recover to him. I had to lead. In the semi-dark cold basement, where the laboratory of the first department of organ transplantation in the USSR was located, Bernard found his teacher ... "

A story from Barnard's life:

TO Christian Barnard gave a series of popular lectures in a number of cities South Africa. His driver, a smart and fairly educated guy, sitting in the hall, always listened very carefully to his patron - he knew everything that he said at lectures by heart. Noticing this, Barnard somehow decided to joke and asked the driver to give another lecture instead of him.

That evening, the professor, dressed in the uniform of a driver, sat in the hall among the audience, and his driver made a report and answered various questions from the audience. But there was still one listener who asked him a very tricky question, to which the speaker found it difficult to answer. However, the resourceful "lecturer" did not lose his head. “I beg your pardon, madam,” he replied, “I am already very tired today. And I will ask my driver to answer your question ...

Heart transplant: the essence and reality of the operation, indications, conduct, prognosis

Heart transplantology, as a separate field of medicine, arose at the intersection of cardiology and immunology, a science that deals with human immunity and has crucial in matters of engraftment and transplant rejection(“planted” biomaterial).

The first research in the field of heart transplantation began in the fifties of the last century. Successful surgeries were performed by doctors in South Africa and the USA in the 1980s. The first heart transplant in the USSR was carried out in 1988 by V.I. Shumakov. Due to the fact that the immunological bases of the graft-host reactions were not previously sufficiently studied, the quality of life and its duration after the operation did not correspond to the desired results, and the prognosis was uncertain.

On present stage level of knowledge allows to carry out such operations with minimal risk development of complications and with sufficient life expectancy after heart transplantation (slightly less than half of patients after surgery live more than 10 years).

In some cases, even repeated transplants are possible, for example, one of the richest people According to Forbes magazine, David Rockefeller, at the age of 99, underwent his sixth heart transplant.

Indications for surgery

Heart transplant surgery is one of the least common operations in cardiac surgery. This is due not only to large financial costs, but also to the following nuances:

• A limited number of donors - people with confirmed brain death, but with a healthy heart,
• The long period of time required to select a donor according to the waiting lists, especially for a heart transplant operation for a child,
• Problems of an ethical nature, including from a religious point of view (in particular, according to Christian ideas, a person is considered alive while his heart is beating),
• Problems postoperative management patients associated with the duration and high cost rehabilitation period,
• Short period of donor heart storage (up to six hours).

However, despite the problems of such a plan, although operations are rare, they are still carried out, and very successfully.

The main indication in which a heart transplant is needed, is the terminal (final) stage (CHF), or the 3rd - 4th functional class (FC), not amenable to treatment medications, with a survival prognosis for this condition of less than a year.

It is the symptoms that are characteristic of last stage(severe limitation of activity, significant swelling of the limbs or the whole body, appearance at rest) with ineffectiveness conservative therapy may require a donor heart transplant.

Such severe heart failure can develop due to the following diseases:

In addition to the above indications, data from objective research methods (ultrasound of the heart and catheterization pulmonary artery):

• less than 20%,
• Absence of severe.

Certain conditions must also be met when planning an operation:

1. The age of the recipient (the person to whom the heart will be transplanted) is less than 65 years old,
2. The patient's performance and willingness to follow a further rigorous treatment and follow-up plan.

What should be the heart of the donor?

A person who is in a coma with a confirmed death can become a heart donor brain, whose cardiac activity is supported by equipment in the intensive care unit. As a rule, such severe patients observed in the hospital after an accident or. That is in fact, the person is already dead, as the apparatus breathes for him artificial ventilation lungs, and the heart works with medications . But if such a heart is transplanted to another person, it will work autonomously already in the new organism. In order to remove the heart from the body of such a patient, the consent of relatives or the patient himself, written during his lifetime, is required. If there are no relatives, or the patient remains unidentified, his heart can be taken without official documents.

After a commission of several people, including the head physician of the clinic where the donor is located, fill out Required documents, a doctor from the transplant center arrives, always with an assistant nurse. Next, an operation is performed to take a donor heart, which is placed in a container with a cardioplegic solution and transported to the center.

Below are the selection criteria for donor hearts:

• The absence of cardiac pathology, confirmed by the results of ultrasound of the heart and (CAG, performed on donors over 45-50 years old),
• Absence of malignant tumors
• No HIV infection viral hepatitis(B, C),
• donor and recipient under the ABO system,
• Approximate sizes of the heart of the donor and recipient, estimated according to the results.

How long to wait for the operation?

In order for a patient to receive a new heart, a waiting list must be drawn up at the transplant center. These centers collaborate with medical institutions, where possible donors can potentially be observed - trauma hospitals, neurological profile etc. Periodically, the center sends a request to hospitals about the availability of a possible heart donor, and then matches those in need of a transplant and available donors according to the above selection criteria. The patient receives a referral to the transplantation center from the attending physician - a cardiologist and / or a cardiac surgeon.

After the waiting list has been drawn up, enough time, and if a suitable donor is never found, the patient may die of heart failure without waiting for the operation. If a donor is found, the operation will be carried out in the coming weeks after that.

Due to the fact that the main indication for CHF is the predicted survival of the patient for less than one year, it is necessary to look for a donor in these critical periods.

The cost of a heart transplant

In the world, a law has been passed to ban the trade in organs, only cadaveric and related transplantation is allowed. Therefore, the heart itself goes to the patient for free. Only the cost of the operation, medical support before and after the transplant, as well as the cost of the rehabilitation period are paid. Generally amounts vary and range from 70 to 500 thousand dollars, on average about 250 thousand dollars. In Russia, it is possible to provide the population with high-tech types of assistance free of charge and pay for quota operations (in the CHI system), but in any case, the exact cost and possibility free operation should be clarified with the attending physician - transplantologist.

In Russia, there is only one single coordinating center that selects donors, operating on the territory of Moscow and the Moscow region. Heart transplantation is carried out directly in:

• Federal scientific center transplantology and artificial organs them. V. I. Shumakov in Moscow, (FGBU "FNTSTIO named after V. I. Shumakov"),
• Research Institute of Circulatory Pathology. E. N. Meshalkin in Novosibirsk,
• Federal State Budgetary Institution "North-Western Federal Medical research center them. V. A. Almazov» in St. Petersburg.

Due to the fact that the legislative and legal principles of organ donation have not been fully developed in our country, heart transplant operations are rarely performed, for example, in 2014, only 200 surgeries were performed, while about 28,000 transplant surgeries were performed in the United States. For the same reason (the ban on organ harvesting from patients under 18), children in need of a heart transplant needed expensive treatment abroad (Italy and India). But in May 2015, a document was adopted on the procedure for ascertaining brain death in people older than 1 year, which makes it possible further development legislative framework in the field of child donation.

Contraindications for surgery

The operation may be contraindicated in the following cases:

Preparing for the operation

When a patient is referred to a transplant center and a decision is made to put him on the waiting list for a heart transplant, he is assigned an examination plan. TO necessary analyzes relate:

• Fluorography or X-ray of the chest organs,
• Blood tests for markers of HIV infection, viral hepatitis, syphilis,
• Clinical blood test, determination of the coagulation system and blood group,
• General urine analysis,
• Ultrasound of the heart, ECG, if necessary - CAG,
• Examination by a cardiac surgeon,
• Examinations by an ENT doctor and a dentist (to exclude foci chronic infections in the cavity of the nasopharynx and mouth),
• Examination by a gynecologist or urologist (for women and men, respectively).

In order to be admitted to the transplant center for surgery if a donor is found, the patient must always have originals and copies of the following documents:

1. Passport, medical policy, SNILS,
2. An extract from the sending institution with the results of the examination,
3. Referral from a medical institution at the place of permanent residence of the patient.

How is the operation carried out?

Heart transplantation begins with the removal of an organ from the donor's body and its placement in a cardioplegic solution for a period of time not longer than 4-6 hours. In it time is running preoperative preparation recipient (introduction of sedative and analgesic drugs - premedication). Further, in the conditions of the operating room under general anesthesia an incision is made in the anterior chest wall of the recipient, large vessels are connected to a heart-lung machine (AIC), which performs the functions of " artificial heart» during the operation.

After that, the right and left ventricles of the heart are cut off, while the atria are preserved. While maintaining its own atria remains active sinus node, which sets the rhythm of contractions of the heart and is the pacemaker.

After the donor's atria have been sutured to the recipient's atria, a temporary pacemaker is placed to allow for adequate heart contractions after surgery. Rib cage sutured, applied aseptic dressing. The operation takes several hours, sometimes no more than six.

The next step in heart transplantation is immunosuppressive and cardiotonic (cardiac support) therapy. Immune suppression (mainly with the help of cyclosporine) is necessary to prevent transplant rejection reactions and better engraftment.

Scheme of removal of the recipient's heart and transplantation:

Video: the course of heart replacement surgery (18+)

Complications

Complications in the early postoperative period include bleeding from operating wound And infectious complications. The first is quite successfully treated by re-opening the wound and suturing the source of bleeding. Prevention of infectious (bacterial, fungal and viral) complications is the appointment of antibiotics and adequate immunosuppression regimens.

In the late postoperative period, the development of a transplant rejection reaction and dysfunction is possible. coronary arteries with the development of myocardial ischemia of the donor heart.

Forecast

The prognosis after surgery is favorable - more than 90% of patients survive the first year, about 60% - the first five years, and slightly less than half of those operated on (45%) live with a donor heart for more than 10 years.

Lifestyle after surgery

Lifestyle after heart transplant surgery consists of the following components:

1. Taking medication. This part of the patient's life after surgery is perhaps the most important. The patient must carefully monitor the time of taking the medication and strictly follow the dosage prescribed by the doctor. Mostly we are talking about taking cytostatics and hormonal drugs, depressing their own immunity, directed against foreign tissues of the heart.
2. Physical activity. In the first month, the patient must comply with a strict restrictive regimen, but daily normal activity should still be present. Within a couple of months, the patient can start driving again, and after a few more, he can begin to light exercise(gymnastics, walking, etc.).
3. Nutrition. Need to lead healthy lifestyle life, completely eliminate the use of alcohol, smoking and follow a diet with an exception harmful products food (fatty, fried, smoked, etc.).
4. Infection protection. The patient should avoid visiting crowded places in the first months after surgery, avoid contact with sick people infectious diseases in the future, wash your hands thoroughly before eating, use only boiled water and thermally processed foods. This is due to the fact that immunosuppression can lead to an increase in the incidence of bacterial, fungal and viral diseases after starting immunosuppressive therapy.

In general, it can be noted that life after surgery, of course, changes a lot, but the quality of life without shortness of breath, palpitations and edema changes for the better.

Religious Heart Transplant

Earlier, when transplantology was just beginning to develop, representatives of various faiths had an ambiguous point of view on heart transplantation. In particular, representatives of Christianity considered such an operation not a charitable deed, because in fact a still “living” heart is taken from a person, and a person can come out of a coma even after a few months (casuistic cases in medicine). However, due to the fact that doctors clearly distinguish between the concept of "coma" and "brain death", in recent years more and more clergy say that to serve after their death to save another human life - true purpose Christian, because at the heart of this doctrine is the concept of sacrifice. And donating your heart is not good for another person?

Video: Channel 1 report on heart transplant

Among transplants various bodies In terms of the frequency of operations, heart transplantation is second only to kidney transplantation. It has become possible to use such operations more often in practice due to the improvement of methods for preserving organs, the technique of cardiopulmonary bypass, suppression with the help of modern drugs rejection reactions. Heart transplantation is performed at the thermal stage of chronic cardiomyopathy with severe heart failure, severe combined

First experiments

The first heart transplant on a dog's neck was performed in 1905. At the same time, the heart vessels were connected to the ends and. Later, a heart transplant was also used in the pleural region, on the thigh, and so on. In 1941 N.P. Sinitsyn carried out the world's first transplantation of additional A in 1961, a technique for orthotopic transplantation was developed. The heart was removed at the level of the atria, and then to the remaining walls of the atria and interatrial septum the donor heart was sutured, after which the aortic roots of the donor heart and pulmonary artery were anastomosed (connected) to the vascular trunks.

First clinical heart transplant

In 1964, an American cardiac surgeon named James Hardy transplanted a monkey heart into a man who was dying of a heart attack. However, the organ stopped working after 90 minutes. And in 1967, another doctor performed the first clinical allotransplantation of the heart (human-to-human transplantation), but the patient died 17 days later. After that, doctors of foreign clinics began to massively carry out such transplants, but the results were often unsatisfactory. Therefore, heart transplantation soon became less and less common. It was also connected with moral and ethical aspects. The most successful heart transplant was performed in the clinic (USA). Currently, this and other large clinics continue to intensively study various nuances heart transplants, including looking for methods to maintain the viability of an organ that has already stopped and restore it contractile function. Research is also being done in the field of creating an artificial heart.

Heart transplant in Russia

Due to the frequent rejection in our country, until the eighties of the last century, heart transplantation was practically not performed. But after the invention in 1980 of the drug "Cyclosporin", which prevents rejection of a transplanted organ, heart transplantation became quite widely used in domestic medicine. So, the first successful transplantation was performed by the surgeon V. Shumakov in 1987. Now science has gone far ahead, and the operation, which was fantastic for that time, has become commonplace today. Not so long ago, a heart transplant required him to be stopped and connected to cardiopulmonary bypass, and now the whole process is carried out with a beating heart.