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Great Ormond Street - BBC2

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    (Original post by Sparkzz)
    Would there be any stage where the transplanted tissue is not recognised as a transplant, so that it is not vulnerable to being attacked by the immune system?

    Also, they stated in the last show that one of the boys who unfortunately died (Sol) had an hole in between the ventricles, and that they were inverted. I was wondering what effect would this have, would the ventricles contract downwards?
    At the moment, there is no stage at which the body will stop trying to reject a transplanted organ if you stop the meds. There is a lot of research going on into this.

    As for the congenital cardiac disease, I haven't seen the show (for some reason iplayer won't work on my husband's computer and mine is being fixed) but I would expect that by "inverted ventricles" they mean that the left ventricle is on the right and vice versa. Although I can't tell from that description exactly what the defect was, there are a variety of conditions that include the two problems you describe. Basically, the right ventricle is thinner and weaker than the left, as it is only designed to pump blood to the lungs. So if you make it try to pump blood to the whole body (as you would be if it's on the left side), it will slowly fail over time. Secondly, if you have a hole between the ventricles, this means that blood can move ("shunt") from one side to the other, depending on which side the pressure is higher. If the right ventricle (which is on the left) is failing, then the pressure on the left side may be higher and so it would force deoxygenated blood across into the right ventricle instead of out to the lungs, causing both volume overload of the right ventricle and decreased overall oxygenation of blood in the systemic circulation, which makes you turn blue.

    That's a pretty basic summary, tbh; it could be refined depending on exactly what the structural defect is and some more complex haemodynamic stuff, but that'll do for now.
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    (Original post by Helenia)
    At the moment, there is no stage at which the body will stop trying to reject a transplanted organ if you stop the meds. There is a lot of research going on into this.

    As for the congenital cardiac disease, I haven't seen the show (for some reason iplayer won't work on my husband's computer and mine is being fixed) but I would expect that by "inverted ventricles" they mean that the left ventricle is on the right and vice versa. Although I can't tell from that description exactly what the defect was, there are a variety of conditions that include the two problems you describe. Basically, the right ventricle is thinner and weaker than the left, as it is only designed to pump blood to the lungs. So if you make it try to pump blood to the whole body (as you would be if it's on the left side), it will slowly fail over time. Secondly, if you have a hole between the ventricles, this means that blood can move ("shunt") from one side to the other, depending on which side the pressure is higher. If the right ventricle (which is on the left) is failing, then the pressure on the left side may be higher and so it would force deoxygenated blood across into the right ventricle instead of out to the lungs, causing both volume overload of the right ventricle and decreased overall oxygenation of blood in the systemic circulation, which makes you turn blue.

    That's a pretty basic summary, tbh; it could be refined depending on exactly what the structural defect is and some more complex haemodynamic stuff, but that'll do for now.
    Thanks for explaining! Are these conditions you've mentioned genetic?


    This was posted from The Student Room's iPhone/iPad Ap
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    (Original post by Sparkzz)
    Thanks for explaining! Are these conditions you've mentioned genetic?
    Not completely. There are certain genetic conditions (e.g. Down's) which predispose to congenital cardiac defects, but not all people with Down's have a cardiac defect. There also seems to be some element of heritability - if you have a congenital heart defect, you are more likely to have a child with one, but again, it's not guaranteed. So there probably is some genetic element but it's not fully identified at the moment. Other things like certain medications/illegal drugs in pregnancy can also contribute.
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    (Original post by Helenia)
    Not completely. There are certain genetic conditions (e.g. Down's) which predispose to congenital cardiac defects, but not all people with Down's have a cardiac defect. There also seems to be some element of heritability - if you have a congenital heart defect, you are more likely to have a child with one, but again, it's not guaranteed. So there probably is some genetic element but it's not fully identified at the moment. Other things like certain medications/illegal drugs in pregnancy can also contribute.
    Thanks! Seems very interesting. May have a look over the internet on the causes.
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    (Original post by Sparkzz)
    Would there be any stage where the transplanted tissue is not recognised as a transplant, so that it is not vulnerable to being attacked by the immune system?
    I think the only case where this would be possible is if you received a transplant from an identical twin, which, of course, is unlikely to ever happen. Twins would have identical DNA hence histocompatability complex etc. which would mean it would be like "your own". The key to finding a suitable donor, is finding an organ which is similar to your own, but it will never be the same.

    Scientist are trying to move away from cell cultures in a petri dish to making organs from your own stem cells so that you could "regrow" organs that wouldn't be rejected (or extremely unlikely to be rejected). They have tried using hearts and cleaning them of all cells aside from the "skeleton" of connective tissue of the heart, and impregnating it with stem cells, so as to create a working heart that is 3D rather than flat heart cells on a dish. If someone manages to get this method to work easily, cheapish and successful in clin. trails, then this would most certainly be like the holy grail and would save millions of people who otherwise die on the transplant list.


    Very moving documentary, and I can't imagine how difficult it is for both patient and adults, but it is very good to see the success stories too. In the last episode, it was interesting how the sensitive topic of cost-effectiveness was mentioned ("bed blocking") - a lot of ethics come up in the series as they are pushing the boundaries of medicine.
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    I think its an amazing series..
    these people are TRUE SUPERHEROES!!!!
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    (Original post by Helenia)
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    Thanks for all the info! Now I understand what people mean when they day they have "a hole in their heart" - very complex sounding stuff
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    (Original post by tania)
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    Just to confuse you further, there is more than one sort of hole in the heart, with different symptoms, problems and treatment!
    This was posted from The Student Room's Android App on my HTC Desire S
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    (Original post by Helenia)
    Just to confuse you further, there is more than one sort of hole in the heart, with different symptoms, problems and treatment!
    This was posted from The Student Room's Android App on my HTC Desire S
    Is it possible for lungs and other organs to be inverted?


    This was posted from The Student Room's iPhone/iPad Ap
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    (Original post by Sparkzz)
    Is it possible for lungs and other organs to be inverted?


    This was posted from The Student Room's iPhone/iPad Ap
    http://en.wikipedia.org/wiki/Situs_inversus

    Although they're more mirrored than inverted, still pretty interesting
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    ''but she's going to die anyway, even if you do the procedure, what will be the nature of her death if you've done the procedure''

    ''...i dont think she will die if we do the procedure, we're trying to do the procedure so she doesn't''

    seriously....
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    (Original post by Orinincandenza)
    http://en.wikipedia.org/wiki/Situs_inversus

    Although they're more mirrored than inverted, still pretty interesting
    I actually saw a dude with dextrocardia in hospital recently. The teaching fellows asked us to do a cardio exam on the guy without telling us what his problem was. They took great pleasure out of watching us try to figure out what the hell we were hearing on auscultation.
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    (Original post by mike2niner4)
    Really good programme!

    I was wondering if someone could explain something to me about last week's show though...

    Mr Curry (one of the surgeons) operated on the South American boy (I think he was called Sebastian) and the other old surgeon assisted him. He wore a mask and quite a large hat in theatre whereas Mr Curry didn't even wear a mask during the operation.... then the boy died from infection! I'm guessing there was a reason why he didn't wear a mask!?
    Sorry for bumping this thread up, but which episode is the one above referring to?
    Does anyone have a link?

    Thanks

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