Peter A. Alivizatos

The Tri-F Titer: A Rapid Test for Estimation of Plasma Fibrinogen and Detection of Fibrinolysis, Fibrin(ogen) Split Products, and Heparin

Abstract The use of extracorporeal circulation has been associated with operative and postoperative hemorrhage. In patients on the pump there are a number of different pathogenetic mechanisms that lead to hemorrhagic disorders. In essence the hemorrhagic diathesis is caused by the increased utilization or destruction of hemostatic factors, the presence of circulating anticoagulants, a reduction in hemostatic factors due to underproduction or dilution by transfused banked blood, or all three. The tri-F titer (TFT) is a new rapid and reproducible test that gives an estimate of the fibrinogen concentration and detects the presence of fibrinolysis, fibrin(ogen) split products, and circulating heparin. The use of the TFT in the diagnosis of various coagulopathies is discussed. The TFT, which depends on the formation and observation of clots in vitro, is considered to have distinct advantages over other tests which rely on immunological, solubility, and other physicochemical phenomena.

Successfully treated pulmonary artery rupture complicated by aneurysm formation

R EPORTED COMPLICATIONS from pulmonary artery (PA) catheterization include atria1 and ventricular dysrhythmias, balloon rupture, pulmonary &hernia and infarction, pulmonary embolization, intracardiac knotting, and bacteremia.’ One of the most severe (and potentially lethal) complications associated with use of balloon-tipped PA catheters is PA rupture with subsequent endobronchial hemorrhage, which occurs with a reported incidence of 0.2% and a fatality rate of approximately .50%.’ A case report of PA perforation and subsequent development of a PA aneurysm is presented. A PA catheter-induced aneurysm and its treatment have not been reported previously.

Fiftieth Anniversary of the First Heart Transplant: The Progress of American Medical Research, the Ethical Dilemmas, and Christiaan Barnard

T his year marks the 50th anniversary of the fi rst heart transplant by South African heart surgeon Christiaan Barnard in Cape Town that caught the world completely unawares. Surprise was succeeded by admiration and idolworshipping of the protagonist, who became famous overnight. Newspapers and television channels competed to interview him and reputable scientifi c associations to recruit him as the principal speaker at their conferences. Th e jet-set of the time embraced him and famous movie stars adored him. But was Barnard the one who was expected to do it, the “chosen” for this procedure? Transplanting a heart had been the dream of surgeons from the beginning of the 20th century. In spite of Russian Vladimir Demikhov’s brilliant techniques in the experimental laboratory in the 1950s, the problem remained unsolved: the invention of a simple yet reliable and reproducible method of implantation so the heart would immediately take over the circulation. All this concerned the technical part, since the problem of rejecting the “foreign” organ still had to be addressed (1). Th e fi rst hurdle was cleared in the late 1950s at Stanford University by Professor Norman Shumway and his close associate Richard Lower (Figure 1), when they achieved the survival of dogs by combining an ingeniously simple surgical technique with local cooling to protect the transplanted heart. Lower came from Michigan; as a Midwesterner, he was a man of few words, with a strong accent and simple manners. After a brief period at Cornell University in New York, Dick, as he was known to his friends, moved to California and Stanford, where cardiac surgery under Norman Shumway was still in its infancy. Shumway came from the famous Minnesota School, which under Owen Wangensteen had made a name for pioneers in heart surgery, like John Lewis and C. W. Lillehei (2). Shumway, another Midwesterner, divided his time between surgery and a primitive experimental From Baylor University Medical Center at Dallas, Dallas, Texas, and the Onassis Cardiac Surgery Center, Athens, Greece. Dr. Alivizatos was founder of cardiothoracic transplantation at Baylor University Medical Center.