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Neighbor's Volunteer Trees
I tried searching and tried reading through multiple postings to see it this subject has already been addressed, but finaly tired out and quit.
I have wonderful neighbors (I live in the city) that I would not want to fight, injure, become angry with, etc. They are beginner gardeners and do not believe in removing volunteer trees that spring up in neglected areas. I have accepted gardening under their volunteer walnut trees -- hostas work well and thrive under that shade. But now several volunteer maples are growing in the only sunny place I have in my yard. These trees are about 6 feet tall now and there are four of them along my fence line. I know I can legally remove anything that grows into my property such as branches, but my neighbors live south of me so eventually these trees will significantly impact my growing conditions.
My yard is small and maple trees from other neighbors already impact my growing conditions in other parts of the yard. This was the only sunny place I had to grow certain things. Yes, I know that I can transition to shade plants, but it hurts to think of the plants I currently grow and that they will die as a result of their growing conditions. Which is really more important -- a spice bush or a maple -- I don't know. I have suggested cutting down the trees, reminding the neighbor of the damage maple roots can cause to building foundations (they are growing within 2 feet of their garage), and the fact that the newest maple tree will impact on the light in their own vegetable garden. I have no other options unless someone out there has an idea that I haven't thought of. I won't try dishonest ideas like spraying Roundup on the trees.
Any suggestions for me other than giving up? My subdivision is a mature area with mature trees. Moving doesn't seem to be an option since house sales are so bad right now and no one wants a small 50s ranch house.
What was there response to your suggestion to remove the trees? Are they lazy? confused? physically unable to do this? Can you offer to help remove the trees?
Do they like the trees? In that case, is there even enough room along the fence to support 4 additional trees? You might want to point out that such crowded trees can become a hazard that a potential buyer of their home might not want to deal with.
I had suggested that I pay to remove the walnut trees and had mentioned the negative effects walnuts have on other plants within the walnut root zone. They had already seen the problems because everything had died on their side of the fence. But the male of the family said he liked the trees and there weren't enough trees on their lot. In fact, when I had tree trimmers work on my trees, he stood and watched them the whole time they were working on the walnut trees to make sure they didn't do anything bad to them, I think (I had told him I was going to have the limbs trimmed back that were on my property because of what the walnuts would do to my metal roof). I had also mentioned the issue with maple tree roots on their garage floor and pointed out my badly cracked driveway as an example. He simply said that he didn't want to take down any trees that decided to grow on his lot.
I won't bring it up again to him. I would say he likes the trees. He doesn't seem too handy with household stuff. Maybe I'll mention to the wife about hazards when they think of selling the house. Frankly I don't want them to sell the house. It's hard to get good neighbors and aside from the excess trees and the perennial morning glory (didn't even want to think about that right now) issue, I really like them. Hmmm maybe I'm talking myself out of this problem -- have to think about that.
Try contacting every real estate agent in your geographic region. Explain to the agents that you and possibly your neighbor (if they can interest or encourage them) may be interested in selling your homes and to please mail both of you information about what other homes are selling for in the neighborhood. This will bombard your neighbors with mail from real estate agents and plant the idea of possible relocation into their minds.
Also ask them for a free appraisal of your property and appraisal of your neighbors property for comparison. When they come out to visit you, explain that you understand that the neighbors tree shade will affect the price you could get from your property. Then ask them if they know of any way to apply pressure to the neighbors so they might remove some of their trees. If they contact your neighbors, they will probably emphasize to them the damage their trees have on potential future sale of their property.
The real estate agents are experienced in this area and would probably be able to supply you with the best options to pursue.
However, don't underestimate the value of your own property.
Thank you for your suggestions -- you certainly gave me a perspective I hadn't considered. I may have to wait until the real estate market heats up again -- we are losing our biggest corporate employer (about 4000 employees) this year and it has truly become a buyer's market.
your neighbor sounds like my stepdad. he refuses to remove any tree that is healthy. and as he has told me each time i try to get him to remove a problem pecan tree, it is HIS LAND AND HIS TREE.
sorry, but as long as your neighbor wants to keep the trees you just have to live with it or move.
around here we love when trees shade the lawn, of course we also have temps in the upper 90's to low 100's from late may to october.
I have neighbors on both sides of me that have huge clumps of Eucalyptus trees growing two feet from the property line, with the branches hanging over my property. The previous owner on one side had had the clump topped to about 30 feet tall, but now there is a new owner whose wife says she likes the monstrosity and it has grown back to sixty feet tall in just a few years. On the other side the owner cut the tree down one time, but it resprouted as multiple trunks and he is now letting it grow, now about 40 feet tall in just a few years. Two of the trees in the clump blew down during a storm, unfortunately it wasn't the four remaining ones that are leaning over the fence. These Eucs will grow to maybe 80 to 100 feet tall with a spread of almost that much. When that happens the branches from both sides will meet in the middle of my 50 foot wide lot and completely block out the sun and I will have to give up gardening and my semidwarf fruit trees will all die. I bought a 14 foot long pole saw and cut off all the branches I can reach, but the one that are higher than 20 feet off the ground are beyond my reach.


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Client Work
Client: Keurig
Objective: Create an interactive holiday banner
Media: Expandable rich media banners, multiple sizes. (300x250; 560x300 shown)
Once banner is expanded, the user can click on individual K-Cups to play their own holiday tune. There is also the option to click Play Jingle Bells and the K-Cups will automatically play the tune of Jingle Bells. Once done playing, the banner then teaches the user how to play.
Client Work - Not Published
Summer 2014 Havas WW Intern Project
Truth: People don't care about how something works. They just want to reap the benefits of a new product.
Insight: Keurig Kold allows me to make the perfect single serving drink, but I don't know how this mystery machine works. And I don't really care. It must be magic.
Big Idea: You're the magician.
Tagline: Made by You. Powered by Magic.
Client: Hershey's - Resse's
Objective: Create an :15 second animated banner promoting the seasonal sale of Reese's One Pound Cups.
Media: 2 40k animated banner, with resizes. (300x250 shown)
Art Director: Brooks Hess, Thomas Shim
Copywriter: Courtney Harris, Michael Lopez
Client: Hershey's
Objective: Create an :15 second animated banner that can act as a campion piece to the new "This Is A Pip" TVC.
Media: 2 300x250 40k animated banner.
Art Director: Brooks Hess
Copywriter: Courtney Harris
Client: Hershey's Kisses
Objective: Create a :15 second animated banner to act as a companion to Hershey's Kisses 2015 TVC.
Media: 1 40k animated banner
Art Directors: Josh Bull, Brooks Hess, Alex Krutchkoff
Role: Concepting
Client: Hershey's - Cadbury
Objective: Create :15 second animated banners promoting the seasonal sale of Cadbury Creme and Mini Eggs. (These are the first digital advertisements for Cadbury in the US.)
Client: Noble Mouse
Insight: A full service agency focusing on digital aspects.
Objective: Create a rebrand positioning the agency in a more serious way.
Target: Males and females.
Media: Identity system.
Client: PayPal
Objective: Create a leave behind/brand book that helps communicate PayPal's new "people-isms."
Target: Small and large business owners.
Media: 8.5x11" interactive book.
A World Where People Rule is an interactive booklet that shows how PayPal is transforming the way people conduct transactions and how PayPal is powering the people economy in an engaging digital leave behind.
The cover has three buttons that have "people-isms" on. When you press each button, a circle illuminates with a brief description of that "people-ism."
On the first page inside you are greeted by our manifesto that encompasses the PayPal spirit and idea of the campaign.
We're all in pursuit of a world where we alone govern our own lives.
Where we don't rely on institutions because self-reliance empowers us.
We're in a world where no one is special because everyone is.
Where anyone is free to buy, sell, create and collaborate.
Where there are no buyers or sellers - just people.
On the left hand side are tabs of "people-isms" that allows readers to quick flip through the book and learn about PayPal.
Visual Design: Erik Arildsson
Copywriter: Neeruj Sethi
Student Work
Insight: Each person drinks coffee for a different reason.
Objective: Create a strong relationship between Keurig and coffee drinkers by finding out what coffee means to them.
Target: Young Professionals 18 - 30 years old.
Media: Print campaign, microsite, social media, and interactive wall.
Awards: Scaddy Gold: Advertising Typography; Scaddy Gold: Magazine Campaign; Student Silver Addy: Consumer Trade Publication; Featured on Ads of the World
Client: Brooklyn Brewery
Insight: Craft beer is popular in the South, however Brooklyn beer is primarily consumed in the North.
Objective: Create a larger consumer demographic and stronger realtionship in the Soutnern United States.
Target: Males and Females 21 - 35 years old who enjoy craft beers.
Media: Theme art, microsite, print ad, outdoor, and bar point of sale.
Client: Ironlak
Insight: Graffiti is often looked down upon and frequently referred to as vandalism.
Objective: Create a digital platform for graffiti artists to produce their work and be able to tag walls in a respectable way.
Target: Graffiti artists, amature and profressional, 18 - 30 years old.
Media: Mini site, app, Facebook wall post, and PR event.
Client: Alarm.com
Insight: Know who is at your home whether they're harmless or not.
Objective: Create a print campaign and utilize direct mail to showcase how with alarm.com you will always know what is going on at your home.
Target: Males and females 30 - 50 years old, married with children, $200k HHI or higher.
Media: Print campaign and direct mail.
Client: Canon
Objective: Promote the photo and video capabilities of the Canon 5D Mark ll.
Insight: The Canon 5D Mark ll allows you to take photos and videos, making it limitless like your imagination. This makes it perfect for young creatives.
Target: Young professional photographers 18 - 30 years old.
Media: Print spread, :15 second pre-roll video.
Photographer: Emily Rowe
Client: Blowin' Smoke
Insight: Previous branding didn't feel welcoming or represented the restraurant well in this day and age.
Objective: Rebrand the restruant to look more modern while still maintain the traditional BBQ feel.
Media: Logo, menu, business card, coasters, and drinking glasses.
Client: Rogue Water Tap House
Insight: A classy gentlemen's bar that stands out from the rest of Savannah's dive bars.
Objective: Create a branding system that reflects a true gentlesmen's bar with a snarky perspective.
Target: Males 25 - 35 years old.
Media: Logo, print campaign, app, direct mail, menu, business card, and bar point of sale.
Client: Glad
Insight: Roommates frequently place things in the fridge without labeling, leaving contents and freshness questionable.
Objective: Create a product line and app that helps keep track of when, who, and what is put into the fridge.
Target: Roommates 18 - 30 years old.
Media: Logo and Utility app.
Client: City of Chicago
Insight: The city of Chicago has open data of real time tracking on snow plows, winters are dreadful for traveling.
Objective: Rebrand the restruant to look more modern while still maintain the traditional BBQ feel.
Target: Resents of the city of Chicago.
Media: Logo and utility app.
SnowEscape is a utility app that tracks snow plows in real time and provides current road conditions. The apps works by using open data provided by the City of Chicago of gps location of each of the city's plows and crowd sourced data and user rating of road conditions. This not only gives reliable information to the users on which route to take, but the information also gets sent back to road services headquarters to ensure and increase quality of road care during winter storms. Another feature of this app is to help find the user the best route to their destination. Sorting out roads based on if a plow went down it and user rated conditions, SnowEscape will deliever the route with the best quality roads to travel on. SnowEscape will help to Keep the City of Chicago Moving.

subset: commoncrawl


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Another Foley ready to give it all in pursuit of European glory
- European Cup
- October 18, 2014, 07:00
Even as Ian Nagle was being singled out for his fine man-of-the-match performance in Munster's win over the Wallabies almost four years ago, the Mu(...)
Jonathan Skerritt's Quest new Class 3 natinal champion
- Other Sports
- June 16, 2014, 01:00
After a dead calm halted almost the entire race programme for the Teng Tools ICRA championships on Saturday, enough breeze returned to Dublin Bay yest(...)
Ian Nagle hoping injury nightmare over as he seeks pastures new
- Rugby
- May 1, 2014, 01:00
If a parallel was drawn between Ian Nagle's senior professional rugby career to date and a musical genre, it would have to be the Blues.Lyrics from th(...)
Munster's Niall Ronan forced to call it quits
- Pro12
- April 30, 2014, 13:05
Munster's Niall Ronan has been forced to retire because of injury. The 31-year-old flanker, one of just seven current squad players with over 100 caps(...)
Rob Penney gives players the chance to stake their claim
- Rugby
- December 1, 2013, 01:00
A lot may have gone in Munster's favour in recent weeks but coach Rob Penney won't have to look far for motivation this evening's clash with Scarlets (...)
Injury concerns for Munster ahead of Warriors trip
- Rugby
- October 21, 2013, 18:39
Munster have a number of injury concerns ahead of the resumption of RaboDirect Pro12 duties against Glasgow Warriors at Scotstoun on Friday.Fullback F(...)
O'Donnell out for up to three months
- Rugby
- September 18, 2013, 11:17
Munster's Tommy O'Donnell is facing up to three months on the sidelines following the knee injury he sustained against Zebre last weekend. The 26-year(...)
Munster's Simon Zebo ready for first start of the season
- Champions League
- September 16, 2013, 17:59
Simon Zebo is in line to make his first appearance of the season when Munster take on Benetton Treviso in the Pro12 next weekend. The British and Iris(...)
Andrew Conway to start for Munster against Zebre
- Rugby
- September 12, 2013, 13:36
Former Leinster back Andrew Conway will make his first competitive start for Munster when they lineout against Zebre at Stadio XXV Aprile on Friday ni(...)
Clark makes six changes to Emerging Ireland line-up
- International
- June 10, 2013, 12:42
Emerging Ireland coach Allen Clark has made six changes from the victory over Georgia for tomorrow's clash against a South Africa President's XV at th(...)


text: Hi My 10 year old granddaughter has autism and has signs she will be in puberty very soon. Big problem is she still will not be potty trained. She has been student of the month several times but this still is not happening for her. When they try with her she refuses to have a bm for days and days We have tried everything, I even promised a trip to Disneyworld but no luck. What happens when she starts her period? My dil is very nervous and she has made an appointment with a psychologist for the potty training and other issues she has. Anyone with experience with this? Advice, please.


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Why The Russos Are The Best Thing to Happen to the MCU Since Joss Whedon
TV, Comic Books
Comic Books
Shelf Life
The Buy Pile
In Your Face Jam
The Mission
Spinoff Online
Robot 6
Spinoff Online
Spinoff Online
Robot 6
Spinoff Online
Milltown, NJ
The Guardians of the Galaxy are on their way to Walt Disney World in Florida, and they're coming to dance.
According to the Disney Parks blog, a Guardians of the Galaxy Awesome Mix Tape Dance Party is being planned as part of a "Villains Unleashed" event at Disney's Hollywood Studios Aug. 23. Per the post, guests can dance to the film's best-selling soundtrack — at least until Star-Lord and Gamora show up to retrieve the tape.
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Learn more about the five boroughs that make up New York City with our complete guide.
Discover what to do, where to stay and what to see in New York City with our planning tool.
NYC is the place for inquisitive minds looking for new things to see, hear, taste and learn.
Enjoy Shakespeare in the Park, Fourth of July fireworks, the US Open and more.
Download your free copy or order a guide online today.
Wireless Internet is available at locations throughout NYC—including many parks and libraries.
Get tips, maps and everything else you'll need during your stay.
These NYC-centric mobile apps put the City at your fingertips.
NYC Comedy Week – 2-for-1 Tickets to New York Comedy Shows
March 23–29, celebrate the show's final season with a two-course lunch or two cocktails for $19.69.
Stay in New York City and save with these offers.
New York City is made up of five boroughs: the Bronx, Brooklyn, Manhattan, Queens and Staten Island. Each one has enough attractions—and enough personality—to be a city all its own. Learn more about them with this guide.
Just two blocks south of the women's shop, the L.A.-based loungewear master's first-ever guys' depot outfits dudes with his frill-free covetable tees and slouchy pants.


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Felipe Avila killed by hit & run driver in 3 car crash on Staten Island.
Modified Date:Wed, 09/24/2014 - 11:17am
Accident Date:Tuesday, December 31, 2013
Victim was driving early on New Year's Day when other motorist ran stop sign and plowed into his Toyota Celica and a parked car before running off on foot, police say
A 29 year old man was killed after a hit-and-run driver blew a stop sign and crashed into his car early Wednesday in Staten Island, cops said.
Felipe Avila was driving a 1996 Toyota Celica north along Lafayette Ave. in New Brighton when a white 2003 Volvo S80 going east on Cassidy Place didn't stop and slammed into him just after 5 a.m. Wednesday, cops said. The Volvo's driver then slammed into a parked Dodge SUV.
The driver stopped only to ditch his ride and run away.
Avila died en route to Richmond University Medical Center, cops said.
People Involved:
Felipe Avila
Roadway:Lafayette Ave.
City:Staten Island, NY
County:Richmond County, NY
Area:New York, NY


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Dear Editor:
March 2010
Volunteer search and rescue in need of financial assistance
Boating course is slated for Beltzville State Park
A Pennsylvania Fish and Boat Commission Basic Boating Course for operators of boats with outboards of 25 hp or greater and personal watercraft born on or after January 1, 1982, will be presented free of charge at Beltzville State Park, Tuesday, March 30, and Thursday, April 1, from 6-10 p.m. each night.
All participants must pre-register by calling the state park at 610-377-0045 and must attend both sessions. This course is designed to supply boaters with practical information so they can make better informed decisions on the water.
Miller-Keystone slates blood drives
The Miller-Keystone Blood Center has scheduled the following blood drives. Please call the Blood Center for donation information at (610) 926-6060 or (570) 455-2018.
* Tuesday, March 30, 3 p.m. to 6:30 p.m.; Jimmy's Gym, 1055 Interchange Rd, Lehighton; contact Jane Schweibinz, (610) 377-2491
* Wednesday, March 31, 9 a.m. to noon, LCCC Carbon, 24 E. Locust St, Nesquehoning; contact Cheryl Fisher, (570) 669-7010
* Wednesday, March 31, 2 p.m. to 5 p.m., LCCC Morgan Center, 234 High St, Tamaqua; contact Cheryl Fisher, (570) 668-6880.
To what degree is fast food addicting?
I had cleaned up a kid's vomit before, so that wasn't the shock of my Saturday night a few weeks ago.
The shock occurred when we deviated from our tried-and-true plan. Normally when my father and I baby-sit my niece and nephew so that my brother and his wife can go out to eat and catch an early movie, we play at Pop-Pop's until the kids get hungry, and then he takes them out to eat at Arby's or McDonald's.
Three are cited after SH incident
Three persons were cited for disorderly conduct by Summit Hill police after an incident at 4:26 a.m. March 19.
Police Chief Joseph Fittos Jr. said officers were called to investigate a disturbance in the area of 264 W. Ludlow St. when neighbors were awakened by persons acting disorderly.
Cited were Isaac Purcell, 31, of 306-1/2 N. First St., and Gabrielle Parisi, 20, of 184 S. First St., Apt. 4, both of Lehighton, and Amanda Messinger, 19, of 264 W. Ludlow St.
The risk factors
The risk factors for colorectal cancer are:
· I am 50 years old or older.
· I am a smoker.
· I have a family history of colorectal cancer or polyps (tissue that grows out of the lining of the colon or rectum).
· I am obese.
· I eat lots of red meat or high fat dairy products.
· I do not exercise at least 3 times a week.
· I am a woman with a history of breast, ovarian, or uterine cancer.
· I have colitis (chronic breaks in the lining of the colon).
· I have chronic inflammatory bowel disease.
Winter wouldn't have felt right without lots of snow
The Spring Festival, so I've been told, usually ushers in a new season with warmer weather and sunnier skies in Beijing. For much of the one-week holiday, this seemed to be true I was able to put away my scarf and gloves and even bring out a lighter jacket. I threw the windows wide open to allow for some cool but no longer frigid air to circulate throughout my apartment. "Spring is on its way," one of my Chinese co-workers told me one day when I was outside standing and sweating from the heat while waiting for my bus home.
Lansford police report
Lansford police have been busy lately with those who would flout the law in check.
A number of people were cited for traffic violations:
Coal Crackers win third straight tourney
The Coal Crackers 17-18 year-old volleyball team recently won its third consecutive tournament championship.
The team, which is comprised of Marian High School varsity team members, captured the AAU Volleyball East Tournament at Lancaster Bible College on Sunday, March 21.
The Coal Crackers rolled to a 12-0 record, improving their mark to 35-0 so far this tournament season.
Carbon court news
Credit defaults
The following actions were filed by credit card companies, or their collection agencies, for alleged defaults on credit card accounts/loans.
Capital One Bank, 4851 Cox Rd., Glen Allen, Va., filed against Paul F. Miller, 338 Held St., Lehighton, seeking $1,906.46.
"Kingston" is a young adult, neutered male cat availablefor adoption at the Carbon County Friends of Animals in JimThorpe. He is white with black markings and is very playful.For more information call the CCFOA at (570) 325-9400.
Neighbors dispute leads to charges
A neighbors dispute has led to both parties being charged.
State police at Lehighton said David Roy Detweiler, 55, and John Joseph Troianiello, 49, both of Jackson Drive, Saylorsburg, Ross Township, Monroe County, where involved in a dispute over property lines. A female victim said Detweiler got "into her face" and continually shouted at her backing her down her driveway and a male victim said Troianiello approached him and repeatedly shouted in his face. The incident occurred about noon on March 20, troopers said.
Code officer doing her job
Dear Editor:
I'm a resident of Lansford. A few weeks ago our Code Enforcement Officer was critized for doing her job regarding snow removal. Perhaps if the District Magistrate did his job by handing out fines appropriate to the offense, more people would clear their sidewalks.
Reader's Turn: March 27
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Do you think the recently departed winter was the worst you ever experienced, or do you remember worse winters when you were growing up?
Recalls: Repair kits offered for high chairs in 2003-10
The following recalls were issued March 14 - 18 by federal and state agencies:
Young criminals came out strong after the hard winter
By JIM ZBICK
There was no shortage of police news during the first quarter of 1910 in the coal regions. After the weather began to turn warm, the swindlers, youth criminals and drunks shed their cabin fever and moved outdoors.
As for the swindlers, farmers were warned to watch out for a clever wire peddler operating in the area. Posing as an "expert fence builder," he would agree to build a fence for eight cents per running foot. That cost was cheaper than what farmers paid for the wire itself.
Ex-mayor receives warm send-off
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The former mayor of Palmerton has received a warm send-off.
Council on Thursday unanimously agreed to adopt a resolution in recognition of former mayor Peter J. Delich.
Delich, who served as mayor from 1990 until his retirement on Dec. 31, 2009, received a certificate of appreciation, as well as a plaque from council.
"It is an honor for me to accept this recognition for the 30 years I spent with the borough," Delich said. "It's been a pleasure working with the borough for 30 years, but as all things go, all good things must come to an end."
Bartonsville man charged with theft
State police at the Fern Ridge barracks said a Bartonsville man will be cited in connection with the theft of a Top Brand trailer valued at $2,500.
James Sargent Jr., 24, is facing a charge of theft by unlawful taking.
Police said it is alleged he removed the trailer from the yard of Robert Corbi, HC 2 Box 37B, Long Pond, Tunkhannock Township.
The incident was reported to have happened at 1 a.m. Tuesday.
Warrant Night conducted by police
Schuylkill County constables and police departments from the boroughs of Tamaqua, McAdoo and Coaldale, as well as Rush, West Penn and Kline townships spent hours during the evening of March 10 executing outstanding warrants.
Warrant Night was directed by District Judge Stephen Bayer, who has an office in Tamaqua. Law enforcement officials served 89 summary warrants, four felony and one fugitive warrant.
Guardian Elder Care: Here's who they are
Want to know about Guardian Elder Care and its owners?
Here are a few facts about the soon-to-be new owners of Weatherwood, the Carbon County Nursing Home and Rehabilitation Center.
Guardian Elder Care's headquarters is located in Brockway, a small town located eight miles north of Dubois, in western Pennsylvania.
The company began in 1995, after the late Frank Varischetti, a community-oriented businessman, believed that he could begin a venture to help care for the elderly.
Attains dean's list
The Dean of the School of Liberal Arts at Edinboro University, Terry L. Smith, has announced that Leah Danielson has been named to the dean's list in recognition of her outstanding academic performanceduring the first semester of the 2009-2010 school year.
Edinboro University is one of the 14 universities in Pennsylvania's State System of Higher Education.
Leah is a 2006 graduate of Palmerton Area High School and is the daughter of Rodger and Diane Danielson of Palmerton. She is majoring in fine arts with a K-12 teaching certificate in art.
Award banquet to be held on Sunday
The 49th Annual Schuylkill County Scholar-Athlete Award Banquet will be held this Sunday, March 28, at Pine View Acres, Pottsville, beginning at 5 p.m.
The event is sponsored by Schuylkill Chapter No. 25 of the National Football Foundation and College Hall of Fame.
The senior scholar-athletes representatives from 13 Schuylkill County high schools, plus Panther Valley, will be honored.
Representing THE TIMES NEWS area among the senior scholar-athletes will be Joseph Kloap, Marian Catholic; Andrew Tucker, Panther Valley; and Michael Gurcsik, Tamaqua Area.
Two drug dealers enter guilty pleas in Carbon
Two drug dealers, one part of a major cocaine trafficking ring, entered guilty pleas in Carbon County court on Thursday with one immediately sentenced to a state prison and the other facing a state prison sentenced at a later date.
Michael A. Dennis, 42, of East Patchogue, N.Y., and Martin Arias, 30, of Hazleton, both pleaded before President Judge Roger N. Nanovic to drug counts stemming from two separate incidents. Defendants in other pending drug cases also entered guilt pleas.
Drug ring
Lehighton debates booze at rec center
Treasurer will contact insurance company
A few months ago, Lehighton Borough Council discussed the possibility of allowing alcoholic beverages to be brought into the Lehighton Recreation Center for private parties.
The council discussed the matter further this week, and some council members don't like this idea.
No formal action was taken, giving the council the opportunity to weigh the both sides of the matter.
"I think it's asking for trouble," said council member John Bird. "There's going to be property damage, vomiting. In some people, it produces temporary insanity."
He asked, "Is it worth it?"
Egg Hunt in Palmerton
Bring the kids and their egg hunting baskets for the annual Palmerton Memorial Pool Park Egg Hunt at the Palmerton Pool picnic grove this Saturday, March 27 at 11 a.m. for children ages 0 to 10. Rain date is Sunday, March 28 at 3 p.m. This event is sponsored by Pool Pals and open to the public. All lucky egg prizes will be toys.
When basketball was a game
Do you remember when basketball was just a game?
Those were the days when you played pick-up games on the hot asphalt in the summertime, and shoveled the snow off the macadam in the winter in order to play.
Those were the days that the term "gym rat" was a compliment.
Those were the days when the high school hardwoods were located in sweaty bandboxes, with the bleachers almost on top of the courts.
Those were the days before the NCAA 64-team brackets.
Tamaqua man rejected for program, sentenced to state jail
A Tamaqua man was ruled not eligible for a special state prison probation program and will have to do time inside its confinements.
Damian W. Shoff, 29, of 327 Owl Creek Road, was sentenced Thursday in the Schuylkill County court by President Judge William E. Baldwin to serve one to two years in a state correctional institution and when released to be on probation for five years and pay all the costs.
Graduates from basic military training
Air Force Airman Joshua A. Hill graduated from basic military training at Lackland Air Force Base, San Antonio, Texas.
The airman completed an intensive, eight-week program that included training in military discipline and studies, Air Force core values, physical fitness, and basic warfare principles and skills.
Airmen who complete basic training earn four credits toward an associate in applied science degree through the Community College of the Air Force.
He is the son of Lisa Neff of Mahoning Street, Lehighton.
March 26, 2004 Jen Bensinger fires a one-hitter and strikes out 16 batters to lead Tamaqua to 7-0 softball win over Lehighton in its season opener. Bensinger allows a single to the game's first batter, Sam Markley, and then doesn't allow another one the rest of the contest. The Raiders receive run-scoring singles from Nicole Miller and Bernadette Guy while Lauren Smetana adds a triple.
Preparing for the big hunt
Palmerton to consider ban on cell phones while driving
Will Palmerton become the latest municipality to ban cell phone use while driving?
The topic was brought forth for discussion during a meeting of Borough Council on Thursday.
Councilman Richard Nothstein asked whether the borough would want to enact such a ban.
Nothstein suggested the borough's public safety committee check into the matter of texting and cell phone use while driving in the borough.


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This book represents my experiences of my first trip to China, where I had the chance to photograph the people on the street.
This book contains 67 pictures, a mix between black & white and color photos.
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When music legend and style icon Cyndi Lauper partners with award-winning playwright Harvey Fierstein to score a Broadway musical, it's sure to be wild fun.
When two of the top acts in contemporary blues join forces for an album and a tour, it's not to be missed. N.M.O., or "North Mississippi Osborne," is the marriage of North Mississippi Allstars and Anders Osborne. The Southern blues-rock mainstays brought their new collaboration to the Old Rock House Saturday night for a three-hour show that provided some of the finest blues guitar work to be seen on any stage.
Pink Floyd Tribute El Monstero kicked off its annual, six-show holiday run at the Pageant on Friday night to a sold-out crowd. Adding large, outdoor shows during the summer doesn't seem to have affected winter attendance for one of St. Louis' favorite tribute band. And what a band it is -- made up of some of the areas finest and most beloved musicians.
At the close of an intense and emotionally-charged week in St. Louis, Jay Farrar – one of the city's most lauded musicians and prolific songwriters – provided respite with an intimate solo show at the Old Rock House.
Tribute bands have become a big deal -- and a big draw -- particularly when they are comprised of talented musicians from some of the most popular local bands. Rolling Stones tribute act Street Fighting Band is one of the latest incarnations of the trend that spawned tributes El Monstero and Celebration Day -- all of which share common members.
After a successful year on Broadway (and four Tony Award nominations), Motown the Musical launched its first national tour last spring, premiering in St. Louis on Tuesday evening at the Fabulous Fox to a packed house.
New Orleans rockers the Revivalists brought their unique sound back to Old Rock House on Wednesday night for a full-force, nearly two-hour set; and the fairly packed house of loyal fans ate up every second.
Jam veterans Widespread Panic returned to St. Louis on Tuesday night for the first of two shows at Peabody Opera House as part paper writing service of its fall tour. As a diehard fan of the band for nearly 25 years, I was of course excited to spend some time with them once again in my home city at such an intimate venue.
It's been four long years since grunge-rock pioneers Pearl Jam graced St. Louis with their musical presence, but that extended absence was rectified Friday night at an electrifying three-hour performance at Scottrade Center for a packed house of rabid fans.
Approximately 8,500 fans of jam rock, blues, funk, soul, bluegrass and more flocked to the heartland this past weekend for the inaugural Phases of the Moon Music and Art Festival, held at Kennekuk County Park just outside of the small town of Danville, Illinois, a stone's throw from the Illinois-Indiana border.
Visit my KDHX.org profile at: /play/roy-kasten/
Concert Co-Ordinator
k2 user profile. you should not be seeing this.
I'm a co-DJ on Literature for the Halibut.
I grew up listening to KDHX since I can remember.
Sleater-Kinney is my favorite band (I think).


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Grammy Awards 2014
PHOTOS: The Grammy Weekend Fun Has Begun!
Cheers! The party's already started for these stars, who've been stepping out this weekend to toast the music world's finest
Credit: Larry Busacca/Getty
Updated: Friday Jan 24, 2014 | 11:00 AM EST By: Kate Hogan, Laura Lane & Nancy Mattia
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Silicon Power-a Growing, Flying Butterfly to 2010 CeBIT Hannover, Germany
Silicon Power-a Growing, Flying Butterfly to 2010 CeBIT Hannover, Germany
Exhibition Theme: USB 3.0 Concept and SDXC Card
World class flash memory module manufacturer, Silicon Power is attending one of the three international computer exhibitions, CeBIT, in Hannover, Germany. Silicon Power, this year, announces to expand its exhibition scales and utilize "butterfly" as the exhibition theme design, symbolizing that Silicon Power is flying to the global stage as a molting butterfly.
Silicon Power's main presentation in 2010 CeBIT includes the most popular USB 3.0 related products which were presented in early 2010 at CES and SDXC memory cards to provide higher quality, larger capacity and speedy transfer rate for users to enjoy more entertainment and storage volume. Silicon Power expects to attract purchasers around the world by the latest and coolest product concept and design, and the whole product lines. This exhibition will definitely be a good start for Silicon Power in 2010.
Accompanying with the most popular and brand-new concept, USB 3.0, Silicon Power is offering its latest products of USB 3.0- USB Flash Drive and Hard Disk Drive. Silicon Power maps out a dynamic exhibition area to present a large progression of USB 3.0 series products in transfer speed in order to impress buyers and media from the real motion experiences.
Silicon Power will also demonstrate all series of products, especially latest popular products, Helios 101 Series USB Flash Drive with an extraterrestrial aura feel and finger-print proof design, and LuxMini 320 and 322 with polished surface and electroplating treatment along the edges for fashion users requiring high quality and modern design.
Not only most popular SDXC memory cards, but also speedy 400X Compact Flash (CF) card with 128GB of storage capacity will be demonstrated in CeBIT exhibition. Silicon Power's 400X 128GB CF card supports PIO Mode-6 and Multi-Word DMA 4 transfer mode in quad-channel configuration. It is faster and more stable for professional photography applications to capture full-resolution raw data in fractions of a second.
Silicon Power, this year 2010, is presenting the full product lines that are of quality, fashion and technologically advanced, and release the whole-new 2010 products in CeBIT Hannover, Germany, from March 2nd to March 6th. Welcome to Silicon Power booth at Hall 17, E23.
About Silicon Power
Silicon Power Computer & Communications Inc., founded by a group of specialists with more than 20 years experience in the field of international trading, global marketing, technical know-how of flash data storage products, is the world's leading manufacturer of flash memory cards, USB flash drives, DRAMS, and card readers. We are also the initiator to offer Lifetime Warranty service both for the Flash Memory Card series and USB Flash Drive products. At the heart of Silicon Power, it exists a strong atmosphere of "Sharing, Caring, and of being Trustworthy." These are our finest commitments at the core. Recognized and supported in over 90 countries, Silicon Power provides fast, international lifetime service and superior products. Silicon Power makes a remarkable and successful achievement in the global community. The company is headquartered in Taipei and has established branches worldwide including the Netherlands and Japan.
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Book Review: The Pendle Curse - Author Catherine CavendishReviewed by: Dave Gammon
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Happy Town (2010) – TV Show Episodes List
A deputy sheriff is confronted with the unsolved mystery of a half-dozen child kidnappings over the past decade in a small town in Minnesota. Check out our Review of Season 1 "Happy Town" Per Wiki Happy Town is an American drama television series that premiered on Wednesday, April 28, 2010, and ended on June 16, 2010 on ABC.[2] It was created by Josh Appelbaum, Andre Nemec and Scott Rosenberg. It had a total of eight … Continue reading
TV Review: Happy Town (TV Series) (2010)
SYNOPSIS: Haplin, Minnesota "Happy Town" is approaching five years of peace after being riddled for years by unsolved kidnappings. But, in the wake of this small town's first crime in five years, some dark truths are being revealed about some familiar faces. They say every town has its secrets… that doesn't even begin to describe Happy Town. Want More info on "Happy Town" TV Series? REVIEW: At the time of this review, the series which … Continue reading


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February 21, 2015 by Doug LaCerte
Spring Training should offer a lot of excitement for Kansas City Royals fans this year. Here are five of the most intriguing Royals storylines to follow. Read More
February 19, 2015 by Aaron Charles
The Kansas City Royals have no shortage of young talent ready for a chance to prove themselves in spring training. Read More
February 16, 2015 by Aaron Charles
Manager Ned Yost has a couple of very tough decisions to make concerning the Kansas City Royals' 2015 roster. Read More
February 10, 2015 by Aaron Charles
Several important factors are working in the Kansas City Royals' favor for the 2015 MLB season. Read More
February 3, 2015 by Aaron Charles
With high expectations, the Kansas City Royals need good answers to all the pressing questions for the 2015 season. Read More
January 31, 2015 by Max Zelenko
What role will each player in the Kansas City Royals' bullpen have in 2015? Find out here! Read More
January 29, 2015 by Drew Jenkins
MLB's arbitration is a flawed process, and the case of Kansas City Royals' Jarrod Dyson shows how. Read More
January 28, 2015 by John Shea
The Kansas City Royals' magical 2014 postseason run ended in disappointment, but they could be on the verge of a continued resurgence. Read More
January 21, 2015 by Doug LaCerte
It seems like nobody really knows where he's going, but James Shields is making plenty of news by not yet being signed. Read More
January 12, 2015 by Brad Berreman
As the Kansas City Royals look to build on a 2014 World Series run, here are five players they could still trade this offseason. Read More
January 9, 2015 by Doug LaCerte
The Kansas City Royals made significant moves at the end of 2014, but the Chicago White Sox changed their team in a much bigger way. The Royals will now see far more of two well-liked former players. Read More
December 22, 2014 by Doug LaCerte
The Kansas City Royals need plenty to go right if they want to contend for another pennant, but the fans and franchise alike just need to keep the faith to get them through the holidays this year. Read More
December 11, 2014 by Doug LaCerte
Omar Infante is one bad season into a four-year deal with the Kansas City Royals, but reports from winter meetings state that KC may be looking to trade their veteran second baseman. Read More
December 9, 2014 by Jordan Wevers
The Royals need to replace Butler's left-handed bat in some way heading into 2015. Read More
December 9, 2014 by Doug LaCerte
Should the Kansas City Royals consider trading away Greg Holland, the AL's best relief pitcher? The Toronto Blue Jays want to know now. Read More
December 3, 2014 by Jacob Kornhauser
The Royals need more bats this offseason. That could start with the signing of Melky Cabrera. Read More
November 15, 2014 by Doug LaCerte
The Kansas City Royals reportedly sat down with representatives of ace free agent Jon Lester. Can KC really reel in such a big-time talent? Don't get your hopes up. Read More
November 13, 2014 by Jacob Kornhauser
It's surprising, but if the Phillies are willing to eat enough of his contract, the Royals may decide to deal for slugger Ryan Howard. Read More
November 13, 2014 by Doug LaCerte
Numerous clubs in the MLB showed interest in Cuban free agent slugger Yasmani Tomas, but should the Kansas City Royals get involved? Could Tomas really be the answer for KC in right field? Read More
November 12, 2014 by Doug LaCerte
The Kansas City Royals must make many tough decisions this offseason, and one of the biggest is who to sign to play right field. Will KC go with the veteran Torii Hunter or welcome back Nori Aoki? Read More
October 26, 2014 by Justin Broyles
Billy Butler is still a capable first baseman in the league, and he will be in high demand this offseason. Read More
October 3, 2014 by Drew Jenkins
James Shields has been an ace for the Kansas City Royals, but the righty is set to hit the open market this year. Who will be his top suitors? Read More
July 30, 2014 by Doug LaCerte
April 16, 2014 by David Miller


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StartUpHire is the place to find MySQL jobs in and near . Review the list below of MySQL jobs. These MySQL jobs represent some of the most rewarding careers available. You can refine your job search for MySQL jobs in by adding a job title, company name, or keyword to the search box above … or click the "Advanced Search" link for more options. Don't see the employment opportunity you're looking for? Check back soon for more MySQL jobs in , or sign up for an email alert (link in upper left) to receive periodic updates on new MySQL jobs in , .
Overview Site Reliability Engineer (SREs) is integrated within the infrastructure team, and we?re looking for engineers who want to be a part of developing infrastructure, maintaining it, and scaling it. As a Site Reliability Engineer (SRE) you will have proven experience in1/26/2015 Bethlehem, PA Save This Job
Ready to work with a small team of senior engineers at a fast growing and successful startup? We are very passionate about technology and building a great company centered around our technology. Ideal candidates will have the experience and skills in the full range of user1/12/2015 Brooklyn, NY Save This Job
Location:Pay-Plus Clearwater, FL Job Code:338 # of Openings:1 Description Be part of an exciting new healthcare solution! Pay-Plus Solutions, Inc. helps to bridge the gap between Payers (insurance) companies and Providers. Our payment network exchange provides a lower cost1/12/2015 Clearwater, FL Save This Job
Job Description / Responsibilities: Support process improvements in the engine performance center @ the engine tech center as part of the Engineering Performance Development Team Minimum Qualifications: Engine performance development experience, perform complex assignments,12/14/2014 Mossville, IL Save This Job
Location:Bedminster, NJ Job Code:1172014N # of Openings:1 Description C#- VB.NET- Web Development- SQL- Cutting Edge Technology PHX: Delivering advanced cost management solutions for health plans. Consistently recognized as an industry leader, we provide our service to12/13/2014 Bedminster, NJ Save This Job
Team Lead- Big Data Team Zoosk's Operations team is looking to add a Team lead for our growing Big Data organization which handles MySQL, Hadoop, and Cassandra production environments. You would be a key member of the team that keeps Zoosk running and serving over 40 million2/17/2015 San Francisco, CA Save This Job
Boston MA or Providence, RI Full Time Technology Experienced SHARE As a Database Administrator at ShapeUp you will help ensure our services are scalable and resilient to failure. This role will also be responsible for the reliability, availability, maintenance and3/17/2015 Boston, MA Save This Job
You are a database administrator with strong foundations supporting SQL Server in a 24/7 production environment. You are looking for an opportunity to delve deeper into and expand your knowledge of heterogeneous database environments. Webroot is seeking to provide a database3/24/2015 Boulder, CO Save This Job
Continuent, a leading provider of database clustering and replication software, has a position available for a highly experience sales engineer in the field of high-performance DBMS replication. As a sales engineer responsible you will handle pre- and post-sales engagements for2/25/2015 San Jose, CA Save This Job
Socialware is seeking a Senior Software Engineer to join our team with an affinity for user interface development. Qualified candidates should consider themselves both smart and humble, and have the drive and talent to transform the lives of our users through the development of1/31/2015 Austin, TX Save This Job
Join GREE's platform team that supports mobile games by building tools for A/B testing, game data management or highly scalable services like in-game chat, push notifications, and leaderboards. Candidates should have a pragmatic approach to applicatSan Francisco, CA Save This Job
Yesterday Twilio managed less than one hundred servers in a single datacenter. Today we manage thousands of servers in multiple globally distributed interconnected datacenters all over the globe. Tomorrow we will manage tens of thousands of servers in a heterogenous network3/23/2015 San Francisco, CA Save This Job
Job ID 2014-2239 Location US-NC-Morrisville Category Information Technology Type Regular Full-Time More information about this job: Overview: SciQuest is the largest publicly-held provider of Software-as-a-Service (SaaS) procure-to-pay technology. We?re on a Quest to develop3/19/2015 Morrisville, NC Save This Job
Position Description: Are you interested in Big Data technologies? Do you have a strong technical background and a keen interest in topics such as Hadoop, highly scalable databases or distributed systems? Are you interested in leveraging your existing technical knowledge as well3/1/2015 San Jose, CA Save This Job
Continuent, a leading provider of database clustering and replication software has a position open for a QA engineer. As a QA engineer you will develop automated tests to shake bugs out of Continuent Tungsten database clustering and replication features and make sure they don't2/25/2015 San Jose, CA Save This Job
About the job: We're seeking engineers to join Twilio's User Data team and help build the best telecommunications API on the planet. This is a senior role focused on transforming large user-driven datasets in our distributed environment into public APIs for2/21/2015 San Francisco, CA Save This Job
About the job: We're seeking engineers to join Twilio's Billing & Payments team and help build the best telecommunications API on the planet. This role is focused on managing the realtime fire-hose of Twilio's transactions in our distributed environment. Successful candidates2/21/2015 San Francisco Save This Job
Requisition Number 14-00431 Area of Interest Engineering Position Type Full-time Job Description JOB SUMMARY: Federated Media Publishing is a dynamic fully integrated media company that curates brand sponsorship and integration opportunities across thousands of independent2/18/2015 San Francisco, CA Save This Job
Company overview: Acquia is leading the open source revolution, fueling the growth of Drupal, which drives some of the most powerful websites across the globe: Twitter, Paypal, MTV, Sony Music and over a million others. Acquia?s been named by Forbes as one of the top 1002/17/2015 Boston, MA Save This Job
Description We are looking for exceptional software developers to help us take Fitocracy to the next level. Our team is solving really tough problems all set behind an awesome user experience that needs to scale to millions of users. You must kick ass at Python, Django, and2/16/2015 New York City, NY Save This Job


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Commander Astar Intergalactic Federation of Light ascended 5th Dimension.
Space ship encounters
Let me clarify to Humanity that most of the UFO Activity in your skies are not our light ships. We have not landed a light ship on your planet and nor have we entered your earth's atmosphere until just recently. When the Merope ascended intergalactic were able to enter a port hole which had been protected by Earth selected group. This group of humans have been trying to stop us from anchoring the Transformational energy to your planet. As we have said we are in your universe at this moment and there has been a lot of activity of interest from the Earth selected group, resulting in combat, which have shown hostility towards our light ships. However as we have said the Merope were able to enter the port hole and anchor the energy to the central sun of earth. Our l light ships can be easily explained as etheric energy.
Transformational light energy
As we have said, we at this stage have anchored this transformational energy on Earth. This energy is being transported to Earth from the centre of the Intergalactic Universe and anchored to your planets central sun.
This energy will help lift your consciousness and help free your mind from the traps that others have had over your knowing. These others are the forces of power and control who have used humanity for their own self gain.
As this energy increase you will start to realise the truth behind the lies. These power forces which have used Humanity for their own gain will not be able to hide behind their lies and conspiracies, as this Transformational light brings your consciousness from darkness into the light. Humanity will be able to see their true potential as humans and the beauty that they are, as well as realise that they can create the world they see as theirs and not living their lives for some foundation separate from themselves.
When we speak of implants we are not speaking about physical devises as an implant. Our implants are of an etheric nature. The implants are only given to a select few star seeds so that they are able to complete their assignment on Earth. We are able to do this on a multidimensional level. Each implant carries a code which represents a vibration. The vibration is knowledge. The knowledge is necessary for the next stage in their assignment. The star seeds have the choice to receive the implant, we do not enforce the implant on them as they have free will to receive the implant, and if they choose not to receive the implant, we respect their choice. We do not abduct humans as part of an implant process, nor do we abduct humans for a breeding programme. However we do know that humans are doing breeding programmes as well as implant processes on their own kind. Most of the UFO sightings and abductions of humans are happening from an earth level and it is your own kind that is doing this. This is the Earth selected group; we call them power vampires that are experimenting on their own kind.
Now here comes the twist in this update. The human control select group have also created the knowledge of etheric implants and are using them on humans now. However they are not the same as ours, their knowledge is still very limited. They use these implants to control people and keep them trapped from becoming clear channels of light. To be a clear channel of light you must clear away all unnecessary knowledge that would normally keep the energy from channeling through a clear passage of the self. As you come to understand who you are and realise that you have had many lives and many different realities in many different times, you are able to bring forward from those times necessary knowledge that will enhance your consciousness in this life time, as well as release bad karma if you like that has transferred from past lives into this life time that is not needed and inhibits you to move freely as well as tops you from being a clear channel of light. It is also important to mention to all the healers on planet earth, most of the sickness and illness are a result of these implants and information from the soul source has been tampered with. As a result information from other life times is crossing into this life time and is resulting in illnesses today. So what we are saying here is that there is tampering of the soul pattern that is not of normal process.
Message From The Pleiadians (I,F,U,W,A)
Channeled by R Page
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Reason for reporting:
Indiana declares public health emergency over HIV outbreak
Monsanto Asks World Health Organization to "Retract" Cancer Link
Silent "Killer" Bug Imported Across the Border Being Called the "New AIDS"
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Preacher Who Believes the 'Blood Moons' Are a Prophetic Sign From God That a 'Great Trial' Is Coming for Israel Responds to His Critics
Casting People With Knowledge Of Aliens Or Reptilians Living Among Us (legit site, read faq)
During organ transplantation there have been numerous reports of emotions, memories and experiences being transferred along with the organ
The Alarming New Report You Should Read If You Live Near A Dam
Major American Cities Now Being Wired With ShotSpotter Invasive Eavesdropping Microphones
Cheap wines reportedly have high levels of arsenic
New synthetic chameleon skin could lead to instant wardrobe changes
New System for Police to "Detect Gunshots" is Also Recording Your Private Conversations
NSA Whistleblower Has Questions About World Trade Center Building 7
Michelle O Proposes Weighing Children in Daycare
Wisconsin Lawmakers Go After Workers' Weekends
FDA Opens Door to Less Expensive Drugs
This Activist Posts Feminist Messages On Pads And Shares Them Around Her City
Commercial Airline Takes Flight On Cooking Oil Bio-Fuel Collected From Restaurants
Black Actress DEFENDS Host Who Compared Michelle Obama to an APE – And All Hell Breaks Loose
18 Hilarious Things Lawyers Have Actually Said to Witnesses in Court
Now Obama Floats Idea Of Forced Mandatory Voting For All US Citizens
Spaceship Lenticular Cloud – Maybe the Coolest Cloud Picture Evah!
Soon You Can Drink Beer Brewed With Space Yeast
Can You Get Diseases From Bad Bathroom Smells?
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Apparatuses and methods are provided to reconstruct an enlarged left ventricle of a human heart, using a shaper, having a size and shape substantially equal to the size and shape of an appropriate left ventricle, wherein the shaper is adapted to be temporarily placed into the enlarged left ventricle during a surgical procedure. Another aspect of one embodiment comprises a ventricular patch adapted for placement into the left ventricle of a heart made from a sheet of biocompatible material, and having a plurality of markings coupled to the sheet, wherein the markings are configured in distinct patterns for post operatively evaluating movement of the patch. In another aspect of one embodiment, a device is presented, comprising of a handle and a sizing template adapted to be coupled to the handle. Such components are also presented as a kit for use during ventricular restoration surgery.
1-28. (canceled)
29. A method for reshaping an enlarged left ventricle of a human heart, comprising:
positioning a shaper in the left ventricle, wherein the left ventricle has a first shape;
using the shaper as a model to reshape at least a portion of the left ventricle such that the reshaped left ventricle has a second shape; and
removing the shaper from the left ventricle.
30. The method of
31. The method of
32. The method of
33. The method of
34. The method of
35. The method of
36. The method of
37. The method of
engaging a wall of the left ventricle of a beating heart to sense tactile feedback; and
determining a demarcation line between non-viable tissue and viable tissue of the left ventricle.
38. The method of
39. The method of
determining a demarcation line between non-viable tissue and viable tissue of the left ventricle; and
excluding at least some of the non-viable tissue;
placing at least one suture along at least a portion of the demarcation line; and
pulling the suture such that the left ventricle is pulled around the shaper.
40. The method of
41. The method of
42. The method of
43. A method for reshaping a left ventricle of a human heart, comprising:
positioning a shaper in the left ventricle; and
reshaping at least a portion of the left ventricle about the shaper such that at least a portion of the left ventricle substantially conforms to a predetermined shape of the shaper.
44. The method of
determining a demarcation line between non-viable tissue and viable tissue;
excluding at least some of the non-viable tissue;
placing at least one suture along at least a portion of the demarcation line; and
pulling the suture such that the left ventricle is pulled around the shaper.
45. The method of
46. The method of
47. The method of
48. The method of
This invention claims the benefit of U.S. Provisional Patent Application Ser. No. 60/272,073 filed on Feb. 28, 2001.
This invention relates generally to surgical methods and apparatus for addressing cardiomyopathy, and more specifically to methods and apparatus for restoring the architecture and normal function of a mammalian heart.
The function of a heart in an animal is primarily to deliver life-supporting oxygenated blood to tissue throughout the body. This function is accomplished in four stages, each relating to a particular chamber of the heart. Initially deoxygenated blood is received in the right auricle of the heart. This deoxygenated blood is pumped by the right ventricle of the heart to the lungs where the blood is oxygenated. The oxygenated blood is initially received in the left auricle of the heart and ultimately pumped by the left ventricle of the heart throughout the body. It can be seen that the left ventricular chamber of the heart is of particular importance in this process as it is relied upon to pump the oxygenated blood initially through an aortic valve into and ultimately throughout the entire vascular system.
The amount of blood pumped from the left ventricle divided by the amount of blood available to be pumped is referred to as the ejection fraction of the heart. Generally, a healthier heart has a higher ejection fraction. A normal heart, for example may have a total volume of one hundred milliliters and an ejection fraction of 60 percent. Under these circumstances, 60 milliliters of blood are pumped with each beat of the heart. It is this volume in the normal heart of this example that is pumped with each beat to provide nutrients including oxygen to the muscles and other tissues of the body.
The heart is part of the body tissue, and the heart muscle also requires oxygenated blood. Its normal function is greatly upset by clotting or closure of the coronary arteries. When the coronary arteries are blocked, an associate portion of the heart muscle becomes oxygen-starved and begins to die. This is clinically referred to as a heart attack. Ischemic cardiomyopathy typically occurs as the rest of the heart dilates in an attempt to maintain the heart's output to the body.
As the ischemia progresses through its various stages, the affected myocardium dies losing its ability to contribute to the pumping action of the heart. The ischemic muscle is no longer capable of contracting so it cannot contribute to either squeezing or twisting motion required to pump blood. This non-contracting tissue is said to be �akinetic.� In severe cases the akinetic tissue, which is not capable of contracting, is elastic so that blood pressure tends to develop a bulge or expansion of the chamber. In this situation, this muscle tissue is not only akinetic, in that it does not contribute to the pumping function, but it is in fact �dyskinetic,� in that it detracts from the pumping function. This situation is particularly detrimental as the heart loses even more of its energy due to pumping the blood to the bulge instead of through the aorta.
After a heart attack, the body seems to realize that with a reduced pumping capacity, the ejection fraction of the heart is automatically reduced. For example, the ejection fraction may drop from a normal 60 percent to 20 percent. Realizing that the body still requires the same volume of blood for oxygen and nutrition, the body causes its heart to dilate or enlarge in size so that the smaller ejection fraction pumps about the same amount of blood. As noted, a normal heart with a blood capacity of seventy milliliters and an ejection fraction of 60 percent would pump approximately 42 milliliters per beat. The body seems to appreciate that this same volume per beat can be maintained by an ejection fraction of only 30 percent if the ventricle enlarges to a capacity of 140 milliliters. This increase in volume, commonly referred to as �remodeling�, not only changes the volume of the left ventricle, but also its shape. The heart becomes greatly enlarged. An enlarged heart will tend to change its architecture from the normal conical or apical shape, to a generally spherical shape.
On the level of the muscle fibers, it has been noted that enlargement or dilation of the heart causes the fibers to reorient themselves so that they are directed away from the inner heart chamber containing the blood. As a consequence, the fibers are poorly oriented to accomplish even the squeezing action, as the lines of force become less perpendicular to the heart wall. This change in fiber orientation occurs as the heart dilates and moves from its normal elliptical shape to its dilated spherical shape. The spherical shape further reduces pumping efficiency since the fibers which normally encircle the apex to facilitate writhing are changed to a more flattened formation as a result of these spherical configurations. The resulting orientation of these fibers produces lines of force, which are also directed laterally of the ventricle chamber. Thus, the dilation and resulting spherical configuration greatly reduces contraction efficiency.
Perhaps the most notable symptom of ischemic cardiomyopathy is the reduction in the ejection fraction which may diminish, for example, from a normal 60 percent to only 20 percent. This results clinically in fatigue and in an inability to do stressful activities that require an increase in output of blood from the heart. The output of blood by the enlarged heart at rest is kept normal, but the capacity to increase output of blood during stress (i.e., exercise, walking) is significantly reduced. Of course, the change in architecture has a dramatic effect on wall thickness, radius, and stress on the heart wall. In particular, it will be noted that absent the normal conical shape, the twisting motion of the heart, which can account for as much as one half of the pumping action, is lost. As a consequence, the more spherical architecture must rely almost totally on the lateral squeezing action to pump blood. This lateral squeezing action is inefficient and very different from the more efficient twisting action of the heart. The change in architecture of the heart will also typically change the structure and ability of the mitral valve to perform its function in the pumping process. Valvular insufficiency can also occur due to dilatation.
Although the dilated heart may be capable of sustaining life, it is significantly stressed and rapidly approaches a stage where it can no longer pump blood effectively. In this stage, commonly referred to as congestive heart failure, the heart becomes distended and is generally incapable of pumping blood returning from the lungs. This further results in lung congestion and fatigue. Congestive heart failure is a major cause of death and disability in the United States with approximately 400,000 new cases annually.
Following coronary occlusion, successful acute reprefusion by thrombolysis, (clot dissolution) percutaneous angioplasty, or urgent surgery can decrease early mortality by reducing arrhythmias and cardiogenic shock. It is also known that addressing ischemic cardiomyopathy in the acute phase, for example with reperfusion, may salvage the epicardial surface. Although the myocardium may be rendered akinetic, at least it is not dyskinetic. Post-infarction surgical re-vascularation can be directed at remote viable muscle to reduce ischemia. However, it does not address the anatomical consequences of the akinetic region of the heart that is scarred. Despite these techniques for monitoring ischemia, cardiac dilation and subsequent heart failure continue to occur in approximately 50 percent of post-infraction patients discharged from the hospital.
Various surgical approaches have been tried to treat the dilation of the ventricle by primarily reducing the ventricular volume. Some of these procedures involve removing or excluding dyskinetic and akinetic regions of the heart, then surgically joining the viable portions of the myocardial walls, typically with the use of a patch surgically placed in the walls using a Fontan stitch.
Typically, the exact placement of the patch has been visually determined using only a visual indication where the typically white scar tissue meets the typically red normal tissue. Location of the patch has been facilitated in a further procedure where a continuous suture has been placed around the ventricular wall to define a neck for receiving the patch. The neck has been formed in the white scar tissue rather than the soft viable muscle. This procedure has relied on cardioplegia methods to stop the beating of the heart and to aid in suture placement.
These surgical procedures have been met with some success as the ejection fraction has been increased, for example, from 24 percent to 42 percent. However, despite this level of success, it is often difficult for the surgeon to reconstruct the shape and size of the left ventricle. If the reconstructed ventricle is too small, the patient will not be able to pump enough oxygenated blood. If the reconstructed ventricle is too large, the ejection fraction may diminish. In addition to the size, the shape of the reconstructed ventricle is also important. If the left ventricle is reconstructed in a spherical shape, a twisting motion of the heart about its apex, which can account for as much as one half of the pumping action, is lost. As a consequence, the spherical shaped reconstructed ventricle must rely almost totally on the lateral squeezing action to pump blood. This lateral squeezing action is inefficient and very different from the more efficient twisting action of the heart. What is needed, therefore is a reliable method and apparatus to allow a surgeon to reconstruct the left ventricle to the appropriate shape, size and contour.
In response to these and other problems, an improved apparatus and method is provided for restoring the geometry of the left ventricle to counteract the effects of cardiac remodeling. One embodiment of the present invention provides an apparatus and method to reconstruct an enlarged left ventricle of a human heart, using a shaper, having a size and shape substantially equal to the size and shape of an appropriate left ventricle, wherein the shaper is adapted to be temporarily placed into the enlarged left ventricle during a surgical procedure. Another aspect of one embodiment comprises a ventricular patch adapted for placement into the left ventricle of a heart made from a sheet of biocompatible material, and having a plurality of markings coupled to the sheet, wherein the markings are configured in distinct patterns for post operatively evaluating movement of the patch. In another aspect of one embodiment, a device is presented, comprising of a handle and a sizing template adapted to be coupled to the handle. Such components are also presented as a kit for use during ventricular restoration surgery.
An overview method of one embodiment is presented which introduces the primary components of one embodiment. A detailed discussion of these components then follows. Finally, a method of using the components is discussed in detail.
Turning to
Description of Components:
The Shaping Device:
The shape of the normal heart is of particular interest as it dramatically affects the way that the blood is pumped. The left ventricle which is the primary pumping chamber, is somewhat conical or apical in shape in that it is longer (long axis longest portion from aortic valve to apex) than it is wide (short axis widest portion from ventricle wall to septum) and descends from a base with a decreasing cross-sectional circumference to a point or apex. The left ventricle is further defined by a lateral and posterior ventricle wall and a septum, which extends between the auricles and the ventricles. The pumping of the blood from the left ventricle is accomplished by two types of motion. One of these motions is a simple squeezing motion, which occurs between the lateral wall and the septum. The squeezing motion occurs as a result of a thickening of the muscle fibers in the myocardium. This compresses the blood in the ventricle chamber and ejects it into the body. The thickness changes as the ventricle contracts. This is seen easily by echocardiogram and can be routinely measured.
The other type of motion is a twisting or writhing motion, which begins at the apex and rises toward the base. The rising writhing motion occurs because the heart muscle fibers run in a circular or spiral direction around the heart. When these fibers constrict, they cause the heart to twist initially at the small area of the apex, but progressively and ultimately to the wide area of the base. These squeezing and twisting motions are equally important, as they are each responsible for moving approximately one-half of the blood pumped. Turning now to
The shaping device may be of an �appropriate shape� for a patient. In other words, the shaping device may be of a shape similar to the shape of the left ventricle. In one embodiment, the shaping device 200 may be a generally conical shaped object composed of portions of spherical elements having different radii. Referring back to
At a line �E-E�, a width W3 of the shaping device 200 is 0.435*L. Between the line C-C and the line E-E, the side surfaces 204 a and 204 b have a radius of 0.945 L. The shaping device 200 narrows from the line designated �E-E� through a line designated as �F-F� to a vertex 206 at point �G�. It is important to note that the above discussion is illustrative of only one embodiment of the present invention and is not meant to limit the invention to the above ratios or shapes.
In some embodiments, such as illustrated in
The fluid pressure inside the balloon 201 may also be monitored by a pressure transducer, such as a piezoelectric transducer (not shown) coupled to the filler tube 208 with a y-connection (not shown). In other words, one lead of the y-connection would be coupled to a pressure monitor and the other lead would be coupled to the fluid source. Alternatively, the pressure monitor could be coupled to a three way stopcock (not shown), which would monitor the pressure on the filler tube side of the three way stopcock.
The fluid used to fill the balloon 201 may be any one of a number of fluids, such as saline solution or distilled water. Alternatively, another embodiment could use a sealed balloon containing a silicone gel, such as a liquid methyl silicone resin capable of being vulcanized blended with a dimethyl silicone fluid. Such gels are available from Applied Silicon Inc. (Ventura, Calif.). An embodiment using a sealed balloon would not need an external fluid reservoir, such as syringe 210.
The balloon 201 may be conventionally formed on a mandrel (not shown) having dimensions corresponding to the shape, contour and size of the shaping device. As is known in the art, the mandrel can be made of metal, glass or a hardened gelatin. To form the balloon 201, the mandrel is dipped into a polymer solution, which leaves a thin polymer coating on the mandrel surface. After the polymer has cured, the balloon 201 is removed by peeling the thin coating off the mandrel or by flushing mandrel material out of the shaping device.
Shaping Device�Other Embodiments:
The shaping device of the present invention may be made out of a variety of materials in a number of configurations creating a number of embodiments. For instance if the shaping device is molded from a thermoplastic polymer such as PVC or polyethylene or a similar material, the balloon may be �non-expandable� when inflated. In other words, once the balloon is inflated, the balloon 201 will not significantly expand beyond the original shape. To illustrate, several shaping devices might have volumes ranging from 100 cc to 150 cc at 10 cc increments. If a surgeon predetermines that a patient's pre-enlarged left ventricle was 128 cc., then the surgeon might select a non-expandable balloon having a volume of 130 cc. A surgeon could also request a custom non-expandable balloon with a volume specifically sized for an individual patient.
In contrast, if the balloon 201 is made from an elastomeric material, the balloon 201 may significantly expand. Such elastomeric materials may include latex, polyurethane, silicone, and other elastomers sold under the trade names KRATON (Shell Chemical, New York, N.Y.), C-FLEX (Concept Polymer, Largo, Fla.) and SANTOPRENE (Monsanto, St. Louis, Mo.) Once the balloon is substantially inflated, the influx of additional fluid causes additional expansion of the balloon. Using this embodiment, the surgeon would simply inflate the balloon to a specific volume. The original shape of the balloon may be maintained during this expansion by selectively thickening the walls of the balloon.
In another embodiment, the shaping device could have walls that are relatively thick and are coupled to foam spacers or thermoplastic polymer pads surrounding the exterior of the balloon. Turning now to
In yet another embodiment, the shaping device could be a balloon within a balloon.
The shaping device is not limited to polymeric balloon embodiments.
The shaping device 280 illustrated in
As will be explained in greater detail below, a patch is often used in the ventricle reconstruction procedure. A patch is made from sheet material and may be a variety of shapes, including circular, elliptical, or triangular, preferably sized and configured with a shape similar to a Fontan neck, as discussed below. As illustrated in
The sheet material for the patch 300 may be formed from a biocompatible synthetic material, for example, from polyester, Dacron (Hemoshield) manufactured by the DuPont Corporation, or polytetrafluoroethylene (Gortex). The sheet material may also be autologous pericardium, or some other fixed mammalium tissue such as bovine pericardium or porcine tissue. The biocompatible synthetic material patch may be collagen impregnated to assist in hemostasis, or it may be sprayed with a hemostatic sealant to achieve better and instantaneous hemostasis.
The patch may have markings that enable the movement and position of the patch to be post-operatively observed and analyzed under imaging systems, such as Magnetic Resonance Imaging (�MRI�), x-ray machines, fluoroscopy or other external visualization methods, for post-operative clinical evaluation. Such markings will allow identification of the patch and allow for analysis of the heart's contractility in future post-operative evaluations.
The markings may be radiopaque. Radiopaque markings are made from material that are impenetrable to radiation such as x-rays. Radiopaque markings may be applied to the patch material in a wide variety of methods. For instance, if the patch material is from a woven fabric, then radiopaque threads could be woven into the fabric at regular intervals. Such radiopaque threads could be metal and made from alloys of gold, nitinol, platinum, or stainless steel. Radiopaque threads could also be made of a biocompatible polymeric material mixed with a metal powder, such as barium sulfate. Radiopaque markings could also be imprinted onto the fabric with radiopaque ink. Such ink is available from Creative Imprints Inc., (Norton, Mass.).
Other techniques for marking the patch 300 might include chemical vapor deposition, physical vapor deposition, electroplating and ion-beam assisted deposition. In ion-beam assisted deposition, an electron beam evaporator is used to create a vapor of atoms that coats the surface of the material.
Radiopaque threads might interfere with MRI scans because MRI is extremely sensitive to metal and metal can substantially mask MRI signals. However, if metal markings are made sufficiently small, they will show as bands in an MRI scan. Using metal fibers 0.1 mm to 0.05 mm to create the grid or pattern by weaving into the patch can make a patch MRI sensitive. Also, the metal can be applied to the patch by ion deposition which could deposit a layer of metal 0.01 mm thick onto the patch material. Small tubular strands filled with fatty acids could also be used as be used as MRI sensitive markings. Such strands could be woven into the patch material.
The markings may be Positron Emission Tomography (�PET�) sensitive by making the markings slightly radioactive. However, such markings would probably only be useful for a relatively short time frame after the procedure because of radioactive decay.
The markings may also be attached to the material by a variety of mechanical means such as sewing or weaving the markings into patch material or using microclips. Similarly, the markings such as metal threads may also be attached to the material by adhesive means, such as a bio-compatible glue. Such bio-compatible glues are available from Bioglue, Cryolife Inc. (Kennesaw, Ga.) or Cyanoacrylate, by Loc Tite Corp.
In order to be useful, the markings must be arranged in a pattern that allows post operative evaluation. One such pattern is a series of equally spaced substantially parallel lines as illustrated in
Turning now to
Turning now to
In another embodiment, the sizers may have a cutting edge which can be used to cut the patch 300 to the appropriate shape. Turning now to
A set of cutting dies could also be provided which corresponds to the set of sizers. In other words, for each sizer provided in a set of sizers, there would be a corresponding cutting die, sized to be slightly larger than the sizer. Once a surgeon has determined the correct sizer, he could then select the corresponding cutting die and use the cutting die to cut the patch material to the appropriate size. Alternatively, a set of pre-cut patches could be provided, each pre-cut patch corresponding to a particular sizer in the set of sizers. The use of pre-cut patches would eliminate the need to cut the patch material to the required shape. The pre-cut patches may also have pre-printed suture lines which may be used as a guide for the surgeon when attaching the patch to the heart.
Patch Holder:
Turning now to
Suture Hook:
Turning now to
In yet another embodiment of the present invention, a kit 600 for surgically reshaping the left ventricle of the heart is illustrated in
With the primary purpose of restoring the ventricle's size, shape and contour, the intent of the procedure initially is to remove that portion of the wall, which is not capable of contracting. Such portions include the scarred dyskinetic segments, which are easy to see visually, and may also include akinetic segments, which do not contract.
Referring now to
In step 706, the patient's chest cavity is opened up in a conventional manner. In step 708, an incision is cut into the myocardial wall of the dilated heart. If the surrounding tissue is dyskinetic, it will typically be formed entirely of thin, elastic scar tissue. It is the elasticity of this scar tissue, which causes the detrimental ballooning, or bulging effects previously discussed.
In step 710, a determination as to where the akinetic portions of the tissue begin and end must be made. The determination between viable and non viable tissue can be made by multiple methods, including: visual inspection, electrical methods, marking with dyes, echocardiography, radionuclear imaging, and palpation of a beating heart.
The electrical methods might include the use of an electromyogram which detects electrical impulses from active tissue to distinguish between the akinetic and viable tissue. Positron Emission Tomography (PET) scanning, Single Proton Emissions Computer Tomography and Electrical Mapping Electrophysiology are all other examples of a method to determine viable tissue from akinetic tissue with by electrical means. With Electrical Mapping Electrophysiology, a catheter is inserted into the heart to find areas void of electrical activity.
Marking with dyes can be accomplished by staining the myocardium tissue with a dye that adheres to viable tissue and does not adhere to scar tissue. Triphenyltetrazolium chloride, Tropinin I or T, and Creatine Kinase are all examples of dyes that perform this marking function.
Once the extent of the non-viable areas are determined, in step 712, the portion of the tissue in the ventricle and septal walls may be excised from the epicardium from the incision to the borderline separating akinetic tissue from viable tissue. This border between akinetic and viable tissue becomes the preferred location of the patch and forms an imaginary circumferential line between the non viable areas and viable areas of the myocardium.
In step 714, the preferred location of the patch 300 is been determined relative to the circumferential line. In step 716, a continuous Fontan stitch may be placed in proximity to the line, along the long axis of the heart. The Fontan stitch produces an annular protrusion, which forms a neck relative to the circumferential line. The annular protrusion may be further defined by placing a rim support around its perimeter. This neck initially may have a round circular configuration. A second Fontan stitch may be placed 90 degrees from the initial stitch along the short axis of the heart. Other stitches may be placed as needed to form the heart to the shaping device. The stitch will serve to shape the heart along the short axis of the heart if needed.
In step 718, the shaping device 200 may then be inserted into the ventricle. The shaping device 200 is then inflated or expanded, the volume of which is equivalent to the appropriate volume of the ventricle for the patient. The shaping device 200 provides the model upon which the ventricle can be shaped and contoured through the use of the Fontan suture in step 720. The Fontan suture may then tightened with the aid of the suture hook 520, in step 722. As the suture or sutures are tightened, the musculature of the myocardium will form the physiologically correct volume, shape and contour over the shaping device. The appropriately oval-shaped opening in the neck defines the area where the patch will be placed. Once the suture is tightened down, the shaping device 200 may be collapsed and removed in step 724.
The size of the opening in the neck formed by the Fontan stitch will vary from patient to patient. If the patch 300 is used to close the ventricle, the surgeon should determine the size of the patch to be used (step 726). To determine the appropriate size of the patch, the surgeon may connect any of the sizers 402 a-402 d to the handle 404 to measure the size of the opening, and thus, the size patch 300 that is needed to fit into the neck formed by the Fontan stitch or stitches. In step 728, the surgeon may then construct a patch. In embodiments with different sizers, once the proper sizer has been selected, the sizer can be placed on the patch and be used as a template to cut the patch 300 to the appropriate size. Alternatively, a surgeon may select a precut patch.
In a preferred method for placing the patch, continuous or interrupted sutures can be threaded through the rim covered annular protrusion. The rim covering acts as a large continuous pledget along the perimeter. After the patch has been moved into position on the neck, the sutures can be tied, in step 730.
Alternatively, in cases of extensive nonfibrotic trabecular tissue on the lateral ventricle, another suture method can be placement of mattressed braided sutures over a pericardial strip from outside the ventricle to its interior through the inner oval of the patch. This procedure can be done in conjunction with other procedures such as: Mitral valve repair, ablation of ventricular arrhythmias for treatment of refractory ischemic ventricular tachycardia.
With the patch, suitably placed, in step 732, the suture line can be sprayed with a hemostatic agent or an agent can be applied to achieve better and instantaneous hemostasis. In step 734, the operative site can be closed by joining or folding over the myocardial walls. Care should be taken not to distort the right ventricle by folding the septum wall over the ventricular wall. Alternatively, the lateral wall can be disposed interiorly of the septum wall so a majority of the force on the patch is diverted to the lateral wall. These walls can be overlapped in close proximity to the patch in order to avoid creating any cavity between the patch and the walls.
When air evacuation is confirmed by transesophageal echo, the patient can be weaned off bypass usually with minimal, if any inotropic support. Decannulasation may be accomplished with conventional methods (step 736).
As is well known, the human heart contains an electrical conduction system which sends electrical impulses to spark the heart muscle into regular cycles of contraction. This conduction system includes a Sinoatrial node (SA node), Atrioventricular Node (AV node), and Purkinie Fibers which act as conduits for the electrical pulses. The SA node is located in the right atrium. The electrical impulse leaves the SA node and travels to the right and left Atria, causing them to contract together. This takes 0.04 seconds. There is now a natural delay to allow the Atria to contract and the Ventricles to fill up with blood. The electrical impulse has now traveled to the Atrioventricular Node (AV node). The electrical impulse now goes to the Bundle of His, then it divides into the Right and Left Bundle Branches where it rapidly spreads using Purkinje Fibers to the muscles of the Right and Left Ventricle, causing them to contract at the same time.
Because ventricular restoration may compromise the conduction system due to the fact that a ventricle portion has been severed or excluded, the pacing or rhythm of the impulses between the right and left ventricles of the heart may get out of synchronization after ventricular restoration. This asynchronous pacing contributes to a reduced output by the left ventricle. Thus, restoring or assuring synchronization would assist the reconstructed left ventricle to maximize the output of the left ventricle. Synchronization may be restored or controlled by implanting a pacemaker or a Biventricular pacing device (�BVP�) before closing the chest cavity.
A pacemaker comprises: (1) an implantable controller that sets the heart rate to the desired interval, and (2) two leads that deliver electrical impulses to specific regions of the heart (i.e., one lead is placed in the right atrium and the second lead in right ventricle) to artificially cause contractions of the ventricle at the appropriate time and synchronization. In contrast, BVPs have a third lead designed to conduct signals directly into the left ventricle. When using a BVP, one lead is placed in the right atrium, the second lead in right ventricle, and third lead is placed to pace the left ventricle (i.e., in a tributary of the coronary sinus in the left ventricle). Thus, with a BVP, simultaneous electrical impulses are given to both left and right ventricles so the time delay in traveling of electrical impulse is significantly reduced which aids in restoring the normal physiology of the heart and improves the pumping action of the heart.
Pacemakers and biventricular pacing devices are available from Medtronic, Inc. (Minneapolis, Minn.), Guidant Corporation (Menlo Park, Calif.), and St. Jude Medical Inc. (St. Paul, Minn.).
The mortality associated with ventricular restoration is primarily from sudden death caused from extremely fast arrthymias. The higher risk of arrthymias may be caused from the removal of a portion of the left ventricle. This risk may be prevented by implanting a defibrillator at the time of the ventricle restoration. The automatic implantable cardioverter/defibrillator is commonly referred to as an AICD. The AICD is a device that is similar to a pacemaker, but continuously monitors the heart rhythm. If the AICD detects an abnormally fast or slow heart rhythm, it either electrically paces the heart very fast or delivers a small electrical shock to the heart to convert the heart rhythm back to normal.
Some BVP devices have defibrillators built into the circuitry that controls the pacing. Implanting a bi-ventricular pacing device with defibrillator after surgical ventricular restoration will not only optimize the output of the ventricle but also prevent many sudden deaths.
After a BVP has been installed in step 738, closure of the chest cavity may be accomplished in step 740 by conventional methods.
It is further understood that other modifications, changes and substitutions are intended in the foregoing disclosure and in some instances some features of the disclosure will be employed without corresponding use of other features. Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the scope of the disclosure.
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