Isner and Crystal believe the genes must be injected directly in the heart muscle to work. Thus the need to cut open the chest. One way around this would be to thread a catheter into the heart with a needle on the end of it. The approach seems to work in animals, but it is not yet ready for people. However, releasing fluids into the heart through catheters is already routine.
Some doctors say injecting the genes with needles is unnecessary.
Just putting some genes into the heart's circulation should be enough. A group led by Dr. H. Kirk Hammond of the Veterans Administration Hospital in San Diego recently started such experiments. One of the things we find very exciting is the possibility that patients may never need to see the inside of an operating room and still have their coronary artery disease attended to in a very thorough way,'' says Hammond. In fact, his study will involve about 100 patients with ordinary treatable angina, not the worst-case patients of Isner and Crystal. While cardiologists and surgeons are intrigued by these experiments, many seem cautious, even dubious, about the prospects.