6/20/16

Last week, some scheduling conflicts arose and Dr. Nguyen was out of town for a few days. making me unable to go to MH. I also had to reschedule a presentation of the Understanding Aortic Stenosis video at The Gardens of Bellaire, a senior community here in Houston. That's pushed it awfully close to another presentation I'm doing at the Elmcroft senior community, but I'll be able to do both. I'm interested in seeing how much the seniors will contribute to the discussion; many of them just want to get to bingo. I'll see how the presentations go and report the details here. Anyways, here's the case from June 20th.

Today was a single CABG (coronary artery bypass graft), a procedure that I haven't exactly seen yet. It's really just half of a double CABG, if that makes sense, since only one new vessel is being grafted on. So, in this case, only the saphenous vein got taken, while the interior mammary artery (which gets used in a double CABG) is disregarded. I forgot to mention (last time I talked about CABG) that the saphenous vein grafts that I've seen have all been harvested endoscopically, meaning that a probe was inserted into the leg to extract them.  I recently learned that there is an "open" method that requires the leg to be cut open length-wise, giving a clear view at the tissue and veins. Today's endoscopic vein harvest could've gone better, as some problems arose with getting appropriate vein segment lengths- I'm not sure if this was a technical issue, but I'd really like to see if the open method is any easier. This seemingly simple misstep made the surgery much longer than expected, delaying bypass and all of the "interesting" parts of the surgery. Nonetheless, the graft placement went rather well, and was definitely the highlight of the case. Grafting the saphenous vein onto the coronary arteries is a lot more complicated than dealing wth the interior mammary artery. With the saphenous, both ends are being attached to the heart, rather than just one with the interior mammary. Interesting instruments are brought in to support the graft placement- my favorite is this gray-colored device with two prongs that encircles the graft area. It has two sets of gears that seem to be used to tighten or loosen the grip on the myocardium, and is really cool to see in action. I still don't know what it is called, though, and "gray rotator tool for CABG" yielded no results on google images. I'll keep looking. 

I’ll have plenty of interesting stuff to report about early next week, including the Elmcroft visit and (possibly) another case. I recently learned that the producers of Great Day Houston won't be able to fit Matt and I onto their TV spot on the 27th, but Dr. Nguyen will still be on that morning to talk about our project. It won't be as cool without us, but hey, things happen. I definitely recommend that you all tune in and see what he says about it!

6/8/16

After a great weekend at Free Press Summerfest, a music festival here in Houston, I return with the memorable events of last week- pertaining to the HVI and Heartwell, of course. Last Wednesday, I entered some previously uncharted territory by staying for an entire case. It was a double coronary artery bypass (CABG) via sternotomy, and a great surgery to watch. I've mentioned in earlier blog posts that the more invasive the procedure, the easier it is to see what's going on; here, I could see everything, especially when the anesthesiologist wasn't tending to the patient's anticoagulant needs. From that angle, I could peer down at the chest cavity, able to see the performing doctors' precise techniques as they worked to graft the new arteries to the patient's heart. Reflections aside, I'll explain the procedure in brief (brief, only because I have some other things to discuss in this post). Coronary artery bypasses allow the coronary arteries to receive proper blood flow if their normal vessels are blocked by plaque, which is usually a result of high cholesterol. Rather than doing something like an angioplasty to repair existing vessels, a CABG uses grafts from other vessels in the body. For this double bypass, a saphenous vein segment was taken from the patient's left leg, and one end of the left interior mammary artery. One might ask, "why one end?" That is because the other is already connected to the subclavian artery, which receives a healthy blood flow from the aorta. Detaching it completely would be super unnecessary, as another hole would have to be created for the other end of the mammary artery. So, the saphenous vein graft connects from the aorta to some part of the right coronary artery, and the interior mammary artery connects from the subclavian artery to some part of the left coronary artery. It was very difficult to tell which of the tiny coronary vessels the new artery and vein were being sutured onto, in this specific case, so that's about as precise as I can be. I will link a picture at the bottom, though those vessel connections might not have been the same as the ones in this case. It all depends on what coronary segments are blocked.

What I really wanted to discuss in this post was my first presentation of the Understanding Aortic Stenosis video. I went to the Amelia Parc senior community, where my grandmother lives, to present the video and do a short Q&A about it. The elderly people there were really receptive of the video, and some had a lot to say about it- ranging from questions to personal accounts of dealing with heart disease. It was good to get the video out to our target audience, as they're the ones who we want to be getting across to. They're the ones meeting with doctors about disease treatment and trying to decipher things. The secret to a good senior community presentation, I've learned, is to stay far away from bingo time; as soon as that started, a good part of the group I had gathered rushed out. I'd never seen people that old move so quickly.

By the way, I might do more local senior community visits- in fact, I already have two set up for this month. If you guys have any suggestions for places to visit and present this information, feel free to contact me or comment on the post. Thanks!

Double CABG (general overview):