8/18/16

Today was a triple bypass CABG- nothing too out of the ordinary, but still a fun surgery to watch. I still want to see a VSARR (valve-sparing aortic root replacement), but those don’t seem to happen too often, which is a bummer. Digressions aside, before the case started, other surgeons called Dr. Nguyen to inform him of stenosis in the superior vena cava, one of the two venous pathways to the heart. It was a potential risk, but it must not have been serious enough, as they opted to continue. Most of what I saw was standard for CABGs; saphenous vein gets harvested from the left leg, the interior mammary artery gets one end detached, and both parts get grafted onto the coronary artery bed. The triple bypass, however, introduces an interesting twist on this familiar procedure- the saphenous vein is actually split in two for the arterial bypass. Instead of just linking the aortic arch to one artery, the saphenous vein bifurcates and leads to two spots on the heart. This is why the initial saphenous vein harvest is so long. It is divided into two parts, with each segment leading to different blockages in the coronary artery bed. This is all sorta complicated, so here’s a picture to explain it a bit better: 

The saphenous vein, in its two parts, are the two white pieces on the right of the heart.Triple bypasses seem to take much longer than the doubles I'm used to seeing; the third piece of the graft takes some extra work to prepare for. But, I’m not sure how extensive the saphenous vein’s cleaning process is (wish I had seen it!). 

I'll probably have some new stuff coming out soon about the Heartwell Project soon. School has just started, and I have a beginning-of-year retreat going on next week- so, I'll really just have to play it by ear until things get back to normal. I'm not sure how my time in the OR will fit into my new schedule, but my fingers are crossed for any morning but Friday (that's valve clinic/patient rounds, which just isn't as fun). Thanks for reading! 

8/4/16

Last Thursday, I finally returned to the idea of doing live presentations of the Understanding Aortic Stenosis video. In the weeks prior to this, I had been in contact with the event coordinators at The Forum at Memorial Woods, working out a good date to present. We eventually decided that it could be done in tandem with a lunch/dessert event- the seniors got to come for food as well as a health presentation, which is a bit more enticing. I was really excited about this event, and it couldn't have gone any better; all of the audio and video aspects of the presentation worked beautifully. The seniors had a great deal of questions, mostly regarding operations they or their family members had in the past. Some I had to politely dismiss, on the grounds that I'm not a doctor and can't diagnose heart diseases. I still had a great time fielding questions, though, and am looking forward to doing more of these presentations this fall.

7/28/16

Today was my first day back in the OR, and I picked a good morning to come. All the while, I had company in some interns from UT, and got to chat with Dr. Nguyen for a bit before he scrubbed in. It's interesting to see how calm and collected these surgeons can be before cutting someone open, but I suppose a lot of the pre-op excitement dies down when you're performing multiple operations each day. One great thing about today was that one of the performing doctors decided to use a headcam, which is perfect for giving us lowly students some insight into the surgery; a fiberoptic cable links whatever they're seeing to suspended TV screens around the room, displaying footage in real time. Otherwise, the only good view in the house is from the anesthesiologist's corner of the room, which can get a bit crowded. Today's case was a double bypass, and was pretty standard fare- sternotomy, saphenous vein harvest from the left leg, interior mammary harvest from the left breast, etc. At this point, unless I see a new procedure or surgical method, I can sit back and enjoy the surgeons' work instead of tapping away at my phone taking notes. But, I did find out about one thing: why the saphenous vein harvests are done endoscopically (within the leg), instead of making an incision along the length of the leg and opening it up completely. When I wrote about the first surgery in which I saw a vein harvest, I didnt know what it was (formally) called, and looked it up to find out. Most of the picture results displayed a long incision spanning the length of the leg, which seemed ridiculously excessive. Turns out that the latter method is is much more traumatic, and takes much longer to recover from. Here's a picture of endoscopic vs. standard vein harvest techniques below, to give an idea of what I'm talking about:

  I also watched one of the doctors prep the saphenous vein for the graft, which is something I've never really paid attention to. The vein gets flushed of blood, the leads going to the venules (smaller vessels along the vein) are sutured shut, and the vein segment is dyed purple to distinguish it as foreign tissue when the time comes to graft it onto the myocardium.