4/15/16

Today, I went to a case w/ Dr. Nguyen. Valve clinic wasn't a lot of fun to blog about, so I wanted to spice things up for a while with a new procedure in each post. Lectures- like the one I covered a few months ago about vena cava filters- are great, but don't crop up often enough for me to consistently post about them. Feedback on what I'm covering is totally welcome, and I could probably even take requests about certain topics.

The case this morning was a sternotomy-CABG, which is a procedure that I've been looking forward to seeing for a while- the mini-repairs and replacements I've talked about in the past few weeks offer much less visibility, and aren't as interesting to watch. CABG is an acronym for coronary artery bypass graft. In this procedure, the doctors remove a faulty segment of a coronary artery in the myocardium (walls) of the heart, and replace it by grafting on an artery from elsewhere. The graft usually comes from the right or left interior mammary arteries, which run under the breast. This operation is performed if there's a blockage in the coronary arteries that can't be solved by PCI/stenting; the heart needs adequate amounts of blood to pump, so if one of its arteries is blocked by plaque (atherosclerosis), that needs to be taken care of. A lack of blood to the heart's muscles can lead to myocardial infarction, better known as a heart attack. Although I've seen this surgery before, I was really looking forward to seeing it in its entirety today. Complications getting the left mammary artery for the graft led to it taking longer than expected, but there was one good thing: the anesthesiologists let me hang out in their corner of the room. They sit adjacent to the patient, amongst a labyrinth of tubes, wires and equipment. They have a direct view into the chest cavity- and it's the best view in the house. It's an entirely different experience to see the patient's chest, spread open with a still-beating heart inside, and be able to look down to see his head. You realize that it's a person who's being operated on. I've had the same view before, but now that I have more experience and actually know what the doctors are doing, I guess it just gave me new perspective. I made it up to bypass before I had to head out, which is a bummer, but the new outlook I gained made it better than all of the past cases I've seen. 

Also, we've decided to call the project The Educated Patient Series. We also picked a name for the doctor/mascot who will be walking viewers through all of the animations: Dr. Heartwell (clever, right?). We're still working with the animator to make revisions and fine-tune the video, but all of the right things are there. More to come about both my neat OR visits and The Educated Patient Series over the next few weeks.

4/8/16

Here's that animation update I talked about last week.

I made some strides towards completing the Kickstarter, and got some feedback from the rest of the group on how it was progressing along. One of the main hurdles I was concerned about was the reward for donors. If you're not familiar with Kickstarter's system, they require the project owners to compensate its contributors (which is often based on how much they give) if the project meets its funding goal. For donors who give $10-$20, mailing stickers or naming them at the end of our videos would be enough- but problems arise when it comes to dealing with $50-$100 donations. Some ideas we thought of were t-shirts, coffee mugs, and even handwritten thank-you notes. I've noticed that plush hearts are given to recovering patients in the HVI ICU- maybe we could brand them with our project's name, or some design, and give those out. What we're doing is not like a lot of the other Kickstarter projects out there; it's really just a (great) community service, not a product. This makes it hard to deal with large donations. Dr. Nguyen recently reached out to Memorial Hermann's PR and marketing department, who loved the idea that we're proposing. They'll probably want to see what it looks like when we've completely finished the first animation, and if they are interested or impressed, we might not even need the Kickstarter. But hey, it never hurts to prepare.

3/31/16

 I don't usually go on Thursdays, which made today's schedule especially weird. I went with Dr. Nguyen to post-op patient checkups, which consisted of mostly severe-condition patients; it's always good to see the patients' families responding well to the recovery process, even if the news they're getting isn't ideal. A lot of the early recovery process involves the management of fluids secreted into the areas around the heart- a chest tube is attached through a chest incision to deal with drainage of blood, pus, and other nasty stuff. It uses suction to evacuate the heart's surrounding tissues of threatening fluid accumulations (called pericardial effusion), and is removed once the leakage stops. Multiple tubes can be installed, and can be removed based on which areas need tending to. Neat, right?

For the case this morning, I arrived with Dr. Nguyen. I got to see the entire pre-surgery process: antibacterial prep, moving bypass equipment into place, etc. The case was a mini-mitral valve repair, which isn't the most fun surgery to watch (mostly due to lack of visibility), but it's complicated and I definitely appreciate the amount of skill involved. I've talked about mini procedure in earlier blog posts- it's basically like digging a tunnel to the heart, starting near the ribs, on the right side of the upper chest. The left femoral artery and vein are cannulated and connected to a bypass machine, allowing the heart to be operated on. The mitral valve is so far back in this cavity that the doctors have to use special elongated tools to reach it, and are forced to jump through all sorts of hoops. It's safer than open-heart surgery and has a much lower recovery time, but is more difficult. From what I can tell, it's hard mode for heart surgery. Back to our specific case, the patient's mitral valve was prolapsed, which is something I haven't heard of before. The mitral valve has two leaflets-posterior and anterior- flaps that open and close when blood is pumped. These leaflets are attached to pieces of tissue called chordae tendinae. In prolapse, a tendon becomes loose, which causes the leaflet it is attached to to not pull shut. The prolapsed leaflet will begin to "climb" over the other one, causing mitral regurgitation, as the blood drips back into the left atrium after being pumped. To solve this problem, a ring has to be sized to fit the mitral annulus, and sutured in to keep the valve from leaking. In addition, a piece of tissue from the prolapsed valve is cut out to prevent overlap. I was familiar with mitral regurgitation/insufficiency before going into this surgery, along with mini procedures, but just about everything else was new. Every time I think I'm getting a handle on basic heart knowledge, something just has to take me down a rung...

Pictures of mitral prolapse and repair are below (non-graphic).

I intended to post a bit more this week, but I was waiting on some new info to roll in about the animation. Now that I've got a sizable amount of info (aka blog-worthy, because I love making long posts), I'll probably have something next week about that. Thanks for reading!

Normal v. Prolapsed, with a cutaway view of the left atrium and ventricle.

Repaired mitral valve, with annulus ring and fixed posterior leaflet overlap.