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.