Anesthesia: open heart

So. I got to see an open heart surgery since anesthesiologists attend all surgeries that happen in the hospital. THis one was a by-pass and a valve replacement.  By-pass surgery is complicated and can depend on the number of arteries in your heart that you have clogged.  There are 3 big arteries that feed your heart muscle-- because like a good dealer it doesn't tap into its own stash (if you know what i mean).  So all the oxygen from the heart is fed through 3 vessels. If one becomes clogged or partially obstructed you are having major problems. Women and elderly seems to have more 'atypical' chest pain.

Anyhow if your artery is clogged then we need to fix it and fast. one way is to go to the 'cath lab' directly from the ER if you are having a heart attack where they use a little mesh wire to hold the artery open-- this is called a stent and I happen to have a picture of it. However, notice that the plaque in your artery is still there. The stent simply stretches the artery so its only a bandaide. It doesn't fix your problem.  This procedure isn't what I saw however, it was just a little background.

So this surgery involved bypass of two arteries in the heart after several stents. Once a stent is placed the artery cannot be messed with in that area.  So we took the internal mammary artery (the artery that supplies your breast) and dissect it away from the tissue and then sew it to the clogged artery after the clogged region of course.  Eventually your body makes tiny vessels that keep the tissue of your anterior chest alive so there is no long term problems with the skin there.  But there are only two arteries one for each side so what if all three arteries are clogged. You can use a vein in your leg called the Saphenous vein.  The problem with this is a) its in your leg so we have to do surgery on your leg and chest b) veins have valve to prevent backflow so in order to allow proper flow we have to put the vein in upside down so the valves don't obstruct or slow the blood flow c) veins are lower pressure than arteries so to suddenly put more pressure in the vein means it can rupture easier and takes time to thicken.

That said, here is a picture of the heart valve we put in. It is a pig valve. The coolest part of this is it isn't actually the heart valve of the pig. Its a valve made out of the pericardium (the wrapping around the heart). Neat right? I took pictures of the side and front. The white cloth is taken off after it is sewed painstakingly into the heart. It is very fragile and people who have valve replacements are at an increased risk for endocarditits (a condition where blood and bacteria form clusters that cling to the valve, if the clusters get big enough it can release bacteria or small pieces through the body to infect or it can clog smaller arteries and cause problems).  Whew that was a long one.

I must say I was all up in the heart surgeon's face asking questions and pointing at things that he got flustered and asked me to back off :) ooops.  then the anesthesiologist was all jealous or something because i wasn't interested in what he was doing. It was ridiculous.  SO i spend almost four hours silent sitting on a stool that felt very reminiscent of 'time out'.  I spent most of the time watching the heart beat in this guy's chest and thinking.... besides the fact that it can beat/move on its own without the brain's imput, its not all that cool.  I mean, cardiologists are essentially the plumbers of medicine dealing with tubes, pressures and the fluids that go through them.   And despite my eager question asking, i have no interest in cardiology or surgery. I can only best explain through an analogy:  Learning to fix your kitchen sink is interesting, especially when its yours and its not working. But do I want to fix everyone's broken kitchen sink for the rest of my life?  No. Not interesting enough.

Okay one more fun fact before I have to go.  So i'm going to make you think.  IF the heart is beating in the chest and your patient requires it to do so to live, how do you do surgery, especially sewing together arteries (which is really hard) on a moving target?  Most medical people will say put them on a bypass machine which essentially is a machine that pumps and oxygenates the blood for the patient. The problem is this carries with it HUGE amounts of side effects, which i won't get into here. So if you don't use a machine, which we don't very much anymore, what can you do?  You can't stop the heart beating.... and the more your push on it the slippery-er it becomes.

So they invented this cool little tool that doesn't hold the heart down instead it has two arms in a V which suction cups on the bottom. THe surgeon places it so the artery is between the arms and then SUCKS the heart was up to him! GENIUS!  On top of all this remember the artery has blood that it has to feed to the heart muscle that is still working... and we can't clamp it off or it would be killing the muscle. SO they have to sew it with the artery still pumping blood. Yeah bet you didn't know that.  That is called some SKILLZ. what up heart surgeons!

haha. anyhow time for me to go.