Day 5

In morning rounds in Cardiac ICU, I was able to watch a balloon being removed from the Day 4 patient. The balloon was inserted into the patients aorta prior to surgery in order to increase cardiac output. The balloon was inserted into the patient's femoral artery, and we watched them remove the balloon from the artery.

An X-Ray that shows the balloon going from
the femeral artery ro the aorta.

The first surgical case of the day was an ascending aorta replacement. The patient had a large aneurysm in her aorta, which if rupture would cause death in a matter of seconds. The aorta was very enlarged and inflamed, so Dr. M removed it and replaced it with a graft. In order to replace the aorta, the patient was placed on bypass and cooled. Since the all of the blood passes through the aorta (even with bypass), the blood supply eventually needed to be cut off to the body and brain. When the patient is cooled, it slows the metabolism of cells down, and it allows for the patient to survive longer on a little blood supply. The blood of the patient was cooled through the heart/lung machine, frozen sponges were added to the chest cavity, the entire operating room was cold, and ice was placed around the patients head. After an hour of cooling, Dr. M went ahead and cut the blood supply and replaced the aorta. When the patient was placed on bypass again, the heart was shocked with 10 J in order to start beating again. The OR was then raised to 80 degrees and the blood was slowly heated (as to not denature blood cells), and the re-warming process began. This surgery is one of the most major heart surgeries that a patient can endure.

The cloth graft that replaces aorta.

The graft in place.

The second surgical case of the day was a mitral valve repair and coronary artery bypass surgery. First Dr. M harvested the one end of a mammary artery (under the clavicle), and used it for "self-bypass" for the coronary artery. Then he replaced some of the mitral valve chords with gore-tex in order to repair the mitral valve. 

A diagram that shows how the mammary graft is used to bypass blockages in coronary arteries.