Tales from the OR

WARNING: This post contains my blood and guts, literally. If you’re squeamish, I recommend skipping this one.

What follows is my journey through the operating room at Columbia-Presbyterian on July 18, 2012. Apologies, but I couldn’t help starting off with yet another pop culture reference (this time from Wes Anderson’s Rushmore).

So the morning started off with my mom and I reporting to the Heart Center at 5:30am. After a lot of forms, waiting, and more forms, we were finally ushered back to the OR prep area. There were curtained off “rooms” galore, each with a different patient awaiting some form of heart surgery that morning. It was a little insane to think how many surgeries Columbia must turn out per day.

What I like to call the heart holding pen.

My prep nurse, Jeanie, had the fun assignment of running me through the assembly line of blood tests, urine tests, vitals, and signing away my consent for Columbia to crack me open.

Jeanie, my prep nurse.

The attending anesthesiologist and his resident then stopped by to give me the run down of how they would be managing my anesthesia and pain medication through the operation and my time in the ICU. I had met the resident during my pre-op appointment, but this was my first encounter with the attending. Needless to say, he had his agenda and I had mine so I had to put him through a few paces before I was satisfied with his answers. I was also able to speak to my surgeon briefly over the phone just to make he tell me one more time that he had my back (or heart so to speak). Next, I put on my hospital gown and walked myself into the OR.

Where the magic happens.

Now for the blood and guts. Just to remind you, my procedure was called a “valve-sparing aortic root replacement.” I previously posted some images that show the anatomy of the heart and aorta, but I found some new ones that pair very well with the pictures of MY heart and MY aorta so I’m interspersing them below.

Up first is an artist’s version of what my heart looked like prior to surgery. The bulging section in the upper left represents an aortic aneurysm (remember aneurysm just means ballooned out). A normal heart would show the upper left section as the same diameter of the aortic arch that crowns the top of the heart.

Illustration of ascending aortic aneurysm (my diagnosis).

Okay, so above is the artist’s version and below is MY version, i.e., my actual heart and aortic aneurysm. The orientation of the photo is such that my head is at the bottom of the screen and my feet are at the top. To get to this point, my surgeon has cut the skin directly down the middle of my chest over my sternum, used a bone saw to cut my sternum in half, used a scalpel to open the sac around my chest cavity, and then used a scalpel again to open the pericardial sac that holds my heart. You can see a flap of the pericardial sac to the right in opening. The large metal contraption is a retractor used to hold either side of my sternum apart for the duration of the operation. You can see a drawing of this set-up here. In the photo below, the retractor is open about FIVE INCHES.

My big fat aneurysmic heart.

The next step was to put me on the heart-lung (cardio-pulmonary) bypass machine. This essentially allows the surgeon to take my heart out of the circulatory system circuit so that he can work on it in “dry” conditions, i.e., no blood. The image below shows my heart now drained of blood and hooked up to bypass. Without all the blood volume in the heart, it collapses a fair amount as you can see.

My deflated heart, after being put on cardio-pulmonary bypass.

Now on bypass, my heart was then manually stopped (it wants to keep on beating if left alone). This was done by running a potassium solution throughout my heart to slow, and then completely disrupt, the electrical activity of the cardiac muscle cells.

The first order of operation (ha!) then is to cut out the part of my aorta that is all stretched out.

Slicing and dicing out the base of my dilated aorta.

Illustration of heart with ascending aorta removed.

The artist’s drawing above shows what is left behind once the root of the aorta has been removed. The photo below shows my surgeon cleaning up his cuts around my now exposed aortic valve in preparation for inserting my synthetic replacement.

Prepping my aortic valve for attachment to the synthetic replacement aorta.

My replacement aortic root is made of a synthetic material known as a dacron graft, show below. A section of it was cut to size and then tweaked as necessary for my specific anatomy.

Section of dacron tubing that will act as my new aorta.

Illustration of how dacron graft is shaped to replace the removed ascending aorta.

The great thing about dacron is that it will last the rest of my life (probably longer if given the chance) and poses no danger of rejection by my body since it’s a synthetic material, as opposed to live tissue.

Customizing the fit of the new aorta and securing it to my valve.

Illustration of how dacron graft is attached to aortic valve.

Illustration of what my heart looks like now.

Once the graft is secured in place between my aortic valve and my aortic arch, the heart of the operation (ha!) is over. My heart was then restarted by stopping the potassium solution they had been flushing it with. I was eased off bypass, my pericardial sac was sewn shut and my sternum was wired back together. As a last step my surgeons celebrated by taking a couple candids over my war torn body. That’s how every surgery ends, right? ;)

Yes, my surgeons actually posed for a picture in the middle of my operation. I expected nothing less.

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62 comments

  1. cakecalamity

    They took photos! And you’re recovering well! RAD POST! A+++ WOULD READ AGAIN

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  3. I had this surgery on July 25th, 2012, although they managed to keep my natural valve. Similar to your aorta, my was all bulged up because of complications with my Marfan Syndrome. I had actually wanted to get photos or video taken of my operation but didn’t have the opprotunity, so I’m glad you were willing to share this and your experience. It’s like getting to breath that sigh of relief all over again.

    Welcome to the zipper club!

  4. Justin, do you know about Losartan? It’s been kind of the miracle drug for my Marfan son as well as his mother. Far fewer ankle sprains, no more aortic dilation in the year to year sonograms, it’s been amazing for them.

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