Sunday, August 29, 2010

Catheterization Lab and Cardiothoracic Surgery!

Two unbelievable experiences for me this summer were spending two weeks in the Catheterization Lab (Cath Lab) and a week in Cardiothoracic surgery (CT surgery) at LIJ Medical Center. It was significant for me to understand the procedures completed in the Cath lab first, before observing in CT surgery.

I learned that these two departments relate to each other in the fact that they can both treat a patient with a coronary artery blockage. The Interventionalists in the Cath lab can diagnose a lesion within the Left Main Coronary artery or the Right Coronary artery. They can also determine if there is a lesion in the Left Anterior Descending (LAD) artery and the Circumflex, the branches of the Left Main. By injecting a dye through a catheter, with access through either the groin or radial artery, the lesions can be seen on images called angiograms from x-ray machines. Depending on the anatomy, location of the lesion and risk factors, such as diabetes, a patient with a significant blockage of 70% or higher will either be treated in the Cath lab or will be transferred over to CT surgery.

In the Cath lab there are a few possibilities as to how to treat the patient. A balloon pump can be wired into the artery on a catheter and expanded to try and open up the vessel. Also a stent can be deployed in the vessel to open it up an push the clot/plaques against the artery wall. There is always the risk of in-stent stenosis when this is done, so the patient is normally medically treated with anti-coagulants to prevent clots from forming. Newer stents called drug-eluting stents decrease this risk greatly due to the coat of chemothraputic-like medicine on the stent. This prevents the overgrowth of the vessel wall covering the stent.

In cases when the lesion is in the Left Main Coronary artery, or the patient is at high risk for a stent, or the anatomy makes it difficult for a stent to be placed, they are transferred to CT surgery. This is when a Coronary Artery Bypass Grafting (CABG) is completed. Internal Mammary arteries, or Internal Thoracic arteries, located behind the rib-cage are often used to bypass the LAD artery which supplies blood to the left ventricle of the heart. Vein grafts from the legs and arteries from the arm can be taken to bypass other vessels in the heart to supply the ischemic tissue with blood.

I was fortunate enough to be able to "scrub-in" on these procedures and stand right behind the surgeons and intervenionalists. Seeing a fully exposed heart beat in a patients chest was one of the most unforgettable experiences I have ever had.

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