Long time no update. Apologies for the hiatus. Things have been moving along here in Kigali, with the 15th and 16th surgeries being performed today. We are halfway through the day and the 15th case just came out of the OR.
This patient is different from all our other patients because he was an atrial septal defect repair - meaning there was a hole in his heart between the left and right atrium - where the blood goes first before it is pumped into the ventricles. The atrium collects the blood and pass it to the ventricles, the ventricles are the chambers that pump the blood out to the lungs and the rest of the body.
Atrial septal defects or ASD's are usually congenital and are the third most common type of congenital heart defects. When there is a defect in the atrial septum several problems can occur. When the defect is large, the problems can be life threatening.
Our patient had a very large ASD and the concern is that normally blood does not cross between the atrium - so that it must pass through the lungs before entering the left side of the heart and being delivered to the body. In a patient with an ASD - some blood from the left atrium passes through the hole back into the right atrium and as a result there is more blood in the right side of the heart than there should be. Over time, the right side of the heart and the arteries in the lungs have to work harder to accommodate this extra blood. The muscles that make up the walls of arteries in the lungs bulk up from all this working out and because they are stronger, there is more resistance to the blood flow causing what is called pulmonary hypertension. Because of this increased resistance, the blood chooses the path of least resistance and starts flowing directly through the hole in the atrial septum and into the left side of the heart without going through the lungs first. This means blood that has not been oxygenated by the lungs is now circulating through the entire body. This causes the obvious challenge of not having enough oxygen.
There are a few other problems caused by an ASD and that is why we needed to fix this one today. Dr. Bolman and Dr. Swain (up and coming fellow at UPENN in cardiothoracic surgery) repaired our patient's ASD today. They used bovine (yep, from a cow) pericardium in the shape of an elliptical about 4x5cm.
This case was special not just because it was the only ASD repaired or because it was the last day of surgery, but also because Dr. Bolman and his daughter got to scrub in together and her husband got to wear scrubs and watch with me from the anesthesia pod. Pictures of all involved are below as well as some pictures of the bovine pericardium and the incision made in the atrium. We tried to capture the ASD, but didn't get it on camera - it was pretty amazing though, just so you know!
Well, that is all folks. I will try to do at least one more update tomorrow. I am working night shift tonight so I am sure I will have at least one good story to report.
Until then… Urabaho!
~Bridget C. and all of us here with Team Heart