From Scrubs to Scenery in La Fortuna

Due to Dr. Bogantes’s vacation absence this week, I shadowed surgeons in the operating room (OR) instead. Suited up in the green OR scrubs, it felt surreal to be watching an open heart surgery 🫀. In this particular case, the patient had hypoplastic right heart syndrome – a congenital condition causing underdevelopment of the right side of the heart [1]. This condition is depicted below.

The right side of the heart is in charge of sending deoxygenated blood to the lungs to get oxygenated. However, this function is compromised in patients with hypoplastic right heart syndrome leading to abnormally low oxygen levels. I’ve included a picture describing blood flow in the heart below. Please note the pathway that blood usually takes from the R ventricle to the lungs to get oxygenated.

One option to address this issue is the Fontan procedure. The Fontan procedure uses tubing to connect the inferior vena cava directly to the pulmonary artery. This way, blood can bypass the hypoplastic right heart and directly go to the lungs to get oxygenated.

I observed the surgeons cut through the chest to get to the heart. While dissecting the part of the heart they needed to access, a complication occurred – a big vein started bleeding. The residents explained that patients with this condition can have distorted anatomy due to the numerous surgeries they need, which leaves their tissue fragile and prone to bleeding. Then the doctors put the patient on an extracorporeal machine so the patient’s blood could be oxygenated while they stopped the heart to stitch the Fontan tubing to connect the inferior vena cava to the pulmonary artery. Talking to the perfusionist, I learned that the extracorporeal machine could potentially cause undetected clots so they need to administer heparin to prevent this. Nearing 6:30pm, they’d just finished stitching the Fontan tubing. The surgery preparation had started shortly before 9am. This was a lengthy and complicated procedure. I wished I could stay to finish it but decided to leave since it’d already gotten dark.

The remainder of the week, I observed neurosurgery 🧠. The first procedure I saw was an operation to treat craniocynostosis. In this condition, the bones in the skull fuse too early, before the brain is fully formed. When more than one of these sutures closes early, the brain might not have enough room for growth causing elevated pressure in the skull. I’ve attached an image of what the patient’s condition looked like.

Surgical intervention for this condition involves minimally invasive access in order to place sagittal springs that increase the room for brain growth and improve skull shape.

Lastly, I observed the replacement of a catheter that was part of a ventriculoperitoneal shunt. In this case, the proximal, ventricular catheter needed to be replaced. However, tissue had grown into the catheter, making removal difficult. The doctor carefully removed the catheter and cauterized any bleeding complications along the way.

After a long and exciting week in the OR, I was ready for more adventure in La Fortuna. Some of the highlights: a cute cat by the airbnb 😸, chocolate 🍫, biking near the volcano 🌋, hanging bridges 🌁, and canyoning/rapelling (basically scaling down canyons and jumping into waterfalls) 💦.

References

[1] SSM Health, “Hypoplastic Right Heart Syndrome,” [Online]. Available: https://www.ssmhealth.com/cardinal-glennon/fetal-care-institute/fetal-heart-program/heart-conditions/hypoplastic-right-heart-syndrome. [Accessed: Jul. 27, 2024].

[2] Cleveland Clinic, “Hypoplastic Right Heart Syndrome,” [Online]. Available: https://my.clevelandclinic.org/health/diseases/hypoplastic-right-heart-syndrome. [Accessed: Jul. 27, 2024].

[3] PBS, “Image of Hypoplastic Right Heart Syndrome,” [Online]. Available: https://pbs.twimg.com/media/GAC6dQFWoAAlSfm.jpg. [Accessed: Jul. 27, 2024].

[4] Cleveland Clinic, “Fontan Procedure,” [Online]. Available: https://my.clevelandclinic.org/health/treatments/24545-fontan-procedure. [Accessed: Jul. 27, 2024].

[5] CDC, “Craniosynostosis,” [Online]. Available: https://www.cdc.gov/birth-defects/about/craniosynostosis.html. [Accessed: Jul. 27, 2024].

[6] Children’s Hospital of Philadelphia, “Surgical Treatment for Craniosynostosis,” [Online]. Available: https://www.chop.edu/treatments/surgical-treatment-craniosynostosis. [Accessed: Jul. 27, 2024].

[7] Wikipedia, “Cerebral Shunt,” [Online]. Available: https://en.wikipedia.org/wiki/Cerebral_shunt. [Accessed: Jul. 27, 2024].

[8] ChatGPT to format citations