The OR

Open Heart Surgery. Need I say more?

Well, probably, because you really have no idea what is involved until you hear all the procedures involved.

The patient I saw was getting an aortic valve replacement (bovine aortic valve). First you get the patient ready, give them an IV and then knock her out. Next, insert a foley catheter (muscle reflexes are down to minimum, you wouldn't want your patient waking up in a pool of urine.)

Then insert a SWAN catheter. This is a form of a central line catheter, but after entering through the sub-clavian vein a blood-pressure sensor is sent through it into the pulmonary arteries (that inside the lungs) to assess the BP in the right ventricle and pulmonary arteries. It also has two lines that can be used to send drugs straight into the heart.

Next, completely cover the patient with iodine and a celephan-like substance to ensure asepsis. Then you're ready to start cutting! Cut through the skin directly over the mid-sternal line over the heart. Then pull out your Mikita buzz-saw and go right through the sternum (I'm not kidding). Then start cauterizing the lining protecting the heart, the pericardium. Then, there she is, the most amazing muscle of the human body, the heart. You might get to see the lungs also.

Now comes the tricky part. You have to cannulate the Aorta. This involves sticking a plastic tube inside it just after it leaves the heart. Then you stop the heart by shooting it up with large amounts of potassium, which you hopefully can flush out when all is said and done. Then you cannulate the Vena Cava and turn on your blood fusion machine: In the Aorta, out the Vena Cava, through the machine and back in the Aorta. It's pretty cool.

Finally, you can cut the bad-boy open and cut out the stenotic (tight) aortic valve. Then it's a long process of sewing the cow aortic valve in. Then you stitch it all back up, de-cannulate, and shock the heart back into motion. Last of all, you sew the patient up, using stainless steel to bring the sternum back together, making sure to turn the stitches down so they don't go through the skin. Also, you might want to cauterize any bleeding vessels as that might present a problem when the patient is trying to heal. Then send your patient to the Surgical ICU. You're done.

PS - I hope you didn't mind the smell of burning flesh.