Thats a Wrap!

After 24 hours in the incubator, the plates definitely had growth, but there were no distinct differences. 

Before incubation: 

After: 

As you can see, the bacterial growth on all three plates look very similar. For this reason, I concluded that the use of neither the braided vicryl nor monocryl led to increased bacterial presence, and bacterial adherence to both sutures is about the same. This conclusion is not accurate for many reasons. For one, the experiment was not conducted in a sterile environment with sterile tools and surfaces. Also, the sutures were placed in pork which was left out for five days so it is only natural that bacteria associated with rotting meat was apparent. 

Since this will be my last post, I would like to thank all of you for keeping up with my posts these last 12 weeks. I will be presenting my project on May 6th at BASIS Phoenix if anyone is interested in attending!

Week 11: Plating the Sutures

Yesterday, I plated the sutures from the pork meat and put them in the incubator. For the control, I swabbed the meat and rolled it onto the agar. The smell of five days old rotting meat was definitely my favorite part...

Anyways, here is a photo of the plated sutures and control.



Today, I will take the plates out of the incubator and analyze the bacterial growth.

Thoracoscopic Pericardial Window

This week in the OR, I watched a few different surgeries, but I want to focus on the thoracoscopy.

Thoracoscopy

The patient presented with pericardial effusion which is an abnormal build up of fluid around the heart (pictured below).

In order to relieve the pressure and drain the fluid, Dr. Patel performed a thoracoscopy to create a pericardial window (a hole in the pericardium). A drain was placed in the pericardial window to remove excess fluid after surgery. Talcum power was then sprayed around the lungs to prevent this problem from returning. The powder induces an inflammatory reaction which causes the lungs to stick to the inner surface of the chest, leaving no room for fluid build up.

Next week, I will plate the sutures for my suture project and post about the results!

Week 10: Getting Started

I started my suture project on Thursday! After three trips to three different grocery stores, I figured it is nearly impossible to find pork belly anywhere near me, so I improvised with sliced pork with a thick layer of fat on top. It was important to suture something similar to human skin and the layer of muscle underneath, so this made do. To my surprise, I found the layer of fat hard to pass a needle through, so it definitely did a good job simulating skin. 

To start, I cut the pork into three pieces and made a cut in the middle of each. With each suture, I closed the incisions I made using an intradermal suturing technique. I must say, as my first time suturing pork, I am proud of how it turned out...!  

Vicryl (left), Monocryl (middle), and Control (right)

All I have to do now is wait for two more days to remove the sutures and plate them!

Previous Research

When deciding to pursue this new and revised project, I found studies and research papers regarding the instance of infection for monofilament and braided sutures. I will reference these papers, namely the following, during my experiment.

The scientific article that really caught my attention is titled "Bacterial Adherence to Surgical Sutures" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1345192/pdf/annsurg00209-0047.pdf). This article considers and studies that bacterial adherence patterns on braided and monofilament sutures. In the abstract, it states that "nylon bound the least bacteria while bacterial adherence to braided sutures was five to eight folds higher" (they used nylon as an example because it is also a monofilament suture). This is what caught my attention right away, because in cardiac surgery, both monocryl and braided vicryl are commonly used to close the skin. Why would we use braided sutures to close the skin when bacteria adhere to them more frequently and increase the chance of infection? This is what I hope to explore in the last couple of weeks of our research projects. Stay tuned!

Week 9: Vicryl Sutures

Since I changed a few things for my suture project, I am going to post this week about certain aspects of my new idea. In this post, I will talk a bit about Monofilament Vicryl (Monocryl) and Braided Vicryl sutures.

Sutures I will used for my project

I will be using size 4-0 in the Monocryl sutures and size 3-0 in Braided Vicryl because these are the two most common types of sutures used for skin closure. Generally, size 3-0 and 4-0 are the preferable sizes for skin closure because they can withstand the amount of tension put on the skin. Below is a helpful guide to understanding suture sizes:

4-0 Monocryl is a monofilament suture, which means it may be tougher to knot and have a lower knot holding security, unlike 3-0 Braided Vicryl. However, it incites a very low tissue reaction and is thought to harbor less bacteria, so it is great for skin closure (lowers risk of skin irritation, and thus infection). 

Both are absorbable sutures which means they will "dissolve" in the skin as the wound heals. 3-0 Braided will break down anytime between 56-70 days while 4-0 Monocryl will take around 90-120 days. The skin will need a couple of months to thicken and heal completely, but by the time the sutures break down, it will be strong enough to remain closed and resist tearing. 

In my experiment, I will do an intradermal stitch which is used to close the skin after surgery. This type of stitch secures the edges of the wound (chosen mostly for cosmetic and healing purposes).

Intradermal stitch

Tricuspid Valvectomy

This week I watched a Tricuspid Valvectomy. The patient was septic (bacteria in the bloodstream), and had Infective Endocarditis, Hepatitis C, and MRSA. Also as an intravenous drug addict, the patient was prone to these serious complications. Infective Endocarditis is caused by a bacterial infection in the heart and can result in inflammation of the valves, heart failure, and abscesses.



The patient had an abscess near the tricuspid valve and the swelling was preventing it from keeping blood from rushing backwards in the heart. Dr. Patel removed the abscess and the replaced the valve. The patient was given antibiotics after surgery.

Week 8: Suture Project

After a couple hours of research and emailing my advisor, I finally have a solid idea for my suture project. I decided to stick to my original proposal, but I made a few changes to eliminate major problems and flaws in the experiment. 

In this experiment, I will focus on the infection rate of Braided and Monofilament Vicryl sutures used to close the layers of fat and skin over the sternum after open heart surgery. I decided to narrow the list of sutures down to Braided and Monofilament Vicryl because these are designed and most commonly used for skin closure. I have read a few published articles online that state that bacteria adhere and grow on braided sutures more frequently than monofilament sutures. I will conduct my own experiment to see this for myself. Instead of using chicken feet, I will sew the sutures into pork belly because it closely resembles the properties of human skin (resistance, thickness, and texture). After five days, I will plate the sutures and observe bacterial growth. I will also swab pork belly without the sutures in it and plate it as a control because bacteria will be present on meat that has been out for five days. I will differentiate the bacteria attributed to rotting meat from the bacteria attributed to the sutures, and make my conclusions. 

When I saw Dr. Patel's patients postoperatively in his office, some complained of itchiness and irritation near the incision. This could be a sign of developing infection, and I wondered if it might be attributed to the sutures used to close the incision. Of course, there are many things that can cause an infection in the wound, but I may be able to trace it back to the type of suture used by observing bacterial growth. 

Week 7: It's Been A Long Day

On Wednesday, I observed two surgeries, one after the other, that lasted eight hours combined! Talk about experiencing what it is really like to be a surgeon...

The first was a right upper lobe resection (lobectomy). The patient had a cancerous mass in the upper part of their right lung, and Dr. Patel removed the lobe to be sent to pathology for staging and therapy options. When performing a lobectomy, an incision is made superficial to the affected lobe of the lung. The surgeon can access the lung through the ribs in order to remove the lobe. It is also important to remove a few enlarged lymph nodes as well, because if they contain a tumor, the cancer therapy process can be properly outlined.



The second procedure was an aortic valve replacement. This was especially exciting to observe because it was the same procedure I saw for my first time in the OR. I blogged about it in detail in my post titled "Week 1: Get Pumped." This time, I had better visualization of the aortic valve while Dr. Patel removed the diseased valve and replaced it with a tissue one. This is what the valve looks like when sewn into place:

Week 6: You Guessed It, More Surgeries!

Hi all! I hope everyone had a terrific spring break!

This week is going to be a bit of a game changer... literally. But before I get into that, I want to talk a bit about the surgeries I watched this week. This post is going to be quite short, but the next two will not disappoint, trust me.

This week, I watched an on-pump CABG and a right thoracotomy. I want to talk about the process of harvesting the left internal mammary artery (LIMA) for use in bypass.

The LIMA supplies the anterior (the front) chest wall and breast to the left of the sternum. It originates at the Subclavian artery right under the clavicle and runs down right past the sixth intercostal space (space between the sixth and seventh ribs) before it splits into two terminal branches.

Subclavian Artery

This particular artery can withstand being used as a graft for a vessel as important as the left anterior descending coronary artery. It is a better choice for the LAD because it can support blood flow at a higher pressure. This is why a saphenous vein graft may not be the best option.  

Removing the LIMA

Once the desired length is achieved, the distal (further from center of body)
end of the artery will be clipped off and the proximal part will be used as a graft for the LAD.

In my next post, I will talk briefly about the independent research project that I mentioned in previous posts. Next week (finally!) I will go into detail about what the next six weeks have in store for you all! 

Empyema Returns

Today, I observed a left chest empyema. Again, empyema is a condition where pus builds up in the chest cavity due to an infection (usually pneumonia). This procedure was the same as the one I described in my last post, but in this case, there was less pus in the pleural space and the infection was on the left side. Dr. Patel removed the pus and the patient was given antibiotics to prevent the infection from returning.

Here is a less graphic picture in case some of you did not particularly enjoy the one in my last post :)

Now, lets talk a little bit about monofilament nylon sutures. Nylon sutures pass through tissues easily and hold knots reliably. These sutures also have excellent tensile strength, and maintain their strength over time. While polypropylene can be used to secure grafts in the heart, nylon is generally used to secure chest tubes and close incisions.

Monofilament Nylon Suture

Next week I will go into the details of how I will carry out my suture project, talk about braided polyester sutures, and describe the materials I will be using.

Week 5: Home Is Where the Heart Is

Hey guys! The first procedure I observed this week was a redo surgery and on-pump mitral valve repair. This was the first open heart case that I have observed since week 3 and it is so exciting to be back at it again! Don't get me wrong, thoracic cases are very interesting, but it is just thrilling to see beating hearts in all of their glory every week! 😃

This on-pump MVR was a little different from the one I described in my second post from week 3 because it was a redo surgery. Also, the patient had a coronary artery bypass surgery in the past, so there are risks associated with doing another surgery such as hemorrhaging, graft injuries, and scar tissue adhesions. Thus, this mitral valve repair was performed with extreme caution and different techniques to avoid these problems.

The cardiopulmonary machine was still necessary in this surgery, but instead of stopping the heart with cardioplegic solution, Dr. Patel shocked it into an abnormally fast sinus rhythm (atrial fibrillation) in order to prevent air embolism. Air embolism occurs when a blood vessel is blocked by pockets of oxygen in the blood, and can cause a stroke if they travel to the brain. This was also avoided during surgery by flooding the thoracic cavity with carbon dioxide because it dissolves faster than oxygen does in the blood. Thus, it is less likely to occlude blood flow and cause a stroke.

In order to access and repair the mitral valve in a bloodless field, Dr. Patel induced atrial fibrillation where the electrical signals in the heart fire rapidly, causing weak, fast, and irregular contractions of each chamber in the heart. In this state, the heart moves so fast it just slightly wiggles, making it easy to access the valve. Also, blood flowing through the cardiopulmonary machine was cooled to around 25 or 30 degrees celsius to sustain fibrillation, lower the body's demand for oxygen, and protect the heart.

In atrial fibrillation, each chamber of the heart will beat rapidly and irregularly as shown by the photo above.

Other than shocking the heart into fibrillation and sustaining a state of hypothermia, the procedure was carried out the same way as the one I described before. Dr. Patel fixed the annuloplasty ring into place around the mitral valve to pull the walls of the heart closer together and prevent regurgitation.

In my next post, I will talk about the surgeries I will see in the next two days and the advantages and disadvantages of monofilament nylon sutures. Until next time!

Change of Heart *graphic photo*

So far in my project, I have been observing open heart surgeries, but since Dr. Patel is a cardiothoracic surgeon, I have the privilege to watch his thoracic procedures as well. For those of you who may be confused about the difference between cardiothoracic and thoracic, thoracic surgeons manage the conditions of anything in the chest cavity except the heart while cardiothoracic surgeons manage everything in the thorax with a focus on the heart. This week, Dr. Patel changed things up a bit and focused on thoracic surgeries rather than open heart surgeries. I observed three thoracotomies, procedures in the pleural space in the chest.

There are many reasons as to why someone may need a thoracotomy. To name a few, a surgeon may need to access the lungs and diaphragm in order to remove a portion of the lung, treat trachea or esophagus disorders, remove blood clots and pus from the chest, or diagnose a lung or chest disease.

In this post, I will briefly discuss the thoracotomy I observed today and touch on the general uses, strengths, and weaknesses of monofilament polypropylene sutures to begin my suture project.

Today, Dr. Patel performed a right thoracotomy with decortication. Decortication is the removal of the pleural membrane surrounding the lungs, and may be necessary if the patient has empyema, which was the case. Empyema is a condition where pus builds up in the pleural space between the lungs and chest wall. The pus is a product of infection of the lungs usually caused by pneumonia, and can cause breathing problems since the lungs can't fill with air completely.

Decortication

Empyema (arrow pointing to pus build-up)

To begin my suture experiment, I will spend the next two weeks explaining the advantages and disadvantages of each suture I will use. Today, I will talk about monofilament polypropylene sutures. These sutures are specially made for cardiac surgery because they can easily pass through cardiac tissue and induce a minimal tissue reaction. Also, they have a higher tensile strength (resistance to breaking under tension) than nylon sutures and may be easier to handle due to their ability to slightly stretch when passing through cardiac tissue. However, polypropylene sutures don't have the most reliable knot holding security.

The blue color of Polypropylene allows for easy visualization during surgery

Next week, I will briefly talk about monofilament nylon sutures and the surgeries I will observe! 

Week 4: Life After Surgery

On Tuesday, I visited Dr. Patel's office and met with pre-op and post-op patients. I have been spending the majority of my time in the operating room for this project, so I want to stray from the topic of surgery in this post and discuss what happens during post-op visits.

Dr. Patel meets with his patients a few weeks after their surgery to make sure their incisions are healing correctly and their quality of life has generally improved. Once he asks how they mentally and physically feel after surgery, he will take a look at their incision to ensure there is no sign of infection anywhere along the cut. The incision site must be kept dry and clean after surgery because moisture and warmth are perfect conditions for bacterial growth. It is also important to press along the edges of the incision to ensure that the sternum is in place and healing correctly. There are many precautions that patients must take to prevent re-injuring the sternum since it is being held together by wires as it heals. Patients should avoid lifting or pushing anything heavier than ten pounds for about six to eight weeks after surgery, because this is usually how long it takes for the sternum to heal. However, walking for at least 2 hours a day and doing easy household chores once patients start to get their energy back is extremely important to keep the blood circulating and prevent swelling in the legs. This light exercise will also prevent blood clots from forming in the feet, traveling up to the heart or lungs, and causing a heart attack or stroke.

Recovering from open heart surgery should never be an independent journey. Of course, it is the patient's responsibility to maintain and form good habits, but they should have support and help from their family to get around and stay healthy mentally. Patients will experience temporary physical limitations and may be dependent on others for performing tasks that they didn't need to think twice about such as walking to the restroom or lifting a package. Thus, it can be easy to fall into depression in the early stages of recovery if the mind is not being constantly stimulated or if the patient doesn't receive the encouragement and support they need. There are medications that can help in this situation, but a family effort to help the patient and the doctor's recommendations should minimize stress during the transition in lifestyle.

Meeting with post-op and pre-op patients at the office was very interesting, and it is extremely gratifying to see how immensely someone's life can improve after one surgery. More to come soon!

Don't Be Tachy!

This week I watched 2 surgeries: an on-pump CABG/Mitral Valve Repair and on-pump CABG. In this post, I am going to focus on the CABG/MVR.

To begin, two sections of the saphenous vein were removed endoscopically from each leg before Dr. Patel opened the chest (simply to make sure they are ready when he reaches the heart). This procedure is sometimes called phlebectomy, or ligation and stripping. A phlebectomy is also a surgical approach to treating varicose veins, enlarged veins in the legs, but in this case it is referring to the removal of the vein for CABG. Ligation is the process of tying off the greater saphenous vein, while stripping is the removal of the vein via a 1 inch incision near the groin area. Removal of a portion of this vein will not negatively effect the function of the leg or circulation. The blood that flowed through the vein will change its course (collateral circulation). The image below shows the endoscopic procedure of harvesting the vein.

Removing SVG endoscopically

This surgery differed from the last mitral valve surgery that I observed and discussed earlier in that it was a repair instead of a replacement. The patient's mitral valve was not diseased or damaged so there was no need to replace it, but the leaflets were not closing completely, causing regurgitation. Thus, the valve was repaired by inserting an annuloplasty ring. This ring brings the walls of the heart around the mitral valve closer together so the valve leaflets can close completely. The image below shows the procedure of finding the right sized ring and inserting it to surround the valve. 

Annuloplasty Ring Insertion

The second surgery I saw this week was a quadruple bypass. I have discussed CABG procedures in previous posts, but in this surgery, a large portion of the saphenous vein was removed and divided to use for three bypasses and the LIMA was used to bypass the LAD. Also, it was an on-pump CABG, meaning the patient was on a heart-lung machine. However, when weaned off the machine, the patient's heart was beating abnormally fast (tachycardia) and was not returning to normal sinus rhythm on its own. Dr. Patel had to shock the heart to control the arrhythmia and a pacemaker was used to ensure a regular heartbeat of at least 80 beats per minute. It was exciting to see the paddles put to use! (Of course, I don't hope for every patient's heart to stop or experience irregular rhythms, because that has bad implications...it was just cool to see it in real life rather than on a tv show)

Please feel free to ask questions regarding the surgeries! It can get pretty tricky to understand sometimes. More to come next week!

Week 3: Cardiopulmonary Bypass Machine

Hey guys! For my first post this week, I want to talk in detail about the cardiopulmonary bypass machine (heart-lung machine or CPB machine). This machine plays a major role in open heart surgery, and I think that by explaining how the machine works, you will have a better understanding of the process.

The CPB machine essentially consists of parts that assume the functions of your heart and lungs, and is meant to keep blood flowing through the patient's body while his/her heart is stopped during surgery. A surgeon may want to stop the heart for certain medical procedures such as a valve replacement to protect the heart from damage and reach a valve without major blood loss. This can be done by administering cardioplegic solution (high concentration of potassium) into the coronary sinus, a venous channel that empties blood from the coronary vein into the right atrium.

CPB Machine

The main parts of the machine are the oxygenator, pumps, and heat-exchanger (controls temperature of the blood). Venous blood can be taken from the body into the machine via a tube inserted into the right atrium, vena cave, or the femoral vein. A reservoir collects the venous blood, and it is passed to the oxygenator via tubing. The oxygenator allows for the exchange of oxygen and carbon dioxide between the blood flowing through it and the surrounding gas. It then travels through the heat exchanger which cools and rewarms blood, giving the surgeon the option to reduce or stop blood flow around the body since hypothermia reduces the body's oxygen requirement. From there, blood is pumped back via tubing into the femoral artery or ascending aorta to travel around the body.

Overview of blood flow through the CPB machine

The oxygenator, pump, and connecting tubes are filled with physiologically compatible fluid to avoid introducing air bubbles into the blood. Also, when blood comes into contact with foreign surfaces, such as those of the CPB machine, it will naturally clot. This can be avoided by administering heparin, the body's own anticoagulant, to the patient before blood enters the machine. Once the patient is taken off the machine, they are given protamine to neutralize the heparin and restore normal blood clotting mechanisms.

Hopefully this explanation was helpful, and you now have a decent understanding of how the CPB machine takes over the function of the lungs and heart. It is crucial in protecting the heart and allowing the surgeon to work in a clear, "bloodless" field during many open heart surgeries. In my next post, I will talk about the procedures that I will be observing in the next few days. Stay tuned!

Citation:
Heart-lung machines. Retrieved from http://www.surgeryencyclopedia.com/Fi-La/Heart-Lung-Machines.html

Figuring it all out

Today, I observed another CABG surgery, similar to the ones mentioned in previous posts. Dr. Patel used the left internal mammary artery to bypass the left anterior descending artery and the saphenous vein graft to bypass the obtuse marginal artery. However, in this case double sternal wires were used to close the patient's sternum after surgery rather than single sternal wires (pictured below). The double wires provide additional support.

Single sternal wires vs. double sternal wires

Each surgery is thrilling to watch from the first cut to the last stitch, and I am extremely grateful to be able to watch these open heart procedures. I am starting to realize what it is really like to be a cardiothoracic surgeon, from the crazy long procedures and work days to the fun conversations in the physicians dining hall and OR. Although it has only been two weeks, I have a much better understanding of the demands of the profession. Thankfully, my experiences with Dr. Patel have made me more excited to jump into the medical field. I am looking forward to the next nine weeks!

Week 2: The Beat Goes On

So far this week, I have observed 2 surgeries: off-pump CABG and a redo Mitral Valve Replacement (MVR).

The off-pump CABG on the 13th was the same procedure that I described in my last post. Dr. Patel exposed the heart and used a stabilizer device to limit the movement of the heart. Again, he used the LIMA to bypass the LAD and the saphenous vein graft (SVG) to bypass the obtuse marginal artery (OM). However, I did learn something new about this procedure this week. In order to bypass the OM, one end of the SVG must connect to the aorta in order for oxygenated blood to flow through. This requires making a hole in the aorta, a high pressure artery, while the heart is beating. See the problem? Dr. Patel used a device called the Aortic Cutter (pictured below) to make a precise hole in the aorta, and covered the hole with his finger immediately to stop blood from flowing out of the artery. He then inserted the seal (also, pictured below) which pulls upwards in the internal wall of the aorta. This creates an opening for the attachment of the saphenous vein without blood escaping from the hole.

Aortic Cutter

Seal

The redo MVR was an extremely complex procedure, and was hard to follow at times. The patient was experiencing severe mitral valve regurgitation, and therefore needed a new mitral valve. Since it was a redo surgery, Dr. Patel spent a considerable amount of time removing and working around scar tissue from the patient's previous surgery. During surgery, the patient was put on a heart-lung machine to protect the heart while replacing the valve. An incision was made in the right atrium and through the septum to expose the mitral valve, and it was replaced with a Pericardial Mitral Bioprosthesis (pictured below).

Pericardial Mitral Bioprosthesis

Week 1: Get Pumped

This was the first week of my internship with Dr. Patel, and let me tell you, it was the most educational and exciting week of the year. I got to watch three surgeries, and spend some time visiting patients and studying angiograms in Dr. Patel's office. But before I get into all of the details, lets go over the general anatomy of the human heart.

Here are labeled diagrams showing the pathway of blood through the heart and the four valves:

Valves in the heart (aerial view)

In short, deoxygenated blood travels through the Right Atrium (RA), into the Right Ventricle (RV), and up the Pulmonary Artery (PA) to the lungs to get oxygenated. It returns via the Pulmonary Veins (PV), and travels through the Left Atrium (LA), into the Left Ventricle (LV), and up the Aorta and circulates throughout the body. In the process, the four valves in the heart keep the blood flowing in the right direction.

However, sometimes the function of these valves can be compromised, causing a backflow of blood in the heart. A problem in the Mitral valve, for example, can increase pressure in the left atrium and consequently in the pulmonary veins. Increased pressure may lead to fluid build-up in the lungs which will then affect the pulmonary artery and the right side of the heart. So you can see how a problem with one component of the heart can affect its functioning as a whole.

On Wednesday, I got to observe my first cardiothoracic surgery in the OR! It was an Aortic Valve Replacement (AVR). In this case, the aortic valve failed to close completely after the passage of oxygenated blood, and some of the blood was flowing back into the LV, causing damage. This is called aortic valve regurgitation. In surgery, Dr. Patel performed a median sternotomy (cut through the sternum) to expose the heart, and once the pericardium was open, he put the patient on a cardiopulmonary bypass machine (heart-lung machine) and infused a potassium solution to stop the heart. This machine essentially acts as a heart and lungs, oxygenating and circulating the blood outside the body, while the surgeon replaces the valve. Dr. Patel removed the aortic valve and replaced it with a Pericardial Aortic Bioprosthesis. With the valve in place and the aorta closed, the patient was taken off the heart-lung machine and Dr. Patel closed with steel sutures in the sternum and Braided Vicryl in the skin.

Pericardial Aortic Bioprosthesis

On Thursday, I spent some time in Dr. Patel's office, learning how to identify calcified and blocked arteries on angiograms and meeting patients. It was very interesting to see how Dr. Patel diagnoses his patients and discusses treatment options with them.

Today, I observed two surgeries, a Thoracotomy and an Off-Pump Coronary Artery Bypass Grafting (CABG). In the Thoracotomy, Dr. Patel removed tissues from the lungs for biopsy. It was a very short procedure, lasting only 45 minutes. The Off-Pump CABG, however was much more complex and lengthy. Dr. Patel performed a median sternotomy to expose the heart and visualize the blocked portion of the coronary artery. He used the left internal mammary artery (LIMA) to bypass the left anterior descending artery (LAD). The LAD is the most important of the three main coronary arteries because it supplies over half the heart muscle with blood, so any blockage must be cleared immediately. He also harvested a portion of the saphenous vein from the calf to bypass the obtuse marginal artery, a smaller branch of the left circumflex artery. The open ends of the LIMA and saphenous vein are sewn to the openings in the coronary arteries to create an alternate pathway for blood to nourish the heart. The term "off-pump" means that the patient was not on a heart-lung machine and the heart was beating through surgery. As a result, Dr. Patel used a stabilizer device, as shown below, to limit the motion of the heart as he operated and was very careful when suturing.

Stabilizing device

Coronary arteries

The environment in the OR is very different from what I expected, but not too different from ORs in TV shows such as Grey's Anatomy (except, without the drama and spewing blood). There is always music playing in the background, and the doctors and nurses constantly talk about the craziness of their daily lives and make funny comments while operating. For example, on Wednesday, we talked for almost twenty minutes about bacon. Random, but hilarious. 

Although it has only been one week, I learned so much already! I am looking forward to the next ten weeks with Dr. Patel in and out of the OR.

Shreya

Introduction

Hi all and welcome to my blog!

My name is Shreya Patel and I am a senior at BASIS Phoenix. Since I have satisfied my graduation requirements, I decided to pursue a research project in my third trimester in order to graduate with high honors and explore what interests me. 

The medical profession is exhilarating, and I am excited to say that for the next few months, I will be observing cardiothoracic surgeries at my project sites: Banner Thunderbird Medical Center and Abrazo West Campus. I will also conduct my own experiment, evaluating the infection rates of Monofilament Polypropylene sutures, Monofilament Nylon sutures, and Braided Polyester sutures when sewn into chicken feet. The chicken feet, with their incorporated sutures, will be put under similar conditions of patients with delayed sternal closure after cardiac surgery. 

By the end of this project, I hope to gain a better understanding of what I would like to pursue in college and as a career. I am confident that my internship will expose me to the intense and gratifying world of surgery, and persuade me to strongly consider a medical profession. 

I would like to thank Dr. Patel for volunteering his time to teach me about what he does every day in the OR. With his help, along with that of my advisor at school, Mrs. Anderson, I know I can get the most out of this internship and the knowledge it has to offer. 

I will blog about my findings and what I have learned from each surgery twice a week. Stay tuned!

Shreya