Cardiovascular Surgery 2-5

For anyone who wants to read the article on ECMO, it's called "Extracorporeal Lung Assist in Severe Respiratory failure and ARDS Current Situation and Clinical Application."

At the OPC, I learned that stens used for coronary artery surgery are not recommended for use in lower limb vessels b/c vessels of lower limbs lie within the muscles. Thus there's a concern that shear force/tearing force will break the stent and cause more serious issues. So for now if there's a stenosis of deep vessels of lower limb, only dilation technique is used. If stenosis repeats, dilate again. In some other countries like France, stent in lower limb vessels is used.

At the clinics, I found that a lot of patient with PAD have DM and also develop gangrene.

For the rest of my CV surgery week, I got to observe many embolectomy/thrombectomy procedures that precede dilation of vessels in patients who have had grafting. Dr. Chen removed the thrombi in patients' vessels then perform PTA balloon to dilate the stenotic vessels. In these cases, stenosis seems to be recurrent.

I also got to see PTA done on a branch of the circumflex and LAD done by a cardiologist. It was amazing! During the procedure, there was an acute thrombus and the surgeons were very calm and quick to remove it. It would have been a serious complication if they hadn't caught that thrombus. Talk about performing under pressure!

On Friday, Dr. Chen performed the AAA surgery. It was the 2nd AAA surgery ever performed at the hospital. I felt privileged to be there. Again, I was so amazed by the complexity of the surgery and the skills that Dr. Chen possesses. I was outside watching the surgery through a glass mirror and from a monitor, admiring modern medicine and technology which allow these kinds of procedures to be done, and a lot of people are saved. Before closing up the patient, Dr. Chen allowed me to be next to him to take a look at the incision site where it all began a couple of hours prior. The surgery went smoothly and ended beautifully with a round of applause.

During my CV surgery rotation, Dr. Chen reminds me that being a good surgeon is mostly about practice and improving one's skills. The intellect is important too, because it helps guide a surgeon's skills. But knowing everything in the textbook is not everything. Sometimes, you need to improvise during a surgery because nothing goes exactly like it is described in books. Surgery is like art; sometimes a good piece of art is purely improvising.