How to Repair a Broken Heart

 by Lissiana J

During half term, I had the exciting opportunity of completing my work experience at King's College Hospital. There, I was able to observe multiple incredible surgeries and procedures and meet professionals whose work is not often appreciated but extremely important. 

Firstly, I observed an Aortic Valve Replacement which was fascinating. I watched how the surgeons carefully removed the patient's calcified aortic valve and used tools to ensure that the size of the aorta was exactly what they were expecting. Then, the surgeons intricately sutured nearly 30 threads around the walls of the aorta which were then attached to the new biological heart valve outside the chest cavity. The next step was arguably the most impressive- the surgeons pulled the threads down resulting in the valve parachuting down to the aorta. As a result of the precise stitches, the valve was lowered down perfectly and when tested, there were no leaks. After a quick shock with defibrillator panels, the heart restarted and had a new stronger beat. I also had the chance to watch a Coronary Artery Bypass Graft which was an enthralling experience. Whilst one surgeon was opening the chest up, another was cautiously harvesting the saphenous vein from the patient's leg, working from ankle to groin. The surgeon, navigated by an Endoscope, used electrocautery to separate the vessel from the surrounding flesh as when flesh burns it seals, making the vessel easier to use as there is no risk of cuts or holes when it branches off. The surgeons carefully attached measured sections of the veins around the brockages and promptly closed up. Throughout both surgeries the patients were on a bypass machine, regulated by a perfusionist who responded swiftly to the surgeons every order and was incharge of altering the patient's body temperature. 

One of the cases which I saw in the Cardiology department was the amazing Impella device insertion.The Impella is a small device that is placed in the left ventricle, across the aorta and pumps blood up, alleviating the pressure on the heart. The patient has been denied heart surgery therefore the only other option was to undertake a non invasive approach. A great team of medical professionals: doctors, nurses, radiologists and anaesthetists took part in the procedure of placing the Impella device in the patient's heart, except the interesting thing was that they could only work from a cut in the upper arm. With the use of numerous tools such as echo scans and CT, the doctors were able to carefully guide the device up the vessels in the arm and into the aorta. However the procedure did not stop there. Once the Impella device was positioned, the doctors started the second part of the procedure- placing several stents in the vessels. Currently, there is a trial taking place where the patient receives the treatment before or after stentage. Although it seems that the best option is to add the Impella pump at the first chance, it can actually cause vascular complications. Therefore, the findings of the trial will help make a final decision regarding the optimum conditions for Impella device insertion.

Overall, I had an incredible experience and gained so much knowledge, however one of the most important was to stay fit. Despite their age, all the patients I saw were allowed surgery only because they were fit and had a healthy lifestyle. The whole process of surgery is absolutely brutal on the body and so the post operative recovery is extremely difficult and painful. Only the patients who appear able to withstand the pressures are put forward for surgery whilst the others have to undergo other, non-invasive procedures. Although, being fit will not prevent one from developing a heart disease, it will certainly allow for the best treatment options and definitely an easier recovery.