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Show 2 The Salt Lake Tribune, Sunday, March 11, B- - 1973 , Repairing the Heart: Medicine in Action Continued From Page B-- soft crinkle vinyl goes two ways l dressed up with your nicest finery or casual with pents and other sportswear. . . team anesthesiologist, computer technician, two assisting But whichever you choose, both styles are long on comfort with stylishly machine surgeons, heart-luntechnician, scrub and circulanurses I went and ting looked at the patient. 1 couldnt see much. All that was exposed was part of the chest and part of her right leg The rest of the body was covered in green surgical g drapes. (The patients head, in ; heels. Ana both h neat feature a soft smooth lining. The pump in black, navy or tan and the sling in black, navy or white. Sizes 9 N; 5 to 9, 10M; mid-hig- 7-- 6-- 9 W. Budget Store Shoes fact, has been covered in every operation, but two, that I've seen. Looking at the operating table like that, its hard to believe theres a human being lying there. Perhaps that's why Ive never become sick) Skin Color The first thing I noticed was the skin color it looked yellow, like a bad case of jaundice. Dr. X explained that since human skin cant be made completely sterile, the patients trunk is wrapped in a sterile, seran-likpaper. (It reminded me of yellow nee paper). Incisions aie made nght through the paper. I walked up to the patient's head and looked over the drape. The two assisting surgeons already had opened her chest. An electric saw is used to cut through the sternum (breastbone) from the base of the throat to the upper abdomen. Metal clamps are used to pry back and hold open the rib cage. fd seen color photographs, but Id never seen a human hem up close, alive and beating, pulsating. This womans hefcrt was yellow with fat, the surgeon explained. (Nore mal hearts are pinkish-red)- Before the mammary artery is grafted, it Is cleaned, dilated and measured for size. Mean- - . A thebeart. Dr. X said one of the artery grafts would be the intern mammary artery. The other two grafts would come from the saphenous vein an accessory vein in the thigh which is dispensable. The mammary artery and saphenous vein are dispensable; Dr. Y said because "all areas of the body except the brain, kidney and heart have double blood supplies. Atherosclerosis is the most common form of arteriosclerosis and contributes directly to more than 850,000 deaths annually from heart attack and stroke. when the inner linthe of arteries become ings thickened and roughened by deposits of fat, fibrin (a dotdeting material), cellular bris and calcium. "They get corroded much as a water pipe does on the inside, the surgeon explained form a These deposits rough, thick surface inside the blood vessels and interfere with both the smooth flow of blood and the amount of blood carried through an artery. It occurs I I ! ! Block Channel As the inner walls become heavy and thick, they lose their ability to expand and contract. The blood moves with difficulty. Its easy for a clot to form which will block the' channel and deprive the heart, brain and other organs of blood. Dr sur-eo- Y ns, forming explained that tne now busy, were pervein a bypass will bypass the ey poi ts of obstruction. graft-th- i Low long would the grafts As the patients body and temperatures were brought back to normal and the machine was gradually slowed down, her own system began to take over. An electric shock was given to get her heart going. (But the patient didnt leap off of the table like in so many television programs). Getting Tired Removed earlier from the patients ihigh, the saphenous vein is then grafted onto one of the hearts main arteries. Tubes at the back, right, lead to the heart-lun- be? Dr. Y said that the one used on the right coronary artery, for example, would be centimeters long, or about inches. 0 8 He handed me what looxed like an ordinary stethoscope. But- - it wasnt. As I listened, I coqjd hear the patient's heart beat and her breathing. This is an esophageal stethoscope, he explained. Its placed down in the esophagus, behind Dr. Y readied a dose of protamine sulfate, given to the patient as she comes off of the heart-lunmachine. This drug counteracts the heparin. Now blood will clot. heart "After the operation, we then will have a pnnt-ou- t of what drugs were given and when and what procedures were done, he said. "Its invaluable. Hear Beat machine is being set up to blood. oxygenate patients g and g 'the anesthesiologist. eaih I hup Dr. Y, explained that he I uses a computer to monitor all, of the patients vital . sigps. He also feeds the computer all information con"well cerning the drugs use 15 to 20 procedures and comments. Every two minutes, the computer shows the patients heart function blood pressure. cardiac output, etc. The patients heart rate and respiration also can be seen continuously on a monitor above the operating table. heart-lun- to the family waiting in the lobby. I tell the family not to come to the hospital until now," he said, glancing up at the clock. At 11 a.m., we start calling down every half hour to reassure them. It sure is tough on the folks who are waiting! Pinkish Lung As I looked to the left, I coiiid see a lung, pinkish with black lines (from breathing Salt Lake Cityair"). The aorta I didnt realize it was quite so big was pinkish-wlitt- e with red marbling. Fascinating! ' while, pump ein Cleaned The vein and artery to be grafted were cleaned, dilated and measured for size. I like to see a vein about twice the size of the coronary artery to which Im attaching it, Dr. X explained, looking up from the operation. While this was going on, the heart-lunmachine was being set up for its important role. Developed in the early 1950s, it enables surgeons to operate on and even inside of the heart while it takes over the functions of the heart and lungs. The machine pumps and oxygenates the blood. g Mr. Z. who operated the machine, explained, while he was setting it up. the shorter a patient is on this, the better. We can go up to six hours, but three hours is optimum. Above three hours, there can be some cellular damage. Bypass Heart heart-lun- g Well bypass the patients heart and lungs. Pressure will be exerted by the machine to pump the blood up to the heart and brain." he continued blood is (Normally, pumped down from the heart, but the aortic valve is like a swinging door; it can pump blood either direction) Plastic tubes are attached from the machine to the femoral (thigh) artery and to the aorta. The anesthesiologist gave the patient a dose of heparin, a drug which prohibits blood clotting. At 9 34 a m the heart-lunmachine was turned on. Its the replaced whoosh of the respirator , g chug-a-chu- g The surgeons poured cup after cup of an iced saline solution over the exposed heart This stops the heart and also produces a st,.te of hibernation, Dr. X explained Simultaneously, gauges were set on machine to the heart-lunlower the body temperature. g g g machine. The patients body temperature is lowered to about 90 degrees; the heart temperature, for minutes, is lowered to about 60 degrees. (It took about 30 minutes to lower the body temperature 4 degrees). Dr. X made an incision into the heart . "This is like sticking a pm into butter. A normal heart would be like sticking a pin into steak. Anesthetics through the chine. now are given heart-lun- g As the last stitches w'ere being taken, Dr. X remarked: I think were ready to come maoff of this silly heart-lunchine. Im getting tired of listening to it." The time now was 12:10 p.m. The patient had been on the heart-lunmachine for two hours and 36 minutes. But the operation wasnt over yet. Weve got to measure how much the grafts will put out,, explained Dr. X. Electric probes were used to measure how much blood the was flowing through freshly-graftearteries. The grafts were doing the job. Dr. X left the operating ma- As the patients blood into the plastic swooshed tubes, the heart stopped pulin sating and diminished size like a deflating balloon. The machine had temporarily taken over the hearts main purpose to move some 4.300 gallons of blood each day through the heart and into the lungs and circulatory system. Never Gain Busy adjusting gauges, Mr. stressed, Its important not to overload or underload the patient. She must never gain or lose any blood or fluid, One of the other suigeons lowered the fiber optic surgical illuminator a light on a bendable tube that is used to see under nooks and crannies of the heart. Its much better, obviouslv, than the overhead light. Z d room. Close Chest The two assisting surgeons began to close the chest cavi ty and finish sewing up the right leg (where the vein had been taken). The clamps, holding back the nb cage, were removed. Steel wire was used to sew together the breastbone. And then more stitches to sew together the skm covering the chest. Four plastic tubes stuck out of the patients chest for fluid and air. As Lynn and I walked out of the operating room, I noticed that all of the gause strips and pads used during the operation were lined up on a towel on the floor. Theyre all counted. Each piece of gauze has a special tape attached to it so that if, inadvertently, one wore left in the chest, an would show its location. turbo 7 ' large pantyhose y Dr. X put on a pair ol magnifying glasses to see the intricate sewing. He needed them. He was beginning to sew two together arteries (mammary). Boy, he commented, you dont know how stiff your neck can get with these things! Mushy Feeling Between intricate tiny, stitches. Dr. X said, In diabetics, the tissues most often have a mushy feeling. These arteries are tortuous, profusely diseased, buried in fat If a person isn t diabetic, the disease usually is localized like a cork not all around like this It was almost 11 a m. Dr. X told one of the nurses to cal! down with a progress report Intensive Care The patient would remain in an intensive care unit for two days, then moved to another room. If everything went smoothly, days after the operation, she would be home. As we walked out of the hospital, still exhilarated, I thought of some of the stories told by several of the surgical team members: about the man who weighed pounds and had to be propped up on the operating table, about the time all the electricity went out during surgery and ihe operation was finished with the help of flashlights and handthe technician macranking the heart-lunchine Oh, and a week later, the patient went home. 8 Pantyhose made of ReCall stretch nylon, the special yarn that insures perfect fit anid comfort. Select beige, tan, taupe or coffee in 4 proportioned Now in ZCMI Budget sizes: Store Hosiery. Outstanding quality pantyhose made lady with an ample figure. 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