Heard of Atrial Myxoma? & The revolutionary CPB Machine

It's week 2 of working with my clinical mentor - Dr Robert Tranbaugh, at the New York-Presbyterian Methodist Hospital. My highlights for this week are:   

1. Observing the Coronary Artery Bypass grafting (CABG) surgical procedure.

2. Viewing endoscopic harvesting of saphenous veins for CABG procedure.  

3. Understanding the working principle of the Cardiopulmonary Bypass Machine (CPB) Machine. 

4. Resection of Atrial Myxoma and closure of the atrial septal defect procedure  

Earlier this week, I got to see the preparation routine for the CABG procedure. This includes patient preparation, anesthetic administration, Swan catheter deployment for measuring pressure from the RA, RV, and Pulmonary arteries, etc. Furthermore, I learnt about the principle of operation of the CPB machine.


The CPB machine, known as the "heart-lung bypass machine" developed by John Gibbon in 1953, brought about a revolution in open-heart surgery. This machine bypasses the heart function, oxygenates the blood and supplies the body through the ascending aorta during the procedure. It consists of a reservoir that acts as the RA, a pump/heart that acts as the RV, and an oxygenator that acts as the lungs. During the CABG procedure, the right atrium will be cannulated to divert blood through the machine's blue (venous) line. Then, the pump drives the blood, the oxygenator oxygenates it, and the red (arterial) line delivers it to the ascending aorta. Once the machine takes over this function, cardioplegia is administered, and the surgeon can operate on the non-beating heart.  


UpToDate. Initiation of Cardiopulmonary bypass. Cardiopulmonary bypass setup 

The next procedure I observed was the Resection of atrial myxoma. Amazed that a cardiac tumor exists? Although rare, cardiac tumor incidence is less than 0.1% and can be accidentally discovered in the clinic using imaging techniques like Echocardiography, CT or MRI. These tumors must be treated to prevent embolization, cardiac obstruction or any other comorbidities that could result in cardiac dysfunction.   

The case presented showed a mass of about 2cm growing in the patient's right atrium. The patient was then operated on, and the tumor was removed with some atrial septum tissue, leading to an atrial septum defect (ASD). This was then closed using tissue from the patient's pericardium.

This second procedure had me thinking,
"What if we run out of the autologous pericardial tissue? Synthetic patches for ASD patients, anyone?"  

Finally, I interacted with Doctors in the Cardiothoracic ICU to gain some insights into Postoperative concerns like hemorrhaging/bleeding. Also, I got to familiarize myself with some important considerations to keep in mind when designing prosthetics for use in the clinic, particularly as it relates to cardiac implants. In the coming weeks, I hope to observe other surgical procedures and discover interesting ideas to move my project forward.  














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