Week 3 Summer Immersion - Gearing up Research and Shadowing

 Cole Latvis – Blog week 3

This week my time was split almost evenly between research preparation and cardiac catheterization lab shadowing. I am happy to have a clearer direction for summer research goals, and I am really enjoying the opportunity to network with so many medical and industry professionals.

For the beginning of the week through Wednesday I focused on acquiring the skills necessary to work on my summer research project. My project will work on assessing strain in the aorta in response to ascending aorta graft placement. While custom tools in MATLAB have been used in the past to measure aortic strains, I will be investigating whether a common general cardiac MRI imaging software can be applied for this purpose. Namely, I will try to repurpose the left ventricle strain tool to be used on the aorta. If I get reliable data, then I will apply the new technique to analyze a dataset of patients with and without ascending aorta Dacron graft replacements. I can try to recreate the findings of a previous paper by Dr. Weinsaft’s group and expand upon it by tracking new variables that may affect aortic strain, such as grafting extent and the angle of the graft bend. Towards these goals, I have learned to use the required software tools and gained access to the data set. So far it appears that I can generate useful data using the common software, but it is unclear how reliable this data is yet.

In addition of preparing for my research project, I got in contact with the cardiothoracic surgeons with the help of Dr. Weinsaft. I was put in direct contact with a fellow in the department and he invited me to meet with him on Wednesday. Ben Johnston from this program also expressed interest in seeing cardiothoracic procedures so I asked if he could join as well. We both met with the fellow and now have plans shadowing surgeries next week. I am especially looking forward to watching ascending aorta replacements since these tie directly into both my summer project and my side second project in Ithaca.

On Thursday and Friday I shadowing in the cardiac catheterizations labs where I observed a variety of fascinating procedures. The two highlights were a PFO closure and an aortic valve-in-valve-in-valve placement. PFO stands for patent foramen ovale, which is an open flap between the right and left atria. In utero, this shunt in the heart allows blood to flow through the heart without it all entering the lungs where there is no oxygen supply yet. After birth, this flap closes in most people allowing for efficient blood flow to the lungs. However, in some people closure never occurs and the hole remains. For the most part this is not a serious issue, but it does increase the risk of stoke as a person ages. This is because clots that form in the peripheral circulation, that would normally be trapped in the lungs, can sometimes pass back into the left heart and be sent to the brain. The solution is to seal this PFO with a small catheter-delivered device. Briefly, the catheter is pasted through the PFO, then a mesh-lined disk is deployed in the left atrium. A second disk is deployed in the right atrium along the same catheter. When pulled, the disks seal together and block the PFO hole. The valve-in-valve-in-valve placement was an extraordinary case. The patient had a surgically replaced aortic valve that began failing, so a transcatheter aortic valve replacement (TAVR) was placed over the surgical valve in a valve-in-valve procedure. A few years later, in the present, the TAVR also began to fail. After investigating the source of the leak, it was decided to place a second TAVR within the two failing valves, making it a valve-in-valve-in-valve placement. Watching a third valve placed over two others was extremely interesting on the X-ray and ultrasound images. However, it does underpin the problem with permanent, non-degradable, and largely biologically inactive implants. These devices just stay in people indefinitely, and in many cased are prone to failure within a decade or less. Since tissue grows/scars over these devices, they become impractical to remove and the foreign objects are just left in the patient. Research, like mine in Ithaca, aims to overcome this problem by developing devices which aid in repair and then degrade away.

I had a great week overall and I look forward to observing cardiothoracic procedures next week.

 

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