Putting a heart back in shape
Apr 05, 2009
LAST week, surgeons at the Uganda Heart Insitute performed a valve-replacement surgery for the very first time in Uganda. This was done by a team of two South Koreans and one Ugandan sponsored by the Hwan sung Medical Charity.
By Lydia Namubiru
LAST week, surgeons at the Uganda Heart Insitute performed a valve-replacement surgery for the very first time in Uganda. This was done by a team of two South Koreans and one Ugandan sponsored by the Hwan sung Medical Charity.
Before the operation, we have a brief chat with Professor Pak, the lead surgeon from South Korea and Dr. John Omagino.
They will soon be replacing a damaged valve in one Evelyn Adikini, a 21-year-old, suffering from rheumatic heart disease. The condition weakened one of her heart valves so much that it could not regulate blood flow.
Consequently, blood pooled and clotted in her heart. The clot later moved to the brain, causing her to suffer a stroke.
It takes close to two hours to prepare the theatre for the surgery, so we are told to wait. Finally, all is set and we (journalists) are asked to change into theatre garb.
In the theatre, Adikin is lying on the table, unconscious under anaesthesia. She is all covered up except for a small section of her chest area, which has a transparent steriled film. the chest has been puffed up so much that it rises high above the rest of her body.
With a sharp pointed blade, one of the surgeons begins to cut into Adikin’s skin. He soon creates a line down Adikin’s chest, exposing a layer of flesh. carefully, he cuts into that layer, then another and another until he exposes the breast bone.
He then binds all the layers on each side by sewing them together using what looks like wire thread.
With the breast bone visible, he is handed a drill-like equipment which he uses to drill into the bone, sending off splinters of bone.
With the bone completely cut through, a clamp is used to keep the two parts of the dissected chest apart.
The two surgeons push their hands into Adikini’s chest area probably to reach the heart. There it is. The beating heart is found and raised close to the surface of the chest. We can all see it beat. It is now time for Prof. Pak who has been outside the theatre to join them.
The senior surgeon drives his hands into Adikini’s chest. It turns out he is trying to find the blood vessels leading to the heart. In this operation, he will need to literally stop the heart. It is, therefore, important that he diverts the blood flow into a heart and lung machine nearby, which takes on the functions of the heart.
With the help of the other two surgeons, they locate all the blood vessels, connect them to tubes and the blood starts flowing into the machine. The heart becomes limp and sinks back into the chest cavity. To preserve it, water cooled to four degrees is driven into it.
Now the real operation can begin. A small incision is made on the heart through which the surgeon accesses the diseased valve. He removes it and replaces it with a factory-made one.
The new mechanical valve consists of two very thin leaflets in a ring. The two leaflets, from now on will serve to shut and open, allowing Adikin’s blood a one-way flow through the heart.
The reserve process now begins. The veins leading to the heart are reconnected, allowing blood back into the heart. A small electric shock is applied to startle the heart back to work. It starts to beat again and is carefully put back in place. Adikin has successfully crossed back to life.
Her chest area is reordered and she is transfered into the intensive care unit with an array of sensors and other gadgets connected to her. Under anaethesia, she will sleep for another four to five hours as her system recovers from surgical stress. She may stay in the hospital for seven days to gradually recapitulate before going home.
Now that she has an artificial valve, she will take blood thinning medication all her life to prevent undue strain on it. Had she been fitted with a human donated valve or one made out of cow or pig tissue, the medication would not have been necessary.
However, doctors prefer the factory-made valves for people of Adikin’s age since they last longer. Tissue valves wear out eventually in which case the patient would need to be re-operated to insert another one.
LAST week, surgeons at the Uganda Heart Insitute performed a valve-replacement surgery for the very first time in Uganda. This was done by a team of two South Koreans and one Ugandan sponsored by the Hwan sung Medical Charity.
Before the operation, we have a brief chat with Professor Pak, the lead surgeon from South Korea and Dr. John Omagino.
They will soon be replacing a damaged valve in one Evelyn Adikini, a 21-year-old, suffering from rheumatic heart disease. The condition weakened one of her heart valves so much that it could not regulate blood flow.
Consequently, blood pooled and clotted in her heart. The clot later moved to the brain, causing her to suffer a stroke.
It takes close to two hours to prepare the theatre for the surgery, so we are told to wait. Finally, all is set and we (journalists) are asked to change into theatre garb.
In the theatre, Adikin is lying on the table, unconscious under anaesthesia. She is all covered up except for a small section of her chest area, which has a transparent steriled film. the chest has been puffed up so much that it rises high above the rest of her body.
With a sharp pointed blade, one of the surgeons begins to cut into Adikin’s skin. He soon creates a line down Adikin’s chest, exposing a layer of flesh. carefully, he cuts into that layer, then another and another until he exposes the breast bone.
He then binds all the layers on each side by sewing them together using what looks like wire thread.
With the breast bone visible, he is handed a drill-like equipment which he uses to drill into the bone, sending off splinters of bone.
With the bone completely cut through, a clamp is used to keep the two parts of the dissected chest apart.
The two surgeons push their hands into Adikini’s chest area probably to reach the heart. There it is. The beating heart is found and raised close to the surface of the chest. We can all see it beat. It is now time for Prof. Pak who has been outside the theatre to join them.
The senior surgeon drives his hands into Adikini’s chest. It turns out he is trying to find the blood vessels leading to the heart. In this operation, he will need to literally stop the heart. It is, therefore, important that he diverts the blood flow into a heart and lung machine nearby, which takes on the functions of the heart.
With the help of the other two surgeons, they locate all the blood vessels, connect them to tubes and the blood starts flowing into the machine. The heart becomes limp and sinks back into the chest cavity. To preserve it, water cooled to four degrees is driven into it.
Now the real operation can begin. A small incision is made on the heart through which the surgeon accesses the diseased valve. He removes it and replaces it with a factory-made one.
The new mechanical valve consists of two very thin leaflets in a ring. The two leaflets, from now on will serve to shut and open, allowing Adikin’s blood a one-way flow through the heart.
The reserve process now begins. The veins leading to the heart are reconnected, allowing blood back into the heart. A small electric shock is applied to startle the heart back to work. It starts to beat again and is carefully put back in place. Adikin has successfully crossed back to life.
Her chest area is reordered and she is transfered into the intensive care unit with an array of sensors and other gadgets connected to her. Under anaethesia, she will sleep for another four to five hours as her system recovers from surgical stress. She may stay in the hospital for seven days to gradually recapitulate before going home.
Now that she has an artificial valve, she will take blood thinning medication all her life to prevent undue strain on it. Had she been fitted with a human donated valve or one made out of cow or pig tissue, the medication would not have been necessary.
However, doctors prefer the factory-made valves for people of Adikin’s age since they last longer. Tissue valves wear out eventually in which case the patient would need to be re-operated to insert another one.