For hours I had been staring at that tiny fragile beating heart, so naked under my eyes, mesmerized. It was the first time I saw an open-heart surgery. I was at the Wolfson Medical Center for a 2 weeks medical internship program sponsored by the organization – Save a Child’s Heart (SACH). SACH has brought many children from around the world that were in dire need of heart operations to Israel to get the treatments they need in order to have a new life. It is truly amazing to see how a pediatric cardiac surgeon can reverse a child’s fate from a death sentence at birth to an almost completely healthy normal life.
For the first few days of the internship, I spent some time at the pediatric ICU, the clinic and the catheterization lab to gain some background knowledge on congenital heart defects and ways to treat them. I also got to see some of the kids they’ve brought to Israel for treatment. Even though they had a broken heart, they had the brightest smiles and positive attitudes that melted my heart away. I could not imagine what went wrong with their hearts.
Then the day came, my first day to see a pediatric cardiac surgery. The first girl had a complete AV block, which means when normally the heart is able to send electric signals to the atrium for it to contract before the ventricle contracts with a delay, her heart was not able to do any of those. Therefore, in order to sustain her life, she had to have a pacemaker implanted to pace the heart. The advances of modern pacemakers have saved countless people’s lives with much better quality of life. What was unimaginable in the past has become normal procedure in the day.
I also got to see a few more complicated procedures like Glenn, arterial switch, and RV-PA conduit. The Glenn procedure is part of a solution package that deals with single ventricle physiology, which means instead of two functional ventricles pumping blood to 2 different systems the heart has only one. The Glenn procedure connects the superior vena cava (SVC) to the pulmonary artery so that the returned venous blood can go directly to the lung, bypassing the right heart. As a result the single functional ventricle of the heart can serve the purpose of systemic blood flow, which is the one that requires much more active pumping. The arterial switch operation is used in cases where the great arteries (pulmonary artery and aorta) are malposed in a way that loses ventriculoarterial concordance (normal: right ventricle to pulmonary artery, left ventricle to aorta). This operation can reconstruct a healthy plumbing system for the patient so that the deoxygenated blood can go to the lungs and oxygenated blood can go to the body. The RV-PA (right ventricle-pulmonary artery) conduit was used in a child with Tetralogy of Fallot that had pulmonary atresia. The atresia blocked blood in the right ventricle from entering the pulmonary artery. The conduit was made from the jugular vein of a cow.
After watching all those surgeries and catching precious teaching moments the surgeons threw my way, I got a much better understanding of the heart, cardiac surgeries, and clinical thinking in general. All the different subjects I’ve learned suddenly came together: microbiology, cardiology, hematology, and the respiratory system. Now that I can see clinical relevance in everything I wish I could have learned more. I’m extremely grateful to this SACH program that has given me a chance to take a peek at the world of cardiac surgery. It is beyond magic to see in actions how to fix a broken heart.