One end, another beginning (5)
In front of the K rosette.
Staff members who were about to perform a pediatric heart transplant were gathered in one place.
Unlike a regular surgery, the number of staff was almost double, so it felt crowded.
The transplant surgery is performed simultaneously on the K rosette and the I rosette because the donor team removes the heart and the recipient team prepares for the transplant surgery separately.
“The final briefing will begin now.”
Choi Ki-seok stood in front of the staff and opened his mouth.
His eyes were sparkling as usual and his tone was calm.
“The beneficiary’s name is Rahul. “I was diagnosed with heart failure through outpatient treatment at James Hopkins, but was told that surgery was not possible so I transferred to our hospital.”
“….”
“While waiting for a heart transplant, my condition worsened and I was put on a ventricular assist device a month ago. Among those waiting for a heart transplant, the risk is level 1, which is the most critical. Next is donor Gerard.”
Ki-Seok Choi’s explanation continued.
‘Anyway, I’m not an average person.’
‘If it were me, even if I died and woke up, I wouldn’t be able to do that.’
I was amazed by the staff’s gaze as they looked at Choi Ki-seok during the briefing.
Everyone knew that this heart transplant surgery was performed because Choi Ki-seok visited the brain-dead patient’s parents and asked for them.
The staff was greatly influenced by his reckless yet caring heart for patients.
“…That is all. “Do you have any questions?”
As soon as she finished speaking, Katarina raised her hand.
However, her gaze was not fixed on Choi Ki-seok but on Kwon Il-soo standing next to him.
“Professor Kwon. I can’t shake the feeling that the professor is forcing this surgery. As Rahul’s heart transplant risk is high, he may be contacted by the transplant center soon. “I think it would be a good idea to postpone the surgery a little longer.”
“What makes you think that?”
“There are two main things.”
Katarina spread her index and middle fingers wide.
Some staff members nodded in agreement with her explanation.
The first risk factor in this surgery is the donor’s heart condition.
During a thorough examination for a heart transplant, a tumor was discovered in Gerard’s heart.
Of course, the tumor was benign.
There are many cases where benign heart tumors in children disappear or become smaller on their own, but this was not a case to be laughed off.
The location of the tumor was not good.
As a result, the tumor narrowed some passages in the left ventricle.
Before a heart transplant, surgery on the donor’s heart had to be performed first.
“It bothers me that a heart with even a slight defect is being transplanted to a recipient.”
“Just as there are no perfect people in the world, there is no perfect heart.”
Kwon Il-soo shook his head with a stern expression.
“Sometimes an artificial heart is transplanted, and sometimes a heart that has stopped beating is revived and transplanted. From that perspective, there is no problem with this surgery.”
“Then how will you perform the vascular anastomosis?”
Katarina went on the offensive again.
“Gerrard is six years older than Rahul. There is a big difference in the size of the heart and blood vessels. “We don’t know what problems may arise during the process of anastomosing blood vessels.”
“How do you perform a blood vessel anastomosis?”
“…yes.”
“You have to do well.”
Katarina blinked in surprise at Kwon Il-soo’s answer.
The answer is too simple.
If this is the answer, even children in kindergarten can do it.
“I’m not making fun of Professor Katarina, I’m serious. Doesn’t Professor Katarina know too? “There is no royal road to suturing.”
“That’s true, but…”
“For this surgery, we have no choice but to trust our staff and ourselves.”
After Kwon Il-soo finished speaking, there was silence for a moment.
“All right. “I will follow the professor’s wishes.”
“great. “Then let’s get started!”
At his signal, the staff went to scrub.
Buck. Buck. Buck. Buck.
Choi Ki-seok repeated the surgical procedure while rubbing his hands and forearms with a brush.
In the past, while training at medical school, I assisted in a heart transplant surgery. However, at that time it was not a pediatric surgery and I was not a first assistant.
Although it seems the same as now, we are in a slightly different situation.
“Are you nervous?”
“no. “There is no such thing.”
Kwon Il-soo smiled at Choi Ki-seok’s answer.
“Well, I started assisting with Saber’s surgery when I was in Korea, so I wouldn’t bat an eye at most surgeries. “Is there a secret to becoming a strong heart?”
“I guess I got lucky.”
“If that’s luck… it’s really great luck. “Every doctor would be envious of this.”
After a brief conversation, the staff dispersed and entered the rosette.
Ki-Seok Choi was a member of the I rosette team donor surgery team, and the team composition was as follows.
Kwon Il-su, the builder.
First Assistant Ki-Seok Choi.
Second assistant Julia.
Third Assistant Michael.
Jiyiing.
Rosette Moon opened its mouth left and right.
Perhaps because of his extraordinary determination for the surgery, the moment I passed through the door, it felt like a martial arts athlete entering the arena.
Countless spectators, bloody fights, victory and defeat that are decided at the end of the game, etc.
Surgery and fighting sports had some similarities.
Choi Ki-seok, who entered Rosette, looked down at Gerrard from time to time as he prepared for surgery.
An unfortunate boy who became brain dead in a car accident.
As I was looking at him, the images of Gerard and his wife who were crying towards him overlapped.
“Timeout is over.”
“Patient monitoring device connection completed.”
“The heart-lung machine is ready for operation.”
“Blood pressure 120/70 mmHg and heart rate 120/min are within normal range. “I will begin general anesthesia.”
The staff’s reports continued as if they were sailing on a tailwind.
Kwon Il-soo glanced up at the observation operating room and then looked down at the patient again.
“From now on, we will begin removing the donor’s heart tumor and removing the heart.”
The staff nodded slightly at Kwon Il-soo’s words.
First, Julia thoroughly disinfected the patient’s chest and abdomen and covered it with a cloth.
Followed by median sternal thoracotomy.
As Kwon Il-soo cut the patient’s skin without hesitation, Julia and Michael attached a retractor to the incision and stretched it left and right.
As the skin opened, the surgical field of view became wider.
With clear vision, I slightly pushed the lungs to the side, revealing the weakly beating heart.
gulp.
Choi Ki-seok swallowed dry saliva without realizing it.
Clearly, a child’s heart is different from an adult’s heart.
To use an analogy, it would be like the difference between a cute plum and an appetizing apple.
I once successfully completed a pulmonary artery stenosis surgery on my own, but at that time, it seemed like luck was on my side.
“Please inject cardiac arrest fluid.”
Choi Ki-seok looked at the anesthesiologist, held the prepared cannula in his hand, and inserted it into the aorta, superior vena cava, and inferior vena cava in that order.
It rattled. It rattled. Drurr.
As soon as the cannula was inserted, the heart-lung machine moved noisily, but on the contrary, the heart fell asleep as if it were dead.
“In fact, this is my first case of a tumor in the donor heart.”
“There is a case that even the professor has not experienced.”
“of course. In some ways, the experience of being a doctor is like a combination of ups and downs. “You may encounter many unusual cases like Mr. Choi, or you may encounter only cases that are quite ordinary.”
As Kwon Il-su spoke, he held the electric cautery in his hand.
“It’s fortunate that the tumor was primary and a myxoma. If not, I wouldn’t have even dreamed of surgery. “Then let’s get started.”
A scalpel reflecting the light of a surgical lamp was pointed at the heart.
The heart tumor is located in the atrial septum, a small tumor located in the wall that blocks the right and left atria.
Cheeeeeeeek.
White smoke rose along with the smell of burning.
Kwon Il-soo used an electric cautery to prick the area around the tumor as if cutting out colored paper.
In this case, the effect of simultaneous resection and hemostasis can be seen.
Meanwhile, Choi Ki-seok secured Kwon Il-su’s surgical field of view and prevented his heart from moving with a fixator.
At the same time, I carefully examined Gerard’s heart using the dragon’s eye zoom-in mode.
How much time has passed?
Empty!
The mucocele fell onto the bench with a clear sound.
“This is sending a biopsy (biopsy).”
“yes!”
The disinfection nurse who received instructions from Kwon Il-soo placed the sample tissue in plastic, stored it, and handed it over to the circulating nurse.
“professor. “I have one thing to tell you.”
At Choi Ki-seok’s words, the staff, including Kwon Il-soo, tilted their heads.
The heart tumor removal surgery was completed flawlessly.
I wondered what else I could say in this situation.
“say it.”
“In Gerrard’s case, the tumor was concentrated in the right atrium. In this case, wouldn’t it be possible for the tumor to damage the tricuspid valve or tendon?”
“that’s right. But Gerrard’s tricuspid valve and tendon…”
Kwon Il-soo adjusted his optical glasses and bowed his head to look closely at the heart.
Blood flow through the tricuspid valve is normal.
There was no sign of even responding to the reflux. However, while examining the valve closely, it was seen that the shape of the cord tendon that supports the valve was slightly deformed.
“I know what you mean. “Do you mean to perform tendonoplasty?”
“yes. This can be overlooked, but I think it’s better to strive for perfection whenever possible. “There should be no need for surgery on a transplanted heart again.”
Choi Ki-seok clearly said what he had to say.
While helping Kwon Il-soo in zoom-in mode, the deformed tendon cord kept bothering me. So, after the tumor was removed, I observed the progress with the eyes of Hippocrates.
The outcome of the surgery was normal.
It means that it is neither good nor bad.
After much deliberation, I decided that it would be right to perform tenodermoplasty to improve the outcome of the surgery.
“Every word of it is correct. Is this a slap in the face to Mr. Choi? “I was only thinking about removing the heart, but I missed something important.”
“Because it’s not a necessary treatment…”
“What are you talking about? “If it is for the sake of the patient’s progress, no matter how trivial the treatment may be, it cannot be overlooked.”
“professor. “I have one more thing to tell you…”
Choi Ki-seok paused before continuing.
“I want to do tendonoplasty. “In the future, you will be responsible for heart extractions and heart transplants, so I would like to ease your burden even a little.”
“Are you confident?”
“of course.”
Kwon Il-soo chuckled at his energetic answer.
“Then, shall we take this opportunity to take a look at Mr. Choi’s skills?”
“thank you.”
Gigigigigeek.
Ki-Seok Choi said thank you and fixed the suture needle with the needle holder like a fish in water.
Followed by tenodermoplasty.
This is an operation that simply involves pulling up the collapsed muscle and tying it to the surrounding tissue without any treatment tools such as rings or artificial tissues.
Ki-seok Choi turned on the light in his eyes and proceeded with the treatment.
Kwon Il-soo pulled the muscle up with forceps and sutured it in no time. Although it was difficult because it was a pediatric heart surgery, it was surprisingly a fight worth fighting.
click!
The clear sound of scissors was heard and the suture was cut.
‘Good.’
A smile slowly appeared on Choi Ki-seok’s lips.
After the surgery was completed, the patient’s progress improved after using the Eye of Hippocrates.
This proved that the choice of tenodermoplasty was correct.
“The more I see Mr. Choi, the more surprising he is. “Aren’t you a fellow disguised as a resident?”
“If you don’t believe me, would you mind taking it off?”
“Put it away. “Because I don’t have such bad taste.”
Kwon Il-soo lightly cracked his neck and held the scalpel in his hand.
“We will start removing the heart now.”
