GE Cardiovascular Ultrasound for Aortic Valve Replacement

This is my second week volunteering in the OR, and now that I come in the morning, I get a chance to see a wide variety of cases. This week I observed a part of an aortic valve replacement procedure. The surgeons were busy with their work, but the anesthesiologist showed me his ultrasound machine that, it turned out, was an integral part of the procedure.

GE Healthcare has created the Vivid Cardiovascular Ultrasound System that gives anesthesiologists unprecedented capabilities for evaluating the heart and other organs. The device used at this OR was the Vivid 4 model. It has a probe that is inserted into the esophagus to show the coronal view of the heart, and into the stomach to show a horizontal view. A large monitor shows the imaged region in real time, which allows to evaluate the mechanical function of the valves and the myocardium (heart muscle). For example, I saw that the aortic valve was opening very poorly, a condition called aortic stenosis. A very cool feature that adds to evaluation and diagnosis is doppler. This allows to monitor blood flow inside the heart. As seen in the image; the blood flow is color coded according to velocity (but it might be mass flow). The heart I saw, had a clear flow back into the left atrium as the AV valves were closing, which is termed ventricular regurgitation. Besides giving different viewing capability, this machine allows to make measurements. In this procedure it is important to determine the size of artificial valve to be inserted, and that was done by measuring the width of the aortic opening in mm.

image source: GE Healthcare (www.gehealthcare.com)

To make a final comment, I learned that contact lenses and OR environment do not mix. My eyes were getting irritated from the dry air and from smoke caused by bowie (if spelled wrong let me know) knife. Also, here are images of the three general planes used in medical imaging.

image source: National Institute of Technology and Evaluation

What $1.5 Million Will Get You

Today I got a chance to see a prostatectomy, and not just any old school prostatectomy but a robotic one. Using a da Vinci robot that costs a whopping $1.5 million plus all the costs of the retractors and cutters it uses, the urologists performed this delicate procedure in about 3 hours. As explained to me, the benefits are the greater control of laparoscopic devices that the robot provides. It makes it easier to sew the sites of incision within the abdomen, and also leaves less bleeding. In addition, the camera of the robot is 3D, which makes it easier to navigate and move the instruments around; the regular laporascopic camera is 2D.

What was interesting was the fact that the procedure wasn't entirely done by the robot, a resident was standing by the incision site and was holding a laparoscopic retractor to help out with the procedure. It was very cool to watch, but seemed a little excessive.

image: www.marketwire.com