John Toftegaard week 3

 This week I continued to watch various cath lab procedures including a trans catheter aortic valve replacement. This was a relatively straight forward procedure for the interventionist I was shadowing as these procedures are relatively common. This procedure first involves the doctors intubating the patient and utilizing a trans esophageal ultrasound to acquire images of the heart and where the device will be implanted in the aortic valve position. They then insert guide catheters into the heart of the patient and then assess the blood flow and pressures of the involved chambers. This is normal time out spot for the procedure as they decide how they want to proceed and if their original plan will still be viable. The valve is then deployed and expanded using a balloon and the blood flow and pressures are taken again to make sure the valve sits right.

I also got to witness a double mastectomy on top of my normal catheter lab shadowing. Our lab in Ithaca collaborates with a plastic surgeon here at Weill and because of this I got to witness this surgery and see what a surgical OR is like. This procedure was done as a gender reaffirming procedure to remove the patients breasts. Once the patient was anesthetized they marked up the patient to determine where they will be cutting and how the final geometry and proportion of the patients remaining tissue will look after the procedure. Once this was determined to be satisfactory they removed the patients nipples and kept them on ice to be later attached. They then slowly began cutting through layers of fat tissue until they reached the patients muscle. Through this process they cauterize any blood vessels they encountered and were constantly checking to make sure they follow the planned geometries. Once the reach the muscle layer they remove the predetermined section of the breast and then close up the remaining fat tissue to create the new breast. The nipples were then reattached and the procedure was completed. This procedure was significantly more invasive then what I had previously witnessed and gave me an appreciation of the work surgeons perform on a daily basis

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