Mum’s heart “fell apart” during heart valve replacement surgery. At least that’s what the surgeon told us in the hospital waiting room when Mum was coming out of the operating room. It’s the kind of simplistic explanation a medical person gives someone they don’t think understands the messy realities. I haven’t seen open heart surgery, but I’ve seen most other types of surgery. TV hospital shows and simple explanations are no substitute for Actually Being There.
The functioning of the human heart is pretty amazing (the mammalian heart in general really) and it’s impressive that it generally works well for as long as it does.
This surgery involved the (anatomical) left side of the heart (see figure below), around the region of the left atrium, left ventricle and the aorta. Oxygenated blood from the lungs is received into the left atrium via the pulmonary veins. The aorta is a big artery into which oxygenated blood is pumped by the left ventricle, to be distributed out to tributary arteries and onto the rest of the body.
Before I’d finished writing this, I heard the news that Neil Armstrong had died subsequent to cardiac bypass surgery. In his case, blocked coronary arteries supplying the heart muscle had to be bypassed. I remember being sent home from school before I could get through the gate to watch the grainy images of the Apollo 11 moon landing on our Black & White TV at the age of 5.
Quite apart from being a reluctant hero for the amazing feat of landing Eagle with about 20 seconds worth of fuel left, and being the first human to step onto the Moon, Neil Armstrong was a loved one, like my mother:
We are heartbroken to share the news that Neil Armstrong has passed away following complications resulting from cardiovascular procedures.
Neil was our loving husband, father, grandfather, brother and friend.
Soon after she died, Dad and I visited the cardiologist who referred Mum to the surgeon. He provided some details to us about what happened during the operation. Of course, that was a second-hand account related to him by the surgeon. As told to us, the sequence of events during the operation went something like this:
- The first valve was sewn in.
- The aorta split!
- The first valve was replaced with a second smaller valve.
The fact that the aorta split implies, purely from a mechanical viewpoint, that the first valve replacement somehow resulted in a pressure increase inside the aorta. Presumably the smaller second valve was intended to reduce the pressure in the aorta. Assuming a smaller valve implies a smaller opening, that ought to be the case due to the Venturi effect.
There is nothing in my notes about what was done about the split aorta. But no matter how you look at it, that’s a pretty dire thing to happen.
- Cardio-pulmonary (?) artery blockage.
- First cardio-pulmonary (?) graft.
- Some semblance of stability (exactly what this means is unclear).
- Off the cardiac bypass machine.
- Poor cardiac function.
- Internal heart massage.
- Back on the bypass machine.
- Second cardio-pulmonary (?) graft.
The use of “cardio-pulmonary” above makes no sense to me looking at it now. This may be a transcription error from the notes I took during the visit to the cardiologist in 2002. I don’t know whether this should be a reference to “coronary artery” (left and right, along with others, that supply the heart muscle with oxygen; related to Neil Armstrong’s problem) or whether it refers to a tributary of the pulmonary artery. The latter seems unlikely; could that have become blocked? But if it does refer to the left coronary artery, that still seems odd because we’re now saying that we have a coronary artery blockage as well! How did that happen during a heart valve replacement operation? To sort out my confusion, I really must ask about this aspect of things again.
The final point in the sequence as I recorded it was:
- Left atrio-ventricular “tear”.
Since the mitral valve sits between the left atrium and left ventricle, I assume this was directly related to the second valve replacement referred to earlier. The surgeon said the heart tissue was friable. Perhaps this was also related to whatever caused the aorta to split, e.g. a pressure increase event, but I don’t have that information.
When Mum was coming out of surgery, we were told that she was “gravely ill” and might not survive. Thinking about the messy details above helps to shed light on why this was the case.
In the Intensive Care Unit, she was on a ventilator, a cocktail of intravenous drugs and a balloon pump (inserted into her aorta) to assist her cardiac function. There was a great deal of fluid pooling, leading to her face becoming very bloated.
After a few days, it all failed. I would like to be able to say that she died with dignity. At least she was sedated. When I saw her before the funeral, they had tried to make her appear as dignified as possible.
Being a pall bearer, then watching the hearse depart for the cremation with a lone piper piping Amazing Grace opened the floodgates, as it should have done.