It was Thursday night with only one day left before my
open-heart surgery. I was having an early dinner with my good friend
Monsignor Ralph Miller. He had experienced a similar fate several months
earlier. Ralph was admitted to Buffalo General Hospital with sever angina,
tests indicated the blockage was so serious that his doctors had to
perform emergency bypass surgery, similar to the one that David Letterman
recently experienced, Ralph had the same, a 5-bypass graft done.
After dinner,
Ralph gave me absolution along with his and GOD'S blessings, then he left
to say mass at St Frances Church. I sat at the bar after he had gone,
gazing into my single malt scotch drink, pondering what life had in store
for me if I were to survive this major heart surgery. I was totally
oblivious to the background chatter of friends who had entered the
restaurant and were waiting for a table. The open-heart surgery
that was imminent was becoming more real with each passing
second.
In the name of Christ, I am only 47 years old, two
years younger than my father when he died of a massive coronary
thrombosis (heart attack). That was 39 years ago. "I guess things have not
changed that much in regard to having heart attacks," I thought to myself.
In my innermost consciousness, the cognizant realization arose:
"If only there was a magic potion one could to take to eliminate
heart blockage! MY TIME IS NEAR!!!!"
It was a very cold Saturday morning on October 18,
1986 in Buffalo, New York. I submitted and committed not only my earthly
self but also my VERY SOUL into the hands of a very GIFTED, SPECIAL HEART
SURGEON. In his sterile gown, rubber gloves, a mask hiding his
face except for his hazel colored eyes, along with a matching
cap, Dr. Bergsland quickly enters a cold sterile environment, eager to
commence a procedure he has successfully performed so many times before.
However, it is my first time. THANK GOD I WILL BE SOUND ASLEEP!!
According to medical records obtained from the
BUFFALO GENERAL HOSPITAL THE FOLLOWING COMMENTARY IS THE ACTUAL PROCEDURE
performed on me.
PRE-OP. DIAG.
Coronary Artery Disease
POSTOP. DIAG.
Coronary Artery Disease
SURGEON
Dr. Jacob Bergsland
Dr. Canver Asst.
NAME OF OP.
Coronary Artery Bypass Grafts Times Two
Report of findings and Procedure
ANESTHESIA:
General
PROCEDURE: The patient, a 47-year-old Caucasian
male, was placed on the Operating Room table in the supine position after
a right sided radial artery line had been started by the Anesthesiologist.
The anesthesiologist also attempted to start an internal jugular line but
hit the carotid artery with a search needle. This was therefore abandoned.
Instead, a SWAN-GANZ catheter was inserted through the subclavian vein.
After full prep and drape and administration of
antibiotics intravenously, the chest was opened through a median
sternotomy incision. The Favoloro retractor was inserted and the internal
mammary artery dissected out using cautery and hemoclips for homeostasis.
The internal mammary artery was of good quality. Saphenous vein was taken
from the right leg, from the ankle up to the mid calf.
Cannulation was performed after purse strings had
been placed on the soft descending aorta and on the right atrium. Heparin
was given directly into the atrium. Sarns plastic cannula was used for the
aorta and a two-stage venous cannula for the Venous return. Both were
connected to the Cardiopulmonary bypass machine. The heart was carefully
examined and it was seen that it would not be feasible to graft the major
marginal with the internal mammary because it was completely posterior. It
was therefore decided to use a saphenous vein for this graft.
Partial occlusion bypass clamp was placed on the
ascending aorta and a punch hole made. The saphanous vein was anastomosed
in a reverse fashion using 6-0 Prolene suture material in a running
fashion. Partial occlusion clamp was taken off and the graft had excellent
flow. It was brought through the transverse sinus over on the left side.
Internal mammary artery was brought through a hole just anterior to the phrenic
nerve, into the pericardial cavity. Cardiopulmonary bypass was initiated
and the heart arrested by infusing cardioplegic solution into the root of
the aorta, cooling the heart externally with ice.
The major marginal coronary artery was opened up
first. It was a 2mm, excellent vessel. The saphenous vein was anastomosed
end-to-side to this vessel using 7-0 prolene in a running fashion. The
huge first diagonal coronary artery was opened up in its proximal portion
just beyond the obstruction. It was a 2 mm vessel of excellent quality.
Internal mammary artery was tailored and anastomosed end-to-side using 8-0
prolene suture material in a running fashion. The Bulldog clamp on the
pedicle was then taken off and the heart could be seen to immediately
perfuse. The aortic cross clamp was then removed. The mammary pedicle was
tacked to prevent kinking. The length of the vein graft was excellent.
After full rewarming, cardiopulmonary bypass was
discontinued and the patient tolerated this without the use of any
inotropic support. After transfusion, he was decannulated and Protamine
given intravenously. Homeostasis was good. Chest tubes were placed on the
left side as well as posterior and anterior to the heart. Atrial and
ventricular pacemaker wires were also placed. The chest was then closed
using stainless wires for the sternum and vieryl for the soft tissues. The
patient tolerated the procedure well and was brought to the Intensive care
unit in stable condition.
Duration of Operation: Approximately 7 1/2 hrs.
Signed: Jacob Bergsland, MD/ Charles Canver,
MD
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