The last time I was in the cath lab was about a year ago October. The the non-medical folks, the cath lab is the room in which they do procedures that involve using real-time xrays to do dye studies. So a big IV is inserted into the groin, and a catheter is snaked up the main artery or vein, or both into the heart, and dye is injected and you get to see all the plumbing and structures of the hear. As well as doing some nifty procedures such as the infamous angioplasty (roto-rooter of clogged arteries) etc.
Of course, the last time I was in the cath lab, I think it was the wee hours of the morning, and I was doing and admission on an adult who has having he big one, and needed to get those blocked arteries unclogged so that the heart muscle wouldn't totally die. Adult caths, for me, seem to be slightly monotonous. Blocked vessel, blow it open, put in stent, admit to the CCU service. And as the admit resident, it's pretty cookie cutter usually, with the important role of gathering data for the admission assessment. There's more to this, but those were my flashbacks.
Today was different.
We did a combination of diagnostic caths (seeing what's going on in the heart, without any intention of fixing any problems) and an attempted therapeutic cath.
It was evident by early morning, that we were possible going to finish hours late tonight.
Kiddo #1 was actually a kid that I admitted back in August. Admitted with hypoxia, gastro, and was/is dysmorphic looking. Turns out he has an extra chromosome #9 (clubbed feet, bilateral inguinal hernias-already repaired, PDA, VSD, expected mental retardation are the main things he has). He's been intubated in the ICU for the past almost 2 weeks. And there has been debate about is his cardiac lesions are contributing significantly to his respiratory distress. So he went for cath today. He's about 4 months now. Due to limitations of ICU beds, his fate was partially going to be decided by this cath. If he had lesions which were thought to be contributing to his respiratory statues, and were amenable to some kind of intervention in the cath lab, he would continue to be vented for a few more days. If he had lesions which were not thought to be contributing to his respiratory distress, and/or they were not amenable to repair in the cath lab, he was likely going to have care withdrawn, leaving a grim prognosis.
Kiddo #2 had a cath done to follow a PDA-which had closed, and a known VSD. The surprise was finding some pulmonary stenosis. Which is something that can be dealt with by inflating a balloon catheter and dilating up the stenotic lesion. Except that we didn't have the right size available today, as this was an unexpected finding, and the balloon caths were not available. She'll have to come back for the procedure.
Kiddo #3 has Down's Syndrome, and the typical heart lesion that goes along with Downs. AVSD/echocardial cushion defect. Which is amenable to surgical repair, but the mother refused the surgery in 2005, and today is a follow up cath to see what the progression of the heart lesion has been like. If there is too much progression, surgery is no longer possible, and then life expectancy drops to 10 years or so.
In the cath lab today there were the 4 consultants, as well as the other reg/resident and myself. It's a great crew, the consultants are fantastic teachers, skilled clinicians, and really enjoy doing what they do. Not to mention that there is constant banter back and forth, and regular laughter. While we only finished an hour late, not the 2-3 hours as was predicted at one point, nobody really seemed to mind because it was rather enjoyable. A stark contrast to last month.
Cheers
