Fontan Pathway and other corrections that are simple, yet genius at the same time

[cardsurgguy]

---

Members do not see this ad.

Is it me or is the Fontan Pathway simply amazing...

It seems to make so much sense, almost to the point of being obvious as a way to temporarily treat things like hypoplastic left heart, single ventricle, tricuspid atresia, and other congenital heart defects.

Connecting the vena cavas directly to the pulmonary arteries so deoxygenated blood goes straight to the pulmonary vasculature into the lungs and doesn't mix with oxygenated blood in heart anymore is absolutely genius...yet at the same time, after you look at it, it seems like such an obvious thing to do!

However, no matter how much I'd like to think so, I probably would never have had the ingenuity and imagination to think it up in the first place as Dr. Fontan did.


I've worked on every floor of the hospital I work at, but the majority of my experience has been in CT surgical areas (both adult and children), so I'm not familiar with the sophisticated procedures yet in other surgical areas.
Well, that, plus the fact that I haven't even begun medical school yet, so haven't had to work on or be interested in anything but CT surgery, which is definitely my passion.

Because of this, I was curious about what types of analogous procedures there are in other fields that I don't know as much about. There must be some in every field.

What other procedures/corrections have all of you come across that are amazing, yet so simple (ie--makes so much sense after you see it), but that you know you probably never would have thought of it originally?

You don't have to describe the procedure in detail. All of you are obviously busy. And besides, I'll just be looking it up anyways whether it's described or not... 😀

 

[Frictionbaby]

Is it me or is the Fontan Pathway simply amazing...

It seems to make so much sense, almost to the point of being obvious as a way to temporarily treat things like hypoplastic left heart, single ventricle, tricuspid atresia, and other congenital heart defects.

Connecting the vena cavas directly to the pulmonary arteries so deoxygenated blood goes straight to the pulmonary vasculature into the lungs and doesn't mix with oxygenated blood in heart anymore is absolutely genius...yet at the same time, after you look at it, it seems like such an obvious thing to do!

However, no matter how much I'd like to think so, I probably would never have had the ingenuity and imagination to think it up in the first place as Dr. Fontan did.


I've worked on every floor of the hospital I work at, but the majority of my experience has been in CT surgical areas (both adult and children), so I'm not familiar with the sophisticated procedures yet in other surgical areas.
Well, that, plus the fact that I haven't even begun medical school yet, so haven't had to work on or be interested in anything but CT surgery, which is definitely my passion.

Because of this, I was curious about what types of analogous procedures there are in other fields that I don't know as much about. There must be some in every field.

What other procedures/corrections have all of you come across that are amazing, yet so simple (ie--makes so much sense after you see it), but that you know you probably never would have thought of it originally?

You don't have to describe the procedure in detail. All of you are obviously busy. And besides, I'll just be looking it up anyways whether it's described or not... 😀

I'd say any of the vascular bypass procedures are simple, yet ingenious (Ax-fem, fem-fem, fem-pop, etc.) also the shunts for portal hypertension (spleno-renal and various portal/caval shunts...though not perfect due to side effects like encephelopathy, are a remarkable example of science/physics at its finest.

Probably the most amazing surgeries I've seen were plastics cases on craniosynostoses and scaphocephaly where the skull was completely reshaped, taking a very abnormal looking child and making them almost totally normal...immediately...if you've never seen one, look it up and read about it....the surgical technique is shear genius. Also look up Crouzon Syndrome if you haven't seen it. The surgery utilizes a LeFort III operation to disarticulate the facial bones entireley from the skull, bolt to a halo and "wrench" forward by daily turns with a screwdriver to reshape the bones of the face in this terrible pediatric syndrome. I've seen it, and its remarkable.

Others? Good post.

 

[Plastikos]

Agree with the above, even if its a little bit obvious. Plastics cases and like friction said the Craniofacial surgeries are nothing short of amazing. As are other plastics cases, though they arent all standardized procedures. Check out some post-onc surgeries in the head and neck using flaps, etc...

 

[Lloyd Christmas]

Those are all great procedures, and that is what makes surgery such a draw for me.
I think a really ingenious procedure is the Nissen fundoplication. Simple idea: a patient has a relaxed/incompetant lower esophageal sphincter and you need a way to make it more competent/tight. Why not just wrap the fundus of the stomach around it to tighten things up a bit? Seems logical, and it works. But this is another one of those things that I don't think I would ever have thought up.
While this is not quite as amazing as the facial reconstructions or Fontans, it is a really novel and elegant solution to a difficult problem.

Any others?

 

[lapape]

Those are all great procedures, and that is what makes surgery such a draw for me.
I think a really ingenious procedure is the Nissen fundoplication. Simple idea: a patient has a relaxed/incompetant lower esophageal sphincter and you need a way to make it more competent/tight. Why not just wrap the fundus of the stomach around it to tighten things up a bit? Seems logical, and it works. But this is another one of those things that I don't think I would ever have thought up.
While this is not quite as amazing as the facial reconstructions or Fontans, it is a really novel and elegant solution to a difficult problem.

Any others?

Well Nissen himself didn't come up with the fundoplication as a treatment for GERD, it was a serendipitous discovery by him.

 

[cardsurgguy]

I'd say any of the vascular bypass procedures are simple, yet ingenious (Ax-fem, fem-fem, fem-pop, etc.) also the shunts for portal hypertension (spleno-renal and various portal/caval shunts...though not perfect due to side effects like encephelopathy, are a remarkable example of science/physics at its finest.

Probably the most amazing surgeries I've seen were plastics cases on craniosynostoses and scaphocephaly where the skull was completely reshaped, taking a very abnormal looking child and making them almost totally normal...immediately...if you've never seen one, look it up and read about it....the surgical technique is shear genius. Also look up Crouzon Syndrome if you haven't seen it. The surgery utilizes a LeFort III operation to disarticulate the facial bones entireley from the skull, bolt to a halo and "wrench" forward by daily turns with a screwdriver to reshape the bones of the face in this terrible pediatric syndrome. I've seen it, and its remarkable.

Others? Good post.

Yeah, I've seen other plastics cases for cleft palatte (sp?) type of surgeries where there are screws that the nurses adjust daily in order to adjust the bone structure of the child's face

As for the portal hypertension shunts, are you talking about procedures like the Tipps procedure to prevent/treat things like Esophageal Varices?

 

[Misterioso]

Currently the most innovative procedure in cardiothoracic surgery is finding a job after you finish training.