Week 2: Jada Okaikoi

 Jada Okaikoi | Clinician Mentor: Dr. Jiwon Kim

This week was filled with new structural heart procedures that helped me better understand how device-based therapies are used to treat valve disease. I observed a TAVR, or transcatheter aortic valve replacement, which is a minimally invasive procedure used to replace a diseased aortic valve through a catheter rather than open-heart surgery. I also observed a MitraClip procedure for mitral regurgitation, where the mitral valve does not close properly and allows blood to leak backward into the left atrium. In this case, the patient’s left ventricle was very dilated, causing the mitral valve leaflets to drift farther apart and making it harder for them to close. The procedure was also challenging because the patient appeared to have a smaller posterior leaflet, which made clip placement more difficult.

I also observed CT, or computed tomography, readings, where physicians used detailed cross-sectional images to help determine the correct size of a Watchman device. The Watchman is an implant placed in the left atrial appendage to help reduce stroke risk in certain patients with atrial fibrillation. In addition, I observed Single-Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging, a type of nuclear stress test used to evaluate blood flow to the heart muscle. In these images, physicians look for areas of the heart that receive less blood flow during stress compared to rest, which may suggest reduced blood supply from a narrowed coronary artery. Stress testing can be performed using either a treadmill or a pharmacological approach. A treadmill test is used when a patient can exercise enough to appropriately stress the heart (goal is ~ 75% max heart rate depending on age). A pharmacological test is used when a patient cannot safely or effectively exercise, so medication is used to mimic the effects of exercise on heart blood flow. This test can take approximately 3-4 hours depending on which approach is used. 

Lastly, I observed rounds in two different units and saw how attendings and their teams can structure patient discussions differently. In some cases, the team reviewed patients together before only the attending went to speak with them. In others, the whole team rounded at the bedside, or the nurse caring for the patient joined the discussion. These differences showed me how communication style and team structure can shape clinical decision-making and patient care.

Fun fact: although the valve between the right atrium and right ventricle is called the tricuspid valve, many individuals actually have more than three leaflets, with some having four or even five.

 

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