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Stunted
01-31-2009, 02:22 AM
Assuming that someone could live without a heart, how would you go about surgically removing one? What if you could only use old fashioned surgical methods? Would you want to fill the cavity with something? With what? Would you sew it all up? Does anyone have any thoughts?

ColoradoGuy
01-31-2009, 02:34 AM
I've been involved in heart transplantation operations. The way the heart is removed is first to expose it by making a skin incision over the sternum (breastbone), then sawing the sternum in half (vertically, from top to bottom) with an electrical saw, and then inserting an instrument called a "chest spreader" between the edges of the breastbone. A hand crank then spreads the chest cavity open (the ribs are quite flexible and bend). The heart itself is removed by cutting into the pericardium (the sac that contains the heart), then cross-clamping the aorta and the pulmonary artery (the great vessels that come out of the top of the heart) and the vena cavae (the vessels that enter the back of the heart), and cutting outside the clamps to remove the heart.

You could google an anatomy picture to see where these vessels are.

Stunted
01-31-2009, 03:02 AM
Wow...I didn't expect to find someone so knowledgeable so quickly. If you pop open the breast bone, is the heart sack right there, or do you need to dig around?

dclary
01-31-2009, 03:17 AM
Why isn't this in the research and funny questions forum?

ColoradoGuy
01-31-2009, 03:19 AM
Wow...I didn't expect to find someone so knowledgeable so quickly. If you pop open the breast bone, is the heart sack right there, or do you need to dig around?
It's essentially right there in front of you, although it's a bit covered by the lungs, especially the left one, so you need to push those aside. Look at any anatomy book. There's always a front view of the open chest with the heart and lungs in position, although anatomy books usually show the organs with the whole chest plate -- the front portions of the ribs and sternum -- removed so you can see a bit better. The only time that is done is during an autopsy, in which case the ribs are cut all the way around the sides using something like a hedge clipper.

ColoradoGuy
01-31-2009, 03:20 AM
Why isn't this in the research and funny questions forum?
Good point. I'll move it to the "ask the experts" forum.

Thomas_Anderson
01-31-2009, 05:11 AM
How do you patch up the sternum? Is there some sort of medical adhesive that you use, or do you just sew the skin and let the bones heal themselves?

GeorgeK
01-31-2009, 07:57 PM
How do you patch up the sternum? Is there some sort of medical adhesive that you use, or do you just sew the skin and let the bones heal themselves?

They typically have used stainless steel wire such that an x ray looks much like a series of about a half dozen bread bag twist ties have been used

Stunted
02-01-2009, 05:51 AM
So the sternum won't just heal on its own?

ColoradoGuy
02-01-2009, 05:56 AM
So the sternum won't just heal on its own?
It heals, but any bone fracture (which is really what sawing the sternum in half is) needs to have the edges of the bones brought together and held in position to heal properly. That's why we put a cast around a broken arm -- to hold the edges together until they heal. Sometimes we need to use plates or screws to hold the edges together. This is the same situation: the wires that George mentions bring the edges of the sternum together and hold them there. By a couple of weeks later the sternum is stable and the wires don't serve any purpose, although we leave them there because it's too much of a hassle to pull them out -- it would take another operation to do that.

Stunted
02-01-2009, 07:59 PM
If someone who is really good with their hands and used to cutting and sewing were to attempt to do everything that you're describing with a couple days of constant instruction and a little practice on dead animals, and infection weren't an issue, how do you think they'd do?

DeleyanLee
02-01-2009, 08:07 PM
Ancient Aztec priests used to slice open the diaphram (just under the ribcage) and reach up with their hand up to grasp the heart. This was for human sacrifice purposes, so they did just rip it out with their hands. Entire process took less than two minutes, IIRC.

If you could live without a heart and had it removed, I don't see any reason to replace it with something else. I mean, you can live without an appendix and when it's removed, nothing's put in place of it.

HoraceJames
02-01-2009, 08:16 PM
There's always the Mayan method... paint 'em blue, hack it out with a sharp rock, burn it in a bowl and feed the rest to the crowd. Then the priests danced around in the dead person's skin.

I was a great honor.

GeorgeK
02-01-2009, 08:48 PM
If someone who is really good with their hands and used to cutting and sewing were to attempt to do everything that you're describing with a couple days of constant instruction and a little practice on dead animals, and infection weren't an issue, how do you think they'd do?

Sewing living tissue is only analogous to non-living tissue. It's not the same. They'd also need to understand blood supplies and the proper technique of cauterizing and oversewing bleeders or very quickly they'd not be able to see what they are doing because of bleeding. I've seen few novices at surgery who knew what needed to be sewn to what, despite doctoral level anatomy courses. Dead does not look like or respond like Living.

ColoradoGuy
02-01-2009, 08:57 PM
If someone who is really good with their hands and used to cutting and sewing were to attempt to do everything that you're describing with a couple days of constant instruction and a little practice on dead animals, and infection weren't an issue, how do you think they'd do?
It would be tough. It takes 7 years after medical school to mint a cardiothoracic surgeon. As George mentions, what you're considering for your plot requires some pretty major stuff. On the other hand, fiction is fiction, so I don't think it's totally impossible. Maybe you could give your character some previous experience? Maybe working with animals? The ranchers around where I live are pretty good practical surgeons.

tlmorganfield
02-13-2009, 08:55 PM
I have a details question. When the heart is removed from the body, can it still beat for a period time on residual electrical current, or does it stop beating immediately once all connections to the body are severed?

GeorgeK
02-13-2009, 10:18 PM
I have a details question. When the heart is removed from the body, can it still beat for a period time on residual electrical current, or does it stop beating immediately once all connections to the body are severed?

I've seen a headless butchered turtle gutted, the meat was replaced into the shell then wrapped in foil and baked for an hour at 250F. the heart happened to be at the center. The outer meat was medium rare. The heart was still beating. It kind of freaked me out and if I hadn't seen it, I wouldn't have believed it. Cardiac muscle is amazing at times. That said, people are far more frail. I doubt a human heart would do much more than fibrilate a minute or so after death, but I've never done heart surgery or an immediate autopsy. In the few organ harvests I've participated in, I was focused on the kidneys.

Mike Martyn
02-14-2009, 12:21 AM
I've seen a headless butchered turtle gutted, the meat was replaced into the shell then wrapped in foil and baked for an hour at 250F. the heart happened to be at the center. The outer meat was medium rare. The heart was still beating. It kind of freaked me out and if I hadn't seen it, I wouldn't have believed it. Cardiac muscle is amazing at times. That said, people are far more frail. I doubt a human heart would do much more than fibrilate a minute or so after death, but I've never done heart surgery or an immediate autopsy. In the few organ harvests I've participated in, I was focused on the kidneys.


For what it may be worth, frog's heart will continue beating in saline solution (salty water) for at least an hour after it's removed from the frog. It's actually rather a creepy sight.

tlmorganfield
02-15-2009, 03:25 AM
Thanks for the info, guys! It's not a plot point, so I don't actually need it to beat once it's removed, but rather I just wanted to get the details right. Interesting stuff about the turtle and the frogs though.

burgy61
02-15-2009, 09:24 AM
If you could live without a heart and had it removed, I don't see any reason to replace it with something else. I mean, you can live without an appendix and when it's removed, nothing's put in place of it.

I don't know about the heart, but when they took out my right lung they moved my Latissimus muscle from my back to fill the area where my lung used to be. The surgeon told me it was done to prevent the area from filling up with fluid.