Kenny Nguyen/Dr. Jonathan Weinsaft - Week 4

 Week 4: 06/26/23 - 06/30/23

The fourth week of my Summer Immersion term consisted of continuing clinical research, shadowing MRI case reviews, and observing cardiac catheterization procedures.

For clinical research, I continued to perform volumetric analysis of cardiac MRI scans. Once I reach the desired number of characterizations of right ventricles in patients, we will be able to evaluate whether certain parameters in measuring right ventricle dysfunction correlate with prognosis of patients that suffered from coronary artery disease.  

In the MRI case reviews, I witnessed the radiologist’s expertise in performing analyses and providing radiology reports to help direct patient care. A notable case that emerged during the week was a scan of a patient who was relatively young. From prior history of the patient, the cardiology fellow inferred that the patient may have a congenital disease that affects the blood flow direction. To investigate further, the fellow conducted many analyses using parameters such as Qs/Qp ratio which compares the pulmonic blood flow to systemic blood flow. It is a privilege to work so closely with the cardiology fellows and learn about the analyses that bring out the full potential of each imaging modality. The fellow compiled his findings and impressions to review with the rest of the radiology team. In the case review, the fellows and Dr. Weinsaft reviewed the findings and concluded that the patient had a congenital heart defect of one pulmonary vein. In a view of the patient’s MRI scan, we were able to distinctly see the anomalous pulmonary vein connected to the right atrium instead of the left atrium. After the case review, Dr. Weinsaft informed the primary care team using clear and impactful language of the radiology team’s impressions. It was insightful to see how radiologists communicated with other healthcare professionals to deliver important reports and provide the highest level of clinical care. 

Additionally, I had the privilege of observing several cardiac catheterization procedures this week. One case that I observed was a percutaneous coronary intervention (PCI) for a right coronary artery blockage. The goal of the procedure was to remove the blockage in the artery and to insert a stent. The stent is left in place permanently to allow blood to flow more freely. It was interesting to see the similarities and differences between PCI and cardiac ablation procedures. Although both procedures follow similar workflows using catheters, the functionality of the catheter when reaching the area of interest greatly differs. The catheters used in PCI used air to widen the arteries, whereas catheters in ablation procedures contained special tips that utilized radio frequency to scar tissue. For imaging modalities, PCI relied mostly on contrast agents and X-ray fluoroscopy while cardiac ablation procedures utilized similar imaging modalities with the addition of 3-D models derived from computed tomography images. Overall, it was an enlightening experience to observe cardiac catheterization procedures and see patients able to go home the same day.

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