... Und vor mir, ein schlagendes Herz! - ... And in front of me, a beating heart!

The most awaited visit yet, perhaps the most amazing experience during this entire trip! We visited the Herz und Diabetes Zentrum Nord-Rhein Westphalia (HDZ-NRW) in Bad Oeynhausen and we did a lot that day! I think our day trip was about much more than just being in one of the most prominent cardiovascular and diabetes centers in Germany, it was an experience we will hardly ever forget.

Our day began with our arrival by train to Bad Oeynhausen and our bus trip to the HDZ, a part of Rühr Universität, Bochum. This center is about 100 miles from the university but nontheless it is a center for research and surgery unrivaled by others. Our visit began in a conference room where we were introduced to the basics of the hospital.

First and foremost it is a 500 bed specialty hospital. The departments handled are thoracic and cardiovascular surgery, cardiology, and congenital heart disease (formerly the children's hospital). It is a not-for-profit organization owned both by the state as well as by private individuals (50/50). It was founded in 1984 and appointed a university hospital five years later. Today, it alone performs around 6000 operations a year, an impressive number for a hospital in Europe. The main focus of the hospital is ventricular assist devices (VADs) with about 60 implants a year. These devices prolong the lives of patients with cardiac insuficiency or failure until a heart can be transplanted. By consequence, orthotopic heart transplantations are also numerous (n=1679). There are 6 ORs equipped to perform open-heart surgeries and one room for pacemakers and smaller surgeries.

Once we were introduced to the hospital we were taken to see a surgery. Oh yes, a surgery... Once again I felt the same excitement I felt when I went to see one in Mexico, except this time, I was not prepared for what I was about to experience. In our group of 12 pre-meds (Well, 10 pre-med, 1 pre-pharm, and 1 undecided) we had the option of watching 6 different surgeries, 2 students per operating theater. Dr. Mirow, gave us a brief introduction to each procedure and showed us angiograms... then we chose.
Theater 1- Bypass (revascularization) due to coronary stenosis
Theater 2- (The one I chose) Aortic -- and mitral -- valve replacement with the possibility of removal and revascularization of the ascending aorta.
Theater 3- Mitral valve replacement and coronary bypass on a pacemaker patient.
Theater 4- Double bypass of the Left Anterior Descending artery and Right Coronary a.
Theater 5- Aortic valve replacement and coronary bypass
Theater 6- Bypasses of the Left Anterior Descending artery and Right Coronary a.

I chose theater number 2. We dressed and walked into the anesthesia room. There we 'met' the patient, and older man who was already under anesthesia and ready to go in. So we walked into the OR, stood to the side and waited. Then the anesthesiologist came and told us "you will be watching the surgery where I am standing at." Wow! It was like a little stage where all the machines for anesthesia and monitoring were! We had the clearest view of the patient anyone could have ever imagined, and it was THE MOST AMAZING EXPERIENCE EVER. When the chest was opened and the heart exposed, we saw that the diameter of the aorta was almost double its normal size. Dr. Murshuis, the surgeon, told us that maybe he would replace the aorta, but that it was a very dangerous procedure for a 70 year old man. This is because circulation needs to be completely arrested (stopped) in addition to the cardioplesia for at least 10 minutes while the aorta is dissected and the anastomosis done. So he began with the repacement of the aortic valve, finished all the guide sutures and then moved on to and fully completed the replacement of the mitral valve... Sadly, this is all we had time to see, so I don't know how the aortic valve fit and if he decided to do the aortic dissection. Nevertheless, it was amazing and exciting to be so close to the patient and observing every single move the surgeon made.

After lunch, we toured the ICU. It sees almost 36 post-op patients per day and around 4000 per year. There are usually 2 people per bedroom unless there is risk of infection (like MRSa... ok Methicillin Resistant Staphilococcus aureus) or unless they are transplant patients. We say patients that have VADs, including a woman with both a left and right VAD - of course, she was confined to her bed. We then saw the different, newer devices that are implanted and talked to several patients about what it felt to have their devices in them. Examples include the Duraheart LVAD, worn by Herr Schaffer, and an Australian-made LVAD.

The last stop of our daytrip was in the MRI labs. We were given a brief introduction of how imaging helps doctors better understand the heart and how it works. We saw several examples of images to detect anything from insufficiency, to scarring, to malformations! Then we talked to the expert, Dr. H. Köperich, who gave us a brief lecture on the physico-chemical basis of MRI. MRI is useful because it provides high soft tissue contrast, it can be used with multiple paremeters (proton density, T1, T2), you can orient in any direction, there is no ionizing or damaging radiation, and you can create stacks for functional acquisitions and even angiographies without catheters! We had a little fun with the 1.5T magnet used, and it was a powerful magnet... just thet the one used in MRI spectroscopy (to detect metabolism and metabolytes) is 21T! For MRI to work you need three simple things: the magnet (0.2T up to 3T, or 21T as explained above), a similar radiofrequency (~64Hz), a detector, and comparison gradients. It was an amazing experience and I learned quite a bit about how MRI may revolutionize cardiology.
After leaving the amazing HDZ, came the sad part of the trip. We said goodbye to our guide Steffi, and we took the train back to Hannover and prepared to fly at 4:15 AM.