This surgical illustration focuses on the repair of a perimembranous ventricular septal defect (VSD) for an infant. The surgeon I worked with was Dr. Danielle Gottlieb Sen at Johns Hopkins.
VSD is a congenital heart disease where there is a hole in the lower internal wall of the heart, causing unwanted shunting of blood between the left and right ventricles.
After opening the pericardium, a cardiopulmonary bypass will be established (Fig. 3), which is a technique that stops the heart from pumping during surgery. A tourniquet is inserted into the right atrium to allow easy manipulation of the flaccid atrial tissue (A) before the atrium was cut open (Fig. 3).
The left series of illustrations are surgeon's views, offering a direct overhead view of the VSD through the tricuspid valve. Only part of the VSD was visible in this context. The anterior leaflet of the tricuspid valve was retracted during surgery. By changing the tension and direction of the retractor, the defect is revealed in sectors.
A patch harvested from the pericardium was tied-down in place to cover the defect using interrupted pledgeted technique and double-armed needles (B, C). Finally, a suture was placed in the anteroseptal commissure to mitigate potential tricuspid leakage (D), and the atrium was closed in layers.
Infants have larger thymus which may get in the way during surgery, so after entering the chest cavity, the thymus will be partially removed. (Fig. 2) These are mock-ups of how the sketches would appear in a journal format.
Care was taken not to injure the septal leaflet during surgery, given its positioning anterior to the VSD.
For this project, I also created a patient education piece, introducing another approach, the transcatheter VSD repair, for selective patients.
Examples of some early sketches when I was initially planning out the illustrations.
