Mitral Valve Repair
An illustrated surgical sequence for instruction and reference
Adobe Photoshop, Hunt 102 nib, Speedball Super Black ink, Vellum paper
Prof. Michael Corrin (MSC2001Y)
Dr. K. An, Dr. D. Rushani
Surgeons-in-training, medical students, cardiologists
April 14, 2022
To create an anatomically-accurate surgical sequence in grayscale
We were fortunate to be able to visit the Mount Sinai Hospital Surgical Skills Centre (SSC) where we observed surgeons during their training sessions. Unfortunately, due to certain constraints we weren’t able to observe a real human heart surgery procedure in situ. Instead, the training surgeons practiced on a bovine heart that had a slightly different morphology. This meant that a lot of reconstruction had to be done on our part in order to tell the story properly.
To start, extensive background research through journal articles, textbooks, and instructional videos was done on the mitral valve repair procedure. Combined with the notes taken during the observation day, I drafted the steps of the surgical sequence as how it was performed during observation in point-form. These steps were then edited to be numerically arranged into a sequential step-by-step instruction. As the illustrations received weekly revisions in the span of nine weeks, the textual descriptions underwent a similar refinement procedure.
Using the textual descriptions along with the rough sketches drawn during observation, I developed thumbnail sketches to get a sense of perspective as well as a rough idea of how many steps I’ll need for the sequence.
During the span of nine weeks, the sequential illustrations received weekly updates in response to the feedback given by the class instructor. Here, I’ll present 3 working versions and share the major changes that were updated in each version.
In the first iteration, I utilized an oblique perspective as I thought it would provide a more interesting viewpoint. Each step was brief and provided the bare-bones information to understand the sequence. The first page attempts to explain the set-up before the surgery (a cardiopulmonary bypass) but the details are fairly glossed over as we thought to focus on the mitral valve instead.
At this stage, the cardiopulmonary bypass and setup has been fleshed out further (no pun intended) into 2 different steps comprised of opening the chest cavity (1A and 1B) and entry into the mitral valve area (2A and 2B). Another major change was also the insertion of steps about the actual repair of the prolapsed leaflet (4A and 4B). In addition, the view of the mitral valve was changed to be closer to what a surgeon would see in an actual procedure. This straight-on view also provided the reader with a greater sense of the symmetry needed during the suturing steps (5 to 8).
By the eighth week a lot of refinement was being done in line quality and weighting. Feathering and shading of different structures were done carefully to ensure proper depiction of volume and surface form. Compared to previous versions, there’s also an omission of soft shading as the main constraint of the project is to utilize pen and ink as the medium. The prolapse repair step was also changed slightly to a more simple procedure of interrupted sutures instead of uninterrupted.
For the final, I focused on cleaning the lines and creating a more dynamic layout that lead the readers down the page. The assets in page 3 of the final layout were redone using a Hunt 102 nib and Speedball ink on vellum paper.
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