2158 Chapter 2158 [2158]

Guozhi Operating Room

After being named and put on a surgical gown and stood by the operating table, Xie Wanying helped the teacher to observe the surgical field of view and verify the three-dimensional image that emerged in her brain, and pointed out: "Mr. Du, there are several types of cardiac hypertrophy. This patient has deep central hypertrophy. .”

Myocardial hypertrophy, also known as hypertrophic cardiomyopathy, is divided into three types. The main basis for classification is whether there is obstruction of the outflow tract of the left ventricle. Non-obstruction and occult obstruction are not ruled out and reversible, and are not within the indications of surgery, so myocardial hypertrophy does not necessarily require surgery. Only the obstructive type requires surgery.

Obstructive myocardial hypertrophy, that is, the left ventricular outflow tract is blocked. Doctors used to call this type subaortic stenosis. Because the previous doctors opened the hearts of such patients and found that the abnormal hypertrophy of the myocardium was mainly under the aortic valve.

Below the aortic valve is the aortic root, which is connected to the left ventricle and has a relatively large area. If there is myocardial hypertrophy in this place, it is impossible to say that it is completely the same. The several types mentioned by Mr. Xie refer to the anatomical classification of lesion structure rather than the above classification.

According to the location of myocardial hypertrophy, doctors roughly divide it into five types through surgery and dissection. The simplest one is the hypertrophy of the muscle under the aortic valve discovered at the beginning. Other types of myocardial hypertrophy go deep and are more troublesome.

Some hypertrophy is a whole piece of interventricular septal muscle hypertrophy, and the hypertrophy runs across the side of the left ventricle in depth. Some aortic valves are not hypertrophic at all, and the hypertrophy reaches the apex of the heart, which completely overturns the doctor's definition and name of the disease at the beginning, which is why the original name has become history. Regardless of the site of hypertrophy, these hypertrophies squeeze the volume of the normal left ventricle, creating an obstacle to healthy left ventricular hemodynamics. Doctors will definitely need to operate on it.

The point of contention returned to the original point: Does the patient’s myocardial hypertrophy conform to what Xie said, which is one of the lesion structures of obstructive myocardial hypertrophy? Or is it that the preoperative examination report failed to clearly point out such problems, and it was judged as a reversible hidden obstruction, so that the surgeon did not need to consider this aspect of surgery before the operation?

Which result is right?

If it wasn't for the problem with the mitral valve, no one would have considered this point at all. Sometimes when there is a problem in a certain place, after searching and finding the crux, we go to another problem.

"Clarify again, is the entire ventricular septal hypertrophy?" Du Yeqing continued to confirm what she said.

"Is that so?" Dr. Yu, the assistant on the stage, seemed to be trying to stretch his neck on tiptoes, trying to see clearly the internal structure of the heart in the operative field.

For heart valve open vision surgery, the valve is located inside the heart, and the doctor must cut the heart open to see and operate. All of this must not be cut randomly. It is impossible for the doctor to say that for the convenience of seeing clearly and easy operation, the patient's heart is completely opened and cut.

It is even more impossible to say that a single knife can cut out the whole picture of the patient's heart, because the heart is not an apple or a pear, it has several cavities, and these cavities and the walls separating the cavities are all asymmetrical, left and right, up and down Asymmetrical, volumetric asymmetry, no point of symmetry.