2159 【2159】Perspective Navigation

The so-called division of the left and right atrium and ventricle is just a rough division, and it is easy to call it by a name. From the perspective of the real heart structure, there is no complete line of symmetry between the left and right.

Not only is the internal structure of the heart obstructing the doctor's scalpel, but the coronary arteries, an important blood supply network on the surface of the heart, are also asymmetrically distributed. Doctors need to avoid important blood vessels when cutting.

How many knives to cut, the less the better, and only one knife is the best. As the old saying goes, a doctor needs to be responsible for every cut he makes, and only a stupid doctor would think about cutting a few more cuts. Where the knife falls depends on the planned surgical site before the operation. If it is just a simple mitral valve replacement, the mitral valve is located on the left side, and a cut can be made directly in the left atrium. Today’s patients need surgery for both mitral and tricuspid valves, one on the left and one on the right. According to the experience summarized by the predecessors, in this case, the conventional surgical approach is to start from the right atrium, cut the right atrium, see The atrial septum is cut up and down in the center of the fossa ovale, and the mitral valve can be seen.

After cutting these parts, the doctor used sutures to suspend the surrounding edges to expose the operating field inside.

The preoperative surgical team only considered the mitral and tricuspid valves and did not consider any myocardial hypertrophy. The surgical approach used did not consider the latter, and the exposed surgical field of view did not take into account the overall picture of the left ventricle. No wonder Dr. Yu is on tiptoe. With such a surgical field of view, he really couldn't see how to judge the hypertrophy of the heart muscle inside the complete left ventricle.

The chief surgeon has rich experience in surgery, and his brain has accumulated more databases of surgical anatomy diagrams than he, a young inpatient. Maybe he can look at a corner of the picture and use his brain to judge other parts like putting together a jigsaw puzzle.

As for classmate Xie, anyone who knew her would know that she was a different kind.

The only embarrassment for classmate Xie now is how to connect ordinary people's head thinking with her special brain, so that everyone can understand the picture in her mind.

After receiving further questions from the chief surgeon, Xie Wanying continued to organize her words: "Please look at it from this angle, Teacher Du."

Others listened to her words like the voice broadcast of the navigation system.

"Here, at this point, at an angle of 35 degrees below the chordae of the large flap that was preserved in the patient's original operation, this piece of muscle is relatively raised, and the thickness of the protrusion is not obvious, but the area is wide, just involving your (the homonym of "milk") the head muscle and the valve orifice."

This time, not only the chief surgeon could see clearly. Dr. Yu didn't need to stand on tiptoes, tilted his perspective, and almost let out a cry of surprise in his throat: I can see it. It turns out that it is not completely impossible to see the whole picture of the ventricle in the limited narrow field of vision, so we have to make great use of the angle of view.

How to open and close the leaflets of the mitral valve depends on the two ru (the homonym for "milk") head muscles, such as the mechanical opening and closing mechanism that pulls the two leaflets. Ru (the homonym of "milk") head muscle is connected to the myocardium of the ventricle, and the power is generated by the rhythmic beating of the myocardium. When the patient's valve has problems and needs to be replaced with an artificial valve, how to deal with the ru (the homonym of "milk") head muscle is a technical problem.

Based on previous experiences, the current mitral valve replacement surgery is very mature. In conventional surgery, the subvalvular structure of the mitral valve can be preserved, that is, the part of the ru (the homophonic sound of "milk") head tendinous chordae. The specific method is generally to trim the part of the original leaflet connected by the ru (the homonym of "milk") head muscle and chord tendine into a sheet, and retain the ru (the homonym of "milk") head muscle and chord tendon.