Chapter 3652 【3652】Two Words

There is a problem to be mentioned here. To deal with the same organ of the human body, there are many ways to intervene in the operation. Especially the heart is a very special organ.

The special thing about the heart is that its internal structure is responsible for the blood circulation center of the human body. On the other hand, it itself needs the nutrition and support of the blood system. Therefore, its internal structure connects the great blood vessels of the body to supply blood throughout the body, and the vascular system arranged outside its myocardium provides its own support.

According to the anatomical characteristics of the heart (on the basis of the anatomy of everything in medicine again), the doctor plans various intervention paths according to the needs. In the last interventional operation, a stent was installed on this patient. The interventional path was to go to the coronary system on the surface of the heart, and the relative "external" vascular path of the heart was taken.

The interventional operation to install a temporary pacemaker this time takes the "internal" path of the heart, and it needs to go to the internal structure of the heart to place electrodes.

Why are the two paths different?

To be clear, the path of treatment is the purpose of treatment.

The last time the "external" vascular system was taken was to solve the "blocked" problem of the "external" vascular system last time.

Electrodes are discharged this time to stimulate the heart muscle. Under this therapeutic purpose, there is no advantage in going with the "external" system.

For example, taking the "external" system is equivalent to walking the intricate alley (blood vessel) to knock on the wall (stimulate the myocardium) through the alley wall (vessel wall), and the knock point is obviously very restricted.

In stark contrast, taking the "internal" route is like going to the room (ventricle atrium) where the walls (myocardium) are, knocking on all sides. My doctor can pick anywhere, pick the best place to hit the wall.

Speaking of this, you may ask again, is it definitely not allowed to "knock on the wall" by taking the path outside the heart? Yes, surgery to place electrodes on the epicardium is just to "knock on the wall" by letting go of the surface of the heart.

In this way, does the intervention of installing a pacemaker not take the "external" route at all? Nor is it.

Pacemakers are divided into single-chamber, dual-chamber and triple-chamber pacing.

Single-chamber pacing has only one electrode, and the electrode is placed in the right atrium or right ventricle.

Why right atrium or right ventricle? Going back to anatomy, the pacemaker is installed through the body veins, such as the subclavian vein, etc., and the path through which the body veins lead to the heart is recycled to the right atrium of the heart by the superior and inferior vena cava.

For dual-chamber pacing, two electrodes are placed, one in the right atrium and the other in the right ventricle.

When it comes to three-chamber pacing, don’t forget that the left and right atrium and ventricle are not connected. If you want to go to the left side of the heart with another wire, you need to go through the "external" system, and go to the coronary sinus to stimulate the side wall of the left ventricle.

The above can be simply understood as the patient's entire cardiac myocardium may not be functioning well, and the doctor stimulates the heart in as many directions as possible in order to mobilize the entire heart to work.

Multi-point electrode discharge surgery is the most complicated, so three-chamber pacing is usually used in permanent pacemaker surgery.

At present, this case is in a rescue state, and what needs to be done is a temporary pacemaker operation. From this we can see the difference between a temporary pacemaker and a permanent pacemaker.

A temporary pacemaker can be simply understood as a temporary shed, which can be removed only for temporary emergency use after completing the task, or it can be a transitional measure, that is, a permanent pacemaker should be placed on the patient after withdrawal.

Having said that, it can be understood that the failure of this intervention may have nothing to do with the "external" coronary system.

After receiving Ren Zhelun's gaze, Shen Youhuan, the chief surgeon just now, stepped up to explain the situation: "It fell off."