Chapter 3653 【3653】Too Difficult

Two words, as long as an insider hears the key words, they don't need to say anything, and they can understand them in seconds.

Thinking about it, how to do internal fixation has always been a big problem for this kind of interventional surgery.

Through tiny blood vessels, would you like to put in forceps, needles, etc. for suture? We need to wait for breakthroughs in basic disciplines such as physics and materials science before imagining.

How to fix without suture?

The doctor learned from the little common sense in life.

For example, when a flood occurs to rescue people, how do firefighters throw a rope in the water and fix the other end of the rope?

There are methods, such as making a loop with the rope and throwing it to a place where there are stones and other fixed objects in the water flow to tie it.

Sometimes the rope doesn’t come back after a failed throw. It turns out that the other end of the rope falls into the vortex at the opposite corner, and the other end of the rope will be stirred by the vortex. If you don’t pull it forcefully, it won’t come back.

These common sense of life are all used by doctors for interventional surgery.

Through the description of the two methods, it will be found that no matter which one you want to fix the foundation, you must have a point that allows the rope to be easily hooked.

After all, the firefighters took advantage of the terrain. Physicians need to borrow the topography of the patient's own heart structure.

For some patients, the terrain is different from that of ordinary people. If it is not good enough, the operation will be over naturally.

Shen Youhuan has to explain a few more sentences about this, and elaborate on his own failure: "The last time the patient came for a heart checkup, he gave the patient an echocardiogram."

Whether it is echocardiography, electrocardiogram, or interventional coronary stenting, they are not strong in the detailed examination of the heart and myocardial structure. It is like the case in Seoul that the patient should be given a heart MRI examination. Since the patient did not have symptoms such as cardiomyopathy before, the doctor did not pay attention to this aspect, so he did not prescribe such a test.

It just so happened that the electrode was placed in this operation. If the electrode is placed in the right ventricle, the doctor needs to use the fixation method mentioned above.

The anatomical feature of the right ventricle is that there are abundant structures such as ridges and trabeculae on the internal surface, such as multiple small piles, and the steel wire head is made into a circular sleeve, which is very easy to fix.

As mentioned above, cardiac magnetic resonance is required to check for trabecular problems, so Shin Woo-hwan and the others did not know that the internal surface structure of the patient's right ventricle might have changed before the operation.

It is very likely that various indicators of the patient's body deteriorated due to advanced age, and the trabeculae at the apex of the right ventricle shrank, and the electrical activity decreased. In this way, the doctor couldn't set the electrode and stimulate it, which led to the failure of the operation.

The right ventricle cannot be placed, but the right atrium can be placed.

The right atrium does not work either. The right atrium does not have the trabeculae like the right ventricle, but it does have the right atrial appendage. For ordinary people, the steel wire sends the electrode to the right atrial appendage and the right atrial appendage hooks the electrode.

The problem today is blind insertion. Without fluoroscopy, the doctor must be lucky if he wants to accurately send the wire to the right atrial appendage so that the right atrial appendage can be hooked. If the right atrial appendage is not used, under conventional surgery, the doctor can use another method to actively fix the pacing lead on the wall of the right atrium. The feature of this active fixed pacing lead is that there are screws on it, which are placed on the selected atrium wall and twisted to screw the electrodes on. In the same way, do you dare to mess around without perspective for the blind insertion done today?