Chapter 4581 【670】Learning

Regarding the first question raised by Dr. Xie, all the doctors in the room nodded: That’s right.

From the definition of the disease seen above, we can know that the key to solving this disease lies in how to close the abnormal channel.

Isn't the most straightforward understanding of closing an abnormal channel just to block the channel entrance?

All you need to know here is what shape the passage opening is, and find a "plug" with a rough shape to block it.

This "plug" that blocks the passage is exactly what Dr. Xie calls an occluder in medicine.

Since the shape of the occluder is determined based on the abnormal passage opening, the shape of the abnormal passage opening must first be clearly understood before surgery.

Generally speaking, the shape of abnormal channel openings is mostly oval or half-moon. The occluders supplied on the medical device market are generally manufactured and classified based on these clinical data. For special abnormal passage openings, special materials will be provided to doctors to solve them.

For this reason, it is routine. The doctor must understand these indicators before surgery and plan in advance the model of medical equipment to be used in the operation.

Dr. Qiu took back the patient's medical record and flipped through it to find the patient's data.

This data of previous patients was measured by transesophageal ultrasound. If possible, CT angiography can be added to be more accurate.

After reviewing the medical records, the value showed: large paravalvular leakage 8.1.

For this type of larger paravalvular mitral leakage, an interatrial septal occluder can be used.

Has the answer here explained how cardiac surgery and cardiology work together? It doesn't look like it?

It can be seen that Dr. Xie sincerely wants to discuss the patient's surgical problems step by step with his partners from the beginning, and is careful and patient in paying attention to the details of the surgery.

After Dr. Xie opened his mind about surgery due to Dr. Xie's first question, Dr. Qiu expressed his own thoughts: "The reason why the occluder becomes a difficulty in surgery is not only its shape selection but also its location and other factors."

Even if the occluder is selected appropriately, the process of inserting it after selection is the real difficulty for interventionalists. This is why it is not easy to carry out this surgery widely in clinical practice under the current situation.

Once again, I emphasize that the heart is a three-dimensional organ, and the internal shape of the heart is complex. According to the two-dimensional plane of the interventional imaging diagram, the "plug" must be accurately sent to the small leak inside the heart with a guide wire and the shape must be adjusted to just seal it. Difficulties can be imagined.

As long as the location is tricky, it is expected that it will be difficult to capture the location of the leak using only two-dimensional images.

Dr. Xie Wanying responded to Dr. Qiu's words: "Often the guidewire needs to be wound around twice when entering the heart to deliver the occluder."

When Dr. Qiu heard her words, her eyes lit up: she really understands the process and key points of interventional surgery.

If the guidewire is wound too much, it will become entangled in the heart, causing accidents and problems such as getting lost, which will lead to a high chance of surgical failure.

Therefore, the usual interventional channel for this operation is: puncture the femoral artery, and need to cross the aortic valve to the left ventricle, and then to the left atrium. It is like a long journey around the earth, which is a retrograde path.

If you don’t want to go in circles and go backwards, you can only use the puncture method.

There are two puncture methods. One is to puncture the femoral vein or jugular vein, then puncture the interatrial septum, and send the guidewire into the left atrium through the interatrial septal puncture sheath. At this time, when the guidewire crosses the paravalvular leakage, the blood flow from the left atrium to the left ventricle is in the retrograde direction. In view of the characteristics of the guidewire that floats easily, this section of the guidewire becomes difficult to deliver, and it is not easy to succeed.

The third method, Dr. Xie Wanying said: "Apical puncture can be assisted by thoracoscopic technology."

In the past, the apical method was a small thoracotomy, but now the thoracoscopic method is more minimally invasive, and extracorporeal circulation is no longer required. The thoracoscopically assisted positioning puncture needle can be directly inserted into the pericardium to the apex of the heart, that is, the left ventricle, to introduce a guidewire.

The above three methods all have difficulties and advantages, and the choice of which one needs to be based on medical science.

Dr. Xie Wanying added: "I suggest the patient choose the third surgical option because the patient's paravalvular leakage is located between 10 o'clock and 6 o'clock."

Using a clock dial to determine the location of the lesion is very common in clinical practice and has been introduced.

Doctor Qiu was absolutely convinced. He is a real boss, not narrow-minded at all. He inspires your thinking and proposes a cooperation roadmap that fits your ideas.

This plan was approved by many doctors present.

Who will do the assisted thoracoscopy?

Dr. Qiu and Professor Fang suggested: "Please thank Teacher Xie to do it faster."

Dr. Xie Wanying's clear thinking about the surgical path is unparalleled by any doctor on site.

One of the most important factors in surgery is the surgical path. If you follow the correct path, you will get twice the result with half the effort. If you follow the wrong path, nothing will be accomplished.

Dr. Xie Wanying nodded: "Then prepare for the surgery quickly."

Doctor Qiu and Professor Fang had confused expressions on their faces: This guy really does what he asks you to do, and do it immediately! ?

Robot Dr. Fu almost couldn't hold back his tight lips: It's conceivable that these people haven't heard that Dr. Xie Wanying's other nickname is getting louder and louder: "The King of Volume".

Don’t delay patient treatment and prepare for surgery without stopping. The operating room was vacated, the patient was sent in, and the extracorporeal bypass technician was on standby. Although it was said before the operation that it was no longer needed, this was really a small worry for the doctors from Guoxi who had not seen Dr. Xie's skills in person.

The anesthesiologist asked about the operation time.

Dr. Qiu and Professor Fang looked at Dr. Fu and asked Dr. Xie.

Dr. Fu had already given all the control in the field to his subordinate Xie.

Dr. Xie Wanying’s answer is: less than half an hour.

It was Guoxi's anesthetist's turn to be shocked: Does this mean that this operation is just a small examination and only requires short-acting general anesthesia?

Dr. Qiu and Professor Fang, who had never expected that the National Association of People's Political Consultative Conference regarded this surgery as a pediatric operation, were immediately nervous: What? !

All doctors put on surgical gowns.

Professor Fang and Dr. Fu work as assistants to Dr. Xie.

Since China West does not have the single-chamber thoracoscope instrument of the National Association, it can only be done by conventional three-hole drilling.

The mirror holder is Dr. Fu, and the instrument assistant, Professor Fang, is the leader of the Guoxi team. Everyone in Guoxi stared at Professor Fang: Don’t embarrass yourself.

Professor Fang was listed as a professor, and everyone knew that his skills were not bad. As a result, Westerners from all over the world soon discovered that their professor had been dumped.

Professor Fang was almost frozen and did not dare to move unless Dr. Xie or Dr. Fu shouted to him to move.

Not to blame Professor Fang, all the Guoxi people at the scene were shocked and fell to the ground: the Guoxian people performed the surgery too fast.

Finally, without being restricted or affected by the difficult conditions in the disaster area, Chief Xie was able to get the opportunity and use his full power.

Of course, the speed of the surgeon was not determined by the surgeon's mood, but simply because the patient had signs of heart and kidney failure and could not survive a long operation.

The hole is opened, the apical puncture position is found, and a puncture needle is inserted directly into the preoperative position, and the entire surgical auxiliary operation is completed.

The rows of onlookers looked down like a blitzkrieg.

The anesthetist clocked eight minutes and was completely shocked: Surgeon Xie was not exaggerating, he really didn't have the time to finish the operation in half an hour.

Dr. Qiu, who took over, couldn't understand the previous few minutes of surgery, and he sweated on his forehead as a sign of respect.

Professor Fang swallowed Dr. Qiu's saliva and wanted to ask: Are you okay?

Dr. Qiu wanted to answer: I feel that if I can do it, wouldn’t I become the Superman of the National Association together?

At this time, Dr. Xie said to Dr. Qiu: "You will feel the position immediately after you put the guide wire in."

Dr. Qiu's eyes narrowed: Is it true or false?

Intraoperative esophageal ultrasound and X-ray assistance have actually shown some clues of surgically assisted puncture points. However, when Dr. Qiu inserted the diagnostic guidewire into the patient's heart through the surgical puncture point, the feeling told him: It's amazing, what Dr. Xie said was true.

There is no need for him to make any adjustments. He only needs to move the guidewire gently with his fingers, and the guidewire will pass through the paravalvular leakage smoothly. This most difficult step is completed, and the next operation is even more logical.

The entire operation was over, and the anesthesiologist watched it finish in just over twenty minutes.

Professor Fang rushed forward and grabbed Chief Xie's hands, unable to speak in his excitement.

Not to be outdone, Dr. Qiu rushed forward and squeezed Professor Fang away. He was also so excited that his face turned red but he didn't know what to say.

After the family members outside learned the good news, they ran to reporters to express their gratitude to the medical team in the newspaper.

Later, there were rumors within Kunisi: What is a real medical genius? This operation finally allowed people from Western China to experience it personally.

Thank you for your support, good night, dear friends~