Chapter 4581【670】Learning
As to 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 is how to close the abnormal channel.
Isn’t the most straightforward understanding of closing an abnormal channel just to block the entrance of the channel?
Here you only need to know the shape of the passage opening, find a "plug" of a rough shape and block it up.
This "plug" that blocks the passage is exactly what Dr. Xie calls an occluder in medicine.
Since the shape of the occluder is determined by the abnormal opening, the shape of the abnormal 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. Doctors must understand these indicators before surgery and plan in advance the model of medical equipment to be used in the surgery.
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 based on transesophageal ultrasound. If possible, CT angiography can be added to be more accurate.
Rechecking the medical records showed a value: large paravalvular leak 8.1.
This kind of large-area mitral valve paravalvular leakage can be treated with an interatrial septal occluder.
Have you 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 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 when the guide wire enters the heart and delivers the occluder, it has to be wound around more than twice.”
Dr. Qiu's eyes lit up when he heard her words: she really understands the process and key points of interventional surgery.
If the guide wire is wound too much, it will be coiled in the heart, causing accidents, getting lost, and other problems, and the probability of surgical failure is too high.
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 retrograde, 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: "The apical puncture method 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. Direct thoracoscopic assistance can be used to position the puncture needle and insert the pericardium to the apex of the heart, that is, the left ventricle, to introduce the 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 recommend the patient to choose the third surgical option because the patient's paravalvular leakage is located between 10 o'clock and 6 o'clock."
ˆUsing a clock dial to determine the location of the lesion is very common in clinical practice and has been introduced.
Doctor Qiu is absolutely convinced now. 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 all the 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 was unparalleled by any doctor on site.
One of the most important issues 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." Dr. Qiu and Professor Fang had confused expressions on their faces: This guy, I really want you to do it, 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 increasingly popular nickname is “The King of Volume”.
Do not delay patient treatment and prepare for surgery without delay. The operating room was vacated, the patient was sent in, and the extracorporeal bypass specialist 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 anesthetist asked about the operation time.
Dr. Qiu and Professor Fang asked Dr. Fu and Dr. Xie.
Dr. Fu has long given all the control in the field to his subordinate Xie.
Dr. Xie Wanying’s answer is: less than half an hour.
It was the anesthesiologist’s turn in Guoxi and was shocked: Does this mean that this operation is just a minor 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 would treat this surgery as a pediatric operation, were immediately nervous: What? !
Doctors, please put on your surgical gown.
Professor Fang and Dr. Fu serve as assistants to Dr. Xie.
Since Western China does not have the single-chamber thoracoscope equipment of the National Association, it can only be done by drilling three holes.
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.
Professor Fang is not to blame, all the people from Guoxi at the scene were shocked and fell to the ground: the Guoxian people performed the surgery too fast.
Finally, he was not restricted by the difficult conditions and images of the disaster area. When he got the opportunity, he was able to go full steam ahead.
Of course, the speed of the surgeon was not determined by the surgeon's mood. It was purely because the patient had signs of heart and kidney failure and could not endure a long operation.
The hole is opened, the apical puncture position is found, a puncture needle is inserted directly into the preoperative planned position, and the entire surgical auxiliary operation is completed.
The row 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 his saliva for Dr. Qiu and wanted to ask: Can you do it?
Dr. Qiu wants to answer: I feel that if I can do it, wouldn’t I become a Superman of the National Association?
At this time, Dr. Xie said to Dr. Qiu: "You will feel the position immediately after you put the guide wire in."
Doctor Qiu’s eyes became round and rounded: Is this true or false?
Esophageal ultrasound and X-ray are assisted during the operation, and some clues of surgical auxiliary puncture points have actually been shown. 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 use his fingers to gently feed the guide wire, and the guide wire will pass smoothly through the paravalvular leakage. 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 Master 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 the country: 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~
(End of this chapter)
