Guozhi Operating Room
After being called to put on a surgical gown and stand beside the operating table, Xie Wanying helped the teacher observe the surgical field again, verified the three-dimensional picture that emerged in her mind, and pointed out: "Teacher Du, there are several types of myocardial hypertrophy. This patient has hypertrophy in the middle part of the body."
Myocardial hypertrophy, also known as hypertrophic cardiomyopathy, is divided into three types. The main basis for classification is whether there is obstruction in the outflow tract of the left ventricle. The types without obstruction and latent obstruction may be reversible, but they are not within the indications for surgery. Therefore, myocardial hypertrophy does not necessarily require surgery. Among them, only the obstructive type requires surgery.
Obstructive myocardial hypertrophy means that the left ventricular outflow tract is blocked. This type of condition was previously called subaortic stenosis by doctors. This is because doctors previously opened the hearts of such patients and found that the abnormal hypertrophy of the myocardium was mainly located under the aortic valve.
Below the aortic valve is the aortic root, which is connected to the left ventricle and has a relatively large area. If there is myocardial hypertrophy in this area, it is impossible to say that it is completely the same. The several types mentioned by Mr. Xie refer to the anatomical classification of the lesion structure here rather than the classification above.
Doctors have classified myocardial hypertrophy into five types based on the location of the disease through surgery and dissection. The simplest type is the muscle hypertrophy under the aortic valve that was discovered at the beginning, while other types of myocardial hypertrophy are deeper and more troublesome.
Some cases of hypertrophy are hypertrophy of the entire ventricular septum muscle, and the hypertrophy runs deep across one side of the left ventricle. Some cases of subaortic valve hypertrophy are not at all, and the hypertrophy reaches the apex of the heart, which completely subverts the definition and name of the disease by doctors at the beginning, which is why the original name has become history. Regardless of where the hypertrophy is located, these hypertrophies squeeze the volume of the normal left ventricle and cause obstacles to the healthy hemodynamics of the left ventricle. Doctors must perform surgery to treat it.
The dispute returned to the original point: Does the myocardial hypertrophy of this patient meet the pathological structure of obstructive myocardial hypertrophy as Xie said? Or is it that the preoperative examination report failed to clearly point out such a problem and it was judged to be a reversible occult obstruction, so that the surgeon did not need to consider this operation before the operation?
Which result is correct?
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If there is no problem with the mitral valve, no one would have considered this. Sometimes when there is a problem somewhere, you will find that the problem is another one.
"Can you explain it again? Is it the entire ventricular septum hypertrophy?" Du Yeqing continued to confirm what she said.
"Is that so?" The assistant on the stage, Doctor Yu, stood on tiptoe and stretched his neck, trying to see the internal structure of the heart in the surgical field more clearly.
During open heart valve surgery, the valve is located inside the heart, and the doctor must open the heart to see and operate. This incision must not be made randomly. The doctor cannot open the patient's heart one by one to make it easier for him to see and operate.
It is even more impossible to say that one knife can cut out the entire picture of the patient's heart, because the heart is not an apple or a pear. It has several cavities, and these cavities and the walls separating the cavities are all asymmetrical. They are asymmetrical left to right, up to down, and in volume. There is no symmetry at all.
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