The so-called division of left and right atria and ventricles is just an approximate division, a name given for convenience. From the actual heart structure, it is impossible to find a completely symmetrical line between the left and right sides.
Not only does the heart's internal structure hinder the doctor's scalpel, but the coronary arteries, an important blood supply network on the heart's surface, are also asymmetrically distributed. Doctors need to avoid important blood vessels when cutting.
As for how many cuts to make, the fewer the better, and only one cut is best. As the old saying goes, doctors need to be responsible for every cut they make, and only stupid doctors would think of making more cuts. Where the cut is made should be planned according to the surgical site planned before the operation. If it is just a simple mitral valve replacement, the mitral valve is located on the left, and it is okay to make a cut directly in the left atrium. Today's patient needs surgery on both the mitral valve and the tricuspid valve, one on the left and the other on the right. According to the experience summarized by predecessors, in this case, the conventional surgical approach is to start from the right atrium, cut the right atrium, see the atrial septum, and then cut upward and downward at the center of the oval fossa to see the mitral valve.
After these parts are cut open, the doctor uses sutures to lift the edges around them to expose the surgical field inside.
Before the operation, the surgical team only considered the mitral valve and tricuspid valve, but not myocardial hypertrophy. The surgical approach used did not consider the latter, and the exposed surgical field of view did not take into account the entire left ventricle. No wonder Dr. Yu had to stand on tiptoe. With such a surgical field of view, he could not see the entire left ventricle, so how could he judge myocardial hypertrophy?
The surgeon in charge has extensive surgical experience and has a larger database of surgical anatomy diagrams than this young resident. He may be able to look at a corner of the picture and use his imagination to judge other parts like putting together a jigsaw puzzle.
As for classmate Xie, anyone who knows her knows that she is an outlier.
Xie’s only embarrassment now is how to connect the thinking of ordinary people with her special brain so that everyone can understand the pictures in her mind.
After receiving further questions from the surgeon, Xie Wanying continued to organize her words: "Please look at it from this angle, Teacher Du."
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To others, her words sounded like the voice announcement of a navigation system.
"Here, at this point, at a 35-degree angle below the chordae tendineae of the large flap that the patient originally preserved during surgery, this muscle is relatively convex. The thickness of the convexity is not very obvious, but the area is large, just involving the Ru (homonym of "nipple") capitis muscle and the valve opening."
This time, not only the surgeon could see clearly. Dr. Yu didn't need to stand on tiptoe, but tilted his view and almost cried out in surprise: I can see it now. It turns out that it is not impossible to see the whole picture of the ventricle in a limited narrow field of vision. You have to make full use of your perspective.
How the mitral valve leaflets open and close depends on the two Ru caps muscles, such as the mechanical opening and closing mechanism pulling the two leaflets. The Ru caps muscles are connected to the myocardium of the ventricle and rely on the rhythmic beating of the myocardium to generate power. When a patient's valve has problems and needs to be replaced with an artificial valve, how to properly handle the Ru caps muscles is a technical issue.
Relying on the experience of predecessors, the current mitral valve replacement is very mature. Conventional surgery can preserve the subvalvular structure of the mitral valve, namely the Ru capitis tendon chordae. The specific method is generally to trim the original leaflet part connected to the Ru capitis tendon chordae into a sheet with the Ru capitis tendon and chordae tendon to be preserved.
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