Holding the note, Xie Wanying continued to communicate with the teacher opposite her: "Teacher Ye, please leave the vena cava a little longer when you trim it."
Oh, oh, oh. Ye Chuangguang understood something and said, "What kind of technique are you planning to use? The children there are nine to ten years old, right?"
Heart transplantation is divided into orthotopic heart transplantation and heterotopic heart transplantation. Orthotopic heart transplantation is easy to understand. The patient's diseased heart is removed and a donor's heart is placed in the original position of the heart. Heterotopic heart transplantation does not remove the diseased heart. The donor's heart is connected to the original diseased heart to support and assist the diseased heart, which is equivalent to a purely biological heart assist device.
Heterotopic heart transplants are rarely performed because there is no future for them. Generally, when cardiomyopathy like Zhu Xing's is in the final stage, even installing a heart assist device as a transition cannot completely solve the root cause of the disease.
Heart transplantation is basically based on orthotopic heart transplantation. Orthotopic heart transplantation sounds simple, just remove the patient's heart and replace the donor heart with the patient's heart. In fact, it is not easy at all.
There are eight blood vessels in and out of the heart that need to be connected. The most difficult one is the pulmonary vein group in the left atrium. There are two upper and lower blood vessel openings of the right pulmonary vein group and two upper and lower blood vessel openings of the left pulmonary vein group on both sides of the posterior wall of the left atrium. Do you think it is complicated enough?
For example, the right atrium has two anastomotic sites of the superior and inferior vena cava that need to be connected, which is not easy.
If all the blood vessels are connected honestly, it is a heart transplant surgery. This is the most complicated and time-consuming surgery. It requires a lot of sutures at the anastomosis, which means a high chance of anastomotic leakage. The principle of surgery has always been that the simpler the steps, the better, and the fewer sutures, the better.
In order to save operation time, protect the myocardium and reduce postoperative complications, surgeons initially adopted a tricky surgical method to perform heart transplants. Specifically, when removing the patient's heart, only the ventricle was removed, leaving the recipient's left and right atria. The donor's atria were directly anastomosed with the recipient's atria, avoiding the complicated left and right atria with multiple anastomotic connections. This is referred to as the bi-atrial method or the standard method of heart transplantation.
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In pediatrics, if the child is very young, especially a newborn whose blood vessels are too thin, it is difficult for the doctor to use a magnifying glass to perform delicate sutures on multiple anastomotic ends. Of course, the double chamber method is best.
The bichamber method is rarely used in other older children and adults because it has a major disadvantage.
We know that the heart has a conduction system that allows the heart to beat rhythmically. The highest pacemaker of this conduction system is the sinoatrial node, which controls how many times a person's heart beats per minute. The sinoatrial node is located just above the right atrium of the heart.
The bi-atrial method leaves behind the right atrium of both the donor heart and the recipient heart, resulting in two sinoatrial nodes. This is equivalent to installing two engine control systems for the heart. Who should the heart listen to when beating? Will it be chaotic? Of course it will be chaotic.
After seeing the drawbacks of this operation, subsequent surgeons improved the operation and developed the following most commonly used double caval method. To put it simply, the double caval method refers to the anastomosis of the superior and inferior vena cava of the right atrium.
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