Just two words, experts will understand them immediately after hearing the key words without any further explanation.
Come to think of it, how to perform internal fixation has always been a big problem for this kind of interventional surgery.
Want to insert forceps and needles and threads to suture tiny blood vessels like a surgeon? We need to wait for breakthroughs in basic disciplines such as physics and materials science before we can imagine it.
How to fix without suturing?
The doctor draws on some common sense in life.
For example, when rescuing people during a flood, if the firefighters throw a rope into the water, how do they secure the other end of the rope?
There are ways, such as making a circle of rope, throwing it into the water where there are fixed objects such as stones and tying it up.
Sometimes when you fail to cast and the rope does not float back, what happens is that the other end of the rope falls into the vortex at the opposite corner. The other end of the rope will be stirred by the vortex, and it will not come back unless you pull it hard.
These little bits of common sense are all used by doctors to perform interventional surgeries.
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From the description of the two methods, you will find that no matter which one you use, if you want to have a good foundation for fixing, there must be a point where the rope can be easily hooked.
In the final analysis, firefighters take advantage of the terrain and topography, while doctors need to take advantage of the topography and topography of the patient's own heart structure.
Some patients have different geographical advantages from ordinary people. If they are not in good condition, the operation will naturally fail.
Shin Youhuan had to explain a little more about this, and elaborated on his failure: "The last time the patient came for a heart checkup, an echocardiogram was performed on the patient."
Whether it is echocardiography, electrocardiogram, or interventional coronary stent surgery, they are not strong in the detailed examination of the heart's myocardial structure. Like the case of Shouer, the patient should be given a cardiac magnetic resonance examination. Since the patient did not have symptoms such as cardiomyopathy before, the doctor did not focus on this aspect and therefore did not prescribe such an examination.
It just so happened that during this surgery, electrodes were placed. If the electrodes were placed in the right ventricle, the doctor would need to use the fixation method mentioned above.
The anatomical feature of the right ventricle is that its internal surface has abundant structures such as trabeculae, like multiple small piles. The wire head is made into a circular sleeve, which is very easy to fix.
As mentioned above, cardiac magnetic resonance imaging is required to clearly examine the problems with the trabeculae, so Shin You-hwan and his colleagues did not know before the operation that the patient might have changes in the internal surface structure of the right ventricle.
It is very likely that the patient's physical indicators have deteriorated severely due to his advanced age, the trabeculae at the apex of the right ventricle have atrophied, and the electrical activity has decreased. As a result, the doctor could not put on the electrodes and could not stimulate the heart, resulting in the failure of the operation.
If it cannot be placed in the right ventricle, it can be placed in the right atrium.
The right atrium is also not possible. The right atrium does not have trabeculae like the right ventricle, but it has a right atrial appendage. For most people, the wire sends the electrode to the right atrial appendage and the right atrial appendage hooks the electrode.
The problem is that today's insertion is blind. Without fluoroscopy, the doctor has to be lucky to accurately deliver the wire to the right atrial appendage and let the right atrial appendage hook it. If the right atrial appendage is not used, under conventional surgery, the doctor can use another method to actively fix the pacing wire on the right atrial wall with an active fixation wire. The characteristic of this active fixation pacing wire is that there is a screw on it, which is placed on the selected atrial wall and rotated and twisted to screw the electrode on. By the same token, would you dare to twist it randomly without fluoroscopy during the blind insertion today?
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