It is said to be blind insertion, but it is impossible to do it completely blindly. It is difficult for patients to move to the interventional room for interventional surgery, but it does not mean that other medical resources cannot be used. Referring to previous neurosurgery cases, using the convenience of ultrasound for positioning is a desirable strategy.
There was indeed an echocardiogram machine in the ward.
Here comes a question. If there are multiple wires for stimulation, ventricular stimulation should be the first choice for rescue, because we know from studying cardiac physiology that ventricular activity is more important.
On the other hand, the right atrial appendage is also difficult to observe by transthoracic echocardiography, which requires a special body position.
Bedside transthoracic echocardiography can help doctors pass the electrode across the tricuspid valve.
Shen Youhuan thought that this junior sister was able to hit the academic point at once even from a long distance away without even reaching the ward. It was obvious that she had a powerful medical clairvoyance or had read the brain of his senior brother Shen.
The question is, she said the patient has a bad tricuspid valve. Which part is the problem? Can't the echocardiogram show it?
Everyone looked back at the medical records and it seemed that this item was not listed in the patient's existing heart examination results.
"His tricuspid valve has moved downward." Xie Wanying said again.
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"Is his tricuspid valve displaced?" Everyone looked again, full of doubts. "Which medical report did you read that from?"
"Chest X-ray."
Chest X-ray?! Advanced dimensionality reduction attack?
"She has a very rich medical association ability." The easy-going doctor Zuo Jinmao couldn't help but make another speech.
Is she just imagining things? Everyone knows that a chest X-ray can only roughly capture the outer contour of the heart, but certainly cannot capture the internal structures of the heart, including the tricuspid valve.
It is better to look at an echocardiogram. An echocardiogram can observe the position of the tricuspid valve by using a control. The attachment point of the tricuspid valve on the tricuspid valve ring is compared with the attachment point of the mitral valve to determine whether the tricuspid valve is abnormally displaced downward. At the same time, if the tricuspid valve is severely displaced downward, it will cause problems with tricuspid valve closure and bring about changes in the hemodynamics inside the heart. These are also reflected in the detection of internal heart blood flow on the echocardiogram.
"I personally think that this patient's condition is not the tricuspid valve displacement deformity that we usually talk about in clinical practice, but the overall structure of the heart that led to this result," said Xie Wanying.
One reason for surgical failure has nothing to do with disease. Sometimes it is because the patient's own organs grow abnormally. Even subtle abnormalities can catch doctors off guard. Doctors learn anatomy and surgical cases based on data from the majority of people. Doctors don't know about niche cases and have no idea where to start.
Everyone understood. What she meant by "downward movement" was that the attachment point of the tricuspid valve of this patient might be lower than that of the mitral valve compared to most people, which was equivalent to the tricuspid valve being longer. Therefore, the path of the guidewire electrode passing through the tricuspid valve opening and closing was longer, and the process was inevitably difficult. Such a special case was very difficult for doctors who had never done such a case and had no relevant experience.
This shows that Senior Brother Shen, an expert in interventional surgery, is not bad. Senior Brother Shen is good enough to sense the danger and is right not to make a big circle over the tricuspid valve.
What are the dangers of coiling the tricuspid valve? If you are not careful and fail, the most worrying thing is that the tricuspid valve will be torn, which will be a complete medical accident, and it will endanger human life instead of saving life.
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