In response to the first question raised by Dr. Xie, all the doctors in the audience nodded: That’s right.
From the disease definition seen above, we can know that the key to solving this disease lies in how to close the abnormal channels.
Isn't the most straightforward understanding of closing an abnormal channel to block the entrance of the channel?
All you need to do here is to know the shape of the passage entrance, find a "plug" of roughly the same shape, and plug it up.
This "plug" that blocks the channel is what Dr. Xie calls an occluder in medicine.
Since the shape of the occluder is determined by the abnormal channel opening, the shape of the abnormal channel opening must be clearly understood before surgery.
Generally speaking, the shape of abnormal passages is mostly oval or half-moon. The occluders supplied in the medical device market are generally manufactured and classified based on these clinical data. Special materials will also be provided to doctors for special abnormal passages.
For this reason, doctors must understand these indicators before surgery and plan in advance the model of medical equipment to be used in the operation.
Doctor Qiu took the patient's medical records and looked through them himself to find the patient's data.
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In the past, this data was measured by transesophageal ultrasound. If conditions permit, vascular CT angiography can be added for greater accuracy.
After reviewing the medical records, the value was shown: large paravalvular leak 8.1.
This type of larger mitral paravalvular leak can be treated with an atrial septal occluder.
Does this answer explain how cardiac surgery and cardiology work together? It seems not.
It can be seen that Dr. Xie really wanted to discuss the patient's surgical problems step by step with his partners from the beginning, and he was careful and patient in paying attention to the details of the surgery.
After Dr. Xie's first question opened Dr. Qiu's surgical thinking, he expressed his own thoughts: "The reason why the occluder is difficult to operate is not only because of its shape, but also because of its location and other factors."
Even if the occluder is chosen appropriately, the process of inserting it is the real difficulty for the interventional physician. This is why it is not easy to carry out this operation widely in clinical practice at present.
Once again, it is emphasized that the heart is a three-dimensional organ with a complex internal shape. It is easy to imagine how difficult it is to use a guide wire to accurately deliver the "plug" to the small leak inside the heart and adjust the shape to seal it according to the two-dimensional plane of the interventional image.
As long as the location is tricky, it is expected that it will be difficult to capture the location of the leak using only interventional two-dimensional imaging.
Dr. Xie Wanying responded to Dr. Qiu: "Often, the guidewire has to go around more than two times to insert the occluder into the heart."
When Dr. Qiu heard her words, his eyes lit up: She really understood the process and key points of interventional surgery.
If the guide wire is wrapped too much, it will get entangled in the heart and cause accidents, such as getting lost, and the chance of surgical failure will be too high.
Therefore, the usual intervention channel for this operation is: puncture the femoral artery, cross the aortic valve to the left ventricle, and then to the left atrium. It is like a long journey around the earth, which is a retrograde route.
If you don’t want to go around in circles and go backwards, you can only use the puncture method.
There are two puncture methods. One is to puncture the femoral vein or jugular vein, then puncture the atrial septum, and send the guidewire through the atrial septum puncture sheath into the left atrium. At this time, the guidewire crosses the paravalvular leak from the left atrium to the left ventricle, which is the retrograde direction of blood flow. Given the characteristics of the light guidewire that is easy to float, this section of guidewire delivery becomes a difficult section and is not easy to succeed.
The third method, Dr. Xie Wanying said: "The apical puncture method can be assisted by thoracoscopic technology."
In the past, the apical method required a small thoracotomy, but now it is more minimally invasive with thoracoscopy, and extracorporeal circulation is no longer necessary. The thoracoscopy-assisted positioning of the puncture needle is directly inserted into the pericardium to the apex, that is, the left ventricle, and a guide wire is sent in.
The above three methods all have their difficulties and advantages, and the choice of which one needs to be based on medical science.
Dr. Xie Wanying added: "I recommended the patient to choose the third surgical option because the patient's paravalvular leak is located between the 10 o'clock and 6 o'clock positions."
It has been introduced that using a clock dial to determine the location of the lesion is very common in clinical practice.
Dr. Qiu was absolutely convinced. He was a real boss, not narrow-minded at all, inspiring your thinking and proposing a roadmap for cooperation in line with your ideas.
This plan was approved by the doctors present.
Who will do the thoracoscopic-assisted surgery?
Dr. Qiu and Professor Fang suggested: "Please ask Teacher Xie to do it faster."
Dr. Xie Wanying has a clear understanding of the surgical path, which is unmatched by any other doctor on the scene.
One of the most important things in an operation is the surgical path. If the path is taken correctly, you will get twice the result with half the effort. If you take the wrong path, nothing will be accomplished.
Doctor Xie Wanying nodded: "Then let's prepare for the operation quickly."
Dr. Qiu and Professor Fang were both stunned: This guy, you really do what I tell you to do, and do it immediately! ?
Robot Doctor Fu almost couldn't hold back his tightly closed mouth: It can be imagined that these people have not heard of Dr. Xie Wanying's other increasingly famous title, "King of Rolls".
In order not to delay the patient's treatment, the preoperative preparations were carried out without delay. The operating room was vacated, the patient was sent in, and the extracorporeal circulation technician was on standby, although it was said that it was no longer needed before the operation. This was a special concern of the Guoxi doctors who had not seen Dr. Xie's skills in person.
The anesthesiologist asked about the surgery time.
Dr. Qiu and Professor Fang looked at Dr. Fu and Dr. Xie and asked.
Dr. Fu had already handed over all the control in the field to his subordinate Xie.
Dr. Xie Wanying’s answer is: less than half an hour.
When it was Kuninishi's turn, the anesthesiologist was stunned: Does this mean that this operation is equivalent to a minor examination and only requires short-term general anesthesia?
Dr. Qiu and Professor Fang, who had never expected that the National Association would treat this operation as a pediatric operation, were immediately extremely nervous: What?!
Doctors, please put on your surgical gowns.
Professor Fang and Dr. Fu serve as assistants to Dr. Xie.
Since Guoxi Hospital does not have the single-chamber thoracoscopic instrument from the National Association, it can only be done by the conventional three-hole method.
The person holding the mirror is Doctor Fu, and Professor Fang, the instrument assistant, is the leader of the Guoxi team. Everyone in Guoxi stared at Professor Fang: Don't embarrass yourself.
Professor Fang was listed as a professor, and everyone knew that his skills were not bad. However, the Western people soon found out that their professor had been dumped.
Professor Fang was almost frozen and dared not move. He would not move unless surgeon Xie or Doctor Fu told him to move.
It’s not Professor Fang’s fault. All the people from the National Western Medicine Hospital present were shocked: the surgery performed by the people from the National Association was too fast.
Finally, without being restricted by the difficult conditions and images in the disaster area, surgeon Xie got the opportunity to operate at full capacity.
The fast speed of the operation was certainly not determined by the surgeon's mood, but purely because the patient already had signs of heart and kidney failure and could not endure a long operation.
Open a hole, find the apical puncture position, and insert a puncture needle directly into the position planned before the operation. The entire surgical assisted operation is completed.
The row of onlookers looked like a blitzkrieg.
When the anesthesiologist counted the timer and saw that it was eight minutes, he was completely shocked again: Surgeon Xie was not exaggerating, the operation really was completed in less than half an hour.
Dr. Qiu, who took over, didn't understand the surgery in the first few minutes, and sweat broke out on his forehead.
Professor Fang swallowed his saliva for Dr. Qiu and wanted to ask: Can you do it?
Dr. Qiu wanted to answer: I feel that if I can do it, wouldn’t we all become supermen of the National Association?
At this time, Dr. Xie said to Dr. Qiu: "You will feel the position point immediately after you put the guide wire in."
Dr. Qiu’s eyeballs shrank: Is it true or false?
During the operation, esophageal ultrasound and X-ray were used to assist, which actually showed some clues of surgical assisted puncture points. However, when Dr. Qiu inserted the diagnostic guide wire into the patient's heart through the surgical puncture point, the feel of it told him: It was amazing, what Dr. Xie said was true.
He did not need to make any adjustments. He only needed to push the guidewire gently with his fingers, and the guidewire passed through the paravalvular leak smoothly. After completing this most difficult step, the following operations were even more logical.
The entire operation was completed, and the anesthesiologist saw that it was finished in just over twenty minutes.
Professor Fang rushed forward and grabbed surgeon Xie's hands, unable to speak due to his excitement.
Not wanting to be left behind, Dr. Qiu rushed forward and pushed Professor Fang aside. He was also so excited that his face turned red, but he didn't know what to say.
After the family members outside learned the good news, they ran to find reporters and asked them to publish an advertisement in the newspaper to thank the medical team.
Later, rumors spread inside Guoxi: What is a true medical genius? This operation finally allowed Guoxi people to experience it firsthand.
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