I can see health

Chapter 855 Bold Technique (Second)
Innovation is always an eternal topic in medical technology.

Every time a new technique appears, it means that a clinical problem is solved.

As the world's number one Mayo Clinic, it has many innovations and discoveries.

For example, the current ECMO machine and the division of various internal medicine departments are all derived from the Mayo Clinic.

Today, in Mayo's cardiovascular intervention, can everyone witness the birth of a new surgery?
Facing the brand new technique, Lu Chen felt a very strange feeling.

All the operations he performed before can be simulated and trained in the system simulation space.

But the current "secondary surgery for valve failure" cannot be simulated in the virtual space of the system.

However, the more difficult the surgery, the more motivated Lu Chen was!
……

in the operating room.

Kebed, Lu Chen, and Kenji Yamada had already made preparations for the operation.

"Prepare for blood vessel puncture!"

Yamada Kenji performed the piercing work consciously.

This is also the basis of TAVR surgery.

Kenji Yamada's puncture surgery is extremely skilled, and he deserves to be a doctor who can come to Mayo.

After puncture of the femoral artery, the catheter and guidewire were successfully implanted.

The three of them don't cooperate much, but they have a tacit understanding.

Kebed, as the chief surgeon, every time he issued an order, Lu Chen and Yamada Kenji would execute it immediately.

Vessel puncture, catheter (guide wire) entry, it all went well.

Among the big coffees watching on the sidelines, everyone appreciated the cooperation of the three of them.

Although both Lu Chen and Yamada Kenji are newcomers, they are definitely the best among their peers.

"Everyone cheer up!"

When it came time to expand the balloon, Kebed said with a serious expression to the two people beside him in a low voice.

Balloon dilation of the aortic valve is one of the most important steps in the operation.

Only after the balloon is expanded can the artificial valve be successfully sent to the designated position.

……

The three immediately worked together.

"start!"

With Kebed's order, the balloon expansion officially began.

Kenji Yamada quickly adjusted the frequency of the temporary pacemaker to 180 beats/min.

The ECG monitor next to the operating table showed an overspeeding heart rate.

At this point, the patient's blood pressure drops to 50-60 mmHg.

Lu Chen immediately performed inflation and dilation of the aortic valve balloon catheter, and DSA exposure.

"Stop!" Kebed yelled again, and Lu Chen stopped what he was doing.

Kenji Yamada adjusted the frequency of the temporary pacemaker back to 60 beats/min.

Balloon inflation is complete.

The three closely observed the patient's blood pressure rise, electrocardiogram waveform, and DSA image.

"Everything is normal!" Lu Chen said slowly.

The three breathed a sigh of relief this time.

In patients without effective cardiac reserve, the dilation process can completely occlude the left ventricular outflow tract.

Some patients cannot tolerate it, and serious complications such as ventricular fibrillation and cardiac arrest may occur.

"Go on." Kebed's eyes were burning.

After balloon dilation of the aortic valve, he again assessed the mean diameter of the aortic valve annulus to determine the size of the aortic valve to be implanted.

Lu Chen compressed the cleaned self-expanding valve to the smallest diameter with a crimping device and a transfer tool, loaded the diameter T ear into the T-shaped slot, and pushed the capsule cavity so that all the outflow ends of the stent were loaded into the capsule cavity. The handle completes the loading.

"The stent valve is ready!" Lu Chen said slowly.

"Got it." Kebed nodded towards Lu Chen, "Ready to deliver the valve!"

……

The delivery and release of the valve is the key to the success of the whole TAVR operation.

Kebed began to slowly deliver the valve.

Lu Chen stared intently at the position of the valve.

In addition, invasive pressures such as left ventricular and aortic pressure will affect the effect of the final operation.

Kenji Yamada adjusted the transducer to "0" before and after valve release to ensure the accuracy of invasive pressure measurement.

As the minutes passed, Kebed couldn't find the location where the valve would finally release.

"I think it should be closer." Yamada Kenji said suddenly, "The position of the valve is a bit low."

"No way!" Kebed shook his head. "If it gets any closer, it's likely to touch the blood vessel. If the blood vessel is torn, the consequences will be too serious."

On the side, Lu Chen has been observing the position of the old valve.

He found that no matter how the valve was released, it was impossible to achieve perfection.

The positions of the old valve and the new valve overlap in some places.

"The current position, I think it's fine." Lu Chen said in a deep voice.

"This won't work, I feel that a paravalvular leak may occur!" Yamada Kenji looked at Lu Chen suspiciously, "Once a paravalvular leak occurs, the patient's heart function will become worse."

Kebed glanced at Lu Chen, "What do you think?"

However, Lu Chen said slowly: "It is impossible to have a perfect position. The current position can only be said to meet the conditions of all parties as much as possible."

"After the valve is released, we can use echocardiography to evaluate the aortic valve regurgitation, and based on the results, consider whether to expand the balloon again or implant the valve-in-valve, and prepare for the implantation of the valve-in-valve!"

"This..." Yamada Kenji was a little surprised, Lu Chen's thoughts were wild and unconstrained.

Others were trying to find the best position, but Lu Chen directly considered the remedy.

Kebed hesitated for a moment.

He recalled Lu Chen's performance in the Fellow review.

The operation of that operation surprised everyone.

"Okay, listen to Lu Chen!"

……

After the valve was released, the professors watching around had different expressions.

"Isn't this a good position? The surrounding positions don't seem to be right?"

"But I feel that there is no better position. The second surgery is different from the first surgery. It is difficult to have a perfect valve release position."

"These young people are really bold! It would be impossible for another person to release the valve at this position, right?"

on the operating table.

Kebed had released the valve.

"Pay attention to blood pressure and heart rate!"

"Received." Kenji Yamada re-measured all the vital signs of the patient, "Everything is normal!"

At this time, Lu Chen pushed the echocardiography machine over.

After valve implantation, the ultrasound position needs to be reassessed.

Sure enough, the valve did not fit perfectly, and a paravalvular leak occurred!
However, Kebed, Lu Chen, and Yamada Kenji did not panic, and immediately started preparing for the implantation of the "petal within a petal".

But when Kenji Yamada inserted the second artificial valve, the alarm on the monitor on the operating table sounded.

"Oops, the patient's blood pressure has collapsed!" Kebed reacted immediately, "Quick! Put on the balance fluid, and pump another norepinephrine!"

The nurse who set up the station moved quickly, and quickly connected the medicine to the patient.

Everyone was wondering, why did the blood pressure suddenly drop?
"Look at the monitor."

Lu Chen suddenly pointed at the monitor on the operating table.

Electrocardiogram on patient monitor, ST segment is significantly depressed!
　There are also updates

　　
　
(End of this chapter)