I can see health

Chapter 874: The Shape of the Catheter (Part [-])
Cardiology cath lab at Mayo.

Lu Chen checked the results of the patient's ultrasound report again.

The ascending aorta was dilated, the inner diameter of the aortic sinus was 4.3cm, and the sinotubular junction nearly disappeared with an inner diameter of 5.1cm. The three valve margins of the aortic valve were echogenic, calcified, adhered, and poorly opened.

CW: The maximum blood flow velocity of the aortic valve in systole: 3.1cm/s, the maximum pressure difference: 38mmHg, the average pressure difference: 19mmHg, the diameter of the aortic valve ring is 2.7cm, and the inner diameter of the aortic valve arch is 3.5cm.

After fully understanding the situation of the valve, the whole operation officially started.

Under Lu Chen's guidance, Yao Jie began to puncture the patient's femoral artery.

As a necessary skill for intervention, Yao Jie tried arterial puncture.

Wearing gloves and holding a puncture needle in his hand, Yao Jie moved unhurriedly, slowly piercing it into the blood vessel.

Arterial blood is brighter in color than venous blood.

With pulsating red blood appearing in the puncture needle, Yao Jie successfully completed the blood vessel puncture.

All beginnings are hard.

A good vascular puncture means that the operation is half successful.

Next, Yao Jie began to enter the catheter and guide wire.

Any balloons, stents, etc. can enter the human heart smoothly only through the guidance of catheters and guide wires.

"Slow down, don't go too fast, haste makes waste!" Lu Chen instructed from the side.

Catheters and guide wires are extremely delicate things, and if the airway is slightly larger, blood vessels may be damaged.

A 6F sheath was placed and 7000U heparin was injected.

Yao Jie sent EBU3.75, EBU4.0, and JL4 guiding catheters respectively.

But, sorry.

She failed to reach the left coronal ostium with the catheter.

Yao Jie's hands trembled slightly.

Is the first operation going to fail?
And was it defeated in such a small place?

She was a little reconciled, and there was even a fine sweat on her forehead.

After debugging several times, the guide catheter still failed to reach the left coronary ostium.

"Senior Brother Lu, I..."

Yao Jie had no choice but to ask for help from Lu Chen beside her.

Lu Chen immediately understood, smiled, and said, "Let me do the rest, you've done a good job."

Yao Jie lowered her head, turned slightly sideways, and gave way to Lu Chen for the surgery seat.

Lu Chen stepped forward, gently held one end of the guiding catheter, and began to operate.

Fiddled with it a little.

Lu Chen also discovered that with the current form of the catheter, it is definitely impossible to pass through the left crown.

"Everyone's condition is different, but the initial state of the catheter is the same." Lu Chen glanced at Yao Jie, and said slowly, "When this kind of catheter cannot pass through, we may use a A skill, that's catheter shaping."

Catheter shaping, in simple terms, is to adjust the catheter into a shape suitable for the passage of the patient's lesion.

It looks simple, but it's actually very difficult!

This requires the surgeon to be very familiar with the anatomy of the heart, but also to be proficient in interventional cardiology.

"To determine the shaping of a guide wire, there are two parameters, the shaping distance of the guide wire and the shaping angle." Lu Chen said while teaching, "The shaping distance and the shaping length are different concepts. We generally The length mentioned actually refers to the shaping distance, not the real length..."

Lu Chen began to gently scrape the catheter with the shaping needle.

This skill is the most test of the operator's ability.

Sometimes, just a couple of light scrapes and it goes right in.

And sometimes, it takes a long time to look at the lesion, look at it, and sculpt it.

Yao Jie listened to Lu Chen's explanation without taking his eyes off it.

She had heard of this skill, but when it was her turn, she realized how difficult it was to sit up!

"Junior Sister, take a look, this angle is very large, so make a big bend, this big bend can be double-bent, it can be curved! This big bend guide wire can be retracted or moved forward. A double-lumen microcatheter assists access below."

"Of course, the most ideal state is to use a microcatheter. The microcatheter is first sent to the proximal end of the lesion, and then replaced with a small curved guide wire."

"Junior Sister, the most important thing is that you have to remember that different lesions and different blood vessel locations have completely different shapes..."

……

Five minutes later, Lu Chen successfully shaped the catheter.

After EBU4.0 shaping, the left coronal mouth was successfully reached.

Lu Chen immediately sent the VT guide wire to the distal end of the anterior descending branch, sent the BMW guide wire to the distal end of the circumflex branch, and sent a 2.0*20mm double guide wire balloon to fully pre-dilate the stenosis in the proximal section of the anterior descending branch.

In the eyes of outsiders, the extremely difficult coronary intervention at this moment was gradually broken in Lu Chen's hands.

However, Lu Chen didn't feel complacent.

He concentrates his attention at all times and avoids any emergencies.

Subsequently, he sent a 3.0*24mm DES to the lesion in the middle of the anterior descending artery.

Release after precise positioning.

Send 3.5*16mm mastoid balloon and 3.0*15mmNC balloon to the stent for modification and expansion respectively.

"Re-check the radiography!"

Lu Chen continued to give instructions, and Yao Jie injected a small amount of contrast agent again.

"The stent expanded well."

After the radiography was over, Lu Chen glanced at the position of the stent and nodded with satisfaction.

"Remove the sheath, pressurize the bandage, and pay attention to whether there is bleeding and high vagal reflex."

"Got it!" Yao Jie nodded slightly.

The coronary intervention was successfully completed, but this was only one of several operations performed by the patient.

"This patient may need a temporary pacemaker as a preventive measure," Lu Chen said suddenly.

Yao Jie was taken aback for a moment, she thought she would start the TAVR operation directly.

Lu Chen actually wanted to implant a pacemaker into the patient.

This pacemaker was implanted after PCI surgery and before TAVR surgery.

"Junior Sister, do you know what my intention is?" Lu Chen asked with a smile.

Yao Jie frowned, thought for a while, then shook her head slowly, "I don't know."

Lu Chen smiled and explained: "Previous PCI treatment did not cause high-grade atrioventricular block, but TAVR surgery will! A pacemaker is implanted after TAVR surgery, and this is to prevent high-grade conduction block."

He placed a 5F temporary pacing electrode in the patient's right jugular vein to the right ventricular outflow tract for backup.

The process of implanting the pacemaker took less than 5 minutes.

Yao Jie, who was beside him, was stunned!
Implant a temporary pacemaker, not even for 5 minutes.

This speed is simply amazing.

As expected of Senior Brother Lu Chen!

Being able to gain a foothold in Mayo, his surgical ability is really not comparable to that of ordinary people.

……

After implanting a temporary pacemaker, it was the turn of TAVR surgery.

Actually, at this time.

Yao Jie's assistant status is completely useless.

At most, it is to help Lu Chen pass things.

"Junior sister, let Yamada Kenji come in and help." Lu Chen thought for a while.

Although he can do it alone, it is still inconvenient without the help of an assistant.

Yao Jie's current experience is still inexperienced, and it is enough for her to watch the surgery for the rest of the surgery.

"Okay, Senior Brother Lu."

Yao Jie nodded slightly, knowing that she couldn't help now, she walked outside the catheter room and called Yamada Kenji in.

Lu Chen and Yamada cooperated in many surgeries.

The two are also very tacit.

Immediately afterwards, came the most critical point of the whole operation - TAVR surgery!

(End of this chapter)