I can see health

Chapter 875 Congratulations, the new African chief! (Second update!)
Cardiology cath lab at Mayo.

Both Lu Chen and Yamada Kenji had serious expressions on their faces.

After performing an angiography on the patient's aortic root again, Lu Chen found that the patient had severe aortic stenosis in a transverse position!
In this case, interventional valve stents are prone to displacement when implanted in the non-calcified aortic valve area, which increases the risk of TAVR failure.

The relative pathological expansion of the aortic root and ascending aorta leads to dilation of the aortic valve annulus.

The area of ​​the valve ring exceeds the area of ​​the largest type of artificial valve currently clinically practiced, and there is a risk of falling off after the valve is released.

The difficulty of this operation is high, and it still exceeds everyone's imagination!
"Lu Chenjun, what should we do? Continue...or give up?"

Seeing this situation, Yamada Kenji faintly wanted to retreat.

Anyway, he didn't want to be an "African chief".

Lu Chen didn't speak, he was rethinking the possibility of surgery.

In the conventional TAVR operation through femoral artery puncture, the valve is implanted at this angle, and the valve is extremely prone to displacement in the case of severe transverse heart disease!
Once displaced, paravalvular leakage occurs, and the entire operation will fail, which is also a fatal blow to the patient.

In the end, what should we do?
Are there better alternatives to surgery?

A scene in the virtual space of the system appeared in Lu Chen's mind.

He is training every possible clinical situation every day and night.

In the virtual space of the system, he has encountered various complications, various surgical procedures, and various unexpected emergencies.

However, this is just a virtual system after all!

In the real situation, it is arbitrary, and it is impossible to have any laws.

Lu Chen searched the past training memory, but did not find a suitable technique.

"Lu Chen-jun, why don't you pause first." Yamada Kenji said, "Let's go back and discuss it again. After the operation is ready, we will make full preparations before performing the second operation."

Lu Chen's heart sank.

At present, it seems that Yamada Kenji's opinion is the most scientific.

However, just when Lu Chen was about to end the operation.

The monitor on the operating table suddenly sounded a piercing siren!
The waveform of the patient's electrocardiogram suddenly became extremely rapid, and the waveform was not regular at all.

The patient himself also lost consciousness, and did not respond at all to the calls of the nurses from outside.

"Oops, ventricular fibrillation!"

Lu Chen growled in a low voice.

"Blood pressure is down!"

He and Kenji Yamada started to move immediately.

Lu Chen performed cardiopulmonary resuscitation.

Kenji Yamada brought the defibrillator.

Fortunately, Lu Chen asked the nurse to prepare the ambulance and defibrillator in advance.

After two defibrillations, the patient's heart rate returned to normal.

However, his blood pressure was in a low state.

Cardiogenic shock!
This time, Lu Chen didn't dare to suspend the operation.

"Go to IABP." Lu Chen said immediately.

IABP is mainly aortic counterpulsation. In short, when the aorta ejects blood, it allows the aortic blood to return to increase coronary blood flow.

This is one of the measures to effectively prevent cardiogenic shock.

However, it only temporarily maintains the patient's vital signs.

If the fundamental problems are not resolved, the IABP will only delay for a while.

If the operation is stopped at this point, the patient's next risk is extremely high, and all unpredictable risks such as cardiac arrest are likely to occur.

"Lu Chenjun..."

Before Yamada Kenji finished speaking, Lu Chen said directly: "The operation cannot be suspended, we must continue!"

The risk of surgery must be considered, but when the life safety of patients is threatened, life-saving should be the main priority!

"Huh?" Yamada Kenji was stunned.

Does Lu Chenjun want to be an African chief so much?
At this time, the risk of failure is too high to force TAVR surgery!

However, at this time, Lu Chen was the chief surgeon, and no one could suspend his operation unless he stopped the operation himself.

And just now, a light flashed in Lu Chen's mind.

He felt that he had been led by the nose by the system, unable to break out of this established circle.

What if we jump out of the framework of the existing transfemoral artery puncture TAVR procedure?

Is there any other way?
Thinking of this, Lu Chen suddenly had an idea.

Since the angle of the femoral artery puncture is too large and it is not easy to implant the valve, what about direct puncture?

"Yamada, do you think that if I puncture directly, will the angle problem be solved?" Lu Chen turned to look at Kenji Yamada beside him.

"Puncture directly?"

Yamada Kenji was stunned for a while, he didn't understand what Lu Chen meant.

"Yes, instead of puncturing through the femoral artery, puncture directly through the apex of the heart!"

As soon as Lu Chen's words came out, Yamada Kenji was stunned.

Puncture directly at the apex of the heart, allowing the catheter to be implanted in the aorta?
And then implant the valve?
What a bold idea!
However, there is no doubt that if pericardiocentesis is really performed, even if the patient has a severe transverse heart, he does not have to worry about the angle and displacement.

Yamada Kenji immediately came back to his senses and figured out the reason.

There was excitement on his face.

"Lu Chenjun, I think your idea is feasible!"

Apical puncture, with the help of an ultrasound machine, is still very safe.

"Okay, without further ado, let's start right away!"

Right now, every second of time is more dangerous.

……

Yao Jie pushed the ultrasound machine in.

With the help of ultrasound, Lu Chen quickly performed apical puncture.

After the apical purse string puncture, a loach guide wire and a 5F single-curved catheter were inserted into the descending aorta.

"After exchanging the plasticity of the head, the Lunderquist stiffened guide wire was used, the 24F sheath was expanded, and the delivery device loaded with the J-Valve valve was delivered to the aortic root through the stiffened guide wire."

Lu Chen instructed Yamada Kenji to say.

He opens the retainer and pulls back into the three sinus valves.

The valves were released in sequence. After the valves were released, the position and function of the valves were evaluated by angiography and TEE. After the locking wire was unhooked, the conveyor was withdrawn.

"Withdraw the hardened guide wire under the protection of the single curved tube!"

Angiography again confirmed that the valve function was good, and the ascending aorta and access vessels were not damaged.

The purse is knotted at the apex of the heart.

After Lu Chen stopped the bleeding, a left chest tube was placed and the chest was closed routinely.

The operation is over.

ECG monitor on the operating table.

The patient's blood pressure and heart rate have returned to normal.

Postoperative echocardiography showed that the interventional valve was in good shape and position, and only paravalvular leakage occurred.

……

When the patient was pushed to the CCU for observation, Lu Chen and Yamada Kenji also got off the operating table.

During the entire operation, the two men were tense, and only now did they relax completely.

Even Yao Jie, who was watching from the sidelines, was in ups and downs.

"Lu Chen-jun." Yamada Kenji patted Lu Chen's shoulder suddenly, "Congratulations!"

Lu Chen looked back at Kenji Yamada suspiciously, "Congratulations?"

"Congratulations on becoming the new African tribal chief."

Lu Chen: "..."

To be honest, the gold mine can stay, but he won't marry someone!

(End of this chapter)