I Can See Health

  Chapter 858 Combined Surgery

   "Lu, can you do this operation?" Lambert asked nervously.

   After a while, Lu Chen nodded slowly.

   "You can try it, but I need to check the echocardiography again and re-evaluate the patient's condition."

  Lambert heaved a sigh of relief, "It's easy to say anything about checking, just have your words."

   "Then let's get started."

  Lu Chen began to put on the surgical gown.

   For this four-leaflet valve deformity, he has done it in the virtual space of the system.

   But he has never tried PCI combined with TAVR.

   "Is it okay to let Kenji Yamada be my assistant?" Lu Chen looked at Lambert.

"No problem at all!"

  Lambert is now preoccupied with solving this patient's condition.

  Yamada Kenji's face brightened.

   It is a good opportunity for him to have several more surgeries.

   It's just that Casas, who was on the operating table, didn't look very good.

   But the attending doctor Lambert had already agreed to Lu Chen, and he had nothing to do.

  …

  Lu Chen has changed into his surgical gown.

   At this time, Kenji Yamada pushed an ultrasound machine.

   The duo restarted to review the patient's echocardiography.

   Ultrasound showed that the aortic peak velocity was 470cm/s and the peak pressure difference was 88mmHg.

   Four-leaf valve deformity, the circumference of the valve ring is 70.3mm, the average diameter is 21.9mm, and the circumference of the LVOT is 70.7mm, and the average diameter is 22.5mm. Lu Chen frowned, the patient's aortic stenosis was worse than expected!

  Lambert watched.

   "Lu, what type of valve are you going to use?"

Lu Chen thought about it and said: "The patient's aortic valve root is severely stenotic, the valve leaflets are thickened significantly, and the risk of coronary occlusion is high. First, use a minimally invasive 18mm balloon for pre-dilation. If there is no obvious regurgitation, then implant the TAV21mm valve. "

   He said these words to Lambert, and also to Kenji Yamada.

   Yamada Kenji heard Lu Chen's words and immediately started preparing the artificial valve and balloon.

   The two of them have cooperated in many surgeries, and now they are extremely tacit.

   "Lu Chenjun, which side of the vascular access to choose?" Yamada Kenji continued to ask.

  Lu Chen re-examined the patient's vascular access.

  Bilateral approach has tortuous vessels, smooth vessel walls and acceptable bifurcation heights.

   The average minimum inner diameter of the left blood vessel was 7.6 mm, and the average minimum inner diameter of the right blood vessel was 7.8 mm.

   "Choose the right femoral artery!" Lu Chen said solemnly.

"it is good!"

  Yamada Kenji nodded and started piercing at the same time.

   His technique is very subtle, even Lu Chen can't beat him 100%.

  This islander is really capable.

   The puncture of the blood vessel was smooth.

  Kenji Yamada immediately put in a pre-expanded balloon.

   is almost the same as Lu Chen's prediction, bilateral coronary imaging, 18mm balloon almost blocked the valve opening, no obvious regurgitation!

   "This 18mm balloon is a good choice!" Lambert said in admiration, "Lu, are these eyes vernier calipers?"

  Lu Chen smiled, "Lambert, you can do it if you do too much. There is an old saying in China, practice makes perfect."

   Surgery continues.

   "Lu Chenjun, the valve position is set, I will release the valve directly?" Yamada Kenji's confidence increased greatly at this time.

  Under the leadership of Lu Chen, the operation is going well so far.

   But Lu Chen immediately poured a ladle of cold water on him.

   "Not yet!"

   "Not released?" Yamada Kenji said in surprise, "After a long time, patients are prone to heart failure."

  Lu Chen pointed to the image of the patient, "The height of the left and right coronary openings is low, especially the right coronary opening. In this case, releasing the valve can easily block the coronary artery!"

   "So you need to protect the coronary arteries in advance?" Kenji Yamada understood.

   "That's right!" Lu Chen nodded, "Routine TAVR doesn't need to take this into consideration, but the patient's coronary vessels are inherently bad, and a little carelessness may cause cardiogenic myocardial infarction!"

   Under the measures of coronary artery protection in advance, Kenji Yamada successfully released the artificial valve!

   "Don't leave yet, take a look, you may have to adjust your position!"

  Lu Chen is now staring at the images during the operation.

  Because of the special four-leaflet valve structure, the positioning and stability of the release valve must be guaranteed to be foolproof.

  After releasing the valve, Lu Chen observed in real time and made corresponding adjustments.

   "Yamada, push a little to the upper right to prevent paravalvular leakage!"

"receive."

  Under the guidance of Lu Chen, Kenji Yamada completed the delivery and positioning of the entire valve without any risk.

   The ultrasound was re-examined after operation, and the aortic valve transvalvular pressure difference was 0mmHg after operation.

  The position of the prosthetic valve is fixed, there is no paravalvular leakage, and the valve shape is good.

   Beside Lu Chen, Lambert and Casas have been watching.

   Every delicate operation is like an art performance.

   Lu Chen's greatest skill is not to complete the TAVR, but to **** the rest of the PCI operation while completing the TAVR, and to protect the patient's coronary arteries as much as possible!

   "Lambert, leave the rest to you." Lu Chen took off his gloves.

   "Don't worry, Lu, you have done such a good TAVR operation, he won't let you down."

  Lambert took over the rest of the PCI procedure.

   His coronary intervention level is one level higher than that of Lu Chen.

   No way, who made Lu Chen's current coronary intervention skill card only advanced.

   He did not go, but stood beside the operating table like Lambert, watching the rest of the PCI operation.

  …

"Recently, the Mayo Clinic Cardiology PCI and TAVR group combined surgery for a high-risk patient: four-leaflet aortic valve, severe aortic valve stenosis combined with moderate regurgitation, low coronary opening, small cavity, and severe calcification of valve leaflets , Acute exacerbation of heart failure, successful combined treatment of PCI + TAVR."

   It is considered a top-level difficult operation in Mayo, and it naturally caused a sensation on a global scale.

  Lu Chen didn't pay much attention.

   He focuses more on himself.

  After this operation, he also understood his shortcomings.

   In addition to TAVR surgery, in the fields of coronary intervention, electrophysiology, congenital heart disease, etc., there is still a big gap between him and the top doctors at Mayo Clinic.

   However, Lu Chen's outstanding performance aroused the idea of ​​the director of Mayo's Cardiology Department.

   "Mr. Kebed, you mean, the director wants me to go to the office to find him?"

  Lu Chen was a little confused.

   "Yes, he called me today." Kebed nodded, "His office is on the fifth floor."

   "Okay, I'll find him right away."

   Lu Chen didn't know much about the director of the Cardiology Department at Mayo Clinic.

  This is not like in China, where the director usually does not interfere with everyone's medical behavior.

   After Lu Chen came to Mayo for so long, he had never met the director of Mayo's Cardiology Department.

  …

   Come to the fifth floor.

   After Lu Chen asked about the specific office location, he knocked on the door of the director's office.

   "Come in!"

   A full-fledged voice came out, and Lu Chen gently pushed open the door.

   To Lu Chen's surprise, the director of the Cardiology Department in front of him had an Asian face.

   There are also updates

   (end of this chapter)