I Can See Health

   Chapter 875 Congratulations, the new African chief! (Second!)

   Mayo's Cardiology Catheterization Lab.

  Lu Chen and Yamada Kenji both had very solemn expressions.

   After performing angiography on the aortic root of the patient again, Lu Chen found that the patient had severe transverse aortic stenosis!

   In this case, intervening valve stents and implantation in the non-calcified aortic valve area are prone to displacement, which increases the risk of TAVR failure.

   Relative pathological dilation of its aortic root and ascending aorta, resulting in enlargement of the aortic valve annulus.

  The area of ​​the valve annulus exceeds the area of ​​the largest conventional artificial valve in clinical practice, and there is a risk of falling off after the valve is released.

   The difficulty of this operation is still beyond everyone's imagination!

   "Lu Chenjun, what should we do? Continue...or give up?"

  Yamada Kenji saw this situation and wanted to back off.

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

  Lu Chen didn't speak, he was thinking about the possibility of surgery again.

  Conventional transfemoral artery puncture for TAVR. The valve is implanted at this angle. In the case of severe transverse heart, the valve is very easy to shift!

  Once it is displaced and paravalvular leakage occurs, the entire operation will be declared a failure, which is also a fatal blow to the patient.

   In the end, what should I do?

  Is there a better alternative to surgery?

   Lu Chen's mind flashed scenes in the virtual space of the system.

   He is training every day and night for various clinical situations that may occur.

   In the virtual space of the system, he encountered various complications, various techniques, and various unexpected emergencies.

   However, this is just a virtual system after all!

  The situation in reality is arbitrary, and there can be no rules.

  Lu Chen searched his past training memories, but couldn't find a suitable technique.

   "Lu Chenjun, why don't you pause first." Yamada Kenji said, "Let's go back and discuss it again. After the surgery is ready, make full preparations and perform the second surgery."

  Lu Chen sank his heart.

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

  But, just when Lu Chen was about to finish the operation.

   The monitor on the operating table suddenly sounded a piercing siren!

   The patient's ECG waveform suddenly became extremely fast, and the waveform was not at all irregular.

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

   "Oops, ventricular fibrillation!"

  Lu Chen roared in a low voice.

   "Blood pressure!"

   He and Yamada Kenji immediately moved.

  Lu Chen performed CPR.

  Yamada Kenji brought a defibrillator.

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

   After two defibrillations, the patient's heart rate recovered.

   However, his blood pressure is 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, the aortic blood is returned to increase coronary blood flow.

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

   However, the patient’s vital signs are only temporarily maintained.

   If the underlying problem is not addressed, the IABP will only be delayed for a while.

  If the operation is stopped at this point, then the patient's next risk is extremely high, and it is very likely that all unpredictable risks such as cardiac arrest will occur.

   "Lu Chenjun..."

   Before Kenji Yamada could finish speaking, Lu Chen said directly, "The operation cannot be suspended, it must be continued!"

  The risk of surgery must be considered, but when the life safety of the patient is threatened, the main thing is to save life!

   "Huh?" Yamada Kenji was stunned.

   Does Lu Chenjun want to be an African chief so much?

  Forcibly performing TAVR surgery at this time, the risk of failure is too high!

   However, at this time, Lu Chen is the chief surgeon, and unless he stops the operation himself, no one can suspend his operation.

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

   He felt that he was being led by the system all the time, unable to jump out of this established circle.

  What if we jump out of the frame of the existing transfemoral 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, it is not easy to implant the valve, so what if it is directly punctured?

   "Yamada, you said that if I pierce directly, will the angle problem be solved?" Lu Chen looked back at Kenji Yamada next to him.

   "Direct puncture?"

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

   "Yes, not through the femoral artery, but directly through the apex of the heart!"

   When Lu Chen's words came out, Yamada Kenji was stunned.

   Directly puncture the apex of the heart and let the catheter be implanted in the aorta?

   And then implant the valve?

   This is such a bold idea!

   But there is no doubt that if the pericardiocentesis is really performed, the patient does not need to worry about the angle and displacement even if the patient has a severe transverse heart.

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

   A look of excitement appeared 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 that passes, that's a little more dangerous.

  …

   Yao Jie pushed the ultrasound machine in.

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

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

   "The Lunderquist reinforced guide wire after exchanging the head plastic, the 24F sheath was dilated, and the delivery device loaded with the J-Valve valve was sent to the aortic root through the reinforced guide wire."

  Lu Chen instructed Kenji Yamada.

  He opened the positioning piece and pulled it back into the three valve sinuses.

  The valves were released in sequence, and the position and function of the valve were assessed by angiography and TEE after valve release, and the delivery device was withdrawn after the lock wire was decoupled.

   "Withdraw the hardened guide wire under the protection of a single bend!"

  Angiography 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 indwelled and the chest was routinely closed.

   Surgery is over.

  The ECG monitor made by 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 there was only paravalvular leakage.

  …

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

   During the entire operation, the two of them were tense, and only then did they relax completely.

   Even Yao Jie, who was watching from the side, was feeling ups and downs.

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

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

   "Congratulations on becoming the new African tribal chief."

  Lu Chen: "..."

   To tell the truth, the gold mine can be left behind, but he will never marry someone!

   (end of this chapter)