I Can See Health

   Chapter 942 Logo of Huaxia Cardiology Department

   Operating room.

  Gu Xinyue started preoperative anesthesia and drape.

   In this operation, the anesthesia method of the patient is general anesthesia.

After Gu Xinyue established venous access, Jin Miao began to puncture the right femoral vein.

   Beside him, Lu Chen performed a transesophageal echocardiography.

  This will be the first difficulty of this operation!

   That is how to determine the atrial septal puncture point.

   The patient's heart and structural morphology have undergone severe changes.

   The normal atrial septal puncture point is not so obvious.

   "Director, I... I didn't find the puncture point!"

  Jin Miao's face was extremely ugly.

   According to the routine operation, he could not touch the patient's atrial septum at all.

   After the patient's overall heart changed, he could not find the puncture site at all.

   Beside, Lu Chen is also constantly checking the patient's heart ultrasound shape.

   In the virtual space of the system in his mind, he kept deducing the correct operation method.

   Simulate various heart shapes and try to puncture the atrial septum.

   in a moment.

  Lu Chen already had a decision in his heart.

   "Jin Miao, you first determine the location of the puncture point on the Bi-bicaval section and the SAX-short-axis section!"

   "Okay Director, received!"

   Hearing Lu Chen's voice, Jin Miao followed his instructions and started the operation.

   "Afterwards, the distance between the puncture point and the mitral valve annulus was determined in the four-chamber view, and the general puncture height was 4-4.5cm."

   Jin Miao was slightly taken aback when she heard the words.

   Director Lu was able to tell all the specific data.

  Where did this data come from?

   In addition to being surprised, Jin Miao's hand movements were not slow at all.

   With the help of fluoroscopy and Lu Chen's reminder, he finally succeeded in puncturing the interatrial septum.

   "Okay, send the Superstiff wire to the left atrium immediately."

  Lu Chen's expression remained unchanged, and he continued to instruct Jin Miao to operate.

  After using the vascular sheath to dilate the femoral vein, Jin Miao introduced the guide wire into the 24F introducer sheath across the atrial septum to the left atrium.

  Through the 24F introducer sheath, the MitraClip valve clip system (CDS) was introduced into the mitral valve.

   Under the guidance of esophageal ultrasound, Jin Miao successfully reached the target position of the mitral valve and captured the flail valve leaflets.

   "Director, the patient's blood pressure has dropped!"

   Suddenly, Gu Xinyue said loudly from the side.

   "Pause surgery, dopamine, norepinephrine pump!"

  Lu Chen was slightly startled, and commanded the road in an orderly manner.

   The event I was most worried about finally happened!

   "Increase the pump speed now!"

   Meanwhile, he had the nurse push the IABP and ECMO machines over.

   These two machines are ready for further operation if the blood pressure cannot be maintained.

   The bedside ECG monitor is intermittently measuring the patient's blood pressure.

  Lu Chen monitored his vital signs at all times.

   "Are IABP and ECMO used?"

  Jin Miao asked nervously.

   "No hurry, stop the operation for observation first." Lu Chen shook his head slightly, "If the blood pressure can be stabilized, IABP and ECMO are not needed."

"it is good!"

   Catheter room and outside.

   Everyone stared at the changes in blood pressure.

   This operation focuses on the difficulty of the operation.

   More importantly, it is the successful removal of the patient.

   If the patient cannot tolerate the surgery, then everything is in vain.

five minutes later.

   The patient's blood pressure finally stabilized at 90/60mmHg.

   "Okay, the operation will continue." Lu Chen said, "I will perform an esophageal ultrasound first to check the position of the valve. You can follow my instructions."

   Jin Miao and Gu Xinyue nodded slightly.

  Lu Chen began to perform esophageal ultrasound.

   He kept adjusting the position and carefully observed the position and shape of the valve.

   "Okay, the position is okay, Jin Miao, you can release the valve."

  Jin Miao nodded with a hint of surprise on his face, "Yeah!"

   After repeated confirmation by transesophageal ultrasound.

  Jin Miao implanted a MitraClipXTR mitral valve clip in the mitral valve A2/P2 offset 1 area.

   "Wait a minute, I'll look at the position of the valve leaflets again."

   At this point, the second difficulty of the operation is how to adjust the position of the valve clamp.

  Lu Chen adjusted the position of the valve clamp on the X-plane plane.

   "Mainly locate the most obvious A2/P2 area of ​​PISIA!" He said to Jin Miao who was on the side.

"receive!"

  Jin Miao responded, and then, with the help of Lu Chen's operation, began to slowly locate.

  Lu Chen continued: "The joint view of the mitral valve commissure and the LVOT view were used to adjust the axial direction of the clip, and at the same time, the orientation and area of ​​the clip were observed on the 3D view."

  Jin Miao's technique, under the guidance of Lu Chen, became more and more proficient from the beginning.

  Esophageal ultrasound was performed again, and the inspection showed that the valve clip was in good position and the valve leaflets were firmly captured.

   However, at this moment, Lu Chen did not relax.

   He said slowly: "Capture the anterior and posterior valve leaflets at the A2/P2 offset 1, and gradually close the valve clip."

   "Okay!" Jin Miao replied while operating, "The valve clamp is in a good position, and the axis and orientation are ideal!"

  TEE showed that mitral regurgitation was significantly reduced to trace amounts.

The   3D view shows that the tissue bridge is continuous and intact, and the leaflet capture is stable.

  Lu Chen nodded with a smile, finally relieved, and said: "The average transvalvular pressure of the mitral valve is 2mmHg, and the multi-sections confirm that the clamping tissue is sufficient, and the Doppler waveform of the left upper pulmonary vein has returned to normal from the reverse."

  Jin Miao was relieved to hear Lu Chen's feedback.

The delivery of the    valve has already indicated that most of the operation is successful.

   Immediately postoperative ultrasound showed that mitral regurgitation decreased to a small amount.

  Colored blood flow indicated a small amount of valvular regurgitation, and a mean transvalvular pressure difference of 3mmHg was measured.

   The blood flow spectrum of the left upper pulmonary vein returned to the positive direction after re-examination, and the surgical effect was satisfactory.

   "Jin Miao, start to gradually release the valve clip system to withdraw from the body!"

"it is good!"

   This last step, although simple, is also very important.

  Jin Miao's every step is meticulous, afraid of the slightest mistake.

   "Take your time, don't rush." ​​Lu Chen instructed, "The most important steps have been completed, don't let the halberds sink into the sand here."

"Um."

  Jin Miao nodded slightly.

  With the assistance of Gu Xinyue, he slowly released the valve clip system, and then successfully withdrawn from the body.

  That's it, the whole operation is over!

   In the operating room of the catheterization laboratory.

  Jin Miao and Gu Xinyue were filled with joy.

   Lu Chen also had a smile on his lips.

  Although they were able to suppress their excitement, the people in the Cardiology Department of the Fifth Hospital of the Magic Capital outside the catheter room couldn't calm down.

  The crowd began to applaud unconsciously.

   The completion of this operation means that the Fifth Hospital of the Magic Capital has entered the ranks of the top hospitals in China.

  From TAVR, electrophysiology, to transcatheter tricuspid valve surgery, TEER surgery.

   In the fifth hospital of the Magic Capital, every operation performed by Lu Chen is a top-level operation in China and a first-class operation in foreign countries.

  Many Mayo people who were at the same time as Lu Chen were watching Lu Chen’s live broadcast at this time.

   Even in Mayo in the United States, Professor Debed was surprised.

   "As expected of Lu!"

  debde sighed in his heart.

   In his heart, the Cardiology Department of the Fifth Hospital of the Magic Capital in China has gradually become the symbol of Huaxia Cardiology Department.

   (end of this chapter)