MTL - I Can See Health-v2 Chapter 855 Bold approach (second more)

   Chapter 855 The Bold Technique (Second)

  Innovation is always the eternal topic of medical technology.

  Each new technique appears, which means that a clinical problem is solved.

   As the number one Mayo Clinic in the world, it has many innovations and discoveries.

   For example, the current ECMO machine and the division of various internal medicine departments are all derived from the Mayo Clinic.

   And today, in Mayo's cardiovascular intervention, can everyone witness the birth of a new surgical procedure?

   Facing the new technique, Lu Chen felt a very unfamiliar feeling.

   All the surgeries he has done before can be simulated and trained in the system simulation space.

   But now this "secondary operation of valve failure" cannot be simulated in the virtual space of the system.

   However, the more difficult the operation, the more motivated Lu Chen's fighting spirit!

  …

   in the operating room.

  Kebed, Lu Chen, and Kenji Yamada were all ready for the surgery.

   "Prepare for vascular puncture!"

  Yamada Kenji consciously carried out the puncture work.

   This is also the basis of TAVR surgery.

  Yamada Kenji's puncture surgery is extremely skilled, and he deserves to be a doctor who can come to Mayo.

   After puncturing the femoral artery, the catheter and guide wire were successfully implanted.

   The three of them don’t cooperate many times, but they are very tacit.

  Kebed, as the chief knife doctor, would immediately execute Lu Chen and Kenji Yamada every time he issued an order.

   Vascular puncture, catheter (guide wire) entry, it all went smoothly.

   Among the big coffees who were watching, everyone highly appreciated the cooperation of the three.

  Although Lu Chen and Yamada Kenji are both newcomers, they are definitely the best among their peers.

   "Everyone needs to cheer up!"

   When it was time to expand the balloon, Kebed had a serious expression and whispered to the two beside him.

   Aortic valve balloon dilatation is one of the important steps in surgery.

   Only after balloon dilation can the prosthetic valve be successfully delivered to the designated position.

  …

   The three of them immediately divided their work and cooperated.

"start!"

With   Kebed's order, the balloon dilation was officially started.

  Yamada Kenji quickly adjusted the temporary pacemaker frequency to 180 beats/min.

   The ECG monitor beside the operating table showed that the heart rate was over-paced.

   At this point, the patient's blood pressure dropped to 50~60mmHg.

  Lu Chen immediately performed filling and dilation of the aortic valve balloon catheter and DSA exposure.

   "Stop!" Kebed shouted again, and Lu Chen stopped what he was doing.

  Yamada Kenji adjusted the temporary pacemaker back to 60 beats/min.

  Balloon dilation ended.

  Three people closely observed the patient's blood pressure recovery, ECG waveform, and DSA images.

   "Everything is normal!" Lu Chen said slowly.

   The three of them breathed a sigh of relief this time.

   In patients without effective cardiac functional reserve, the dilation process can completely obstruct the left ventricular outflow tract.

  Some patients cannot tolerate it and may experience serious complications such as ventricular fibrillation and cardiac arrest.

   "Go on." Kebed's eyes flashed.

  After the aortic valve balloon was dilated, he reassessed the mean diameter of the aortic valve annulus to determine the size of the implanted aortic valve.

Lu Chen compresses the cleaned self-expanding valve to the minimum diameter with a gripper and a transfer tool, loads the diameter T ear into the T-shaped groove, and pushes the capsule cavity so that the outflow end of the stent is fully loaded into the capsule cavity, and rotates at a constant speed to control The handle completes the loading.

   "The stent valve is ready!" Lu Chen said slowly.

   "Received." Kebed nodded towards Lu Chen, "Ready to deliver the valve!"

  …

The delivery and release of the    valve is the key to the success of the entire TAVR procedure.

  Kebed began to slowly deliver the valve.

  Lu Chen was staring intently at the position of the valve.

   In addition, invasive pressure such as left ventricular and aortic pressure will affect the effect of the final operation.

  Yamada Kenji adjusted the transducer to "0" before and after valve release to ensure the accuracy of invasive pressure measurement.

   As time passed by, Kebed was unable to find the final location of the valve release.

   "I think it should be closer." Yamada Kenji suddenly said, "The status of the valve is a bit low."

   "No!" Kebed shook his head, "If you get closer, it is likely to resist the blood vessel. If the blood vessel is torn, the consequences will be too serious."

   Beside, Lu Chen has been observing the position of the old valve.

   He found that no matter how the valve was released, it was impossible to achieve perfection.

   The positions of the old valve and the new valve overlap in some places.

   "At this position, I think it's fine." Lu Chen said in a deep voice.

   "This is not good, I feel that paravalvular leakage may occur!" Yamada Kenji looked at Lu Chen suspiciously, "Once paravalvular leakage occurs, the patient's heart function will become worse."

  Kebed glanced at Lu Chen, "How did you think about it?"

  Lu Chen said slowly: "It's impossible to have a perfect position. Now this position can only be said to try to meet the conditions of all parties."

   "After the valve is released, we can evaluate the aortic regurgitation with echocardiography, and consider whether to re-balloon or valve-in-valve implantation based on the results, and prepare for valve-in-valve implantation!"

   "This..." Kenji Yamada was a little surprised, Lu Chen's ideas were wild.

  Others are trying to find the best position, but Lu Chen directly considers the remedy.

  Kebed hesitated for a while.

   He recalled Lu Chen's performance in the Fellow review.

   The operation of that operation surprised everyone.

   "Okay, listen to Lu Chen!"

  …

  When the valve was released, the expressions of the professors around were different.

   "This position is not good? The surrounding positions don't seem to be right?"

   "But I don't think there is a better position. The second surgery is different from the first surgery, and it is difficult to have a perfect valve release position."

   "These young people are really bold! It's impossible for another person to release the valve in this position, right?"

   on the operating table.

  Kebed has released the valve.

   "Pay attention to blood pressure and heart rate!"

   "Received." Kenji Yamada re-measured all vital signs of the patient, "Everything is normal!"

   At this moment, Lu Chen pushed the echocardiograph over.

   After valve implantation, the location of the ultrasound needs to be reassessed.

   Sure enough, the valve was not fully sutured, and paravalvular leakage occurred!

   However, Kebed, Lu Chen, and Kenji Yamada did not panic, and immediately began to prepare for the implantation of the "valve within the valve".

   But just when Kenji Yamada put in the second artificial valve, the alarm on the monitor on the operating table went off.

   "Oops, the patient's blood pressure has collapsed!" Kebed responded immediately, "Quick! Put on the balance fluid and pump another norepinephrine!"

   The nurse at the support desk was very quick and quickly connected the patient with medicine.

   Everyone is wondering, why did the blood pressure suddenly collapse?

   "Look at the monitor."

  Lu Chen suddenly pointed to the monitor on the operating table.

   ECG on the patient monitor, ST segment is significantly depressed!

   There are also updates

   (end of this chapter)