Nineteenth Century Medical Guide

Chapter 237. 233. Repair of Heartbeat
Rogerini's situation is indeed a blessing in misfortune, the probability is very low.

To be able to go to the operating table alive, his luck has surpassed most of the wounded with heart firearms.While the bullet grazed the heart and shot into the back, it only caused a tangential injury to the heart and did not cause damage to other important anatomical structures behind the heart, which made him truly lucky one in a million.

The anatomical structure behind the heart does not have a fuel-efficient lamp except the lungs in the face of firearm injuries.Whether it is the aorta or the esophagus, it is very troublesome to repair.

The esophagus may be better. It is close to the heart. After expanding the incision and lifting the apex of the heart, it can be seen after a little soft tissue separation, and there is still room for operation.However, the position of the thoracic aorta is much deeper. Once it is hit by a bullet, it is difficult to block it with fingers alone, and the difficulty of handling increases exponentially [1].

Of course, there are many wounded soldiers in Austria every day. Although such a situation is rare, as long as the sample is large enough, there will always be a few "Rogerini".However, it is impossible for the surgeons needed to cure these "Rogerini" to be mass-produced, at least in a short period of time, there is only Kawei alone.

There were many people standing around the operating table, and the voices of bad-mouthing heart surgery just now had dissipated, leaving only endless curiosity.

It is a pity that the exposure of the surgical window on Rogerini's left chest is limited.After accepting the observation of the four surgical personnel, it has become very narrow, unable to accommodate too many sightlines.

This makes it possible for only the few people standing in the front to see the operation clearly. Others who want to see the picture clearly must have a pair of good eyes and a good viewing angle in addition to having sufficient height.

This includes Bill Roth, who just banned heart surgery.

He never denied the feasibility of heart surgery because he himself tried it on animals with a low but not zero success rate.He has done this kind of experiment himself and knows that the success rate of surgery is low, so he questioned the necessity and safety of cardiac surgery.

In the inherent cognition of most surgeons, the extremely high-risk cardiac surgery is the limit of surgery, and there is no way to overcome this difficulty, just like Massimov believed that abdominal surgery was the limit of surgery.

At the Paris Surgical Congress just a few years ago, Bill Roth, along with several surgeons, set the tone for heart surgery that still rings in his head today [2]

"Mr. Billrot"

Bill Roth stared at the open surgical incision: "Don't look at me, I don't agree with heart surgery."

"Even if Rogerini was successfully treated by me, you don't agree?"

"That shows that his heart injury is not serious, and he can survive conservative treatment."

Carvey smiled and explained: "If there is no blood pressure and heart rate value, it is really difficult to judge his injury just by looking at the symptoms. But his vital signs are not stable, and there is a tendency to deteriorate further. To be honest, the pericardium With so many blood clots in the cavity and blood spilling out continuously, it might be too late for another half an hour."

Bill Roth is very stubborn, so stubborn that he still refuses to admit Carvey's "On Microorganisms".

But surgery is different. The surgical scene and anatomical structure are much more intuitive than microorganisms.Coupled with the value of vital signs that should not have appeared in 1866, the definition of shock, and the heterogeneity of Carvey, they are all changing Billroth's cognition.

Although he refused to admit it, in the past half hour, his belief and understanding of surgery were once again shattered.Bill Roth is no stranger to this wonderful experience that completely subverts cognition, because he had experienced it four months ago in the surgery stand at Michelle Square.

As for how long it takes to put it back together, it depends on whether the operation can really be completed and how well Rogerini recovers after surgery.

In Vienna, Bill Roth was able to overwhelm Karvey with his title of vice president, but now Karvey doesn't care about his opinion.In the fortress hospital, he had the final say, the thoracotomy went smoothly and the effect was obvious, there was no need to stop at all.

He dropped the lead bullet into the bend and asked, "Blood pressure and heart rate?"

"90/48, 127."

"It seems that our great imperial soldiers have recovered."

Carvey looked at the assortment of glass bottles on the infusion stand, and slightly reduced the dripping speed of the pituitary gland extract: "The bullet slowed down significantly after penetrating his left upper arm, so the injection position was not deep, and there was no sign of bursting. Now that the bullet has been taken out, the operation can be completed as long as the heart is sutured and the drainage tube is placed."

"It's crazy to actually have to suture!"

"It's unbelievable. It's hard to imagine how difficult it is to suture such a heart."

"Can this really be done?"

People around gave out all kinds of exclamations. Who would have thought that heart trauma, which was originally independent of surgery, would become a treatment item for surgery in the blink of an eye.

Unlike Bill Roth, who worked in big cities, many surgeons did not come from civilized and elegant Vienna.The Austrians they came into contact with often choose daggers or table knives when they quarrel, and the heart is the main target of attack.

"If traumatic cardiac injuries had been managed successfully, probably many people would not have died."

"It was truly an indescribable day, it was amazing"

That's what Kavi wanted, but it's not easy to suture the heart, at least not for Lucius right now: "Doctor Lucius, let's switch hands again, and let me plug the rupture."

Lucius's spirit was highly concentrated, and his fingers kept feeling the rapid beating of the heart.He also questioned the rationality and feasibility of opening the chest and suturing the heart before, but now that the surgeon's professional pursuit has occupied all his brain nerves, these are no longer a problem.

So exciting!
It's so exciting!
Don't want to let go, really don't want to let go!If possible, he was willing to just press on the breach and keep pressing.

After all, the heart is not an abdominal organ, it can obediently stop at its original position and let the doctor handle it.The heart in the living body is beating all the time, especially those broken hearts, the number of beatings must exceed 100. The high frequency has a great impact on the operation. Needless to say, you can feel it just by looking at it.

A cold corpse cannot reproduce the beating of the heart, and it is impossible to feel the beating of the heart on the corpse. In the 19th century, there was no extracorporeal circulation. If you want to learn how to suture the heart, in addition to using a lot of animal experiments, you can only practice repeatedly on the operating table.

For Lucius and the vast number of surgeons accompanying the army, it is impossible to contact animals next, and some only have wounded soldiers.

In fact, even if he returned to Grants, he didn't have much spare money to keep buying live animals for heart repair experiments.

If they want to gain experience, they need to start with heart repair surgery directly, but they have no experience in heart repair. Only by handing over the surgery to Kavi can the wounded survive, so this is an endless loop in a short period of time.

Now any operation touching the beating heart is a valuable experience and an important process of accumulating experience. The next time I encounter heart repair, I don’t know if I will have to wait until the year of the monkey.
"Dr. Lucius, Dr. Lucius!" Carvey interrupted his thoughts, "I know the feeling of pressing the heart is very interesting, but for Rogerini's health, I have to sew up the rupture as soon as possible." Row."

Lucius finally came back to his senses: "Um, I'm sorry"

The rhythm of exchanging fingers this time is very fast, and the proficiency that Kavey has trained outside the emergency department for many years is beyond their comparison: "Sarsen continued to stare at the incision of the xiphoid process, and Goram rinsed the surface of the heart with warm saline. "

"it is good."

"Lucius, use your fingers to help the two sides of the heart gap together, just like I did just now." Carvey waved to the nurse in the distance, "Give me the needle holder and needle thread, just use it The kind of chrome cotton thread you use to sew muscles together."

The heart is very important, but the tissue is still mainly composed of muscles. Apart from getting used to the beating of the heart, the stitching itself is nothing special.

The only ones to care about are the blood vessels that supply the heart, the coronary arteries.

The heart provides blood supply to the whole body and is also responsible for its own blood supply. The coronary artery is different from other organs and blood vessels in that it floats on the surface of the heart.If the heart rupture touches or is close to a coronary artery, the difficulty of suturing is different. 【3】

This is also the main reason why Carvey needs to flush the heart with saline. He needs to remove the blood on the surface and expose these coronary arteries as much as possible.

The result was not bad, the tangential injury above the apex grazed the edge of the distal left anterior descending artery, and did not damage the vessel.However, the wound is very close to the blood vessels, so special care must be taken when suturing.

"Stitching the heart is not that simple." Billrot asked suddenly, "How do you deal with the stitching? Do you just use needles and threads? If you really want to do this, I advise you to give up as soon as possible."

Carvey understood what he meant: "Of course, not."

"Oh? Do you have any good ideas?"

The reason why Billroth's heart suture experiment was not very successful was because the beating heart brought great difficulties to the suture, and secondly, it was because the suture itself would cause damage.

In the 19th century, the operation time was short and it was difficult to deal with massive bleeding from cardiac trauma, so the operation was very rough, but the surgery of the 21st century has already solved this problem.Carvey called Sarson who had been helping to look at the incision under the xiphoid process: "You and Goram, take the surgical scissors, open the incision under the xiphoid process, and take some pericardium."

The two were puzzled and didn't know the reason for doing so.

"You want to cover the wound with a pericardium?" Lucius was more experienced than them, and seemed to have seen the function of the pericardium. "It may be easier to prevent blood from spilling out, and it is also more conducive to repair."

"No, the suture repair of the myocardium completely stops the blood."

Bill Roth realized Carvey's true purpose: "Do you want to use the pericardium to block the sutures and cut the heart?"【4】

Carvey smiled: "The teacher is right. The heart is constantly beating, and the sutures need to bear a certain amount of tension, which can easily damage the tissue at the suture. After all, it is the heart. If there is a problem with the suture itself, after the operation There is a good chance of winning a second rupture."

"Using pericardium to make spacers" Bill Roth never thought about this method, "Is it really feasible?"

"It's feasible, I tried it on animals (actually I didn't)." Carvey fooled the past with the sentence "the experiment has been done", "After you cut off the pericardium, cut it into small squares of 0.3*0.3, I need Pad them over the seams."

The texture of the pericardium itself is not soft. It needs to be flattened and then sandwiched between gauze and soaked in carbolic acid for 5 minutes, and then rinsed with normal saline three times before it can be used.

And then threading them into the suture piece by piece is also a delicate job, which took a lot of time for several assistants.

"We do interrupted mattress sutures for full-thickness myocardium." Carvey carefully held the needle holder in his hand, and with the help of Lucius to close the tear, he slowly moved his finger down, exposing one end of the tear, "From the rupture The mouth should not be too close or too far away, and the surrounding coronary arteries should also be taken into consideration.”

Under the beating of the heart, the needle tip of the suture pierced into the surface of the heart, crossed the underlying myocardium, and penetrated into the muscle on the other side of the tear.Lucius' technique is very good, knowing that Carvey does not have an auxiliary left hand, he immediately uses the forceps to support the heart, helping the needle tip to penetrate the muscle.

Kavey's left index finger needs to stabilize the rupture while his right hand is suturing, and the suturing can only be handed over to one assistant: "You do the suturing."

Lucius knew very well that this was his opportunity to practice.

He gently leaned the sterilized spacer against the heart wall, relaxed his hands, followed the rhythm of the heart, and entangled the sutures at both ends, tightened them, entangled them again, and tightened them again: "One knot, two knots .Three knots, done."

Carvey carefully observed the surgical knot, and it was beautifully done.

He quickly moved his finger down again, revealing the middle of the rupture: "Strike while the iron is hot, continue"

The operation, which began with a wrong incision, was completed in just an hour.Compared with the three-hour abdominal surgery, the intensity and difficulty of heart repair are not low, and this time seems unreal.

Rogerini was out of the crisis caused by cardiac tamponade the day he was admitted to the hospital.

"The suture is good." Carvey looked at the three surgical knots on the surface of the heart, praised him, and continued, "Take some saline and rinse it to see if there are any other ruptured wounds."

The next step was simple finishing work. Carvey listened to the vital signs three times repeatedly, and checked the stock of the drugs used. After confirming that Rogerini's body was fine, he got off the operating table.

"The heart repair is complete, and the operation is over."

He took off the leather skirt and gloves in front of him, and walked towards the door of the operating room: "Don't look, the rest is just suturing the skin of the muscles. If you are fine, you can follow me now. We have time in the morning. It’s just a good time to review this operation.”

(End of this chapter)