Start From Emergency Doctor

Chapter 393

In addition, there are cardiac color Doppler ultrasound, left ventricular angiography, and coronary angiography. The operation can only be performed after detailed understanding of left heart function and aortic valve disease.

The only thing that is fortunate is that Zhao Qiang does not smoke. If smokers want to undergo aortic valve replacement surgery, they must quit smoking for more than ten days before surgery… Zhao Qiang has no time to wait for ten days, let alone ten days, two days or three days are possible. Killed him.

Another point is the anti-arrhythmic drugs. Because Zhao Qiang was onset in time, he could only take one day today, and the operation would be performed immediately on the next day. The delay in the start of the operation became more dangerous.

One week before the operation, GIK solution was needed to protect the myocardium intravenously, but now it is obviously impossible to continue to wait. I can only use one day’s amount temporarily, and I can barely perform the operation.

He Jianyi, Deputy Director of Cardiac Surgery, and Lu Chenxi did not return to their posts, but followed Zhou Yuan all the way in silence.

He Jianyi’s face is complicated: “Zhou Yuan, can you also do aortic valve replacement surgery?”

After asking, He Jianyi regretted it. It seems that he asked the same before, right?

The deputy director of cardiac surgery has consciously kept silent.

Aortic valve replacement surgery is actually not too difficult in principle, but after all, surgery is performed on the heart. The heart is the most important internal organ of the human body. It is bloody and moves around, so the risk of surgery is very high. Large, even the operation difficulty of aortic valve replacement surgery is also higher.

Zhao Qiang’s current cardiac function is very poor, which naturally makes the operation more difficult. This is why the deputy director of cardiac surgery wants Zhao Qiang to be transferred…

“The detailed report has come out.” Lin Wen, who had gone to fetch the inspection results, ran back at this time.

Zhou Yuan took it and looked at the film carefully.

The main pathophysiological change of aortic regurgitation is the increase in left ventricular volume load. When the left ventricle receives the extra blood volume from the aortic regurgitation during ventricular diastole, the magnitude of the regurgitation is mainly related to the degree of insufficiency and the time limit of the diastolic period. , And the pressure difference between the left ventricle and the aorta.

The greater the pressure difference, the greater the regurgitation volume, and the more serious the aortic valve insufficiency. According to Zhou Yuan’s angiography, the patient’s aortic valve regurgitation has exceeded 50% of the left heart stroke volume!

This means that half of the left heart stroke has blood reflux!

A large amount of reflux caused a sudden increase in the pressure of the left atrium, and the atrioventricular of the heart was naturally also under tremendous pressure…In short, the situation is not optimistic!(Read more @ wuxiax.com)

“Maybe I can’t wait until tomorrow. Let’s have an operation tonight.” Zhou Yuan said after a long time.

Zhao Qiang’s aortic insufficiency is more serious than he thought. As the course of the disease progresses, his left ventricular diastolic volume is overburdened for a long time, the myocardium increases compensatoryly, and hypertrophy occurs. At the same time, myocardial fibers are elongated by external force .

As the myocardial fibers elongated, Zhao Qiang’s left ventricular contractility increased accordingly, and myocardial oxygen consumption also increased, but myocardial compliance decreased. The left ventricular end-diastolic pressure increased significantly, and the end-systolic volume index increased. The ejection fraction and short axis shortening rate are significantly reduced, and the forward centripetal displacement is reduced…

This series of abnormal changes caused Zhao Qiang to experience changes in cardiac insufficiency such as reduced cardiac output. At the same time, the left atrial and pulmonary venous pressures are at risk of increased, and there may even be pulmonary edema!

All of this shows that Zhao Qiang can’t wait any longer, waiting any longer is just looking for death…

Zhou Yuan had already felt the expansion of the blood vessels inside and outside the chest cavity when he opened his chest for intra-chest compressions. This is one of the characteristics of aortic regurgitation, but Zhou Yuan thought it was caused by high blood pressure at the time and did not pay special attention. .

“A large amount of blood in the patient enters the underfilled arteries rapidly in the early stage of contraction, resulting in an obvious shock to the surrounding blood vessels… The blood vessels are under tremendous pressure, coupled with the lack of blood compensation in the patient’s left ventricle, hypertrophy causes the volume of the heart cavity to decrease. , Increasing blood pressure indirectly, his condition will develop very rapidly…”

“Soon, acute left heart failure may occur!”

The patient’s atria and ventricles are now under tremendous pressure, especially the left atrium and left ventricle, the main compression area, which is most likely to fail!

“It must be operated as soon as possible! Otherwise, the patient may die of acute heart failure in a short time!” Zhou Yuan said.

It seems that he still somewhat underestimated the seriousness of Zhao Qiang’s condition. At first, everyone wanted to have surgery tomorrow, at least to be fully prepared-surgery in any department cannot be performed at any time, and many require several days of preparation. , And even some major operations require months of preparation.

In addition, special departments like the emergency department often perform operations on the fly.

“I have had a very difficult aortic valve replacement operation before. The patient was 59 years old. His symptoms were occasional nighttime suffocation and shortness of breath after exercise. Finally, he was diagnosed with severe aortic valve insufficiency and moderate mitral valve closure. Insufficiency, follow-up examination revealed mild calcification of arteriography.”

“The patient’s age is older, the blood vessels are more fragile, coupled with calcification and complications, the difficulty of the operation has increased by several levels, but in comparison, it is far less difficult than Zhao Qiang!”

The implication is that the deputy director of cardiac surgery dare not accept this operation…

Zhou Yuan’s original intention was to be complete by himself. He closed his eyes and summoned the system.

“Exchange master-class aortic valve replacement surgery.” Zhou Yuan said calmly.

The next moment, the voice of the system suddenly sounded in Zhou Yuan’s mind.

“Get it! Master aortic valve replacement surgery!”

A large amount of knowledge and muscle memory about aortic valve replacement surgery instantly flooded Zhou Yuan’s body. The extraction of the aortic valve, the selection of replacement valves, the measurement of the valve annulus caliber, the sewing ring, etc. have gradually become clear.

Zhou Yuan let out a sigh of relief.

The surgical treatment of aortic insufficiency is the same as the aortic stenosis previously mastered by Zhou Yuan. There are also two surgical methods.

The first is valvuloplasty, and the other is valve replacement.

The former is an older operation. Before the advent of cardiopulmonary bypass, surgeons used valvuloplasty, which mainly included circumcision and bicuspid valve formation, but it was later discovered that this method could not improve coronary artery disease. Blood supply, high incidence of embolism, and serious complications such as thrombotic infection, did not continue.

Nowadays, valve replacement surgery is adopted, which is relatively high. It requires modern equipment, such as extracorporeal circulation machine, and also needs to use porcine aortic valve, bovine pericardial valve and other biological valves. These are all products of modern technology. Don’t even talk about extracorporeal circulation machines with the previous level of technology, even decent biological valves are not available. .