Chapter 401 Xu Qiu, you are not a human being!
Under the surgical field, a large amount of yellowish liquid can be seen in the pericardial cavity.
The ascending aorta has been twisted, and a large piece of it bulges outward, presenting a tumor shape.
This is also the reason why aortic dissection is called aortic aneurysm.
Elsewhere, the root of the aorta is significantly thickened and the left heart is significantly enlarged.
Of course, the most shocking thing is still the ascending aorta.
Its intima has been peeled off, and the root has been torn to the junction of the right and non-coronary sinuses. The further tear is located on the inside of the opening of the left subclavian artery.
In fact, the aortic vascular wall is torn open, and a false cavity is regenerated next to the original vascular cavity.
Moreover, as the disease is delayed, the violent blood flow will gradually impact the false cavity, causing the vascular wall to be torn more severely, and the danger and mortality rate will soar.
At this time, the patient is already on the verge of death.
The average person's blood vessel wall is as thick as twenty pages of paper, but because Lv Guilan's dissecting aneurysm was too large and the blood vessel wall was stretched like a balloon, the wall was only about one page of paper thick.
Such a thin and fragile blood vessel, not to mention coughing, turning over, etc., even deep breathing may cause the dissection to tear further and cause heavy bleeding and death!
"Fortunately, emergency surgery..." Director Zheng's face was covered with sweat.
Yang Chenxi also stared with a fear.
If the conventional treatment procedures were followed, CTA, MR and other examinations were done slowly, and then a perfect surgical plan was discussed, the patient might have died from the next heavy bleeding!
"Don't be too happy too soon." At this time, Joseph snorted coldly.
Let's not talk about Bentall and modified aortic arch replacement for the time being. Can such a dangerous aneurysm dissection really be successfully relieved?
"Doctor Xu, can it be done?" The director of the interventional center came up.
For aortic aneurysm, there are three clinical treatment options.
One is conservative medication.
It is a surgery to repair or replace the ascending aorta.
The third is intravascular interventional treatment, which is also called minimally invasive intravascular isolation.
During the famous knife competition, Xu Qiu had performed a combined operation of lower limb reconstruction + minimally invasive intravascular isolation, and the patient used stent intervention.
The director of the interventional department was called in for this operation, and the factor that the operation might be converted to minimally invasive was also taken into consideration.
"No, the intimal tear is too large and the vascular wall is too weak." Xu Qiu shook his head.
"Then..." The director of intervention was stunned.
To prevent aneurysm rupture, the first choice must be intravascular isolation.
Although the location and shape of the aneurysm expansion are not suitable for isolation, it is safer than surgery...
Xu Qiu's expression has become more solemn.
The director of intervention is indeed right.
If it is the original aortic arch replacement, it is indeed extremely dangerous, and the safety and efficacy are definitely not as good as intravascular isolation.
But...
He did a modified replacement!
Moreover, not only the aortic arch replacement has been improved, but even the Bentall procedure has been improved by Xu Qiu!
"Prepare for the triple procedure and start deep hypothermic extracorporeal circulation."
When the words fell, everyone was stunned at first.
Deep hypothermia during the operation? Sure enough, we still have to do a SUN-style operation!
After a brief hesitation, the operating room immediately resumed operation.
Cold blood cardioplegia was infused through the left and right coronary arteries to stop the heartbeat and protect the myocardium...
Deep hypothermia...
Block the brachiocephalic trunk vessels to stop the circulation...
Selective cerebral perfusion and cerebral protection...
Deep hypothermic extracorporeal circulation was completed, the aorta was successfully blocked, and Xu Qiu, who had been waiting for a long time, lightly dropped the scalpel.
Wow——
The aneurysm dissection was cut open.
Because the blood flow was blocked, the aneurysm had no blood supply pathway at this time. After absorbing all the blood flow in the false lumen, it shrank down.
On the other side, Yang Chenxi skillfully blocked three brachiocephalic vessels.
Everything was ready, and the Bentall operation began!
Cut open the aneurysmal ascending aorta...
Remove the diseased aortic valve...
"28mm artificial blood vessel."
"ST Jude No. 25 artificial mechanical valve from Meiguo."
"Linhai small blood vessel, A4 subtype."
Xu Qiu stared at the surgical field, and everyone in the operating room was like a skilled worker on the assembly line, performing their own work.
Soon, the valved conduit was prepared, and Xu Qiu inserted it into the resected diseased aorta.
"3/0 prolene line."
Continuous suture that was easily pinched.
"Valve tester."
This is a device to test whether the artificial valve leaflet can function normally.
"It's done!" The young nurses cheered.
However, Joseph, Yang Chenxi, Director Zheng and others stared with disbelief on their faces.
This is... Bentall procedure? !
How can this be a Bentall procedure!
What the hell is the Linhai small blood vessel that came in randomly? Shouldn't it be used in the next step?
"Xu Qiu, this..." Joseph finally couldn't help his curiosity.
Xu Qiu glanced at it and said casually: "I have also improved it."
"Improved? How did you improve it..."
"Using small-caliber artificial blood vessels and coronary artery anastomosis can avoid complications such as postoperative malignant bleeding and pseudoaneurysm, and avoid the natural shortcomings of Bentall's procedure."
Joseph and other famous doctors all stared with their eyes wide open.
Are you still human?
A procedure that has been widely used in clinical practice for a long time, can it be improved just like that?
The shortcomings that have plagued the medical community for so many years have been solved easily? !
How come the Bentall procedure has been improved before the improved aortic arch replacement has been seen?
Moreover, even if others know the method, they can't learn it at all.
One is that the end-to-end anastomosis of small blood vessels and coronary arteries places extremely high demands on suturing ability.
If there are some defects in the suturing, or there is tension, misalignment, etc., not only can the original shortcomings not be avoided, but more complications will be brought.
Second, the small blood vessels in the sea are not something that can be taken out casually...
Although it will be put on the market later, its price is not cheap.
Daxia is okay, only 30,000.
But in countries such as Meiguo and Xiaorizi, it may go up to 60,000 or even 80,000 or 90,000.
This is definitely not an expense that can be easily afforded.
And the only way to do the modified Bentall procedure is to use this small-caliber blood vessel...
Joseph suddenly thought of another question, "You signed the surgery, and the patient was in a coma throughout the whole process. Can she afford the postoperative expenses?"
Lv Guilan's son killed a pedestrian on the spot, and three other passers-by were seriously injured, and seven were slightly injured. In addition to Joseph, the compensation alone was a very exaggerated figure.
After paying the money, can she still pay for the surgery?
"I don't know."
Xu Qiu didn't even raise his head. At this moment, he didn't care about other things and was immersed in the surgery.
With the completion of the Bentall surgery, it was time to do the modified total aortic arch reconstruction + stent elephant trunk surgery.
Xu Qiu took a deep breath.
Two-in-one surgery is extremely difficult.
After the improvement, the complexity and precision of the operation have reached an unimaginable height.
The SUN surgery alone has surpassed heart transplantation in terms of surgical difficulty and risk.
What's more, Xu Qiu made great improvements to two of the three procedures based on the SUN surgery!
It can even be said that this is the most difficult surgery Xu Qiu has ever performed.
Approaching the perfect cranial brain separation.
"Ding."
At this time, the sound of the system suddenly sounded in the quiet operating room.
