Chapter 3652: 【3652】two words

   Chapter 3652 [3652] two words

  Here I want to talk about a problem. To deal with the same organ of the human body, there are many ways of interventional surgery. Especially the heart is a very special organ.

  The special thing about the heart is that its internal structure is responsible for the blood circulation center of the human body. On the other hand, it itself needs the nutrition and support of the blood system. Therefore, its internal structure connects the great blood vessels of the body to supply blood throughout the body, and the vascular system arranged outside its myocardium provides its own support.

  The doctor plans various intervention paths according to the needs according to the anatomical characteristics of the heart (again based on the anatomy of everything in medicine). In the last interventional operation, a stent was installed on this patient. The interventional path was to go to the coronary system on the surface of the heart, and the relative "external" vascular path of the heart was taken.

  The interventional operation to install a temporary pacemaker this time takes the "internal" path of the heart, and it needs to go to the inner structure of the heart to place electrodes.

  Why are the two paths different?

  It must be clear that the path of treatment is the purpose of treatment.

  The "external" vascular system was used last time to solve the "blocked" problem of the "external" vascular system last time.

  The electrodes are discharged this time to stimulate the myocardium. Under this therapeutic purpose, there is no advantage in going with the "external" system.

   To use an analogy, taking the "external" system is equivalent to walking an intricate alley (blood vessel) to knock on the wall (stimulate the myocardium) through the alley wall (vessel wall), and the knock point is obviously very restricted.

   In stark contrast, taking the "internal" path is like going to the room where the walls (myocardium) are (the ventricles and atria), knocking on all sides. My doctor can pick anywhere, pick the best place to hit the wall.

   Speaking of this, you may ask again, is it definitely not allowed to "knock on the wall" by taking the path outside the heart? Yes, surgery to place electrodes on the epicardium is just to "knock on the wall" by letting go of the surface of the heart.

   In this way, does the intervention of installing a pacemaker not take the "external" route at all? Nor is it.

   Pacemakers are divided into single-chamber, dual-chamber and triple-chamber pacing.

  Single-chamber pacing has only one electrode, and the electrode is placed in the right atrium or right ventricle.

  Why right atrium or right ventricle? Going back to anatomy, the pacemaker is installed through the body veins, such as the subclavian vein, etc., and the path through which the body veins lead to the heart is recycled to the right atrium of the heart by the superior and inferior vena cava.

  Dual-chamber pacing involves placing two electrodes, one in the right atrium and the other in the right ventricle.

   When it comes to three-chamber pacing, don’t forget that the left and right atrium and ventricle are not connected. If you want to go to the left side of the heart with another wire, you need to go through the "external" system, and go to the coronary sinus to stimulate the side wall of the left ventricle.

  The above can be simply understood as that the patient's entire cardiac myocardium may not be functioning well, and the doctor stimulates the heart in as many directions as possible in order to mobilize the entire heart to work.

  Multipoint electrode discharge surgery is the most complicated, so triple-chamber pacing is usually used in permanent pacemaker surgery.

  Currently, this case is in a rescue state, and what needs to be done is a temporary pacemaker operation. From this we can see the difference between a temporary pacemaker and a permanent pacemaker.

  Temporary pacemaker can be simply understood as a temporary shed, which can be dismantled after completion of the task only for temporary emergency use, or it can be a transitional measure, that is, a permanent pacemaker should be placed on the patient after withdrawal.

   Speaking of this, it can be understood that the failure of this intervention may have nothing to do with the "external" coronary system.

  Receiving Ren Zhelun's eyes, Shen Youhuan, the chief surgeon just now, stepped up and explained the situation: "She fell off."

  (end of this chapter)