Chapter 3653: 【3653】too difficult
Chapter 3653【3653】Too difficult
Two words, as long as an insider hears the key words, they don't need to say anything, and they can understand it in seconds.
Thinking about it, how to do internal fixation has always been a big problem for this kind of interventional surgery.
Through the tiny blood vessels, would you like to put forceps, needles and thread in surgery for suture? We need to wait for breakthroughs in basic disciplines such as physics and materials science before imagining.
How to fix without stitching?
The doctor borrowed common sense from life.
For example, when there is a flood to save people, how do firefighters throw a rope in the water and fix the other end of the rope?
There are methods, such as making a circle with the rope and throwing it to a place where there are stones and other fixed objects in the water flow to tie it.
Sometimes the rope fails to float back when the throw fails. It turns out that the other end of the rope falls into the vortex at the opposite corner, and the other end of the rope will be stirred by the vortex.
These little common sense of life are all used by doctors for interventional surgery.
Through the description of the two methods, you will find that no matter which one you want to fix the foundation, you must have a point that allows the rope to be easily hooked.
After all, the firefighters took advantage of the terrain. Physicians need to borrow the topography of the patient's own heart structure.
For some patients, the terrain is different from ordinary people. If they are not good enough, the operation will be over naturally.
Shen Youhuan has to explain a few more sentences about this, and elaborate on his own failure: "The last time the patient came for a heart checkup, he gave the patient an echocardiogram."
Echocardiography, electrocardiogram, or interventional coronary stent surgery are not strong points in the detailed examination of the heart and myocardial structure. It is like the case in Seoul that the patient should be given a heart MRI examination. Since the patient did not have symptoms such as cardiomyopathy before, the doctor did not pay attention to this aspect, so he did not prescribe such a test.
It just so happened that the electrodes were placed in this operation. If the electrodes are placed in the right ventricle, the doctor needs to adopt the active fixation method mentioned above.
The anatomical feature of the right ventricle is that there are abundant structures such as spines and trabeculae on its internal surface, such as multiple small piles, and the steel wire head is made into a circular sleeve, which is very easy to fix.
As mentioned above, cardiac magnetic resonance is required to check for trabecular problems, so Shen Youhuan and the others did not know that the internal surface structure of the right ventricle of the patient might have changed before the operation.
It is very likely that the patient’s physical indicators have deteriorated severely due to his advanced age, and the trabecular spine at the apex of the right ventricle has shrunk, and the electrical activity has decreased. In this way, the doctor can’t set the electrodes and can’t stimulate them, which leads to the failure of the operation.
It cannot be placed in the right ventricle, but it can be placed in the right atrium.
The right atrium also fails. The right atrium does not have the trabeculae like the right ventricle, but it does have the right atrial appendage. For ordinary people, the steel wire sends the electrode to the right atrial appendage and the right atrial appendage hooks the electrode.
The problem today is blind insertion. Without fluoroscopy, the doctor must be lucky if he wants to accurately send the wire to the right atrial appendage so that the right atrial appendage can be hooked. If the right atrial appendage is not used, under conventional surgery, the doctor can use another method to actively fix the pacing lead on the wall of the right atrium. The feature of this active fixed pacing lead is that there are screws on it, which are placed on the selected atrium wall and twisted to screw the electrodes on. In the same way, do you dare to mess around without perspective for the blind insertion done today?
(end of this chapter)
