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Remember [new] in one second! “Percutaneous hepatic vein puncture implantation?” Everyone was shocked.

Compared with other paths, this should be the most popular implantation path.

On the podium, Xiao Shikang said: "Dr. Lu is the surgeon of this patient. During the first operation, the two of us performed it together."

Everyone's attention shifted to Lu Chen.

Most of the doctors present knew him.

Although Lu Chen was just an outside doctor, his performance in the cath lab during this period was obvious to everyone.

Not only did he successfully complete dry pericardiocentesis, he also went to Kyoto Central Hospital as a hospital representative to assist in the operation.

This is a topic of conversation after dinner, and is talked about by many people.

Qin Sifeng frowned after listening to Lu Chen's speech.

"Percutaneous hepatic vein puncture implantation, we rarely use this route." Qin Sifeng glanced at Lu Chen, "I remember that Western Sichuan Medical College once used this puncture route. They were the first in the world at that time."

"Yes." Lu Chen nodded, "After I went back, I looked through the literature and found a case report published by Western Sichuan Hospital two years ago. They had used this percutaneous hepatic vein puncture implant to treat a patient with upper respiratory tract disease. Patients with vena cava obstruction.”

"I know the case you are talking about. I was consulted remotely in Western Sichuan at that time." Qin Sifeng frowned, "But do you know, Lu Chen, that although the method you mentioned is feasible in theory, it is difficult to operate in practice?" Extremely high!”

After everyone heard Qin Sifeng's words, they also started talking.

Fang Ruzhang frowned deeply: "Subclavian and superior vena cava puncture is a short path and only needs to go through one curved arc, but implantation through the hepatic vein not only has a longer path, but also needs to go through three arcs in a row!"

The difficulty of operating an arc with three turns is exponentially higher than that of an arc!

Another doctor said: "I think it's better to have more arcs. If you try a few more times, you should be able to pass. But the most difficult thing about transhepatic vein surgery is that the entire path requires backhand operation. This kind of backhand operation Skills, everyone probably has little experience, right?”

There are few opportunities for surgical training in normal times, and we almost never encounter this situation. Who would deliberately train the backhand operation?

At this time, Qin Sifeng added fuel to the fire, "Actually, there is another problem that you may not have noticed. This operation not only involves the implantation of a pacemaker, but also the implantation of an ICD. It is implanted through the hepatic vein. icd? I have never seen such a case..."

Everyone was talking about it, and Lu Chen's proposal of "transhepatic vein puncture and implantation" was quickly rejected.

Theoretically it is possible, but in practice it is extremely difficult!

Lu Chen moved his lips, wanting to say something, but gave up.

He really wanted to shout, "I want to try transhepatic venipuncture."

However, the doctors present were much richer than him in terms of clinical diagnosis and treatment experience and interventional surgery experience.

When he shouted like this, he was overestimating his abilities.

…

Half an hour later, the cardiology consultation ended.

Everyone did not come to a good conclusion through discussion, so they could only postpone the surgery for the time being and conduct conservative treatment with drugs.

Lu Chen didn't have any solution. He read the literature all night and finally came up with a solution, but it was not recognized by everyone.

However, Lu Chen was not discouraged.

Since it is possible to use this "percutaneous hepatic vein puncture implantation" skill, he can just train in the system's virtual space.

In the system's virtual space, Lu Chen set the surgical simulator to a situation similar to reality.

The superior vena cava was occluded and transhepatic vein puncture was performed instead.

…

In the blink of an eye, two days passed.

Three zones in the heart.

Fang Ruzhang looked at the patient in front of him, anxious.

The old man just suffered from heart failure again!

This was also his fourth episode of acute heart failure in three days.

"Doctor, how is my dad's condition?" A middle-aged family member of the patient came to the office and asked proactively.

Fang Ruzhang shook his head slightly: "The old man's condition is not very good, as you can see. He has only been in the hospital for a few days, and he needs to be rescued at least once a day."

"How could this happen?" The middle-aged man's face was full of worry and confusion.

"If the heartbeat slows down to less than 40 beats/minute, there is a risk of sudden death." Fang Ruzhang explained, "Your father's heartbeat has long pauses due to his dependence on pacing. At the same time, his heart also has potential for cardiac arrest. In the case of rapid heart disease, the ejection function of a normal person's heart is above 50%, but it is already below 25%."

The middle-aged man sighed deeply, then raised his head and stared at Fang Ruzhang, saying, "You are one of the top cardiologists in the country. You have been discussing for so many days and you still can't come up with a feasible plan?"

When Fang Ruzhang heard this, he felt bitter in his heart: "Don't worry, we have a general consultation in the Department of Cardiology."

"What's the use of just a general consultation?" The middle-aged man frowned, "What we need is a treatment plan!"

"Don't worry, we will do it as soon as possible." Fang Ruzhang talked to the patient's family and finally calmed down his emotions.

Fang Ruzhang also understood very well that anyone whose father was lying sickly in bed would only be in a worse mood than him!

"Hey, the operation can't be delayed any longer!" Fang Ruzhang thought to himself.

Thinking of this, he immediately started to contact Qin Sifeng on the phone.

"Professor Qin, about the patient with superior vena cava obstruction..."

Before Fang Ruzhang finished speaking, Qin Sifeng said, "I know, the dean called me just now. The patient's family must have found a connection and told him about it. The dean asked us to come up with a solution as soon as possible."

"Oh, the leaders above are really something." Fang Ruzhang was a little helpless, "As soon as they talk, we are in trouble. This solution is not that easy to come up with!"

Qin Sifeng was silent on the other end of the phone.

Fang Ruzhang thought he had hung up, and was about to hang up when Qin Sifeng's voice came again: "Xiao Fang, go apply for a remote joint consultation for the patient from Sichuan West Medical College, Zhongshan Medical College, and Shanghai Medical College."

Fang Ruzhang was stunned, "Professor Qin, joint consultation? Are you preparing for surgery?"

Qin Sifeng sighed, "Whether the dean talks about this today or not, I have actually thought about it. We can't just sit and wait for death because of the risk issue and continue to drag it out. We must take the safety of patients' lives as the primary principle! After the joint consultation, come up with a specific surgical plan, and we will start to implement it!"

"Okay!" Fang Ruzhang said.

After hanging up the phone, he immediately began to contact the hospital's medical department.

Let the medical department come forward and notify the external hospital to conduct a remote joint consultation with multiple hospitals.

...

Because of the dean's order, this joint consultation ended quickly.

That afternoon, the joint diagnosis and treatment plan of major hospitals was released.

After intense discussions, major hospitals, led by Sichuan West Medical College, unanimously recommended the use of the "transhepatic vein puncture and implantation" plan!

This is exactly the plan proposed by Lu Chen, and it is also the most compromised surgical plan at present.

Because other paths cannot be used, only "hepatic vein puncture" can be used.

The only disadvantage of this operation is that it is difficult!

So, Qin Sifeng came up with an idea.

Before the formal operation, a small-scale simulated surgery evaluation will be held in the catheter room.

The person with the highest surgical proficiency will have the opportunity to become the first assistant of the operation and participate in this operation.

As soon as this notice came out, all electrophysiological interventional doctors in the cardiology department began to gear up.

For such a difficult operation, it may not be possible for them to be the main surgeon.

But if they are an assistant, then they can still do it.

If it succeeds, they can also get a reputation.

This may be the world's first case of simultaneous implantation of ICD and pacemaker through the hepatic vein!