Start as an Emergency Physician

In addition, there are also cardiac color ultrasound, left ventricular angiography, coronary angiography, and a detailed understanding of left heart function and aortic valve lesions before surgery.

The only fortunate thing is that Zhao Qiang is not a smoker, and if a smoking patient wants to undergo aortic valve replacement surgery, he must quit smoking for more than ten days before the operation... Zhao Qiang didn't have ten days to wait, let alone ten days, two days or three days might kill him.

Another point is the anti-arrhythmic drug, because Zhao Qiang became sick in time, he can only take it for one day today, and the operation will be performed immediately on the next day - the longer the operation starts, the more dangerous it is.

One week before the operation, it was necessary to use GIK solution to protect the myocardium, but now it is obviously impossible to continue to wait, so I can only temporarily use the amount of one day and reluctantly go for the operation.

He Jianyi and Lu Chenxi, deputy director of cardiac surgery, did not return to their posts, but followed Zhou Yuan all the way, silent.

He Jianyi's face was complicated: "Zhou Yuan, you can also do aortic valve replacement surgery?"

After asking, He Jianyi regretted it a little, it seems that he asked the same question before, right?

The deputy chief of cardiac surgery was consciously silent.

Aortic valve replacement surgery is actually not too difficult in principle, but after all, it is operated on the heart, the heart is the most important internal organ of the human body, and there is a lot of blood, and it will move around, so the operation is very risky, and the operation difficulty of aortic valve replacement surgery is also high.

Zhao Qiang's current heart function is very poor, which naturally makes the difficulty of the operation skyrocket, which is why the deputy director of cardiac surgery wants to transfer Zhao Qiang to the hospital...

"The detailed report is out. Lin Wen, who went to get the test results, ran back at this time.

Zhou Yuan took it and looked at the film carefully.

The main pathophysiology of aortic regurgitation is the increased volume load of the left ventricle, when the left ventricle is subjected to additional blood volume by aortic regurgitation during ventricular diastole, and the magnitude of the regurgitation is mainly related to the degree of regurgitation, the duration of diastole, and the pressure difference between the left ventricle and the aorta.

The larger the pressure difference, the greater the regurgitation, the more serious the aortic regurgitation, Zhou Yuan judged according to the contrast that the patient's aortic regurgitation has exceeded 50% of the left heart stroke volume!

This means that half of the left heart beats out of the blood regurgitation!

The large amount of regurgitation caused the pressure in the left atrium to increase sharply, and the atrioventricles of the heart were naturally under tremendous pressure... In short, the situation is far from optimistic!

"I probably can't wait until tomorrow, so let's have surgery tonight. After a long time, Zhou Yuan said.

Zhao Qiang's aortic regurgitation was more serious than he thought, and with the development of the disease, his left ventricular diastolic volume was overloaded for a long time, myocardial compensatory increase and hypertrophy occurred, and at the same time, myocardial fibers were elongated by external forces.

With the elongation of myocardial fibers, Zhao Qiang's left ventricular contractility is correspondingly enhanced, myocardial oxygen consumption is also correspondingly increased, but myocardial compliance is reduced, the left ventricular end-diastolic pressure is significantly increased, the end-systolic volume index is increased, the left ventricular ejection fraction and short-axis shortening rate are significantly reduced, and the anterior centricity displacement is reduced...

This series of abnormal changes led to changes in cardiac insufficiency such as decreased cardiac output, and at the same time, the left atrial and pulmonary venous pressure were at risk of elevation, and pulmonary edema may even occur!

Everything shows that Zhao Qiang can't wait, and if he waits any longer, it's like looking for death...

When Zhou Yuan did intrathoracic compressions before, he had already felt the dilatation of the peripheral blood vessels in the chest cavity, which was one of the characteristics of aortic regurgitation, but at that time, Zhou Yuan thought it was caused by high blood pressure and did not pay special attention.

"The patient's large volume of blood rushes into an insufficiently filled artery in the early stages of constriction, resulting in a noticeable sensation of impingement in the peripheral vessels... The tremendous pressure on the blood vessels, coupled with the lack of blood compensation in the left ventricle and the hypertrophy of the heart chambers, which indirectly increases the blood pressure, will cause his condition to progress 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!

"Surgery must be done as soon as possible, otherwise the patient will die of acute heart failure in a short period of time!" Zhou Yuan said.

It seems that he still underestimated the seriousness of Zhao Qiang's condition, and everyone originally wanted to carry out the operation tomorrow, at least make sufficient preparations - the operation of any department cannot be carried out at any time, many need to be prepared for several days, and even some major surgeries require several months of preparation.

It is also a special department such as the emergency department that often performs surgeries on the spot.

"I had a difficult aortic valve replacement operation before, the patient was 59 years old, the symptoms were occasional nocturnal breath-holding, shortness of breath after activity, and finally diagnosed severe aortic regurgitation and moderate mitral regurgitation, and subsequent examination found that there was mild calcification of arteriography vessels. "

"The patient's age is older, the blood vessels are more fragile, coupled with calcification and concurrent syndrome, the difficulty of the operation has increased by several levels, but if you really want to compare, it is far less difficult than Zhao Qiang!"

The implication is that the deputy director of cardiac surgery did not dare to take this operation...

Zhou Yuan's original intention was also to be complete by himself, he closed his eyes and summoned the system.

"Redeem 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! Master Aortic Valve Replacement Surgery!"

A large amount of knowledge and muscle memory about aortic valve replacement surgery instantly filled Zhou Yuan's body, and the removal of aortic valves, the selection of replacement valves, the measurement of the diameter of the valve ring, the suture ring, etc. were gradually clarified.

Zhou Yuan slowly breathed a sigh of relief.

The surgical treatment of aortic regurgitation is the same as that of aortic stenosis that Zhou Yuan previously mastered, and there are also two surgical methods.

The first is valvuloplasty and the other is valve replacement.

The former is a relatively old surgery, before the advent of cardiopulmonary bypass technology, surgeons are using valvuloplasty, mainly including circumcision and valve bicuspid surgery, but later found that this method can not improve the blood supply to the coronary arteries, the incidence of embolism is high, and there are serious complications such as thrombotic infection, so it has not continued.

Now the use of valve replacement, the pressure is relatively high, with the help of modern equipment, such as extracorporeal bypass machine, but also need to use pig aortic valve, bovine pericardial valve and other biological valves, these are the products of modern science and technology, the previous technical level not to mention the extracorporeal bypass machine, even a decent biological valve.