"Can't do it?" After Xu Qiu sat down, he flipped through Miao Yue's medical records and said, "What can't be done?" Director Zheng pressed the remote control, and the patient's ultrasound image appeared on the screen in front. "Cardiac catheterization and angiography have indeed confirmed the shunt of pulmonary veins. Echocardiography, color Doppler blood flow and pulsed Doppler all found that the patient had a secundum atrial septal defect. Enhanced CT also found horseshoe kidney. The diagnosis of scimitar syndrome was completely confirmed. But... When we further examined, we found that the patient's pulmonary vein diameter was only about 5mm!" The faces of the people present were a little heavy.
The diameter of normal pulmonary veins ranges from 8 to 21mm. Clinically, artificial blood vessels have been widely used in the replacement of large blood vessels such as the aorta, and the postoperative effect is very optimistic. The pulmonary vein is naturally included in this list. But... Small blood vessels with a diameter of less than 6mm have always been one of the most challenging research directions in the field of cardiovascular intervention. It is even one of the key problems restricting the development of international small and microvascular intervention! If Miao Yue's pulmonary veins were normal, this problem would not exist. However... She has scimitar syndrome. Her right lung is underdeveloped, which even makes the pulmonary veins only 5mm in size, far below the standard of normal adults! As a result, the vascular replacement, which was originally only a little technically difficult, has suddenly soared to the point where "no one can do it"... Director Zheng said with some regret: "Small blood vessels have always been a difficult problem in cardiac intervention. No one expected that the patient's pulmonary veins would shrink to this extent. This operation cannot be performed!" Everyone looked at Xu Qiu. When they heard the news, they were also surprised, and more regretful. But, to everyone's surprise, they did not see a trace of surprise on Xu Qiu's face! Click-- On the seat, Xu Qiu gently closed Miao Yue's medical record, and said calmly: "I know this, and I am going to do small blood vessel replacement." Wow! This sentence caused an uproar in the conference room.
Director Zheng couldn't sit still any longer. He choked for a moment and then said in shock: "You expected it a long time ago?" "Yes." "You wanted to replace the small blood vessels from the beginning?" "Yes." Director Zheng's eyes widened. At this time, Xu Qiu still had a relaxed expression, as if he was just talking about the most ordinary topic of "hemostasis". This is a small blood vessel replacement... Why can you still be so calm? At this moment, Director Zheng realized that he really couldn't see through Xu Qiu! This kind of psychological quality makes people feel terrible! … After Xu Qiu nodded to indicate that it was okay, Director Zheng also waved his hand and agreed to carry out the operation. He is a decisive person. After choosing to trust, he will not do those tricks and immediately delegate power to Xu Qiu. Of course, two conditions were attached. First: the entire operation will be recorded and left to the Department of Cardiac Surgery as a treasure. Second: Doctors from the Department of Cardiac Surgery and the Department of Interventional Surgery are allowed to observe on the spot. These two points are not requirements for Xu Qiu. Which of his surgeries has not become a teaching video, and which one has not been crowded with people watching? Before the operation began, Xu Qiu went over the operation in his mind again. This operation was completely led by Xu Qiu, so the procedure was also different. The conventional surgical procedure for the treatment of scimitar syndrome is to cut the heart from the middle of the sternum with the support of the extracorporeal circulation machine, find the opening of the right pulmonary vein, and re-drain it to the left atrium through patches, gaskets, etc. Artificial blood vessels are used in the process. However, this traditional surgical method has great limitations. One is that it must be performed under extracorporeal circulation. Although extracorporeal circulation can maintain the oxygen and blood supply of tissues and organs throughout the body, it can also cause a series of complications. Such as metabolic acidosis, respiratory alkalosis; destruction of blood components; electrolyte imbalance; renal failure, etc. ... Among them, what Miao Yue can't tolerate the most is- damage to her already fragile lungs, causing pulmonary interstitial edema, and even perfusion of the lungs, etc. The second hazard is that the operation is very traumatic.
The most critical thing is that the gasket repair will cause venous return obstruction! Kong Huixia's surgery at that time actually used a gasket. But she had an intracardiac repair and had no primary disease. Her heart, lungs, kidneys, etc. were all well developed, and the chance of obstruction was very small. Even if it happened, a little obstruction would not be a big deal for such a big heart. But, Miao Yue's heart, lungs, and kidneys all had problems, and the vessels were small, so the lumen was narrow. Another obstruction would be a death sentence. Therefore, Xu Qiu chose a more difficult one - non-extracorporeal pulmonary venous anomalous drainage correction. The core of the surgery was naturally the artificial blood vessel replacement that had been mastered. In addition, since the patient also had an atrial septal defect, it had to be combined with an atrial septal defect repair. "Teacher, I'm here!" In the distance, Chen Qiao rushed over, blinking, looking forward to the next surgery. Xu Qiu also finished simulating the surgery at this time, nodded, and entered the staff passage. ... Half an hour later. In the operating room. Miao Yue on the operating table looked very nervous, and her tired and weak eyes looked around. This was her first time in the operating room. It was so different from the delivery room. The doctors standing around were all a little solemn. Miao Yue was too thin and in poor health. Most doctors would not dare to touch such a patient. I have to say that Dr. Xu was really skilled and courageous... Just then, footsteps were heard in the operating corridor, and then the airtight door was stepped on. All the doctors looked over at the same time, with a hint of expectation in their eyes. Miao Yue also turned her head and recognized Xu Qiu at a glance, with gratitude in her eyes. If it weren't for Xu Qiu, she might still be lying on the bed waiting to die! "Dr. Xu, thank you..." Miao Yue's voice was weak. Xu Qiu put on his surgical gown, came closer, and comforted him: "Sleep, you'll be fine when you wake up."
"Okay!" Miao Yue closed her eyes without any doubt. The anesthesiologist looked at Xu Qiu, After receiving the latter's instruction, he began to implement tracheal intubation and intravenous combined anesthesia. "Anesthesia is complete." "The operation begins!" Xu Qiu's voice was calm, giving people a sense of reassurance. He picked up the scalpel and followed the mark that had been made long ago, moving backwards along the fourth intercostal space from the side edge of the sternum. Pieces of muscle popped out. Cut the pectoralis major muscle. Cut the serratus anterior muscle. Then, rows of white ribs were exposed in front of him. On the side, the assistant held up the hemostatic gauze and looked at the instrument nurse in surprise. Then, the two looked at Director Zheng at the same time. This action was like a fuse, and then, the eyes of all the doctors in the operating room gathered on Director Zheng. Director Zheng: "Why are you looking at me?"
