Doctor Peerless

Chapter 661 Which valve to replace

Central hospital.

In the office of the director of heart surgery, a big test is beginning.

The examiners are three directors and one dean.

Two of them were old fellows from cardiac surgery.

If you don't have some skills, it is simply impossible to fool the past.

Even if you have some skills, you will inevitably be nervous under this kind of aura.

But Zhou Sheng was as calm as water.

The strength is as high as the sky, so naturally don't panic.

Zhou Sheng said: "Through the previous films and examination reports, it was found that the patient had all valve lesions, common rheumatic heart disease, mainly damage to the mitral valve. At present, the patient is more like Ludenbach Syndrome sign."

"The initial problem should be the beginning of the mitral valve. Since the right ventricle is significantly larger than the left ventricle, as the degree of stenosis gradually increases, it will lead to the rapid development of pulmonary hypertension, right ventricular hypertrophy, and progressive enlargement of the right heart, thereby affecting other valves..."

The four people present have been practicing medicine for many years and have rich clinical experience.

Even Fang Jianzhang and Dean Cheng know a little about clinical heart disease.

Now listening to Zhou Sheng's condition analysis, both of them nodded frequently.

Director Tian and Cao Xiangwen are experts here, and they naturally understand what Zhou Sheng said.

Although ordinary rheumatic heart disease has damage to the valves, it is generally not so serious that all four valves are broken.

Ludenbach syndrome is much more complicated than rheumatic heart disease.Clinically, it is also relatively rare. Long-term illness can cause irreversible multi-valvular damage.

"Now the patient has palpitations and paroxysmal dyspnea. It seems that the disease has entered the terminal stage. The only feasible way is to replace the whole valve."

Speaking of this, Cao Xiangwen said coldly: "We all understand this truth, but this operation has never been done before, and you have also seen that the patient's physical condition is very bad. How to ensure the safety of the operation?"

In the face of Cao Xiangwen's aggressiveness.

Zhou Yisheng responded in a deep voice, "Surgery, no one can guarantee that it will be foolproof. Especially a difficult operation, but we can only carefully plan the preoperative plan and fight hard on the operating table. Of course, for safety, so I just asked Director Tian to go on stage with you. Only in this way can the safety of the operation be ensured."

Zhou Yisheng's words were extremely embarrassing to Director Tian and Cao Xiangwen.

At this time, Cao Xiangwen is not easy to make trouble.

He looked at Fang Jianzhang beside him.

Fang Jianzhang said at this time, "Xiao Zhou is right. As a family member and as a doctor, I support him. I believe that there should be no problem with the joint operation between Director Arita, Director Cao and Xiao Zhou."

Seeing Fang Jianzhang, Cao Xiangwen also made a decision.

He had no reason to object.

He also knew that if it was a joint operation, he would definitely not undertake too many surgical tasks.More of my roles should be secondary assistants and the like.

If something goes wrong, there is no responsibility for it.

What follows is a discussion of specific surgical details.

From preoperative examination to selection of surgical approach.

Along the way, we talked about the choice of artificial valve during replacement.

This is a very professional thing for valve replacement.

Fang Jianzhang and Dean Cheng are completely ignorant.

Only Zhou Sheng, Director Tian and Cao Xiangwen have the right to speak.

At present, the more popular artificial valves are divided into two types: mechanical valves and biological valves.

Mechanical valves are made of metal and have a long service life, usually more than 35 years. The price is relatively low, but they need to take anticoagulant drugs for life.

Biological valves are generally extracted from animals, and have a short service life, generally no more than 15 years. They are more expensive than mechanical valves, but they do not require anticoagulant drugs.

Cao Xiangwen's opinion is to use biological valves.

There is no need to take anticoagulant drugs, and the service life of more than 10 years is enough for the elderly.

Director Tian didn't make a decision right away, because if this kind of large-scale heart surgery was successful, it would be almost impossible to do it again in 10 years, considering the patient's age.

Although the patient is relatively old now, only 70 years old, and there is no contraindication for anticoagulation.Replace the mechanical valve, once and for all.

While hesitating, Director Tian also gave his own opinion.

Both Director Tian and Cao Xiangwen have no experience in total valve replacement.

They are completely based on the service life of the artificial valve in the previous single valve replacement.It is not considered comprehensively.

Zhou Sheng was not. In the dungeon, the operation must not only be successful, but also perfect.

For this reason, he did a lot of redo operations.

At this moment, Zhou Sheng was thinking more comprehensively and thoughtfully.

For total valve replacement due to Ludenbach syndrome.

Zhou was born on the use of artificial valves, which are both mechanical and biological!
This scheme has been verified countless times in copies.

It was Zhou Sheng's practical experience.

Director Tian and Cao Xiangwen were still hesitating whether to use a mechanical valve or a biological valve.

Zhou Sheng said directly: "I think the two valves should be used together!"

Zhou Sheng's voice fell.

Both Fang Jianzhang and Dean Cheng were stunned.

Director Tian and Cao Xiangwen were full of doubts.

Both of them were thinking, why should the two valves be used together? This is not a combination of the shortcomings of the two valves.

Both the mechanical valve and the biological valve are used, which means that the blood coagulation agent must be taken for life. After more than ten years, the biological valve is broken, and the biological valve needs to be replaced by open chest surgery.

This is completely stupid behavior.

At this moment, Cao Xiangwen was even thinking that Zhou Sheng would reveal his secrets this week.Sure enough, he is still a child who only knows some clinical skills, and he probably has never seen what an artificial valve looks like.

Thinking of this, he smiled contemptuously at Zhou Sheng.

Director Tian is much older, and he feels that Zhou Sheng has always performed very well, and he will definitely not make such a low-level mistake. Using the two valves together must have his effect.

Where does it work?

Director Tian, ​​who had never had a total valve replacement, couldn't think of it all at once.

Zhou Sheng didn’t give a shit, he explained directly: “I think it’s best to choose a mechanical valve with good durability for the left heart valve, and a biological valve with lower anticoagulation requirements and better hemodynamics for the right heart valve. The reason is: the left heart pressure is greater than that of the right heart, and the shear force of the mitral valve and aortic valve is greater than that of the tricuspid valve and pulmonary valve. The service life of the biological valve is closely related to the shear force. Both choose bioprosthetic valves, the degeneration rate of the left heart valve is obviously faster than that of the right heart, and the possibility of reoperation is high..."

Zhou Sheng talked about it.

Dean Cheng and Director Fang are completely incomprehensible.

They could only look at Zhou Sheng for a while, Director Tian and Cao Xiangwen for a while.

The two hoped to see from Director Tian and Cao Xiangwen's expressions whether Zhou Sheng's statement was reasonable.

Director Tian and Cao Xiangwen are different.

Both of them are elderly people outside their hearts.

It's just that a full valve replacement like this has never been done before.

Therefore, I have not studied these things in detail, and I lack experience.

But they all understand the truth. When Zhou Sheng said it, they immediately felt a sense of enlightenment.

That's it!
……

(End of this chapter)