Auto chess in the operating room

Chapter 342 DORV-AVSD Syndrome

Professor Liu took Professor Yang and his doctoral student Wang Xiaoying to her office.

After an introduction to the other party, he directly talked about this time, the content of the academic exchange, and the discussion on ventricular corrective surgery.

Professor Yang is very accomplished in this area.

"Professor Yang, this time there happened to be a very special case in our department. It was transferred from the First Hospital of Ninglang City. It was a very rare congenital heart disease with double outlet right ventricle (DORV) and complete atrioventricular septal defect. It just so happens that our department is still working on the surgical plan, and I would like to ask Professor Yang to give us guidance."

Wang Xiaoying's eyes were shining brightly. It was the first time she encountered this kind of disease.

Seeing the curiosity on his doctoral student's face, Yang Guoshu also became interested and explained to Wang Xiaoying: "DORV-AVSD is a complex and rare cardiac malformation. It includes forward-extending unrestricted VSD, primary Aortic straddling or right ventricular outflow tract stenosis caused by ASD, common atrioventricular valve, anterior and superior displacement of infundibular septum, etc."

"Internationally, in 1975, it was proposed for the first time that the combined deformity could be corrected by enlarging the ventricular septal junction. In 1980, the first corrective operation was successfully performed, but the surgical mortality rate was very high, especially when combined with pulmonary artery stenosis or pulmonary vein ectopic connection The surgical mortality rate of patients is higher. In the 1s, it was reported that the surgical mortality rate was about 90%.”

Hearing the data from Professor Yang, Wang Xiaoying was obviously a little surprised, it is really a terrible disease.

"Professor Liu, let's not waste time, let's go to see the patient's condition first?"

Professor Yang is a very dedicated veteran expert who is also very dedicated to medicine, and he doesn't care about the fatigue of traveling.

"Okay, then I will work hard for Professor Yang. I will ask Director Huang and Deputy Director Qian to participate in this joint consultation, so that they can also study."

Professor Liu's remarks are of course sincere. After all, Professor Yang's level is recognized in the country, especially in ventricular surgery.

Soon, after receiving a call from Professor Liu, Director Huang and Deputy Director Qian rushed over.

I saw that the famous Professor Yang, Director Huang and Deputy Director Qian were naturally humble and respectful, with a particularly low posture.

"Professor Yang, I have admired your name for a long time. This time, I want to learn from you the experience and skills in ventricular correction."

Director Huang said excitedly, and Deputy Director Qian on the side also boasted about business.

"Director Huang, Director Qian is being polite, we are just communicating and sharing with each other. Then let's see the patient's condition first?"

"Okay, okay."

Deputy Director Qian had already prepared the patient's situation in advance.

"Professor Yang, here are the patient's echocardiogram and angiography data."

After Professor Yang took it, he looked carefully, and saw that the patient's two major arteries completely originated from the right ventricle, and there was pulmonary hypertension, which is a typical DORV-AVSD disease.

Professor Yang continued to look at the rest of the patient's examination information:
The patient was moderately stunted and had mild heart failure. Grade 3/4 systolic murmurs could be heard in the 3rd and 6th intercostal spaces on the left side of the sternum, and P2 hyperactivity; chest X-ray showed: whole heart enlarged, bilateral Pulmonary blood increased significantly, the pulmonary artery segment protruded, and the cardiothoracic ratio was 0.62-0.85.

After reading it, even Professor Yang felt a little heavy: "Professor Liu, this patient's condition is a bit complicated. It's really tricky."

Regarding Professor Yang's reaction, Professor Liu was not too surprised, but he was still slightly disappointed. Could it be that even the senior experts from the 301 PLA Hospital couldn't come up with a perfect solution?

In the office, everyone was silent for a while, only the sound of turning pages was heard.

Director Huang looked at the prestigious Professor Yang and couldn't help but sigh.

Although Professor Yang lowered his head, looked at the information, and thought about the plan, but in the quiet office, Director Huang's sigh was very obvious, and it hit Professor Yang's heart heavily.

This Zijingang Hospital was the first to propose a consultation, but they couldn't come up with a solution, which was a bit embarrassing.

After all, Professor Yang is also a well-known expert, and he pondered for a while. Although he couldn't come up with a one-time solution, it also made him think of a transitional method: "Professor Liu, Director Huang, and Director Qian, although they are still Can't think of a one-off solution, but I do have an idea that we could do two-stage surgery to fix this."

"In the first stage of surgery, we can use systemic pulmonary shunt, which can increase blood perfusion in the lungs, increase the amount of oxygenated blood, promote the further development of the pulmonary artery and left ventricle, and provide conditions for the second stage of radical surgery. "

"In two installments?"

Hearing Professor Yang's thoughts, Professor Liu also pondered for a while: "Professor Yang's suggestion is actually a solution. However, body-to-lung shunt surgery, maintenance of the function of the operation center, whether the shunt vessels are unobstructed and the size of the shunt flow are factors that affect the operation. The key factor of the effect. If the shunt is too large to cause pulmonary edema and lung perfusion, it will not be possible to wait for the second-stage radical operation."

"Yeah, so, the selection of the surgeon for this stage of body-to-lung bypass surgery is very critical. It requires superb skills and a keen judgment on artificial blood vessels. Moreover, the response and speed requirements during the operation are very high. It is also best to have superb suturing and incision techniques.”

Professor Yang also sighed, although he was able to formulate the overall operation plan divided into two phases, but he is not too sure about the implementation of this operation.

"Moreover, this patient has a patent ductus arteriosus, and it is necessary to avoid the opening of the ductus arteriosus as much as possible during the operation to prevent hypoxia."

Professor Liu has the deepest understanding of this patient's situation, so he added a little detail that Professor Yang ignored, but it is also a key point.

Hearing this, Professor Yang directly took the patient's detailed medical examination information from Professor Liu, and took a closer look: "It's true, the difficulty and risk of the first stage of this operation have doubled again. The operator must be required to complete these complicated operations within one and a half hours. Based on my current experience, I don’t know how much better the control over the entire operation than when I was young, but after all, now that I am older and physically Some of them can't keep up. If I were the surgeon, I might not be able to do it so fast, it would be difficult."

Professor Yang made another assessment. As a cautious expert, the success rate was less than [-]%. Of course he would not take risks. He said with great regret: "Professor Liu, I carefully evaluated the patient's physical condition and tolerance. This surgery When the plan is implemented, the success rate is too low, and I am not in favor of trying it.”

Hearing what Professor Yang said, the glimmer of hope that Professor Liu, Director Huang and others had just raised was dashed again.

Professor Yang shrugged. He proposed the operation plan, but the doctors at Zijingang Hospital couldn't do it, so they could only do nothing.

Of course, this does not mean that the doctors in Zijingang are not good. In fact, this patient’s physical condition is too poor and the surgery is too complicated:

"If I were ten years younger, I would be [-]% sure."

Director Huang muttered: "Excellent technology, keen judgment on artificial blood vessels, operation speed, suturing skills, and incision skills at the same time."

Suddenly, his eyes lit up, and Deputy Director Qian next to him clearly understood. The two of them said in unison:

"Doctor Tang!"

(End of this chapter)