In order to prevent the previous embarrassment from happening again, Dr. Tian followed suit this time: "Doctor Wang, the first stage is over and the patient is temporarily out of danger. Go and invite Director Huang over for another valve replacement surgery."

Doctor Wang nodded: "Okay."

Just as Dr. Tian was about to start repairing, he heard doubtful voices from the side of the tenement building: "Dr. Tian, ​​why did you ask Director Huang? Could it be that you still don't know how to perform valve replacement surgery again?"

Seeing Tanglou asking such an obvious question seriously, Dr. Tian was stunned for a moment, then blushed and said, "No way. Of course I don't know how to do such a difficult surgery. What, you know how?"

Doctor Tian looked at Tanglou, who almost overturned in the first stage, and asked. The latter nodded gently: "Yes!"

Dr. Tian: "..."

Finally, Dr. Wang, who was about to walk out of the operating room, stopped. His face was covered with black lines. He now seriously suspected that Tanglou was just showing off.

"Dr. Tang, this is no joke. Are you really sure it can be operated on? The patient is now out of danger. We have enough time to wait for Director Huang to come back."

Doctor Tian confirmed it again, not wanting to admit that Tanglou had crushed him again!

Tanglou waved his hand and shouted directly to the instrument nurse: "Scalpel..."

He took the scalpel and said to Dr. Tian: "Next, cooperate with me in performing another mitral valve replacement. I will use the right atrium-atrial septal incision. You are all optimistic. If you don't know how to do this, you dare

When I entered the operating room, my heart was really big."

Listening to Tanglou's complaints, Dr. Tian and Dr. Wang also choked and wanted to hit someone.

Dr. Tian glanced at Dr. Wang helplessly and shrugged: "Since Dr. Tang has spoken, we will cooperate."

"oh."

Dr. Wang is like a duckweed in the water, drifting with the current. He can only drift wherever the wind from the superior doctor blows.

At this time, Tanglou's scalpel had already made a longitudinal incision on the lateral wall of the right atrium, about 2cm away from the interatrial groove.

"This patient's right atrium is small. If you encounter this situation in the future, the incision will be extended to the inferior vena cava cannulation site to expand the surgical field. However, remember not to injure the terminal ridge because it contains the internodal

It is also impossible for the conduction bundle to damage the atrioventricular groove, which contains the right coronary artery."

After hearing Tanglou's instructions, Dr. Tian and Dr. Wang wanted to refute, but when they thought about it carefully, they really didn't dare to operate in such a small surgical field as Tanglou.

"What kind of looks are these? They are so powerful."

Doctor Tian sighed in his heart, and his confidence was hit again.

"Sutures..."

Tang Lou continued the next step of the operation. Seeing Tang Lou using sutures, Dr. Tian was a little confused.

"Doctor Tang, what are you doing?"

"The incisal edge of the atrium can be pulled with sutures to expose the interatrial septum. After that, the incision is made in the center of the fossa ovale, and then extends up and down. The ascending incision can reach some of the upper edge muscle bundles, and the descending incision must end at

The medial coronary sinus is more than 1.5cm."

When Tanglou finished speaking, he had completed this step of operation.

"I see, Dr. Tang, your resection is too powerful."

Tanglou continued the operation, fixing the incisal edge of the right atrial septum to the parietal pericardium with sutures, and suturing the left edge with the right atrial wall with two traction sutures.

Doctor Wang, after the operation in Tanglou, suddenly found that his hook became very easy.

"Social experience has improved again!"

Dr. Wang's eyes lit up as he looked at Tanglou's operation. It turned out that it could still be done like this. It was a bit difficult to control the hook and gently pulled it to expose the mitral valve.

Oh ho!

The mitral valve and artificial valve appear very clearly in the field of vision.

"Next, we must first remove possible thrombus and check for valve failure."

While Tanglou was operating, he passed on his experience to Dr. Tian and Dr. Wang.

"Okay, Doctor Tang."

Doctor Tian began to perform examinations according to Tanglou's instructions. After a while, he felt that his whole body was not feeling well.

"Dr. Tang, this situation is a bit dangerous. The suture ring has been covered by new endocardial growth. How to do it?"

If Tanglou hadn't been there, Dr. Tian would have panicked long ago when faced with this extreme situation.

"Round blade..."

Tanglou took one look, then took a scalpel directly from the instrument nurse's hand, and began to cut with a round-head blade at the area where the suture ring was close to the host's suture ring.

"So direct?"

Doctor Tian's heart almost jumped out of his chest: "Doctor Tang, please slow down, slow down."

Tanglou ignored it and extended it directly to both sides. After a while, he cut a full 3cm in the seam ring.

"Doctor Tang, you are just digging like this! How do you determine the depth and length of the incision?"

Tanglou's mind was full of various cases. The three-star level was equivalent to decades of skills of an ordinary chief physician. He casually said: "Nothing but familiarity."

Doctor Tian cursed in his heart: "I believe you are a ghost!"

Then, he watched helplessly as Tanglou peeled off the tissue embedded in the suture ring toward the ventricular wall with great ease. Is it so barbaric?

"pliers..."

After a while, a whole seam ring was pinched out by the tenement building and thrown on the iron plate. It was very clean and there was no trace of adhesion.

Looking at the suture rings processed by Tanglou, Dr. Tian was envious and confused at the same time. How on earth was this technique achieved?

"Scalpel..."

Tanglou did not give Dr. Tian any time to make adjustments, and went directly to the next step, which was the most critical step of removing the artificial valve.

"You two, please remember that next time you remove the artificial valve, you must find the suture ring from the annulus and remove it at this location. Otherwise, you may damage the mitral valve annulus and important tissues around it, and even cause atrioventricular annulus.

ventricular perforation."

"Okay, okay, but Dr. Tang, can you slow down the operation a little bit? I can't keep up."

Dr. Tian's old face turned red.

"oh."

Tanglou responded casually, and then the operation movements remained unchanged: "I will help flush the ventricular cavity with a large amount of saline..."

Dr. Tian: "..."

Doctor Wang smiled on the side, as if he saw himself when he was assisting Doctor Tian again.

It turned out that Dr. Tian looked like a not-so-smart guy in front of Dr. Tang.

The next step is to replace the artificial valve. Since the previous steps were done very cleanly and perfectly, Tanglou’s subsequent valve suturing method is exactly the same as the first operation.

The only difference is that Tanglou inserts the needle on the atrial surface and exits the needle through the endocardium on the atrial surface and ventricular surface to avoid leaving rough surfaces and affecting the movement of the disc.

Ten minutes later, Tanglou completed the entire operation.

“The post-operative treatment after a second valve replacement surgery is basically the same as the first surgery, but there are a few points that need to be noted:

The first point is hemodynamic monitoring. Swan-Ganz catheter can be used to measure pulmonary intrusion pressure and cardiac output, and at the same time monitor central venous pressure and arterial pressure to accurately judge cardiac function status, blood volume, vascular resistance and other important

Abnormalities in indicators will be dealt with in a timely manner.”

After listening to what was said, Dr. Tian's brain processor was a little exhausted, so he looked at Dr. Wang opposite.

Dr. Wang said softly: "Doctor Tian, ​​don't panic, we still have video recording, doesn't it sound good at eight times speed?"

Doctor Tian, ​​I feel relieved now.

Tang Lou continued: "The second point is cardiac function support, the third respiratory support, and finally, close observation and treatment of bleeding. If there is a coagulation clot in the mediastinum that blocks the drainage tube and causes cardiac tamponade, trypeptidase can reduce the risk of non-surgical

Sexual bleeding."

After Tang Lou gave his instructions, he walked out of the operating room.

The two doctors were left in shock.
Chapter completed!