It is said that it is a blind insertion, but it is impossible to completely blind it. It is difficult for patients to move to the interventional room for interventional surgery, but it does not mean that other medical resources cannot be used. Referring to previous neurosurgery cases, it is advisable to use the convenience of ultrasound for positioning
strategy.
When I saw the ward, there was indeed an echocardiography machine.
Let’s talk about a problem here. If multiple leads can be used to choose stimulation, ventricular stimulation should be the first choice during rescue. Because after studying cardiac physiology, we know that ventricular activity is more important.
On the other hand, the right atrial appendage is also difficult to observe by transthoracic echocardiography and requires special positioning.
Using bedside transthoracic echocardiography can help doctors send electrodes across the tricuspid valve.
Shen Youhuan wanted to say that this little junior sister, who was so far away from the ward and could not reach the ward, was able to say that she had hit an academic key point. It was obvious that she had great medical clairvoyance or had touched the brain of his senior brother Shen.
The question is, the patient she said has a bad tricuspid valve, what is wrong with it, can't it be seen on the echocardiogram?
Everyone looked back at the medical records, and it seemed that this was not listed among the patient's current cardiac examination results.
"His tricuspid valve has moved downward." Xie Wanying said again.
"Did his tricuspid valve move downward?" Everyone looked again, filled with questions, "Which examination report did you read this from?"
"She has a lot of medical associations." Dr. Zuo Jinmao, who is so talkative, can't help but publish more eloquent remarks.
Is she just imagining things? Everyone knows that ordinary chest X-rays refer to X-rays of the chest. They can only roughly capture the outer outline of the heart, but they certainly cannot capture the inner structures of the heart, including the tricuspid valve.
It is better to look at echocardiography. Echocardiography can observe the position of the tricuspid valve and use contrast. Compare the attachment point of the tricuspid valve on the tricuspid annulus with the attachment point of the mitral valve to see if there is any difference beyond the normal range.
To determine whether the tricuspid valve has malformed and moved downward. At the same time, if the tricuspid valve moves downward seriously, it will cause tricuspid valve closure problems and cause changes in the internal hemodynamics of the heart. These are the same as the internal heart blood flow detection on echocardiography.
Reflected.
"I personally think that this patient is not suffering from the tricuspid valve deformation that we usually talk about clinically, but that the overall structure of the heart leads to such a result." Xie Wanying said.
Some of the reasons for surgical failure have nothing to do with disease factors. Some are abnormal growth of the patient's own organs. Even subtle abnormalities may catch the doctor off guard. The human body that doctors learn anatomy and surgical cases is based on the data of most people. Xiao
Doctors who deal with all kinds of cases don’t know what to do when they encounter something they don’t know.
Everyone understood. The "downward movement" she said meant that compared to most people, the attachment point of the patient's tricuspid valve may be lower than the mitral valve. This is equivalent to the length of the tricuspid valve, so the guidewire electrode passes over the tricuspid valve.
The path of the valve opening and closing becomes longer and the process is inevitably difficult. Such a special case is very difficult for doctors who have never done such a case and have no relevant experience.
From the side, it can be seen that senior brother Shen, an interventional expert, is not bad. The powerful senior brother Shen can feel the danger and is right to not dare to circle the tricuspid valve too much.
What are the dangers of trying to pass the tricuspid valve hurdle? If you accidentally fail, you are most afraid that the tricuspid valve will be trapped and torn, which will be a serious medical accident. If you fail to save a life, it will endanger your life.
