The so-called division of the left and right atria and ventricles is just a rough division, just to give it a good name. From the perspective of the real heart structure, there is no complete line of symmetry between the left and right.
Not only the internal structure of the heart hinders the doctor's scalpel, but also the coronary arteries, an important blood supply network on the surface of the heart, are also asymmetrical. Doctors need to avoid important blood supply vessels when cutting.
When it comes to how many cuts to make, the fewer the better, and only one cut is best. As the old saying goes, doctors need to be responsible for every cut they make. Only stupid doctors will think about making more cuts. Where the cut is placed is important.
Plan according to the surgical site planned before surgery. If it is just a simple mitral valve replacement, and the mitral valve is on the left side, you can directly make a cut in the left atrium. Today's patients require surgery on both the mitral valve and the tricuspid valve.
One left and one right. According to the experience summarized by previous people, the conventional surgical approach in this case is to start from the right atrium. Cut the right atrium, see the interatrial septum, and then cut up and down in the center of the oval fossa.
The mitral valve is seen.
After these parts are incised, the doctor uses sutures to lift the surrounding edges to expose the surgical field inside.
Before the operation, the surgical team only considered the mitral and tricuspid valves but not myocardial hypertrophy. The surgical approach used did not consider the latter, and the exposed surgical field did not take into account the full view of the left ventricle. No wonder Dr. Yu wanted to
Standing on tiptoes. With such a surgical field of view, he really couldn't see the complete inside of the left ventricle. How could he judge the myocardial hypertrophy.
The surgeon has rich surgical experience, and he has accumulated a larger database of surgical anatomy diagrams than a resident with a younger brain. Perhaps he can look at one corner of the picture and rely on his brain to judge other parts, just like putting together a jigsaw puzzle.
As for classmate Xie, anyone who knows her will know that she is a different kind of person.
Xie's only embarrassment now is how to connect the thinking of ordinary people with her special brain so that everyone can understand the picture in her mind.
After receiving further questions from the surgeon, Xie Wanying continued to organize her words: "Please look at it from this angle, Teacher Du."
Others listened to her words as if they were speaking from a navigation system.
"Here, at this point, at an angle of 35 degrees below the large chordae tendineae that were retained by the patient's original surgery, this muscle is relatively convex. The thickness of the bulge is not obvious, but the area is wide, and it just involves*
*Muscle and valve opening."
This time, it was not just the surgeon who could see clearly. Dr. Yu didn’t have to stand on his toes, tilted his perspective, and almost exclaimed in his throat: He could see. It turns out that it is not completely impossible to peek into the full view of the ventricle in the limited narrow field of view.
Yes, you have to make full use of your perspective.
How to open and close the mitral valve leaflets relies on two aphrodisiac muscles, such as a mechanical opening and closing locking mechanism that pulls the two valve leaflets. The axillary muscles are connected to the myocardium of the ventricle and depend on the myocardial rhythm.
Pulsation generates power. When a patient has a valve problem and needs to be replaced with an artificial valve, how to deal with the vaginal muscles is a technical issue.
Based on the accumulated experience of previous people, the current mitral valve replacement surgery is very mature. Conventional surgery can preserve the subvalvular structure of the mitral valve, that is, the chordae tendineae. The specific method is generally to connect the original valve with the chordae tendineae.
The leaf part is trimmed into a piece with the muscle and chordae tendineae retained.