Taking the precautions on the note, Xie Wanying continued to communicate with the teacher opposite: "Teacher Ye, please leave a little longer length of the vena cava when trimming."
Oh oh oh. Ye Chuanguang heard something and said: "What kind of magic are you planning to use? The child over there is nine years old and not ten years old, right?"
Heart transplantation is divided into orthotopic heart transplantation and heterotopic heart transplantation. Orthotopic heart transplantation is easy to understand. The patient's diseased heart is removed and a donor heart is placed in the original position of the heart. Heterotopic heart transplantation is not
The diseased heart is removed and the donor heart is connected to the original diseased heart to support and assist the diseased heart, which is equivalent to a purely biological heart assist device.
Heterotopic heart transplant operations are rarely performed because there is no future. Generally, when cardiomyopathy like Zhu Xing reaches the end stage, even installing a cardiac assist device for transition cannot completely solve the root cause of the disease.
Heart transplantation basically revolves around orthotopic heart transplantation. Orthotopic heart transplantation sounds simple. It only requires removing the patient's heart and replacing the patient's heart with the donor heart. In fact, it is not simple at all.
There are a total of eight blood vessels in and out of the heart that need to be connected. The most difficult one is the pulmonary vein group in the left atrium. On both sides of the posterior wall of the left atrium, there are two upper and lower blood vessel ports of the right pulmonary vein group and two upper and lower blood vessel ports of the left pulmonary vein group. What do you think?
Is it complicated enough?
Like the right atrium, there are two anastomoses of the superior and inferior vena cava that need to be connected, which is not easy.
If the above-mentioned blood vessels are connected honestly, it is a heart transplant surgery. This kind of surgery is the most complex, time-consuming and labor-intensive. There are many anastomotic sutures, which means that the probability of complications of anastomotic leakage is high. Surgery
The principle of surgery has always been that the simpler the steps, the better, and the fewer sutures, the better.
In order to save operating time, protect myocardium and reduce postoperative complications, surgeons initially adopted opportunistic surgical methods to perform heart transplantation. Specifically, they did this: when removing the patient's heart, only the ventricle was cut off, leaving the recipient's heart transplanted.
The left and right atria, the donor atrium and the recipient atrium are directly anastomosed, directly avoiding the complex multiple anastomotic connections of the left atrium and right atrium. It is referred to as the double-atrial method or the standard method of heart transplantation.
In pediatrics, if the child is very young, especially if the blood vessels of newborns are too thin, it will be difficult for the doctor to use a magnifying glass to carefully suture multiple anastomosis ends. Of course, the two-room method is best.
Other older children and adults rarely use the two-room method. The reason is that this surgery has a big shortcoming.
We know that the heart has a conduction system that allows the heart to beat rhythmically. The highest pacemaker of this conduction system is the sinus node, which controls how many times a person's heart beats per minute. The position of the sinus node is just
The benefit is in the upper right atrium of the heart.
The two-chamber method leaves both the donor heart and the recipient's right atrium intact, creating two sinoatrial nodes, which is equivalent to installing two engine control systems on the heart. Whose word does your heart want to beat? Do you want it?
Chaos, there will definitely be chaos.
After seeing the shortcomings of this operation, later surgeons improved this operation and came up with the following most commonly used double-caval method. In simple terms, this double-caval method refers to the upper and lower vena cava of the right atrium.