In the director's office, a big exam is beginning.
The examiners are three directors and a dean.
Two of them are old guys from cardiac surgery.
If you don't have some skills, it's simply impossible to fool around.
Even if you are somewhat capable, you will inevitably become nervous in such an aura.
But Zhou Yisheng was as calm as water.
His strength is so great that he naturally doesn’t panic.
Zhou Shengsheng said: "After looking at the early films and examination reports, we found that the patient has full valve disease, which is common in rheumatic heart disease, mainly damage to the mitral valve. At present, the patient is more likely to have Rudenbach syndrome.
levy.”
"The initial problem should start with the mitral valve. Since the right ventricle is significantly larger than the left ventricle, as the degree of stenosis gradually increases, pulmonary hypertension develops rapidly, right ventricular hypertrophy, and the right heart progressively enlarges, thereby affecting other valves..."
The four people present have been practicing medicine for many years and have rich clinical experience.
Even Fang Jianzhang and Dean Cheng know something about clinical heart disease.
After listening to Zhou Sheng's condition analysis, both of them nodded frequently.
Director Tian and Cao Xiangwen are experts in this, so Zhou Shengsheng made it easy for them to understand.
Although common rheumatic heart disease can cause damage to the valves, it is generally not serious enough to cause all four valves to be damaged.
Rudenbach syndrome is much more complicated than rheumatic heart disease. It is also relatively rare clinically. Long-term illness can cause irreversible multi-valvular damage.
"Now the patient has heart palpitations and paroxysmal dyspnea. It seems that the condition has entered the terminal stage. The only feasible way is to replace the full valve."
At this point, Cao Xiangwen said coldly: "We all understand this truth, but no one has ever done this surgery. You have also seen that the patient's physical condition is very bad. How to ensure the safety of the surgery?"
Faced with Cao Xiangwen's aggressiveness.
Zhou Sheng responded in a deep voice, "No one can guarantee that something like surgery will be foolproof. Especially if it is a difficult surgery, we can only make a pre-operative plan carefully and go to the operating table to do our best. Of course, for the sake of safety, so
I just asked Director Tian to go on stage with you. Only in this way can we ensure the safety of the operation."
What Zhou Sheng said was extremely embarrassing for Director Tian and Cao Xiangwen.
At this time, it was difficult for Cao Xiangwen to make an attack.
He looked at Fang Jianzhang beside him.
Fang Jianzhang said at this time, "Xiao Zhou is right. As a family member and a doctor, I support him. I believe that there should be no problem if Director Arita, Director Cao, and Xiao Zhou perform a joint operation together."
Cao Xiangwen also made up his mind when he saw Fang Jianzhang.
He has no reason to object.
He also knew that if it was a combined surgery, he would definitely not be responsible for too many surgical tasks. His more role would be as a second assistant or something like that.
If something happens, you are not responsible.
Next is a discussion of some specific surgical details.
From preoperative examination to selection of surgical approach.
Along the way we talked about the choice of artificial valve during replacement.
This is a very professional matter for valve replacement.
Fang Jianzhang and Dean Cheng are completely ignorant.
Only Zhou Sheng, Director Tian, and Cao Xiangwen have the right to speak.
Currently, the more popular artificial valves are divided into two types: mechanical valves and biological valves.
Mechanical valves are made of metal and have a long service life, generally more than 35 years. They are relatively cheap, but they require lifelong anticoagulant medication.
Biological valves are generally extracted from animals and have a short service life, generally no more than 15 years. They are more expensive than mechanical valves, but they do not require anticoagulant drugs.
Cao Xiangwen’s opinion is to use biological valves.
There is no need to take anticoagulant drugs, and the service life of more than 10 years is enough for the elderly.
Director Tian did not make an immediate decision, because if such a large-scale heart surgery was successful this time, it would be almost impossible to do it again in 10 years, considering the age of the patient.
Although the patient is relatively old now, only 70 years old, and has no contraindications to anticoagulation. Replacing a mechanical valve can solve the problem once and for all.
While hesitating, Director Tian also gave his own opinion.
Neither Director Tian nor Cao Xiangwen had experience in total valve replacement.
They completely based their thinking on the service life of artificial valves in previous single-valve replacements. Their consideration was very incomplete.
But this is not the case for Zhou Yi. In the copy, the operation must not only be successful, but also perfect.
For this reason, he had to undergo multiple surgeries.
At this moment, Zhou Yisheng was more comprehensive and thoughtful.
Total valve replacement for Rudenbach syndrome.
Monday was born on the use of artificial valves, which are both mechanical and biological!
This scheme has been verified countless times in copies.
This is a lifetime of practical experience.
When Director Tian and Cao Xiangwen were still hesitating whether to use a mechanical valve or a biological valve.
Zhou Shengsheng said directly: "I think the two types of valves should be used together!"
As soon as Zhou Sheng's words fell.
Fang Jianzhang and Dean Cheng both looked confused.
Director Tian and Cao Xiangwen had puzzled faces.
Both of them were thinking, why should the two valves be used together? This is not combining the shortcomings of the two valves.
Both mechanical valves and biological valves are used, which means that you have to take coagulants for life. When the biological valve breaks down after more than ten years, you will have to open the chest to replace the biological valve.
This is completely stupid behavior.
At this time, Cao Xiangwen was even thinking that his whole life would be exposed this week. As expected, he was still a child who only knew some clinical knowledge. He probably had never seen what an artificial valve looked like.
Thinking of this, he smiled contemptuously at Zhou Sheng.
Director Tian was much older than Shen. He felt that Zhou Yisheng had always performed very well and would definitely not make such a stupid mistake. Using the two valves together would definitely have its effect.
Where does it work?
Director Tian, who had never had a total valve replacement, couldn't think of it at once.
Zhou Shengsheng did not give in. He explained directly: "I think it is best to choose a mechanical valve with good durability for the left heart valve, and a biological valve with lower anticoagulation requirements and better hemodynamics for the right heart valve."
.The reason is: the left heart pressure is greater than the right heart, bicuspid
The shear force endured by the aortic valve is greater than that of the tricuspid valve and pulmonary valve. The service life of biological valves is closely related to the shear force they experience. If biological valves are chosen for all heart valve replacements, the left heart valve will degenerate at a significant rate.
If it is larger than the right heart, the possibility of re-operation is high..."
Zhou Shengsheng spoke eloquently.
Dean Cheng and Director Fang were completely incomprehensible.
They could only look at Zhou Sheng for a while, Director Tian and Cao Xiangwen for a while.
The two hoped to see from the expressions of Director Tian and Cao Xiangwen whether Zhou Shengsheng's statement was reasonable.
Director Tian and Cao Xiangwen are different.
Both of them are old people at heart.
But this kind of total valve replacement has never been done.
Therefore, I have not studied these things in detail, and I am lacking in experience.
But they all understood the truth. As soon as Zhou Shengsheng explained it, they immediately felt like they suddenly understood.