Instruments The nurse handed over the valve forceps and No. 15 round knife.
Zhou Shengsheng held the valve forceps in his left hand and the round knife in his right hand, and began to remove the calcified aortic valve.
The valve forceps are fixed, and the round knife is cut along the edge of the calcified valve in a circle.
The diseased valve was successfully removed.
Next, measure the size of the valve and select a suitable valve replacement.
suture.
This process is the most difficult.
The small artificial valve needs to be sewn precisely into the valve position.
The distance of each stitch is precisely controlled between 2 and 3 mm.
The whole process can be said to be a blood vessel-level suturing requirement.
Do it on Monday to become proficient in movements.
In half an hour, the aortic valve replacement was completed.
Zhou Shengsheng took a pair of tweezers with a rubber cover at the front and tested the newly replaced "door" to see if the door could be opened and closed flexibly.
Although it is a man-made thing, it is small and exquisite and has no problems at all.
The "door" replacement was successful.
This is just the first of four "doors".
Next, there are three "doors" waiting for Zhou Sheng to deal with.
But before that, cardioplegia fluid must be added to the heart a second time.
The effectiveness of cardioplegia solution is only about half an hour.
The second time high potassium solution was added to the heart, Zhou Sheng had another half hour of surgery time.
Although the cardioplegia solution can be added multiple times, it does not mean that Zhou Sheng’s operation time is unlimited.
As an auxiliary means, extracorporeal circulation should generally be used within 3 hours.
Moreover, the duration of cardiac arrest should not be too long.
Especially when the patient is very old and has limited cardiac tolerance.
Stopping jumping for too long and resuscitating it is also very dangerous.
If not done properly, it will become a permanent stop.
Zhou Yisheng had to race against time to perform the surgery.
The mitral valve replacement started non-stop on Monday.
…
Two hours later, cardioplegia was added four times.
All four valves were replaced successfully.
The extracorporeal circulation equipment is also functioning normally, and the patient's various physiological indicators are also in normal condition.
Everyone present breathed a sigh of relief.
At this point, the surgery can almost be declared a success.
The next step is to remove the extracorporeal circulation.
Originally this was an uncomplicated process.
After processing several intubations, restore aortic blood flow, and wait quietly for the patient's heartbeat to resume.
But I never thought of it.
After the artery clamp was loosened, blood entered the heart, and the heartbeat resumed for just over a minute, and the heart rate slowed down immediately.
Fang Jianzhang was the first to become nervous. He didn't care whether to disturb Zhou Sheng or not, and shouted directly: "Xiao Zhou, your heart rate has dropped!"
Of course Zhou Sheng also noticed it.
This is a cardiac resuscitation problem!
After the heart rate is too slow, there is a high probability of cardiac arrest, which can be said to be very dangerous.
As for why recovery is difficult, there are many reasons.
Many possibilities immediately appeared in Cao Xiangwen's mind.
Coronary air inflow, poor oxygenation, low arterial pressure, high potassium, and even aortic valve installation may occur.
Is the aortic valve installed backwards? This possibility can be ruled out immediately.
Zhou’s skills are obvious to all.
Moreover, Cao Xiangwen also "monitored" without stopping for a moment.
Finally, Zhou Yisheng also checked the installation flexibility of the valve. If it is installed incorrectly, it can be discovered immediately.
There are too many possibilities left.
For a while, Cao Xiangwen didn't know what the problem was, so he could only check it out one by one.
However, for an elderly patient, his heart cannot withstand much time.
Failure to resuscitate may mean that you cannot get off the operating table.
However, Zhou Yisheng was still very calm at this moment.
Because, with the auxiliary system, he can save a lot of troubleshooting time.
In a moment, the system has given the accurate reason.
High potassium!
At this moment, the patient's blood potassium level has reached 7.0 units. The normal level is below 5.5.
Zhou Shengsheng immediately told everyone: "I guess it's high potassium. The electrocardiogram shows towering T waves."
Director Tian and Cao Xiangwen looked at the electrocardiogram.
Indeed, as Zhou Sheng said, high potassium is very likely.
Zhou Sheng continued: "It may be that the potassium was absorbed too much after four infusions. We must give diuresis, calcium and insulin treatment immediately."
At this point in the operation, Zhou Sheng had already taken control of the entire scene.
He gave the doctor's advice.
The circulating nurse immediately took action.
…
Some intravenous drug treatment.
The patient's blood potassium dropped significantly.
Bang……
Bang……
Bang……
The heart is full of life again.
Fang Jianzhang's heart dropped in his throat again, and he breathed a long sigh of relief. He was secretly glad that he was wise to choose Zhou Yisheng for surgery. Not only was this guy skilled in surgery, but he was also able to deal with emergencies without any hesitation.
Don't panic. Your judgment is even more accurate.
Wait until the heartbeat stabilizes.
It is a chest closing operation such as suturing the pericardium, fixing the sternum, etc.
Compared with the previous work, this is considered a job with no technical content.
It's hard work, tiring work.
Generally speaking, after a long operation, the surgeon will not do such chores.
This should be a matter between the first assistant and the second assistant.
If Bai Mingming and Su Quan were on the operating table at this moment, Zhou Yisheng would let them take over. He could relax a little and let them practice their skills.
But today is a special situation.
The first assistant is Director Tian, and the second assistant is Cao Xiangwen.
These are all well-known figures. Usually others do chores for them, but once upon a time it was their turn to wipe others' butts.
Although Zhou Shengsheng was in charge of the whole scene and had an unparalleled reputation, he still had a clear mind at the moment. "Respecting the elders" was still a traditional virtue. At this time, he did not mention letting the first assistant take over, and the second assistant took over.
After sewing the pericardium, he then had to deal with the sternum.
The operation was thrilling, and Director Tian and Cao Xiangwen focused their attention on the operation.
Now that they were relaxed, the two of them suddenly became awkward again.
The two are nominally co-surgeons, and so far, they have never even touched the scalpel.
It's really a bit embarrassing.
After all, Cao Xiangwen was younger and at a lower level. At this time, he also understood that he could not let his dignified director suture his chest.
At this time, he was the only one who lowered his face and said: "Dr. Zhou, please take a rest and let me take care of it next."
Of course Zhou Sheng would not let Cao Xiangwen be "wronged".
Stealing the extracardiac surgery was enough to make the two extracardiac bosses look bad.
It would be a bit too much to ask them to serve as his subordinates again.
His skills in cardiothoracic surgery don't have many opportunities to be used in the emergency department. He might have to deal with them a lot in the future, so of course Zhou Yisheng had to give them face.
Zhou Shengsheng said immediately: "Director Cao, you can take a rest. For such a small matter, you and Director Tian can just provide guidance."
Cao Xiangwen certainly had nothing to guide Zhou Yisheng.
But at least some of the face was saved.
His favorable impression of Zhou Yisheng suddenly increased...