I Can See Health

Remember [new] in one second! Lu Chen withdrew the guide wire, feeling quite complicated.

In helplessness, there is also a trace of unwillingness to admit defeat.

He tried his best and tried many times, but in the end he still couldn't get the guidewire through the superior vena cava.

This was his first failed surgical experience since he entered the field of electrophysiology!

Xiao Shikang patted Lu Chen on the shoulder, seeming to read his thoughts, "Lu Chen, it's okay, this is not your problem. No one would have thought that the patient's superior vena cava would be blocked."

Lu Chen took off his gloves and stared at the screen of the operating table, "Teacher Xiao, I'm fine."

"Well, with this medical record, I will apply for a cardiology conference." Xiao Shikang continued, "At that time, I will see if there are any good ideas from other cardiology doctors."

Lu Chen nodded slightly, withdrew his gaze, and silently arranged the tools on the operating table.

…

"Doctor, is my operation finished?"

At this time, the old man on the hospital bed suddenly said.

Lu Chen moved his lips, wanting to say something, but he didn't say it.

Xiao Shikang slowly walked to the patient's side and said softly: "Uncle, it's not yet. There is a problem. Don't worry, we will take care of it."

In this case, in order to avoid the patient's emotional fluctuations, Xiao Shikang decided to communicate with the patient's family first, and then slowly explain to the patient himself.

"Lu Chen, please tidy up the equipment, and I'll go communicate with the patient's family about the patient's condition."

"good."

After Xiao Shikang said something, he left the cath lab.

…

Outside the duct.

Lu Chen had already packed up the surgical equipment and asked Dr. Guipei to push the patient back to the ward.

He sat on the instrument outside the catheter room and repeatedly watched the patient's X-ray vascular imaging on the computer screen.

Before today, he was very confident, even a little arrogant.

Although Lu Chen has only been exposed to electrophysiological surgery for a short period of one year, with the help of the systematic surgical simulation room and the realistic simulated operating room, his level of electrophysiological interventional surgery has improved rapidly.

Whether it is pacemaker implantation or arrhythmia ablation, he can do it with ease.

Even the difficult dry pericardiocentesis is not a problem.

His level of electrophysiological intervention has surpassed that of most attending and deputy chief physicians.

But today's failure made Lu Chen suddenly wake up.

His efforts are not enough!

There are still many diseases that have not yet been completely conquered, and there are still many, many things he has to do!

Thinking of this, the proud and conceited mood in Lu Chen's heart was slowly disappearing.

What replaced it was an indomitable drive!

…

After afternoon, Lu Chen had dinner and returned to his hotel.

Tonight, he did not continue training in the systematic simulated surgery space, but began to read relevant literature.

This is definitely not the first case of superior vena cava obstruction in this patient.

He wants to read the case reports from various countries and see what other people's handling measures are.

Doctors can only continue to improve through this kind of learning.

No doctor can survive by resting on his laurels.

After looking through domestic and foreign literature from the past five years, it was already ten o'clock in the evening.

"Ding ding..."

The familiar WeChat alert sounded. Lu Chen took out his phone and saw another message from Min Xiaobo.

"Lu Chen, it's been half a month, how many surgeries have you completed?"

Two weeks have passed since the second stage of assessment.

Lu Chen recalled the surgeries he had completed, and there were only six cases so far.

Among all the students, this is considered below average.

"Ah? You only have six?" Min Xiaobo said in surprise, "I feel like I have very few, but I have made eleven."

In two weeks, six surgeries were completed. This amount of surgeries may be at the bottom.

Although the assessment indicators are not calculated entirely based on the volume of surgeries, it is also an important indicator.

"There's no way." Lu Chen said helplessly.

In fact, he had quite a few surgeries here, but three of them were canceled after Lu Chen re-evaluated them and found that they were no longer necessary.

Then today the operation failed, and there was one less operation.

"There are still two weeks left for the assessment, come on!" Min Xiaobo said.

Both of them came from Beijing, and their relationship was much better than the others.

Min Xiaobo was still very optimistic about Lu Chen.

"Well, thank you for your concern, Brother Bo." Lu Chen replied.

Turning off his phone, Lu Chen continued to browse the literature.

This look lasted all night.

…

The next day.

In response to this failed case, Xiao Shikang quickly organized a cardiology conference.

Kyoto University First Affiliated Hospital, Department of Cardiology Classroom.

The small classroom was full of people.

Each ward of the Department of Cardiology has at least one doctor with a deputy senior professional title.

A team of doctors of this level is considered a top "luxury team" even if you look at it nationwide.

Xiao Shikang was standing on the podium, introducing the patient's condition to everyone.

"The patient's pacemaker battery is exhausted and needs to be replaced. At the same time, the patient's heart failure symptoms are severe and malignant arrhythmias occur. We are preparing to implant an ICD."

"But during the surgery, we discovered that the patient's superior vena cava was blocked."

While Xiao Shikang was speaking, the live broadcast of yesterday's surgery was also played on the projector screen on the podium.

"My surgical assistant and I tried many times, but the guide wire still couldn't pass, so we had to give up the operation."

After introducing the condition, everyone in the audience began to discuss with each other.

Qin Sifeng was the first to say: "The patient's current diagnosis is severe refractory heart failure. If a pacemaker and ICD are not implanted, the symptoms of heart failure will become more and more severe, which will not only affect the quality of life, but also affect life safety."

After Qin Sifeng, a heavyweight, spoke, everyone agreed.

"Professor Qin is right." Fang Ruzhang on the side said, "This patient is from our ward. I went to see him in person as soon as possible. The symptoms of heart failure were very obvious. He was tired from walking and eating. He lay completely in bed and could not move. I can't move at all. At night, I basically can't sleep on my back. We can use medicine to maintain it, but if things go on like this, the effect will definitely not be good. We still need to implant a pacemaker and ICD as soon as possible. "

After some discussion, everyone agreed that a pacemaker and ICD must be done.

The question now is how to do it?

The superior vena cava was blocked and the guidewire could not pass through it, and the superior vena cava was the only way for conventional pacemaker lead implantation.

On the podium, Xiao Shikang continued: "I wonder if teachers, do you have any good opinions on the next step of diagnosis and treatment plan?"

As soon as he finished speaking, everyone started talking again.

Fang Ruzhang was the first to say: "The superior vena cava is blocked. We may be able to choose other venous access. How about puncturing the jugular vein?"

In the early days, pacemakers were installed through thoracotomy, which was very invasive.

Since the invention of the endocardial electrode in 1965, transvenous endocardial cannulation has been used to install pacemakers.

There are 4 conventional access veins for electrode lead insertion, 2 on each side of the left and right sides, namely the cephalic vein and the subclavian vein, and 6 non-conventional access veins, 3 on each side of the left and right sides, namely the external jugular vein. , internal jugular vein and axillary vein.

The most common is of course the subclavian vein - the implantation path of the superior vena cava.

This is the shortest and most established path.

Qin Sifeng shook his head and rejected the idea: "The patient is old, thin, has few muscles, and has thin skin. If the electrode is implanted through the jugular vein, UU Reading www.uukanshu.net may wear the skin and damage the electrode in the future."

"Professor Qin, what if we use a leadless pacemaker?" Another deputy chief physician suggested.

Qin Sifeng was stunned for a moment, thought for a moment, and then looked at Xiao Shikang on the stage.

When Xiao Shikang heard this, he said helplessly: "In addition to a slow heart rate, the patient also has III-degree atrioventricular block and junctional escape rhythm. He needs to use a dual-chamber pacemaker. A leadless pacemaker is not suitable for this name." patient."

For a while, most of the ideas didn’t hold up.

This doesn't work, that doesn't work either, everyone is a little discouraged.

Could it be that we should always use medication?

The patient's survival period will be rapidly reduced, and he may even need to be hospitalized for a long time.

Just like this, Lu Chen, who had been sitting in the corner, suddenly stood up.

He looked around at everyone and said slowly: "Teachers, if percutaneous hepatic vein puncture is implanted, what is this route?"

As soon as Lu Chen's words came out, everyone present was stunned.