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Mayo's Cardiology Cath Lab.

Lu Chen and Yamada Kenji's expressions were both very solemn.

After performing aortic root angiography on the patient again, Lu Chen discovered that the patient had severe transverse aortic valve stenosis!

In this case, the interventional valve stent is prone to displacement when implanted in the non-calcified aortic valve area, which increases the risk of

TAVR

Risk of surgical failure.

The relative pathological expansion of the aortic root and ascending aorta leads to the enlargement of the aortic valve annulus.

The annulus area exceeds the area of ​​the largest artificial valve currently used clinically, and there is a risk of the valve falling off after release.

The difficulty of this operation was beyond everyone’s imagination!

"Lu Chenjun, what should we do? Continue...or give up?"

Seeing this situation, Yamada Kenji secretly wanted to retreat.

Anyway, he doesn't want to be an "African chief".

Lu Chen didn't speak. He was rethinking the possibility of surgery.

Conventional transfemoral artery puncture is used to perform TAVR. The valve is implanted at this angle. The valve is easily displaced in the case of severe transverse heart disease!

Once displaced and paravalvular leakage occurs, the entire operation will fail, which will be a fatal blow to the patient.

In the end, what should be done?

Are there any better alternatives to surgery?

Scenes in the system's virtual space appeared in Lu Chen's mind.

He trains on various clinical situations that may occur every day and night.

In the system virtual space, he encountered various complications, various surgeries, and various unexpected emergencies.

However, this is just a virtual system after all!

In reality, the situation is arbitrary and there cannot be any rules.

Lu Chen searched his past training memories, but couldn't find a suitable technique.

"Lu Chenjun, why don't we pause first." Yamada Kenji said, "Let's go back and discuss it again. After preparing the surgery, we will be fully prepared before performing the second surgery."

Lu Chen calmed down.

At present, it seems that Yamada Kenji's opinion is the most scientific.

However, just when Lu Chen was about to end the operation.

The monitor on the operating table suddenly sounded a piercing alarm!

The patient's electrocardiogram waveform suddenly became extremely rapid, and the waveform was not irregular at all.

The patient himself also lost consciousness and had no response at all to calls from outside nurses.

"Oops, ventricular fibrillation!"

Lu Chen roared in a low voice.

"Blood pressure is down!"

He and Yamada Kenji immediately started moving.

Lu Chen performed cardiopulmonary resuscitation.

Kenji Yamada brought a defibrillator.

Fortunately, Lu Chen asked the nurse to prepare an ambulance and a defibrillator in advance.

After two defibrillations, the patient's heart rate recovered.

However, his blood pressure was on the low side.

Cardiogenic shock!

At this time, Lu Chen did not dare to suspend the operation.

"Go to IABP." Lu Chen said immediately.

IABP is mainly aortic counterpulsation. In short, it allows the aortic blood to return when the aorta ejects blood, thereby increasing the coronary blood flow.

This is one of the effective measures to prevent cardiogenic shock.

However, it only temporarily maintains the patient's vital signs.

If the fundamental problem is not solved, IABP will only delay for a while.

If the operation is stopped at this point, the risk to the patient will be extremely high, and unpredictable risks such as cardiac arrest are likely to occur.

"Lu Chenjun..."

Before Yamada Kenji could finish speaking, Lu Chen said directly: "The operation cannot be suspended, we must continue it!"

The risks of surgery must be considered, but when the patient's life safety is threatened, life-saving must still be the priority!

"Ah?" Yamada Kenji was stunned.

Does Lu Chenjun really want to be an African chief?

If you forcefully perform TAVR surgery at this time, the risk of failure is too high!

However, Lu Chen was the chief surgeon at this time. Unless he stopped the operation himself, no one could stop his operation.

Just now, an idea suddenly appeared in Lu Chen's mind.

He feels that he has always been led by the system and cannot break out of this established circle.

What if we break out of the framework of the existing transfemoral artery puncture TAVR procedure?

Is there any other way?

Thinking of this, Lu Chen suddenly had an idea.

Since the angle of the femoral artery puncture is too large and it is not easy to implant the valve, what if it is punctured directly?

"Yamada, do you think if I pierce directly, will the angle problem be solved?" Lu Chen looked back at Kenji Yamada beside him.

"Direct puncture?"

Yamada Kenji was stunned. He didn't understand what Lu Chen meant for a while.

"Yes, not through the femoral artery, but directly through the apex of the heart!"

As soon as Lu Chen's words came out, Yamada Kenji was stunned.

Directly puncture the apex of the heart and allow the catheter to be implanted in the aorta?

And then implant the valve?

What a bold idea!

But there is no doubt that if pericardiocentesis is really performed, the patient does not have to worry about angle and displacement even if the patient has a severely transverse heart.

Yamada Kenji immediately came to his senses and figured out the reason.

There was excitement on his face.

"Lu Chenjun, I think your idea is feasible!"

Apical puncture is very safe with the help of an ultrasound machine.

"Okay, without further ado, let's start right away!"

Right now, every second that passes becomes more dangerous.

…

Yao Jie pushed the ultrasound machine in.

With the assistance of ultrasound, Lu Chen quickly performed apical puncture.

After apical purse-string puncture, a loach guidewire and a 5F single-curved catheter were inserted into the descending aorta.

"Exchange the Lunderquist hardened guidewire after the head has been plasticized, expand the 24F sheath, and deliver the delivery device loaded with the J-Valve into the aortic root through the hardened guidewire."

Lu Chen told Yamada Kenji.

He opened the positioning piece and pulled it back into the three sinuses.

The valves are released sequentially. After the valves are released, angiography and TEE are used to evaluate the position and function of the valves. After the locking wire is unhooked, the transporter is withdrawn.

"Withdraw the hardened guide wire under the protection of a single bent tube!"

Repeat angiography confirmed that the valve function was good and that the ascending aorta and access vessels were not damaged.

The purse strings are knotted at the apex of the heart.

After Lu Chen stopped bleeding, he placed a left chest tube and closed his chest routinely.

The operation is over.

ECG monitor on the operating table.

The patient's blood pressure and heart rate have returned to normal.

Postoperative cardiac ultrasound showed that the interventional valve was in good shape and position, and only paravalvular leakage occurred.

…

When the patient was pushed to the CCU for observation, Lu Chen and Yamada Kenji also got off the operating table.

The two of them were tense throughout the entire operation, and only then did they relax completely.

Even Yao Jie, who was watching from the sidelines, was in ups and downs.

"Lu Chen-kun." Yamada Kenji suddenly patted Lu Chen on the shoulder, "Congratulations!"

Lu Chen looked back at Yamada Kenji in confusion, "Congratulations for what?"

"Congratulations on becoming the new African tribal chief."

Lu Chen: "..."

To be honest, if the gold mine can be kept, he will not marry the man!

"Brother Shen!"

"Um!"

When Shen Changqing walks on the road, whenever he meets someone he knows, he will say hello or nod to each other.

But no matter who it is.

There was no unnecessary expression on everyone's face, as if they were indifferent to everything.

To this.

Shen Changqing has become accustomed to it.

Because this is the Demon Suppression Division, an organization that maintains the stability of the Qin Dynasty. Its main responsibility is to kill monsters and monsters. Of course, there are also some other side jobs.

It can be said.

Everyone in the Demon Suppression Division has a lot of blood on their hands.

When a person is used to seeing life and death, he will become indifferent to many things.

When he first came to this world, Shen Changqing was a little uncomfortable, but he got used to it over time.

The Demon-Suppressing Division is huge.

Those who can stay in the Demon Suppressing Division are all powerful masters, or those who have the potential to become masters.

Shen Changqing belongs to the latter.

Among them, the Demon Suppressor Division is divided into two professions, one is the Guardian Envoy and the other is the Demon Slayer.

Anyone who enters the Demon Suppression Department starts from the lowest level as a demon slayer.

Then he will be promoted step by step, and he is expected to eventually become a guardian envoy.

Shen Changqing's predecessor was a trainee demon slayer in the Demon Suppression Division, and he was also the lowest level among the demon slayers.

Possessing the memory of a previous life.

He is also very familiar with the environment of the Demon Suppressing Division. UU Reading www.uukanshu.net.

It didn't take long for Shen Changqing to stop in front of a loft.

Unlike other places in the Demon Suppressing Division that were full of chills, the attic here seemed to stand out from the crowd, showing a different kind of tranquility in the bloody Demon Suppressing Division.

At this time, the attic door was open, and occasionally people came in and out.

Shen Changqing only hesitated for a moment before stepping in.

Enter the attic.

The environment changes in vain.

The fragrance of ink mixed with the faint smell of blood hit his face, causing him to frown instinctively, but then relaxed it quickly.

There is almost no way to cleanse away the smell of blood on everyone in the Demon-Suppressing Division.

:,!