Two words, an expert only needs to hear the key words and understand them instantly without any need for words.
Think about it, for this kind of interventional surgery, how to do internal fixation has always been a big problem.
Through small blood vessels, do you want to insert pliers, needles and threads into the surgery to suture? We need to wait for breakthroughs in basic disciplines such as physics and materials science before we can dream about it.
How to fix without suturing?
Doctors learn from common sense in life.
For example, when there is a flood to rescue people, how do firefighters throw a rope in the water and fix the other end of the rope?
There are ways to do this, such as making a loop with the rope and throwing it into the water where there are rocks or other fixed objects to tie it.
Sometimes the rope does not float back after being thrown away. It turns out that the other end of the rope fell into the whirlpool in the opposite corner. The other end of the rope will be stirred by the whirlpool. If you don't force it to pull it, it will not come back.
These common sense of daily life are all used by doctors to perform interventional surgeries.
Through the description of the two methods, you will find that no matter which method you want to make a fixed foundation, you must have a point that allows the rope to be easily hooked.
After all, the firefighters took advantage of the terrain. Doctors need to use the topography of the patient's own heart structure.
Some patients have different geographical conditions than ordinary people. If it is not suitable, the operation will be completed naturally.
Shen Youhuan had to explain a few more sentences, explaining his failure in detail: "The last time the patient came for a cardiac examination, an echocardiogram was performed on the patient."
Whether it is echocardiography, electrocardiography, or coronary stent surgery, they are not strong in the detailed examination of the myocardial structure of the heart. It is necessary to perform a magnetic resonance examination of the patient's heart, as in Shouer's case. Since this patient did not have symptoms such as cardiomyopathy before, the doctor did not focus on this aspect and therefore did not prescribe such a test.
It just so happened that the electrode was discharged during this operation. If the electrode was placed in the right ventricle, the doctor would need to use the active fixation method mentioned above.
The anatomical feature of the right ventricle is that its internal surface has abundant structures such as ridged trabeculae, such as multiple small piles, and the wire head is made into a quasi-circular sleeve, which is very easy to fix.
As mentioned above, cardiac magnetic resonance is required to clearly detect trabecular problems, so Shin You-hwan and others did not know before the operation that the patient's internal surface structure of the right ventricle might have changed.
It is very likely that the patient's physical indicators have deteriorated greatly due to his advanced age, the trabeculae at the apex of the right ventricle have atrophied, and the electrical activity has decreased. In this way, the doctor could not put the electrode on or stimulate it, leading to the failure of the operation.
It cannot be placed in the right ventricle, but it can be placed in the right atrium.
The same goes for the right atrium. The right atrium does not have ridged trabeculae like the right ventricle, but it does have a right atrial appendage. For ordinary people, the steel wire sends the electrode to the right atrial appendage for the right atrial appendage to hook the electrode.
The problem today is blind insertion. Without fluoroscopy, the doctor will have to be lucky if he wants to accurately deliver the wire to the right atrial appendage so that it can be hooked. If the right atrial appendage is not used, doctors can use another method to actively fix the pacing lead on the right atrial wall during routine surgery. The characteristic of this actively fixed pacing lead is that it has screws on it, which can be placed on the selected atrial wall and rotated to tighten the electrode. By the same token, today’s blind insertion is done. Do you dare to twist it without seeing through it?
(End of chapter)
