Chapter 865: The First Live Broadcast of Rescue Operations?

Surgery live room.

The medical records of the patients undergoing the operation were also displayed in front of the doctors and audience.

The patient was a 37-year-old male.

He was admitted to the hospital due to "repeated palpitations and fatigue".

He was previously diagnosed with "dilated cardiomyopathy, heart failure, and ventricular tachycardia". Later, an ICD was implanted and long-term oral anti-heart failure drugs were used for treatment.

ICD is an automatic defibrillator implanted in the human heart. When it detects malignant arrhythmias, it will automatically discharge and defibrillate.

Every time the electric shock is given, the patient will suffer great pain.

However, this is the only effective way to prevent sudden death from malignant arrhythmias!

After this, the patient still had repeated palpitations, which were often induced in a noisy environment or when he was in a bad mood.

Each time lasted about 5-15 minutes, with a heart rate of 170-200 beats/minute. During the attack, the blood pressure was low and blackouts occurred.

ICD discharged more than 60 times in succession!

Every attack will make the patient feel a strong sense of fear.

In the long run, his quality of life is very poor!

…

After carefully analyzing the patient's medical history, the expert team of the Department of Cardiology of Kyoto First Affiliated Hospital considered trying to perform radiofrequency ablation on the patient.

The patient's ventricular tachycardia was ablated so that he would no longer have malignant arrhythmias and no longer be subjected to the electric shock of ICD.

However, the difficulty and risk of the operation on this patient were very high. It happened that the cardiology experts from Mayo came and handed it over to them for teaching demonstration.

And now, he has become Lu Chen's surgical patient.

Before the operation, Lu Chen had seen the patient and carefully analyzed the patient's medical records.

The patient's condition is indeed extremely complicated!

First, the patient's heart function is poor, the left ventricular end-diastolic diameter f  27%, low blood pressure (80+/60+mmhg), and poor surgical tolerance!

Ventricular fibrillation is very likely to occur during the operation, leading to cardiogenic shock!

Secondly, the patient's ventricular tachycardia has various forms, and the form is not completely consistent with the ventricular premature beats, making mapping extremely difficult.

Finally, the patient has dilated cardiomyopathy, with obvious myocardial remodeling, and there may be a large area of ​​scars. The ablation area is large, and the ablation catheter is difficult to reach the target.

These three surgical difficulties seriously affect the overall success rate of the operation.

Each of these points is a difficult barrier to overcome in the Department of Cardiology of Kyoto First Affiliated Hospital.

However, Lu Chen has done a lot of this type of ablation surgery.

Whether in reality or in the system virtual space, the ablation of special ventricular tachycardia is his main practice.

So, after a short period of thinking, Lu Chen quickly formulated the best surgical plan.

…

After the puncture, Lu Chen took over Xiao Shikang's position.

The most difficult point of electrophysiological ablation surgery appeared, which is the mapping and ablation of arrhythmias.

Simply put, mapping is to find the origin of arrhythmias.

Ablation is to ablate the origin.

"Lu Chen, how are you going to do the mapping?"

Mapping is divided into excitation mapping, pacing mapping and substrate mapping.

"Let's find the P site first." Lu Chen fiddled with the instrument in his hand and glanced at Xiao Shikang. "I looked at the patient's electrocardiogram. The origin of ventricular tachycardia is quite special. It should be left posterior branch ventricular tachycardia."

The P site is to find a high-frequency, low-amplitude site in the left ventricular septum that is ahead of the QRS.

Xiao Shikang was very familiar with the patient's electrocardiogram, so he said, "Let's take the P potential as the target first?"

Lu Chen nodded and began to operate.

He placed a 20-level high-density mapping catheter in the left ventricular septum.

When ventricular tachycardia occurs, two sets of high-frequency potentials can be recorded.

They are the P1 potential (located before the P2 potential, sharp and high-frequency, excited from the proximal end to the distal end), and the P2 potential (located after the P1, before the local V wave, high-frequency, excited from the earliest excited site to both ends).

Xiao Shikang stared at Lu Chen's operation closely.

At this time, it is time to learn from others!

The gap between electrophysiological surgeons is not in vascular puncture, but in mapping and ablation!

Lu Chen's movements are neither fast nor slow.

The hearts of the audience in the live broadcast of the operation were already in their throats.

…

As the operation progressed, Lu Chen began to encounter difficulties.

He couldn't find the P1 and P2 sites!

The shape of P1 was perpendicular to the left posterior branch, which made it impossible for the machine to record the P1 site.

The people in the live broadcast room saw Lu Chen's stagnation and found that something was wrong with the operation.

"Hey, why didn't the mapping come out?"

"How can we map if we can't even find the P1 site?"

"Is this surgeon not very good? He couldn't even find the P site!"

"Don't talk nonsense here, this patient has a special type of ventricular tachycardia, and no one can find it all at once!"

Everyone was a little nervous.

But Lu Chen was calm and fearless. He glanced at Xiao Shikang beside him and said, "Teacher Xiao, help me measure the HV interval."

Xiao Shikang was stunned, but his hands were not slow, "Okay."

During ventricular tachycardia, the HV interval and the HV interval during sinus rhythm are important electrophysiological indicators.

For left posterior fascicular tachycardia, the HV interval has a certain correlation with whether the P1 potential can be recorded and the location of the connection point between the distal end of the P1 potential and the left posterior fascicle.

The HV interval is mostly negative. The larger the absolute value of the negative value of the HV interval, the easier it is to record the P1 potential.

In addition, the more negative the HV interval is (the larger the absolute value of the negative value is), the closer the distal connection point of P1 and P2 is to the apex of the heart; on the contrary, the more positive the HV interval is (the larger the positive value is), the closer the distal connection point of P1 and P2 is to the bottom of the heart.

The measurement is over.

Xiao Shikang looked at Lu Chen and read out the value he measured.

Lu Chen nodded slightly and said seriously: "The P potential should be close to the apex of the heart. Teacher Xiao, help me find it at the apex of the heart."

"Okay." Xiao Shikang started the operation immediately.

Sure enough, after five minutes, the two successfully found the P1 and P2 potentials in the heart.

But before the two were happy, the ECG monitor next to the operating room sounded a harsh alarm!

"Not good, the patient is in ventricular fibrillation!"

Lu Chen's face was as heavy as water. He immediately put down the operating tools in his hand and began to perform cardiopulmonary resuscitation on the patient.

This kind of stimulation causes the patient to have ventricular tachycardia, which is likely to cause ventricular fibrillation!

If you want to successfully map, the risk of this ventricular fibrillation is impossible to avoid.

"Hurry up and bring the rescue vehicle and defibrillator!"

Xiao Shikang also reacted immediately and called the nurse on stage.

The nurse moved quickly and immediately pushed the rescue vehicle and defibrillator over. UU Reading www.uukanshu.net

Lu Chen was performing cardiopulmonary resuscitation, and Xiao Shikang picked up the defibrillator.

"I'm starting to defibrillate!"

Xiao Shikang said in a low voice, and Lu Chen immediately made way.

The two electrodes of the defibrillator were placed on the patient's chest area.

Charging, discharging!

After one defibrillation, the patient recovered sinus rhythm, and within two seconds, he immediately turned to ventricular fibrillation!

In the live broadcast room of the operation.

The audience was a little confused when they saw this sudden situation.

Is this the first time to broadcast rescue live?

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