Chapter 870: Catheter Shaping

Mayo's Cardiology Cath Lab.

Lu Chen checked the patient's ultrasound report results again.

The ascending aorta was dilated, the inner diameter of the aortic sinus was 4.3cm, the sinotubular junction was nearly disappeared, and the inner diameter was 5.1cm. The three valve edges of the aortic valve had echo calcification, adhesion, and poor opening.

cw: Maximum blood flow velocity of aortic valve during systole: 3.1cm/s, maximum pressure difference: 38mmhg, average pressure difference: 19mmhg, aortic valve annulus diameter 2.7cm, aortic valve arch inner diameter 3.5cm.

After fully understanding the condition of the valve, the entire operation officially begins.

Under Lu Chen's guidance, Yao Jie began to puncture the patient's femoral artery.

As a necessary skill for intervention, Yao Jie tried arterial puncture.

Wearing gloves and holding the puncture needle in her hand, Yao Jie moved unhurriedly and slowly inserted it into the blood vessel.

The color of arterial blood is more vivid than that of venous blood.

As pulsating red blood appeared in the puncture needle, Yao Jie successfully completed the vascular puncture.

All beginnings are hard.

Good vascular puncture means half the success of the operation.

Next, Yao Jie began to enter the catheter and guide wire.

Any balloon, stent, etc. can enter the human heart smoothly only through the guidance of catheters and guide wires.

"Slow down, don't go too fast, haste makes waste!" Lu Chen warned from the side.

Catheters and guidewires are extremely delicate things. If the airway is slightly larger, it may damage the blood vessels.

A 6f sheath was inserted and 7000u heparin was injected.

Yao Jie sent ebu3.75, ebu4.0, and jl4 guide catheters respectively.

But, unfortunately.

She was unable to reach the left coronal ostium with the catheter.

Yao Jie's hands were trembling slightly.

Is the first operation going to fail?

And was it defeated in such a small place?

She was a little unwilling, and there was even a small amount of sweat on her forehead.

After several adjustments, the guiding catheter still failed to reach the left coronary ostium.

"Senior Brother Lu, I..."

Yao Jie had no choice but to ask for help from Lu Chen beside her.

Lu Chen immediately understood, smiled, and said, "Let me do the rest. You have already done a good job."

Yao Jie lowered her head and turned slightly to make way for Lu Chen to perform surgery.

Lu Chen stepped forward, gently held one end of the guide tube, and began to operate it.

Fiddled with it a little.

Lu Chen also discovered that with the current shape of the catheter, it would definitely not be able to pass through the left coronal orifice.

"Everyone's condition is different, but the initial state of the catheter is the same." Lu Chen glanced at Yao Jie and said slowly, "When this kind of catheter cannot pass, we may use a One skill, that’s catheter shaping.”

Catheter shaping, simply put, is to adjust the catheter into a shape suitable for the patient's lesions to pass through.

It looks simple, but it's actually very difficult!

This requires the surgeon to be extremely familiar with cardiac anatomy and to be proficient in cardiac interventional medicine.

"There are two parameters to determine the shaping of a guide wire, the shaping distance and the shaping angle of the guide wire." Lu Chen said while teaching, "The shaping distance and the shaping length are different concepts. We generally The length I talk about actually refers to the shaping distance, not the real length..."

Lu Chen began to gently scrape the catheter with the shaping needle.

This skill is the greatest test of the spellcaster's ability.

Sometimes, just a few scrapes and it goes right in.

Sometimes, it takes a long time to look at the lesions, look at them, and sculpt them, which takes a long time.

Yao Jie listened intently to Lu Chen's explanation.

She had heard of this skill, but when it was her turn, she realized how difficult it was to sit up!

"Junior sister, take a look, this angle is very large, so we need to make a big bend. This big bend can be double-bent or arc-shaped! This big bend guide wire can be retracted or moved forward. Of course, it can also be used The double-lumen microcatheter assists in entry.”

"Of course, the ideal situation is to use a microcatheter. The microcatheter is first sent to the proximal end of the lesion and then replaced with a small curved guidewire."

"Junior sister, the most important thing you have to remember is that different lesions and different blood vessel positions have completely different shapes..."

…

Five minutes later, Lu Chen successfully shaped the catheter.

After ebu4.0 shaping, the left coronal ostium was successfully reached.

Lu Chen immediately sent a VT guidewire to the distal anterior descending artery, a BMW guidewire to the distal circumflex artery, and a 2.0*20mm double guidewire balloon to fully predilate the proximal stenosis of the anterior descending artery.

In the eyes of outsiders, coronary intervention, which was extremely difficult at the moment, was gradually overcome in Lu Chen's hands.

However, Lu Chen was not complacent in any way.

He concentrates his attention at all times to avoid any emergencies.

Subsequently, he sent a 3.0*24mmdes to the middle part of the anterior descending artery lesion.

Release after precise positioning.

A 3.5*16mm mastoid balloon and a 3.0*15mm NC balloon were sent to the stent for modification and expansion.

"Recheck the angiography!"

Lu Chen continued to give instructions, and Yao Jie injected a small amount of contrast agent again.

"The stent expanded well."

After the imaging, Lu Chen looked at the position of the stent and nodded with satisfaction.

"Remove the sheath, apply pressure bandage, and pay attention to bleeding and high vagal reflex."

"Received!" Yao Jie nodded slightly.

The coronary surgical intervention was successfully completed, but it was only one of several operations for the patient.

"This patient may need to use a temporary pacemaker as a precaution." Lu Chen suddenly said.

Yao Jie was stunned. She thought that the TAVR surgery would start directly.

Lu Chen actually wanted to implant a pacemaker for the patient.

This pacemaker was implanted after the PCI surgery and before the TAVR surgery.

"Junior sister, do you know what my intention is?" Lu Chen asked with a smile.

Yao Jie frowned, thought about it, and then shook her head slowly, "I don't know."

Lu Chen smiled and explained: "Previously, PCI treatment did not cause high-degree atrioventricular block, but the TAVR surgery did! The pacemaker was implanted after the TAVR surgery, and this is to prevent high-degree conduction block."

He inserted a 5F temporary pacing electrode into the right ventricular outflow tract of the patient's right jugular vein for standby.

The process of implanting the pacemaker took less than five minutes.

Yao Jie, who was beside him, was stunned!

It took less than five minutes to implant a temporary pacemaker.

This speed is simply amazing.

He is worthy of being Senior Brother Lu Chen!

He was able to gain a foothold in Mayo, and his surgical skills were really unmatched by ordinary people.

…

After the temporary pacemaker was implanted, it was time for the tavr surgery.

In fact, at this time.

Yao Jie's assistant status was completely useless.

At most, she could help Lu Chen pass things. UU Reading www. ｕukanshu. net

"Junior sister, let Yamada Kenci come in to help." Lu Chen thought for a while and said.

Although he could do it alone, it was still inconvenient to have an assistant's help.

Yao Jie's current experience was still shallow, so for the remaining surgeries, it was enough for her to watch the surgery from the side.

"Okay, Senior Brother Lu."

Yao Jie nodded slightly, knowing that she could not help much now, she walked outside the catheter room and called Yamada Kenci in.

Lu Chen and Yamada cooperated in many surgeries.

The two of them also had a tacit understanding.

Then, it was the most critical point of the entire operation-tavr surgery!

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