MTL - I Can See Health-v2 Chapter 874 Shaping of the catheter (first update)

  Chapter 874 Shaping of the catheter (first update)

   Mayo's Cardiology Catheterization Lab.

  Lu Chen checked the patient's ultrasound report again.

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

  CW: systolic aortic valve orifice maximum blood flow velocity: 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 whole operation officially begins.

   Under the guidance of Lu Chen, 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 a puncture needle in his hand, Yao Jie's movements were unhurried and slowly pierced into the blood vessel.

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

   With the pulsating red blood appearing in the puncture needle, Yao Jie successfully finished the vascular puncture.

All beginnings are hard.

  A 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., are guided by catheters and guide wires to smoothly enter the human heart.

   "Slow down, don't go too fast, haste is not enough!" Lu Chen instructed from the side.

   Catheters and guide wires are very delicate things. If the airway is slightly larger, it may damage the blood vessels.

   Insert a 6F sheath and inject 7000U heparin.

   Yao Jie sent EBU3.75, EBU4.0 and JL4 guiding catheters respectively.

   But, unfortunately.

   She failed to get the catheter to the left coronary ostium.

   Yao Jie's hands trembled slightly.

   The first operation, is it about to fail?

   And lost in such a small place?

   She was a little unwilling, and there was even fine sweat oozing from her forehead.

After    debugging several times, the guide catheter still failed to reach the left coronary ostium.

   "Senior Brother Lu, I..."

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

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

   Yao Jie lowered her head, turned slightly to the side, and gave Lu Chen the seat for the surgery.

  Lu Chen took a step forward, gently held one end of the guide catheter, and started the operation.

   fiddled a little.

  Lu Chen also discovered that with the current shape of the catheter, it must not be able to pass through the left coronary ostium.

"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 A skill, it's catheter shaping."

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

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

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

"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 shaping length are different concepts. We generally The length we talk about actually refers to the shaping distance, not the real length..."

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

   This skill is the most test of the ability of the practitioner.

  Sometimes, just shave twice and go straight in.

   And sometimes, it takes a long time to see the lesions, look at them, and shape them for a long time.

   Yao Jie listened to Lu Chen's explanation and kept her eyes fixed.

   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 make a big bend. This big bend can be double-bended or curved! This large-bend guide wire can be retracted or advanced. Of course, it can also be used The double-lumen microcatheter assists in entering below.”

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

   "Sister, the most important thing is that you have to remember 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 crown mouth was successfully reached.

  Lu Chen immediately sent a VT guide wire to the distal end of the anterior descending branch, sent a BMW guide wire to the distal end of the circumflex branch, and sent a 2.0*20mm double guide wire balloon to fully pre-expand the proximal stenosis of the anterior descending branch.

   In the eyes of outsiders, the extremely difficult coronary intervention at this moment was gradually broken by Lu Chen.

   However, Lu Chen was not complacent.

   He concentrates his attention at all times and avoids any emergencies.

   Subsequently, he delivered a 3.0*24mmDES to the mid-segment lesion of the anterior descending artery.

  Release after precise positioning.

   Send 3.5*16mm mastoid balloon and 3.0*15mm NC balloon respectively to the stent for modification and expansion.

   "Recheck the angiography!"

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

   "The stent expands well."

   After the angiography was over, Lu Chen glanced at the position of the bracket and nodded in satisfaction.

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

   "Received!" Yao Jie nodded slightly.

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

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

   Yao Jie was taken aback, she thought she would start the TAVR surgery directly.

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

  This pacemaker was implanted after PCI and before TAVR.

   "Junior sister, do you know what I'm doing?" Lu Chen asked with a smile.

   Yao Jie frowned, thought for a moment, then slowly shook his head, "I don't know."

  Lu Chen smiled and explained: "Previous PCI treatment did not cause high-grade atrioventricular block, but TAVR surgery will! A pacemaker is implanted after TAVR surgery, and this is to prevent high-grade conduction block."

   He placed a 5F temporary pacing lead in the patient's right jugular vein to the right ventricular outflow tract for backup.

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

   Seeing Yao Jie beside her, she was stunned!

   Implanted a temporary pacemaker, not even for five minutes.

   This speed is simply amazing.

   As expected of Senior Brother Lu Chen!

   He can stand in Mayo, and his surgical ability is really not comparable to ordinary people.

  …

   After the temporary pacemaker was implanted, the TAVR surgery came.

   Actually, at this time.

   Yao Jie's assistantship is completely useless.

   At most, it is to help Lu Chen deliver something.

   "Junior sister, let Kenji Yamada come in and help." Lu Chen thought about it.

  Although he can do it alone, it is still inconvenient without the help of an assistant.

   Yao Jie's current experience is still shallow, and for the rest of the operation, it is enough for her to watch the operation by the side.

   "Okay, Brother Lu."

   Yao Jie nodded slightly, knowing that she couldn't be of much help right now, she walked to the catheter room and called Kenji Yamada in.

  Lu Chen and Yamada cooperated in many surgeries.

   The two of them are also very tacit.

   Next, is the most critical point of the whole operation - TAVR surgery!

   (end of this chapter)