Soon, Director Jia Yanguan and Ruan Bin went to the family to talk before the operation.

Tell the family that there are two options for surgery, the first is zero contrast surgery, if it cannot be carried out during the operation, it can only be imaging.

The consequence of the imaging is that the kidney damage is aggravated, and dialysis treatment is expected to be done in the future.

Dialysis treatment is very troublesome, almost a symptom but not a cure, and it also has certain drawbacks, such as "dialysis is easy to "addictive", the cost is high, and long-term dialysis will gradually atrophy the kidney, and eventually start the road to kidney replacement.

But there's no way around it!

If you don't have stenting surgery, you may have another myocardial infarction at any time, and the next myocardial infarction may not be detected and saved in time.

So this is the last resort, and the helpless way!

In the end, the family agreed to this plan!

In the operating room.

Ruan Bin was in charge, Director Jia and Deputy Director He were his first and second assistants, and Chang Wenwei was watching from the side.

To be honest, it was the first time he had an operation to have the deputy director as his assistant, and it was estimated that it would be a lot of coaxing.

At this time, the anesthesiologist began to inject anesthetic at the puncture site, while Ruan Bin was looking at the patient's imaging image from half a year ago, because it was a zero-contrast operation, so there was no reference at all, and he could only make judgments and predictions based on this imaging image from half a year ago.

"Doctor Ruan, are you nervous?" Jia Yanguan couldn't help but ask, after all, this operation was very difficult, and he was a little nervous in his heart, not to mention Ruan Bin, the chief surgeon?

"It's ok, but not a big problem. Ruan Bin smiled slightly.

Soon, the anesthesia was effective and the operation began.

A puncture is performed at the femoral artery, and a sheath is placed after the puncture.

The sheath is passed into the guide wire and intravascular ultrasound, which is a tiny ultrasound probe.

All the next surgeries depend on it.

Because imaging is not possible, everything is done blindly.

But intravascular ultrasound still doesn't help much!

You can only rely on Ruan Bin to find the road ahead of the blood vessels on his own!

Intravascular ultrasound guides the guidewire along the artery to the heart, and then along the guidewire into the catheter, both of which go all the way to the heart until it reaches the coronary artery.

This process is completely operated by Ruan Bin's feel and experience.

Ruan Bin, who has world-class resuscitation aortic balloon occlusion, coupled with his proficiency in coronary artery stent implantation, still has the ability to guide the catheter into the heart without danger.

"It's in the coronary arteries. Ruan Bin said.

"Whew...... It's a first step. After hearing this, Director Jia was surprised that Ruan Bin was so fast, but then his face became solemn.

Because the next step is the most important step - find the lesion and place the stent!

Usually the most critical procedure is to push a contrast agent through the catheter to clearly visualize the blood vessels on x-rays and find the lesion.

But now there is no contrast agent at all, so X-rays are not used.

At this time, you need to grope like a blind person to find the lesion site, determine the location, and then send the balloon into the blood vessel at the lesion site, inflate and deflate the balloon, extrapolate the blood vessel wall, restore the patency of the blood vessel, and then implant the stent.

Ruan Bin looked at the patient's imaging image from half a year ago, and there were a total of 2 lesions in it, but both of these places were stent placed by Director Jia half a year ago.

But why is the patient's myocardial annine still so high after half a year? There are only two reasons, first, there is a problem in the place where the stent has been done before, or the lesion is persistent, and the stent must be continued. Second, there are other lesions!

Since there was no contrast agent, Ruan Bin could only search the entire coronary artery carpet to see if he could feel the lesions.

This is a blind exercise, if you are not careful, you will have an accident, if the heart artery ruptures, then it will be fatal. So be careful.

At this time, Director Jia and the other three were all holding their breath, nervously watching Ruan Bin's operation.

With his rich experience, Ruan Bin began to slowly operate the catheter to move through the coronary arteries.

He first operated the catheter and went to the first lesion to check the first lesion according to this imaging image from half a year ago to see if there was any problem.

His hands were steady, and there was not the slightest tremor. He is well aware that sometimes a mistake of five millimeters can cause problems.

At this time, his pre-hospital REBOA's strong spatial operation ability was demonstrated.

The catheter is unobstructed inside the coronary arteries and reaches its destination quickly.

"There was no blockage and narrowing of the diseased blood vessel before, and it seems that there was no problem with the stent that was placed before!"

"Look at the second place. ”

"No problem!"

"Then there is only one possibility, the third or even the fourth new lesion in the patient's heart!" Ruan Bin frowned.

"How's it going?" asked Director Jia.

"There are no problems in the two stents you did before, it seems that the patient has a new lesion, and I slowly explored. Ruan Bin continued to operate.

"New lesions?" Director Jia also frowned, which undoubtedly made this operation more difficult again!

No one knows where the new lesion is blocked in the coronary artery!

At this time, Ruan Bin was like walking in the dark night, without any light.

He can only feel the catheter with his own hands, and then feel the inside of the coronary arteries through the touch of the catheter.

Finally, after ten minutes, Ruan Bin finally found the new lesion.

He could thank the arteries through the catheter in his hand that the arteries had indeed narrowed!

"Found it!"

Once the location is found, the next step is to perform a further stent implantation, in which a balloon wrapped around the stent is passed along the catheter into the lesion site, after which the balloon is inflated and used for about 10

The pressure of double atmospheric pressure pushes the metal bracket open.

But there was a problem with the balloon being fed.

"The blood vessels in that part?" Jia Yanguan hurriedly asked.

"Roundabout!" replied Ruan Bin.

"That should be 2.5×33

mm minimally invasive stent!" Director Jia said with great experience.

"Well, I think so too. Ruan Bin nodded.

At this point, he uses 2.0×15

The mm semi-compliant balloon is pre-dilated at the lesion site, but it is found that the cyst cannot pass at all.

"What's wrong?" Director Jia asked puzzled when he saw Ruan Bin stop.

"The IVUS catheter had difficulty passing through the occlusion segment and had to be replaced with 2.5×12

mm non-compliant balloon re-expand!" Ruan Bin said.

Soon, a smaller capsule was replaced, the blood vessels were successfully dilated, the stent was implanted, and it was completed!

：。 : I want to talk about "Krypton Doctor" with more like-minded people, pay attention to "excellent reading literature" on WeChat, talk about life, and find confidants~