At the end of the free discussion, Professor Li Zehui will talk about the latest progress in the treatment of pediatric congenital heart disease.

As a professor at the Cleveland Clinic and a rising star in cardiac surgery in the world, Li Zehui's classes are naturally full of cutting-edge technologies, which are all things that cannot be seen in textbooks.

The case discussion of a department, the academician, the top international expert, or the special flight to participate in the case discussion, this kind of meeting will undoubtedly increase students' knowledge and enhance their self-confidence.

He Xiangjun, director of the Department of Thoracic Surgery at Sanbo Hospital, has not spoken much, probably because the longer he works, the less passion and curiosity he has, and he has no interest in what these young graduate students discuss.

Yang Ping is about to serve as the chief surgeon of infant cases, so Academician Wang hopes that Yang Ping can make a concluding speech on the discussion just now.

As the head of the section, this is how it should be, Yang Ping slowly walked to the podium and said:

"I think a lot about this case, just now I said to bury the dilator in the dysplastic left ventricle, I don't just talk about it, but really want to set up a topic to specialize, I hope to find a radical cure for the treatment of left ventricular dysplasia, the general direction is already there, the rest is to refine the topic, I hope that every doctor and student in the department will be involved, how to design the dilator, how to bury it, how to draw out the pipe, how to expand the specific expansion, we can expand the space of the left ventricle, It also ensures the thickness and contraction force of the myocardial wall, so that the left ventricle can beat normally and vigorously after completing the expansion. ”

"I'm signing up!" Li Guodong raised his hand excitedly.

Immediately, many people at the venue followed and raised their hands to sign up, and everyone was highly motivated and felt that they could get things done.

"Okay, after the meeting, Li Guodong will take the lead and build the team first."

"There are also two cases of failure that Wang Lao just mentioned about his failure, failure is the mother of success, and without Wang Lao's pioneering work to provide experience and lessons for latecomers, latecomers cannot succeed."

"Just now Wang Lao didn't say a little, I would like to add that this case not only has particularly high requirements for suturing technology, but also requires very fast suturing speed, because the case is an infant, the baby can not accept a long period of extracorporeal bypass, and must use the deep and low temperature stop circulation technology, the use time of the deep and low temperature stop circulation technology is generally 45 minutes, and the use of special brain protection technology can only be extended to 60 minutes, so all the sutures must be completed within this time, in fact, it is very difficult."

Academician Wang deliberately didn't say this just now, but he didn't want to put objective difficulties on the table, failure is failure, and we must face it squarely.

In Yang Ping's summary, the case discussion ended, and everyone was very much looking forward to the arrival of this operation, and heard that the suture of this operation is the ceiling of surgical suture technology.

——

Early the next morning, the baby was brought to Sanbo Hospital by his parents and hospitalized.

The little guy has obvious cyanosis on his lips, cyanosis is a symptom of hypoxia, it stands to reason that a phase of surgery should be completed within a month, and now it is more than a few days in a month, if there is no surgery, this doll is afraid that it will not live for a few days.

The parents of the doll also tried their best to fight for it, and they didn't want to give up just like that, so they found Fuwai Hospital and found Professor Chen, Professor Chen is the top expert in pediatric congenital heart disease, except for Academician Wang, who has retreated to the second line, Professor Chen is not an exaggeration to call the first person in Chinese pediatric congenital heart disease surgery.

The doll's mother unbuttoned the baby's clothes, Yang Ping checked the condition of his whole body, then auscultated the heart, and then looked at the various examinations brought from the outer hospital, the indications for surgery were clear, and there were no contraindications to surgery, so there was nothing to say - surgery!

Do it a day earlier, less risk, more hope.

"Complete the preoperative examination today, and do the surgery tomorrow." Yang Ping said after the inspection.

Academician Wang admired Yang Ping's decisiveness very much, did not drag the mud and water, just did what he said, and did not push back because of difficulties.

If there is no problem in the first step, it means that the blood vessels sutured by Yang Ping can be qualified, then the second and third steps are generally not a big problem, so the first stage of surgery is the most important.

Xia Shu entered the state quickly, perhaps he originally liked the work state of comprehensive surgery, and as soon as he went to work, he gave full play to his specialty advantages to assist the bed manager to participate in the perioperative management of the baby.

The surgery began the next day.

Yang Ping was the chief surgeon, and Academician Wang and Professor Chen were assistants, because they had experience in this kind of surgery.

Song Zimo and Xu Zhiliang also came to power, but they were marginal characters.

Li Zehui, He Xiangjun, and Xia Shu, as observers, sat in the corner of the operating room, preparing to use the screen in the operating room to observe the operation.

Professor Cao didn't come this time, he felt that he was older, and Yang Ping's surgery was less than good.

In order to cope with possible emergencies, Yang Ping adopts the median sternal approach, which is the most open and open approach.

When the chest cavity is opened, the heart is revealed, and this small heart is not as big as a walnut, and the large blood vessels are even smaller.

Anastomosis blood vessels is Yang Ping's housekeeping skill, is the debut stunt, when he came to Sanbo Hospital, it is to rely on a hand amputated limb replantation to fight the world, all the way to fight monsters and upgrade, what is the core technology of amputated limb replantation, is the vascular anastomosis, and thinner than the baby's finger blood vessels.

The aorta, pulmonary artery and the connection with the heart were also revealed, and Yang Ping gently touched the tiny blood vessels with his fingers, and the first feeling was that the elasticity of the blood vessels was very bad.

"Prepare for cardiopulmonary bypass and cardiac arrest!"

Cardiopulmonary bypass is turned on, and cardiac arrest fluid is injected to stop the heart.

In the process of cardiopulmonary bypass, the baby's body temperature is gradually reduced, and when the central body temperature is reduced to 15C, the cardiopulmonary bypass machine is turned off and all blood circulation is stopped, which is DHCA - deep hypothermia circulation arrest technology.

Because babies cannot tolerate prolonged cardiopulmonary bypass, this technique is mandatory.

In the state of cryogenic circulatory arrest, the heart is stopped, and the blood is still and does not flow, so it is similar to "death", except that this is an artificially controlled "death", which can be reversible under certain conditions and can be "resurrected".

This condition is that this state cannot exceed 45 minutes, and it can be "resurrected" within 45 minutes, and it cannot be "resurrected" after the time, so the operation must be completed within 45 minutes.

"Is it necessary to combine anterograde brachiocephalostrual artery perfusion and superior vena cava retrograde perfusion for brain protection?" Academician Wang proposed.

Adding this step to protect the brain can extend the cryogenic cycle stop time to 60 minutes, creating more time for surgery.

"No, I'll try to finish the surgery in 20 minutes." Yang Ping said without thinking.

20 minutes, what are you kidding, but Academician Wang has no doubts now, and he must not use ordinary thinking for this young man.

Yang Ping began to quickly examine the heart and the blood vessels connected to the heart, the aorta is very thin, there is severe stenosis, now Yang Ping wants to cut the aorta, but also widen the aorta to restore the normal diameter.

When the aorta was cut and the severed end of the blood vessel was exposed, Academician Wang took a deep breath.

This is exactly the same as the two failed cases that year, the blood vessel wall is like paper, thin and inelastic, even if the suture is perfect, it cannot be done evenly with each stitch, and if it is not uniform, there is a weak point, and the stress will be concentrated in the weak point, which directly leads to the blood pressure impact weak link, tearing the blood vessel from here.

In the first case of that year, when he saw such blood vessels, Academician Wang's heart was like ashes, which could not be sutured at all, although he tried to do the best suturing, but still could not achieve the ideal uniform state.

"Do you want artificial blood vessels?"

Academician Wang asked.

Artificial blood vessels are a good solution, artificial blood vessels can bear the stress and protect the suture site, but there is an Achilles heel: the baby will grow up over time, and the diameter of the artificial blood vessel is unchanged, so it is not suitable for minors, especially infants. The presence of this weakness leads to the removal of artificial blood vessels for a certain period of time after surgery.

"No!"

Yang Ping decided to use his superb suturing skills to solve the problem, since the blood vessels can withstand the impact of blood before cutting, as long as the sutures reach the ideal uniform state, there is still hope for success.

Not only should the stitching be even, but also the needle distance and margin should be carefully designed, and it must not be designed according to the normal blood vessels.

In principle, the tighter the suture, the better, so that the stress per needle is dispersed as little as possible, but the denser the needle holes, the more pinholes, the lower the strength of the blood vessels, so find a balance between the two.

This kind of suturing is not just a matter of suturing technique, there are many factors to consider.

Academician Wang's experience of two failures made him palpitate, this kind of surgery really hurts the tip of the knife, and he can't make a mistake.

Yang Ping's movements are very careful, but they are also very fast, in fact, when they are proficient to a certain extent, fast and slow are only relative.

The ductus arteriosus between the pulmonary artery and the aorta is ligated and severed with wire, the pulmonary artery is cut above the pulmonary valve, and the fracture on the side of the pulmonary artery is closed with a patch.

Take a section of vein, Yang Ping will cut the vein, and then use it as a patch, for expanding the diameter of the aorta, his entry and exit of each needle is precisely calculated, each action is completed at one time, each time the needle is inserted is 90 degrees perpendicular to the suture surface, and then use the sudden force of the wrist to let the needle tip quickly pierce the blood vessel wall, so that if the pinhole of the blood vessel wall is enlarged, its edge is the most aligned, and the damage is the smallest.

Academician Wang noticed that when Yang Ping was suturing, each stitch was very silky from in to out, and the blood vessel wall seemed to be stationary, without a trace of pulling.

The diameter of the aorta was enlarged, and Yang Ping connected the aorta to the residual part of the pulmonary artery that had just been cut off from the right ventricle, that is, the aorta was connected to the right ventricle.

At this step, Academician Wang found that the caliber of the aorta was completely consistent with the diameter of the base of the pulmonary artery remaining in the right ventricle, that is, when Yang Ping expanded the diameter of the aorta, he had already considered that the diameter of the aorta was consistent with the base of the butted pulmonary artery.

This is so meticulous that it is simply watertight.

The same is true for anastomosis diameters, one stitch and one thread, each stitch is in place at one time, and no stitch needs to be repeated or the quality is reduced.

After the suture is completed, the diameter of the pipe is just right and very sealed.

The atrial septum is removed, and the left and right atria are opened, and the side becomes a large room.

The next step is the most difficult step, bridging the pulmonary artery with the aorta, which is not to dock them because the aorta is already connected to the right ventricle, but to use a blood vessel to temporarily connect the pulmonary artery to the aorta.

For this temporary bridging vessel, Yang Ping chose the branch of the aorta - the innominate artery, which is not nameless, but the name is called the innominate artery.

The heart is not as big as a walnut, and the aorta is also very small, so it is conceivable that its branch innominate artery must be very small, but no matter how small it is, it is thicker than the blood vessels of a baby's finger, which is not a problem for Yang Ping at all.

The small vessel anastomosis tests the stability of the hand, especially the operation of the arms in the air, but for Yang Ping, this is not a problem, this is exactly what he has to become famous for.

Anastomoses small blood vessels with both arms in the air, a stunt that drove the doctors crazy when they were operating at Mayo Clinic.

Academician Wang and Professor Chen, as assistants, try to breathe evenly, even hold their breath during key operations, and try to control after relaxing their breathing, and try not to inhale and exhale in large gulps, so as not to disturb Yang Ping's operation.

The bridging was completed with extremely skilled vascular anastomosis technology, and there were still 5 minutes left until 20 minutes, that is, only 15 minutes were used, and Yang Ping completed the entire suture just now, thanks to his unparalleled vascular anastomosis technique.

Academician Wang didn't know what to say at this time, and was completely shocked by the speed of this operation.

"Restore your body temperature!"

Rewarming needs to be done gradually, slowly recovering, not too fast, after the reduction, the cardiopulmonary bypass specialist connects the cardiopulmonary bypass, so that the blood body can flow again in the baby's body.

Then the cardiopulmonary bypass is dismantled and the heart is allowed to rebeat, and after the heart is rebeaten, the real autologous circulation with the heart as the core begins.

This step is the most thrilling, the scene of that year is still engraved in Academician Wang's mind - the heart began to beat, soon, the bleeding points came out one by one, then there was blood, and finally there was blood, and finally there was a spurt of blood, the entire chest cavity was full of blood, a mess, in a hurry, there was no way to stop the bleeding, the more the needle was supplemented, the worse the blood vessels became, and finally they could only rely on blocking the large blood vessels to stop the bleeding, but this was in vain, and it was impossible to rely on temporary blockade forever.

"I'm starting to beat my heart again and see how the stitches go?" Yang Ping announced.

Academician Wang and Professor Chen stared at their hearts, holding their breath, their hearts began to beat, and they sweated in their hearts, will blood spurt everywhere like before, and finally all the sutures will disintegrate.

One minute, two minutes, three minutes, four minutes, five minutes - and still no blood leakage, not even a single bleeding point, let alone blood gushing and spurting.

"Observe for another ten minutes, and if it's okay, close your chest."

Yang Ping put down the instrument in his hand.

"Song Zimo, wrap it up!"

"Okay!"

Song Zimo and Xu Zhiliang, who have been marginalized, immediately cheered up, just now they were also watching the screen in the operating room, and the operation was also broadcast live.

"Professor, it seems that the baby finger replantation stunt has not degenerated." Song Zimo said with a smile.

Back then? It's only been a long time, and it's like it's a long history.

"This is my debut trick, can you say that you will lose it?"

Yang Ping gave up the position of the chief knife and handed it over to his assistant to do the finishing work.

And Li Zehui, who was just sitting next to the screen in the operating room, was also shocked, and completed the main steps of the operation in only 15 minutes, and there was no problem with a single needle.

"When Professor Yang did baby finger replantation, it was still a premature baby, and the technique of anastomosis was simply amazing, and I admired it so much."

"I was -—— in the emergency department"

"Professor Yang used to do finger replantation?"

"Of course-—— the ability to get started."

(End of chapter)