Although Lin Yi said this, Zhou Chao looked at him and couldn't help but worry.

How is it so easy to add a new repair material?

After Lin Yi confirmed the lesion again, he said to Zhou Chao:

"It has been confirmed that the cause is the upper and lower vena cava obstruction, so let's prepare to operate on the patient immediately!"

After Zhou Chao communicated with the patient's family again, he was ready to perform surgery for the patient immediately after obtaining the signed informed consent form for the operation.

Soon, the anesthesiologist was in place, and the patient was anesthetized.

The operation was first performed by Zhou Chao, who opened the chest from the middle of the patient's sternum very neatly.

Then, the right innominate vein, left innominate vein, and superior and inferior vena cava are fully freed, and one femoral vein is freed at the same time for backup.

At this moment, Lin Yi stared at Zhou Chao's hand movements.

Although Zhou Chao is the director of the emergency department, he is also very strong in the free vein part of the operation.

Lin Yi was still thinking, and after heparinization, Zhou Chao inserted the ascending aorta into the arterial line, the femoral vein with an intravenous line for inferior vena cava drainage, and the right innominate vein cannula for superior vena cava drainage, and cardiopulmonary bypass.

Soon, the old horse said:

"Director Zhou, the patient's cardiopulmonary bypass is normal, and he can proceed to the next operation!"

However, at this point, it has to be replaced by Lin Yi. After all, it is now necessary to operate on the patient's heart, and this kind of surgical operation that requires extremely meticulous operation, Lin Yi is naturally much better than others.

Zhou Chao naturally understood this truth.

Therefore, after cooperating with the anesthesiologist to do cardiopulmonary bypass, he took the initiative to give up the position of the chief surgeon.

Lin Yi was not polite, he just stood there, picked up the scalpel prepared by Wang Qiaoya in advance, and cut it at the patient's heart.

The scalpel that had been prepared first was cut into the patient's heart.

The volume of the patient's right atrium was small, and after Lin Yi cut the superior vena cava and part of the left innominate vein, Zhou Chao immediately helped to clean up the surgical field.

Then, everyone looked together, only to see that the surface of the pacing lead was widely endothelialized, and the lumen of the blood vessel was widely thin.

Wang Qiaoya said.

"Oh my God, it's all like this! It's no wonder if it's not blocked! ”

Lin Yi continued to go down, cut the inferior vena cava near the entrance of the right atrium, and saw that the tissue of the right atrial wall was thickened in a ring, and the endothelialized pacing leads were curled into a clump, resulting in obvious stenosis of the inferior vena cava into the atrium.

Lin Yi frowned.

"It seems that the embolism is caused by the curling of the pacing leads."

Subsequently, Lin Yi quickly removed the endothelialized pacing leads, and then cut off the thickened atrial tissue.

The next step is the critical restoration.

However, what about the material of this patch......

Lin Yi thought about it again and again, and finally decided that it was more suitable to take the heart bag as a patch.

This choice has nothing to do with whether or not it will be ridiculed by Director Zhang Zicheng of the Department of Thoracic Surgery, but it is more suitable to make a patch with heart for the patient's current situation.

As for the rest, it doesn't matter!

Zhou Chao also seemed to see the fluctuations in Lin Yi's heart, and asked softly.

"Lin Yi, it seems that the pericardium is going to be used as a patch this time, right?"

Lin Yi did not deny it.

"Yes, because the location is on the inferior vena cava, superior vena cava, and part of the left innominate vein, it is more suitable to use the heart bag to do the patch."

Lin Yi is very calm, he will never do anything that harms the health of patients because of his own face or the ridicule of others.

Before the Zhou Dynasty could say anything, Wang Qiaoya asked:

"Wouldn't this be cheaper? Didn't he hope that would happen? ”

Lin Yi shook his head and said:

"The patient's health comes first, we only choose the most suitable solution, and nothing else matters."

After a little preparation, Lin Yi took the patient's autologous pericardium and trimmed it into a suitable large pericardium.

The narrowed inferior vena cava, right atrium, superior vena cava, and part of the left innominate vein are then widened.

After doing this, Lin Yi made a follow-up action that neither Zhou Chao nor Wang Qiaoya expected.

He removed the pacemaker and sent the fibrous tissue on the surface of the pacing lead for pathological examination.

Wang Qiaoya asked puzzled.

"Brother Yi, why do you want to send the fibrous tissue on the surface of the pacing lead for pathological examination? What's the point? ”

Lin Yi said with a frown.

"I'm concerned that patients have a tendency to have calcified lesions in their vascular tissues...... It will worsen in the future, so I have to take this opportunity to analyze the case. ”

"One more ......"

Zhou Chao looked at Lin Yi and asked:

"One more point? What do you want to say? ”

"Another point is that the patient's venous embolism this time is directly related to the pacing lead."

Then Lin Yi said.

After Zhou Chao heard Lin Yi say this, he was taken aback.

"Are you trying to say it's an accident?"

If it is blamed for the accident, the problem is big.

Lin Yi shook his head and denied Zhou Dynasty's speculation.

"No, I didn't say it was an accident, but I was worried that the patient had secretly stopped taking the medication on her own, and she was not taking the anticoagulant medication on time and in the right dose.

That's why venous thrombosis occurred so early. Under normal circumstances, taking the medication exactly as prescribed would not have caused such a severe venous thrombosis so early.

That's just my guess, though. Whether this is the case or not needs to be communicated and confirmed with the patient. ”

Wang Qiaoya and Zhou Chao also kept shaking their heads after hearing Lin Yi say this.

Indeed, it is not uncommon for patients to stop or reduce the dose of the drug without permission.

This is not an isolated case.

Zhou Chao has encountered a situation like a patient.

No matter how much he tells him, the patient will still secretly stop the drug on his own.

However, because the patient stopped the drug without authorization, the disease could not be controlled, resulting in the recurrence and aggravation of the disease.

In addition, even if the patient seeks medical attention in a timely manner, if the patient does not describe the medical history carefully, it is easier to confuse the real disease with other diseases and delay the time for treatment.

However, it is surprising that this kind of private withdrawal of medication generally occurs in elderly patients, such as worrying that taking too much medicine will not be good for their health. Therefore, once the symptoms are relieved, the drug will be stopped on its own, which will unknowingly lead to the aggravation of the disease.

However, Wang Qiaoya looked at the patient in front of her and said:

"Isn't it generally the elderly patients who like to stop taking the drug without permission? Now that even middle-aged patients have begun to stop taking the drug on their own? “

After hearing Wang Qiaoya say this, Lin Yi couldn't cry or laugh.

"What else is there to roll up after taking medicine, how can this thing be compared?"

"I'm afraid it's probably because of some reason that the patient will stop taking the drug without permission. However, this will not be known until you continue to communicate with the patient after the surgery. ”

After Lin Yi had a complete operation, they immediately followed up with an upper and lower vena cava angiogram for the patient.

Of course, the purpose of this is to check the repair effect after surgery.

Angiography showed that the patient's superior vena cava was widened by Lin Yi with a pericardial patch, and the blood flow was smooth.