Chapter 2221

Heart treatment center of Sao Paulo hospital, Brazil.

Dr. Domingo Paul personally retrieved various data for preoperative evaluation.

Just like doing mathematical problems, lvvr first needs to calculate the amount of myocardium to be cut through various clinical values.

According to Laplace's Law: T = 2P × r. That is, the larger the volume and inner diameter, the higher the liquid tension (P) and the container tension (T).

Batista observed a large number of animal heart samples and human heart samples of dilated cardiomyopathy and reached a similar conclusion: M = 4.18 × R3, where m is left ventricular wall tension and R is left ventricular inner diameter.

Left ventricular enlargement leads to a disproportionate increase in left ventricular tension and oxygen consumption, resulting in a decrease in left ventricular efficacy. He hypothesized that the function of all enlarged hearts was improved after the inner diameter was reduced.

The purpose of left ventricular volume reduction is to reduce the left ventricular diameter in order to re-establish the new relationship between left ventricular volume, tension and diameter.

With the deepening of research, recent studies on Frank Starling mechanism can not be used to explain end-stage heart failure.

Left ventricular enlargement in advanced cardiomyopathy may be a malignant compensation for myocardial damage. Left ventricular volume reduction may affect the process of this vicious circle.

In end-stage cardiomyopathy, mitral valve reconstruction alone can also improve the cardiac function of some patients. Other simultaneous operations such as coronary artery bypass grafting are also helpful to the recovery of left heart.

The left ventricle is not spherical after remodeling, which makes the left ventricular contraction more coordinated and reduces the distortion of the heart. Other possible influencing factors include changes in blood volume and peripheral vascular tension and drug adjuvant therapy.

Theoretical research is only theoretical research, and mathematical problems have to be done.

Because there are few heart donors, the research on left ventricular volume reduction by the heart treatment center of Sao Paulo hospital in Brazil is second to none in the world.

The number of operations per year is also far ahead of other hospitals. Dr. Domingo Paul is one of the leaders. Since Dr. randas Batista initiated left ventricular volume reduction surgery in 1996, he is a doctor who does more of this kind of surgery.

After huge and complex calculations and surgical simulation, Dr. Domingo Paul was stunned to find that the surgical complexity of this patient was far beyond imagination.

Left ventricular volume reduction surgery needs to cut off a lot of myocardium. In a sense, the removed myocardial tissue can prove the difficulty of the operation.

So far, the most resected operation has cut off 302g myocardium.

However, according to my own calculation, the patient in front of me must remove at least 330g of myocardium before the operation can be considered successful.

After careful study, Dr. Domingo Paul's first idea was to give up the operation.

However, after the relevant personnel contacted by the patient implicitly expressed that he would donate to the heart treatment center if the operation was successful, he changed his mind.

Especially when he saw the patient's son and got the check, Dr. Domingo Paul decided to give it a try.

The patient's condition was very poor because he flew half the world by plane and had severe symptoms of heart failure. Even if left ventricular assist system is applied, it will inevitably continue to deteriorate.

On the third day, Johns Hopkins' critical care team was invited to Sao Paulo, where Dr. Domingo Paul was the surgeon.

The whole operation was extremely difficult. It barely ended after 11 hours and 22 minutes.

Although the operation was successful, Dr. Domingo Paul finally measured the cut left ventricle - 343g!

I have fully improved my previous record by 41g!

You know, every 10g more resection is a sill, and the difficulty of operation will rise in geometric order.

Because that means left ventricular hypertrophy is more serious; The patient's own health is worse; Surgical risk and perioperative risk are huge.

But!

Anyway, I successfully completed the operation.

Dr. Domingo Paul is proud of this.

The patient was sent to the intensive care unit for postoperative treatment and care, which was cared by the professional team of Johns Hopkins Hospital.

On the third day after operation, Dr. Domingo Paul stood outside the transparent isolation room and looked at the value displayed on the monitor. He was very satisfied with this.

This is the highest level of combination in the world, whether it is surgery or perioperative treatment. With the best surgeon and the best intensive care team, the mortality of patients is greatly reduced.

"It seems that the patient will recover soon." Dr. Domingo Paul's assistant said happily.

"Yes."

"Doctor, left ventricular volume reduction, your operation is fully mature and worthy of being the first in the world." The assistant said happily.

Dr. Domingo Paul thought his assistant was telling the truth.

He is sorting out the data and medical records about the operation into a paper and publishing it. This paper is a bomb, which shocked the medical community, Domingo thought.

"Doctor, it is estimated that within 20 years, you will keep the records of myocardial tissue removed by left ventricular volume reduction." His assistant continued, "this is your field. No one else can get involved!"

"Hahaha ~" Dr. Domingo Paul smiled happily.

The previous record was maintained by his competitor Nai Amaral. Operation time doesn't mean anything. Operation is not a race. Doing it fast doesn't mean anything.

Moreover, the successful surgical cases completed by the two people are similar every year. Nai has been pressing Dr. Domingo Paul because he had an operation to remove the myocardium of 302g of the left ventricle.

This is a natural cut that separates Dr. Nai Amaral from other doctors who perform similar operations.

This time, Dr. Domingo Paul went beyond the past and raised the record by 41g!

Domingo believes that his record can be maintained for 20 years, which is a conservative estimate. It is no exaggeration to say that this record may be sealed on the altar forever.

Nai... Is no longer the king of left ventricular volume reduction. The crown of the king has fallen on his head.

This time you know your strength. Domingo smiled happily. Leaving the intensive care unit, I happened to meet Nai Amaral.

Domingo Paul walked over with his head up, completely ignoring Nai's existence.

Nai used to treat himself like this. He can finally look down on him! Domingo was very happy.

"Doctor, I began to sort out the data, send the paper to the lancet or..." Dr. Domingo Paul's assistant asked him for advice.

"The lancet." Domingo was in a very good mood and said with a smile, "I'm more interested in the new breakthrough of surgery."

"This paper will certainly change the views of those stubborn Americans on volume reduction." Dr. Domingo Paul's assistant added: "343g! This is an appalling figure. It's time for those Americans to question the authenticity of our surgery."