After being called, she put on a surgical gown and stood beside the operating table. Xie Wanying helped the teacher observe the surgical field again, verified the three-dimensional picture emerging in her brain, and pointed out: "Teacher Du, there are several types of myocardial hypertrophy. This patient has deep central hypertrophy.
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Myocardial hypertrophy, also known as hypertrophic cardiomyopathy, is divided into three types. The main basis for classification is whether there is obstruction in the left ventricular outflow tract. Those with no obstruction and occult obstruction do not rule out reversibility, and are not in the
It is within the indications for surgery, so surgery is not necessary for myocardial hypertrophy. Among them, only the obstructive type requires surgery.
Obstructive myocardial hypertrophy, that is, the left ventricular outflow tract is blocked. Doctors used to call this type subaortic stenosis. Because after doctors opened the hearts of such patients, they found that the abnormal hypertrophy of the myocardium was mainly in the aortic valve.
The location beneath the arterial valve.
Under the aortic valve is the aortic root, which is connected to the left ventricle and covers a relatively large area. If there is myocardial hypertrophy here, it is impossible to say that it is exactly the same. The several types mentioned by Xie refer to the anatomy here
Look at the structural classification of lesions rather than the above classification.
Through surgery and dissection, doctors roughly classify the myocardial hypertrophy into five types based on the location. The simplest one is the muscle hypertrophy under the aortic valve that was discovered at the beginning. Other types of myocardial hypertrophy are deeper and more troublesome.
Some hypertrophy is a whole piece of interventricular septal muscle hypertrophy, with the hypertrophy extending across the left ventricle side. Some cases have no hypertrophy at all under the aortic valve, and the hypertrophy reaches the apex of the heart, completely subverting the initial definition of the disease by doctors.
and name, which is why the original name has become history. Regardless of where the hypertrophy is located, these hyperplasia squeezes the volume of the normal left ventricle and creates obstacles to healthy hemodynamics of the left ventricle. Doctors definitely need to treat it
Perform surgical treatment.
The point of dispute once again returned to the original place: Does the patient's myocardial hypertrophy in front of me conform to what Xie said is one of the pathological structures of obstructive myocardial hypertrophy? Or is it something that the preoperative examination report failed to clearly point out?
This kind of problem is judged to be a reversible hidden obstruction, so the surgeon does not need to consider this aspect of surgery before surgery?
Which result is correct?
If it weren't for a problem with the mitral valve orifice, no one would have considered this at all. Sometimes when there is a problem somewhere, the crux of the problem turns to another problem.
"Can you explain again, is the entire ventricular septum hypertrophic?" Du Yeqing continued to confirm what she said.
"Is that so?" Dr. Yu, the assistant on the stage, tried to stand on tiptoes and stretch his neck, trying to get a clearer view of the internal structure of the heart in the surgical field.
When performing open heart valve surgery, the valve is located inside the heart. If the doctor wants to see and operate, the heart must be cut open. This must not be done randomly. The doctor cannot say that in order to facilitate his own clear vision and easy operation, he must cut the heart with one knife.
The patient's heart was completely opened.
It is even more impossible to say that a knife can cut out the entire heart of a patient, because the heart is not an apple or a pear. It has several cavities, and these cavities and the walls that separate the cavities are all asymmetrical, left, right, up and down.
Asymmetrical, asymmetrical in volume, no point of symmetry.