Just two words, an expert only needs to hear the keyword and understand it instantly without any need for words.
Think about it, for this kind of interventional surgery, how to do internal fixation has always been a big problem.
Through small blood vessels, do you want to insert pliers, needles and threads to perform sutures like surgery? You need to wait for breakthroughs in basic disciplines such as physics and materials science before you can imagine.
How to fix without suturing?
Doctors learn from common sense in daily life.
For example, when there is a flood to rescue people, how do firefighters throw a rope in the water and fix the other end of the rope?
There are ways to do this, such as making a loop with the rope and throwing it into the water where there are rocks or other fixed objects to tie it.
Sometimes the rope does not float back after being thrown away. It turns out that the other end of the rope falls into the whirlpool in the opposite corner. The other end of the rope will be stirred by the whirlpool. If you don't pull it forcefully, it will not come back.
These common sense of daily life are all used by doctors to perform interventional surgeries.
Through the description of the two methods, you will find that no matter which method you want to have a fixed foundation, you must have a point that allows the rope to be easily hooked.
To put it bluntly, firefighters are borrowing terrain and location. Doctors need to borrow the topography and location of the patient's own heart structure.
Some patients have different terrains than ordinary people. If it is not suitable, the surgery will be finished.
Shin You-hwan had to explain a few more sentences, explaining his failure in detail: "The last time the patient came for a cardiac examination, he did an echocardiogram."
Neither echocardiography, nor electrocardiography, nor coronary stent surgery is strong in the detailed examination of the myocardial structure of the heart. Instead, as in Shou'er's case, the patient should be given a magnetic resonance imaging of the heart.
Examination. Since this patient did not have symptoms such as cardiomyopathy before, the doctor did not focus on this aspect and therefore did not prescribe such an examination.
It just so happened that during this surgery, the electrode was placed. If the electrode was placed in the right ventricle, the doctor would need to use the active fixation method mentioned above.
The anatomical feature of the right ventricle is that its internal surface has abundant structures such as ridged trabeculae, such as multiple small piles, and the wire head is made into a circular sleeve, which is very easy to fix.
As mentioned above, cardiac magnetic resonance is required to clearly detect trabecular problems, so Shin You-hwan and others did not know before the operation that the patient's internal surface structure of the right ventricle might have changed.
It is most likely that the patient's physical indicators have deteriorated greatly due to his advanced age, the trabeculae at the apex of the right ventricle have atrophied, and the electrical activity has decreased. As a result, the doctor could not put the electrode on or stimulate it, causing the operation to fail.
If it cannot be placed in the right ventricle, it can be placed in the right atrium.
The same cannot be said for the right atrium. The right atrium does not have ridged trabeculae like the right ventricle, but it does have a right atrial appendage. For ordinary people, a steel wire sends the electrode to the right atrial appendage for the right atrial appendage to hook the electrode.
The problem today is blind insertion. Without fluoroscopy, if the doctor wants to accurately deliver the wire to the right atrial appendage and hook it, he will have to be lucky. If the right atrial appendage is not used, the doctor can use another one during routine surgery.
This method uses active fixation of the pacing lead to actively fix it on the right atrial wall. The characteristic of this active fixation of the pacing lead is that there are screws on it. Place it on the selected atrial wall and rotate it to tighten the electrode.
Go up. In the same way, for the blind insertion done today, do you dare to twist it without seeing through it?