Chapter 2159: Chapter 2159: Perspective Navigation
The division of left and right atrium and ventricle is just a rough categorization, given for convenience, as there is no complete symmetry line from the truly structural perspective of the heart.
Not only does the internal structure of the heart pose a challenge for the surgeon’s scalpel, but the surface’s critical blood supply network—the coronary arteries—are also asymmetrically distributed. The surgeon needs to avoid critical blood vessels while making incisions.
The fewer incisions, the better; ideally, just one incision is best. As always, the old saying goes: a surgeon must be accountable for every incision, and only a foolish surgeon would want to make multiple cuts. Where this incision will fall must be planned according to the preoperative designated surgical site. If it’s simply a mitral valve replacement, the mitral valve is located on the left side, thus a straightforward incision on the left atrium will suffice. Today’s patient requires both mitral and tricuspid valve surgery; one on the left and one on the right. According to the experience summarized by predecessors, in such a situation, the conventional surgical approach is to start from the right atrium, cut open the right atrium, find the atrial septum, then make an incision up and down at its fossa ovalis central part, with the mitral valve visible.
Upon cutting these parts open, the doctor uses thread to suspend the surrounding edges for better exposure of the surgical field inside.
Before surgery, the team only considered the mitral and tricuspid valves, not myocardial hypertrophy. The chosen surgical approach does not consider the latter, and the exposed surgical view does not consider the full view of the Left Ventricle. No wonder Dr. Yuh needs to stand on tiptoes. With this surgical view, he truly can’t see the complete interior of the Left Ventricle to diagnose myocardial hypertrophy.
The Chief Surgeon has extensive surgical experience and has accumulated a larger library of surgical anatomy graphs in his mind than this young inpatient, perhaps able to glance at part of the picture, like piecing together a puzzle using mental imagery to judge other areas.
As for Student Xie, anyone who knows her knows she’s a unique case.
The only awkwardness for Student Xie now is how to link the thought process of an ordinary mind with her exceptional brain, to let everyone understand the image she has in her head.
Responding to further inquiries from the Chief Surgeon, Xie Wanying proceeds to organize her thoughts: "Please view from this angle here, Teacher Du."
Others listen to her as if it’s a navigation system’s voice guidance.
"Here, this point, beneath the preserved large chordae tendineae from the patient’s original surgery at an angle of thirty-five degrees, this piece of muscle is relatively prominent; its raised thickness isn’t very obvious, but the area is broad, just involving this part of the papillary muscle and valve opening."
This time, not only can the Chief Surgeon see it clearly. Dr. Yuh doesn’t have to stand on tiptoes; he shifts his angle, almost letting out a gasp: it is visible. It turns out that in a limited narrow view, looking at the whole ventricle isn’t entirely impossible; it requires effort to utilize the perspective.
The opening and closing of the mitral valve leaflets depend on two papillary muscles, much like how mechanical locks open and close, pulling the two leaflets. The papillary muscles are connected to the cardiac muscle in the ventricle, powered by the rhythmical contractions of the myocardium. When a patient’s valve has issues and needs to be replaced with an artificial valve, how to handle the papillary muscles becomes a technical challenge.
Relying on accumulated experience from predecessors, the current mitral valve Replacement Surgery is very mature; conventional surgery can retain the subvalvular structure, that is, the papillary muscle and chordae tendineae. The specific method generally involves trimming the original leaflet part connected to the papillary muscle and chordae tendineae to create a segment that carries the papillary muscle and chordae tendineae for retention.
