Chapter 2160: Chapter 2160: A New Way of Thinking
The amount to be trimmed and retained depends on the specific case. For some patients, the anterior cusp is completely cut off, leaving only its papillary muscle base, while the posterior cusp can be completely retained with its chordae tendineae. The anterior cusp and posterior cusp here refer to the mitral valve’s anterior and posterior leaflets. The anterior leaflet is larger, hence called the large cusp. The posterior leaflet is smaller, so it’s called the small cusp.
The tissue that can be retained needs to be sutured and connected to the artificial valve. This part that the artificial valve connects to is called the annulus. In the second surgery, when the damaged artificial valve is removed, the first annuloplasty ring must be entirely excised, which will undoubtedly result in the further removal and damage of these original human tissues.
It’s not that the initial surgery was poorly performed by the surgeon, leading to a bizarre shape after the second cut. Instead, the problem lies in the hyperplastic tissue that grew on the artificial valve, forcing the second surgeon to cut repeatedly, rendering the orderly valve orifice crafted by the first surgery moot.
It’s unavoidable; the dysfunctional tissue must be excised.
After cutting, if it’s determined that the initial surgeon’s approach to organizing the valve orifice is beneficial for reshaping the original human tissue for resewing, Student Xie’s sharp gaze and pointed guidance were first to highlight that the initial surgeon’s handling of the subvalvular structure had retained a large cusp, even if the second surgeon was forced to excise part of it again.
Judging by the surrounding conditions of the preserved subvalvular structure, Xie Wanying pointed out a protruding thickened area. This thickened piece of flesh is cleverly positioned and structured, almost like a little demon hiding inside the patient’s heart. Without careful calculation and thinking by the doctor, the problem is not apparent at first glance.
It seemed to reveal something peculiar, but to fully understand it like Student Xie requires swirling the thoughts around in the mind a few more times. Dr. Yuh felt a touch of dizziness and dared not question the Chief Surgeon, for fear of being reprimanded, so he turned to his senior Shilei beside him.
Shilei remained expressionless; since Student Xie began speaking, he tightened his lips and seemed even more like a mute Stone.
Having nearly flipped the situation, he clearly knew that Student Xie’s thought process needed to be pondered over and over.
How this muscle affects the valve orifice is difficult to comprehend just by looking directly at it. It needs to incorporate the papillary muscle as pointed out by Xie Wanying. The biggest feature of the papillary muscle is its motion.
In other words, what Student Xie calculated in his mind is not just the static state of the valve but its dynamic state.
When the papillary muscle pulls the valve, it’s not just the valve moving; it’s the entire heart moving. If the muscle near the valve orifice is said to be completely immobile, that’s absolutely contrary to human physiology.
It’s like when you put something into an opening, whether the narrow opening where you place the item is a completely fixed dead object or a movable living object makes all the difference. The extent to which a dead object’s opening can adjust is much more limited than that of a living object.
This point opens up the thought process.
"Mm hmm." The Chief Surgeon made a sound, indicating the thought process was initiated.
"I understand now."
With the First Assistant echoing these words, Dr. Yuh bowed his head: his mind was still in a muddle, nearly twisted to death.
Being a doctor, having to process thoughts so swiftly, is indeed very challenging.
Even if it’s perplexing, it’s okay; Dr. Yuh knows there’s another way to get around the bend: observe the outcome.
