Chapter 875: Chapter 775 Myocardial Reduction Surgery_2 Chapter 875: Chapter 775 Myocardial Reduction Surgery_2 The small circulation allows the blood to obtain oxygen, and the oxygenated blood flows from the left atrium to the left ventricle.
Then it is pumped out from the left ventricle into the aorta, travels through the arteries to the whole body, transports oxygen to all the cells, and after completing its task, the blood is collected through the veins to the vena cava and finally returns to the right atrium.
At this point, the blood is lacking oxygen, so it flows from the right atrium to the right ventricle and begins the small circulation again to obtain oxygen—thus cycling back and forth, life continues unceasingly.
The heart relies on its rhythmic contraction and relaxation, pumping out and receiving blood, to achieve a continuous cycle.
There are active valves between each chamber to ensure that the blood flows in one direction only.
Hypertrophic obstructive cardiomyopathy can be understood as the heart becoming “fat,” especially the valves between the two ventricles are most prone to thickening. Heart thickening brings about a series of problems, such as causing narrowing of the chamber passages, especially during systole when the thickened interventricular septum bulges into the left ventricle, and the forward movent of the mitral valve approaching the protruding septum exacerbates the obstruction of the outflow tract.
As a result, the heart pump is obstructed, and the blood irrigating the whole body is insufficient, leading to symptoms of ischemia and hypoxemia.
Moreover, when the left ventricle is thickened, there is insufficient space after relaxation, and the collected blood is also insufficient. Now, because of the blockage, not all of it can be sent out, which further reduces the blood’s oxygen level.
The surgical approach is to “slim down” the thickened heart, which can be regarded as a myocardial weight loss surgery.
Opening the chest cavity, cutting through the heart, and slicing off a layer of the thickened myocardium from the inside makes it thinner, thereby clearing the obstructed pathways and enlarging the narrowed spaces.
In such cases, where both the left ventricle and interventricular septum are severely thickened, there is a high possibility of insufficient resection during the surgery. If the resection is not enough, it leads to poor surgical outcos, and even if symptoms are temporarily relieved, they may recur after a few years, necessitating another surgery.
Not removing enough tissue is unacceptable, but removing too much is also problematic, as excessive resection can easily cause complications such as conduction block and septal perforation. There is a very high possibility that a permanent pacemaker will be needed to assist the heart’s normal beating for life.
It’s like when a person is dieting—if the weight loss isn’t enough, he is still “Fatty”; but if he loses too much weight, he becos skin and bones, with no energy to walk, relying on others to push him in a wheelchair.
For such cases, traditional surgical thods definitely won’t work well, and the risks are high.
Therefore, Yang Ping didn’t want to continue with traditional surgery. Since he had the conditions, why not try a better thod? He should make full use of the system space to conduct extensive exploration and create so new thods.
So Yang Ping started to review a large number of papers and monographs on this subject. Although he had read many papers and monographs before, this ti the review was targeted, and the effect would be different.
Based on the incidence rate, it is estimated that there are more than 2 million people in the country with hypertrophic obstructive cardiomyopathy, but fewer than 1,000 patients undergo surgery annually due to the high difficulty and risk of the surgery, as well as the low number of doctors capable of performing it and the low number of patients willing to undergo it.
Why is traditional surgery difficult? Because conventional surgery requires opening the chest cavity and entering through the aorta, approaching the ventricle through an incision in the aorta, it is like trying to glimpse a leopard through a tube, unable to see the full view of the thickened part. Thus, the surgery suffers from a seriously insufficient field of vision and operational space.
Yang Ping considered that if he could invent a precise power instrunt that enters the heart from the apex, then under surface ultrasound guidance, the entire left ventricle would be completely visible, and the instrunt could perform any kind of cutting, free from the limitations of the operational field of vision and space.
Indeed, so doctors had already invented transapical ablation surgery by piercing through the myocardium for ablation procedures.
If minimally invasive surgery is to be perford by entering through the heart apex, several issues must be considered: how should the power resection instrunt be designed? How to remove the thickened myocardium? After resection, how to extract the removed myocardial tissue? Otherwise, these myocardial tissues would run around with the blood flow, becoming embolism agents. If they reach the brain, they can cause cerebral infarction.
Another very important issue is the manufacturing material of the instrunt.
Because the surgery must be guided and monitored by surface ultrasound, tallic instrunts would cause image artifacts in the ultrasound, and a large number of artifacts would make the image unclear, rendering the surgery impossible.
If it were an ordinary person trying to solve these problems, it would be impossible without several years. But Yang Ping had the support of the system space; he could experint at any ti. Moreover, such small-scale experints were completely affordable for the current Yang Ping in terms of points.
Entering through the heart’s apex, then removing the thickened myocardium and bringing it out of the body—following this train of thought.
No sooner said than done, Yang Ping entered the system space and began designing a rotary cutting system, utilizing a rotary cutter blade to remove the myocardium, and then extracting it from the body.
After Yang Ping drew the blueprints, in reality, he would need to find a factory to manufacture them, which would take a lot of ti. In the system space, all he needed to do was input the blueprints into the system panel, and the system would act as a factory, directly outputting the instrunts, of course, precisely according to his blueprints.
Yang Ping used the laboratory to begin simulating the surgery.
In the beginning, it didn’t work at all; the tal instrunts seriously interfered with the ultrasound images, making it impossible to complete the surgery.
So Yang Ping improved the material of the instrunts, using an anti-interference coating, which solved the problem of image disturbance, but the rotary cutting wasn’t precise enough.
Yang Ping then improved the blade, and once he was satisfied with the blade, he discovered a new problem.
The removed myocardium created debris, and this debris could leak into the ventricular blood, circulating with the blood throughout the body. These emboli are potential danger branches, and it’s uncertain where they would cause embolism.
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