Chapter 2218 The Birth of a King

Cardiac Treatment Center, Sao Paulo Hospital, Brazil.

Dr. Domingo Paul personally retrieved various data for preoperative evaluation.

Just like doing a math problem, left ventricular volume reduction surgery first needs to calculate the amount of myocardium to be cut through various clinical values.

According to Laplace's law: T=2P×r, that is, the larger the volume and inner diameter, the higher the liquid tension (P), and the greater the container tension (T).

Batista obtained a similar conclusion after observing a large number of animal heart specimens and human dilated cardiomyopathy heart specimens: M=4.18×R3, where M is the left ventricular wall tension and R is the left ventricular diameter.

Left ventricular enlargement causes a disproportionate increase in left ventricular tension and increased oxygen consumption, reducing left ventricular efficiency. He hypothesized that all the functions of an enlarged heart would improve after the inner diameter was reduced.

The purpose of left ventricular volume reduction surgery is to reduce the left ventricular diameter in order to re-establish a new relationship between left ventricular volume, tension, and diameter.

With the deepening of research, the recent Frank-Starling mechanism cannot be used to explain end-stage heart failure.

Left ventricular enlargement in advanced cardiomyopathy may be a vicious compensation for myocardial damage, and left ventricular volume reduction surgery may affect the process of this vicious circle.

Simple mitral valve reconstruction in end-stage cardiomyopathy can also improve the cardiac function of some patients, and other simultaneous operations such as coronary artery bypass grafting are also helpful for the recovery of the left heart.

LV remodeling following non-sphericality results in more coordinated LV contraction and less twisting of the heart. Other possible influencing factors include changes in blood volume and peripheral vascular tension, and drug-assisted treatment.

Theoretical research is just theoretical research, and the math problems have to be done.

Because of the small number of heart donors, the Cardiac Therapy Center of Sao Paulo Hospital in Brazil is the world's leading research center on left ventricular volume reduction surgery.

The number of operations per year is also far ahead of other hospitals. Dr. Domingo Paul is one of the leaders. From 1996 when Dr. Randas Batista created the left ventricular volume reduction surgery, he is the doctor who has done most of this kind of surgery until now.

After huge and complex calculations and surgical simulations, Dr. Domingo Paul was astonished to find that the complexity of this patient's surgery was far beyond imagination.

Left ventricular volume reduction requires the removal of a lot of myocardium. In a sense, the amount of myocardium removed can prove the difficulty of the operation.

So far, the most resected case has removed 302g of myocardium.

But according to my own calculations, the patient in front of me must have at least about 330g of myocardium removed for the operation to be considered a success.

After careful study, Dr. Domingo Paulo's first thought was to give up the operation.

However, he changed his mind after the relevant personnel who contacted him from the patient's side implicitly expressed that he would donate to the heart treatment center if the operation was successful.

Especially after seeing the patient's son, getting a check, Dr. Domingo Paulo decided to give it a try.

The patient's condition is very poor, because he flew halfway around the world by plane, and the symptoms of heart failure are extremely severe. Even with the use of a left ventricular assist system, continued deterioration is inevitable.

On the third day, the Johns Hopkins critical care team was called to Sao Paulo, where Dr. Domingo Paul performed the surgery.

The whole operation was extremely difficult. After 11 hours and 22 minutes, the operation was barely completed.

Although the operation was successful, Dr. Domingo Paulo finally measured the excised left ventricle—it was 343g!

I fully improved the previous record by 41g!

It should be known that every 10 grams removed is a hurdle, and the difficulty of surgery will increase geometrically.

Because that means that the left ventricular hypertrophy is more serious; the patient's own health is worse; the surgical risk and perioperative risk are huge.

but!

In any case, he successfully completed the operation.

Dr. Domingo Paulo is proud of it.

Patients are sent to the intensive care unit for postoperative treatment and care, under the care of a professional team from Johns Hopkins Hospital.

On the third day after the operation, Dr. Domingo Paul stood outside the transparent isolation room and looked at the values ​​displayed on the monitor. He was very satisfied with it.

This is the highest level of combination in the world, whether it is surgery or perioperative treatment. With the best surgeons and the best intensive care team, the mortality rate of patients has been greatly reduced.

"It seems that the patient will recover soon." Dr. Domingo Paul's assistant said happily.

"Um."

"Doctor, left ventricle volume reduction surgery, your operation is fully mature, and you are indeed the world's number one." The assistant said happily.

Dr. Domingo Paulo thinks his assistant is telling the truth.

He is organizing the data and medical records related to the operation into a paper and publishing it. This paper is the bomb that will shock the medical world, Domingo thought.

"Doctor, it is estimated that within 20 years, you will keep the record of left ventricular volume reduction surgery to remove myocardial tissue." His assistant continued, "This is your field, and no one else can set foot in it!"

"Hahaha~" Dr. Domingo Paulo smiled happily.

The previous record was held by his competitor Nai Amaral. The operation time and the like can't explain anything. Surgery is not a race, and it can't explain the problem if it is done quickly.

Moreover, the number of successful surgeries completed by the two is almost the same every year. Ney has been pressing Dr. Domingo Paul because he has performed an operation to remove 302g of myocardium from the left ventricle.

This is the natural barrier that separates Dr. Nay Amaral from other doctors who perform the same type of surgery.

But this time, Dr. Domingo Paul crossed over and raised the record by a full 41g!

Domingo believes that his record can be maintained for 20 years, which is a conservative estimate. It is no exaggeration to say that this record may be sealed on the altar forever.

And Ney... is no longer the king of left ventricle volume reduction surgery, the crown of the king has already fallen on his head.

This time he knew how good he was, and Domingo smiled happily. Leaving the intensive care unit just in time to meet Ney Amaral.

Domingo Paul walked over with his head held high, completely ignoring Ney's presence.

That's how Nai treated her in the past, and she can finally look down on him! Domingo was very happy.

"Doctor, I'm starting to sort out the materials, should the paper be sent to the Lancet or..." Dr. Domingo Paulo's assistant asked for his opinion.

"The Lancet." Domingo was in a particularly good mood and said with a smile, "I'm more interested in new breakthroughs in surgery."

"This paper will definitely change the views of those stubborn Yankees on volume reduction surgery." Dr. Domingo Paul's assistant added: "343g! This is a shocking number. It is estimated that the group of Yankees should Question the authenticity of our surgery."