Brazil, Sao Paulo Hospital Cardiac Treatment Center.
Dr. Domingo Paulo personally retrieved all kinds of data for preoperative evaluation.
Like solving a math problem, left ventricular volume reduction surgery first required various clinical calculations to calculate the amount of myocardium to be removed.
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 observed a large number of animal heart specimens and human heart specimens with dilated cardiomyopathy and came to a similar conclusion: M = 4.18 × R3, where M was left ventricular wall tension and R was left ventricular diameter.
Left ventricular enlargement caused a disproportionate increase in left ventricular tension and oxygen consumption, which reduced left ventricular efficiency. He hypothesized that the function of all enlarged hearts improved after the inner diameter was reduced.
The goal of left ventricular volume reduction surgery was to reduce the left ventricular diameter to achieve a new relationship between left ventricular volume, tension, and diameter.
Recent studies have shown that the Frank-Starling mechanism could not be used to explain end-stage heart failure.
Left ventricular enlargement in advanced cardiomyopathy may be a malignant compensation for myocardial damage, and left ventricular volume reduction surgery may affect this vicious cycle.
Mitral valve reconstruction alone in end-stage cardiomyopathy could also improve cardiac function in some patients. Other simultaneous surgeries such as coronary artery bypass grafting could also help the left ventricle recovery.
The left ventricle was not spherical after remodeling, which made left ventricular contraction more coordinated and reduced cardiac distortion. Other factors that could affect this included changes in blood volume and peripheral vascular tension, as well as medication-assisted therapy.
Theoretical research was only theoretical research, and the math problem still had to be solved.
Due to the scarcity of heart donors, the Sao Paulo Hospital Cardiac Treatment Center in Brazil was second to none in the world in the research of left ventricular volume reduction surgery.
The number of surgeries per year was also far ahead of other hospitals. Dr. Domingo Paolo is one of the best of the best.
Since 1996, Dr. Batista pioneered left ventricular volume reduction surgery, and he was the doctor who performed this surgery the most.
After complex calculations and surgical simulations, Dr. Domingo Paulo was shocked to find that this patient's surgery was far more complicated than he had imagined.
Left ventricular volume reduction surgery required the removal of a lot of myocardium. In a sense, the amount of myocardial tissue removed could indirectly prove the difficulty of the surgery.
So far, the most removed surgery had removed 302 grams of myocardium.
However, according to his calculations, the patient in front of him had to remove at least 330 grams of myocardium for the surgery to be considered successful.
After careful study, Dr. Domingo Paulo's first thought was to abandon the surgery.
However, when the patient contacted him, he changed his mind after the relevant personnel vaguely expressed that if the surgery was successful, they would donate to the Cardiac Treatment Center.
Especially when he saw the patient's son. With the check in hand, Dr. Domingo Paulo decided to give it a try.
The patient's condition was very poor. Because he had flown halfway around the world by plane, his symptoms of heart failure were extremely severe. Even with the use of the left ventricular assist system, it was inevitable that his condition would continue to deteriorate.
On the third day, the intensive care team from Johns Hopkins was invited to São Paulo, and Dr. Domingo Paulo performed the surgery.
The difficulty of the entire operation was extremely high. After 11 hours and 22 minutes, the operation was barely completed.
Although the operation was successful, Dr. Domingo Paolo measured the left ventricle — it was 343g!
He had broken the previous record by 41g!
It was important to know that every 10 grams more was a threshold, and the difficulty of the surgery would increase exponentially.
Because it meant that the condition of the left ventricular hypertrophy was more severe, the patient's physical condition was worse, and the surgical and perioperative risks were greater.
But!
No matter what, he had successfully completed the surgery.
Dr. Domingo Paulo was proud of it.
The patient was sent to the intensive care unit for postoperative treatment and care, and the professional team from Johns Hopkins Hospital would take care of him.
On the third day after the surgery, Dr. Domingo Paulo stood outside the transparent isolation room and looked at the values displayed on the monitor. He was very satisfied with the results.
This was the world's highest level of integration, whether it was the surgery or the perioperative treatment, it was the same. The best surgeons, the best intensive care team, and the patient's mortality rate was greatly reduced.
"It seems that the patient will recover soon," Dr. Domingo Paulo's assistant said happily.
"Yes."
"Doctor, the left ventricular volume reduction surgery, your surgery is completely mature, worthy of being the world's first," the assistant said happily.
Dr. Domingo Paulo believed that his assistant was telling the truth.
He was compiling the data and medical records of the surgery into a paper and publishing it. This paper is a bomb that will shock the entire medical world, Domingo thought.
"Doctor, it is estimated that in the next 20 years, you will keep the record of myocardial tissue resection in the left ventricular volume reduction surgery," his assistant continued, "This is your field, no one else can step in!"
"Hahaha …" Dr. Domingo Paulo laughed happily.
The previous record was held by his competitor, Nye Amaral. The time of the surgery did not mean anything. Surgery was not a race, and the speed of the surgery did not mean anything.
Moreover, the number of successful surgeries completed by the two every year was similar. Nye had always surpassed Dr. Domingo Paulo because he had performed a surgery to remove 302 grams of myocardial tissue in the left ventricle.
This was a natural barrier that separated Dr. Nye Amaral from other doctors who performed the same type of surgery.
But this time, Dr. Domingo Paolo surpassed it and improved the record by 41 grams!
Domingo Paulo believed that his record could be maintained for 20 years, and that was a conservative estimate. It was not an exaggeration to say that this record could be sealed on the altar forever.
As for Nye … He was no longer the king of left ventricular volume reduction surgery, the crown of the king had fallen on his head.
Now that he knew how good he was, Domingo Paulo laughed happily. When he left the intensive care unit, he ran into Nye Amaral.
Domingo Paulo walked over with his head held high, completely ignoring Nye's existence.
This was how Nye used to treat him. Finally, he could look down on him! Domingo Paulo was very happy.
"Doctor, I'll start to organize the data. Should we send the paper to Lancet or …" Dr. Domingo Paulo's assistant asked for his opinion.
"Let's go with the lancet." Domingo Paulo was in a very good mood. He smiled and said, "Then I'll be more interested in the new breakthrough in surgery."
"This paper will definitely change the opinion of those stubborn Americans on volume reduction surgery," Dr. Domingo Paulo's assistant added, "343 grams! This is a shocking number. I guess that group of Americans will question the authenticity of our surgery again. "
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