The operation of the built-in floating catheter was simple. Zheng Ren put on sterile gloves and completed the operation within a minute.
A floating catheter was implanted in the right internal jugular vein.
6.1L/min, 51% SVO2.
The anesthesiologist picked up a pen and paper to start calculating. Zheng Ren said in a low voice, "There's no need to calculate. The systemic resistance is 760/cm5."
"…" The anesthesiologist and Zhao Yunlong were stunned. They were not the only ones. Even Su Yun was stunned.
The floating catheter had to be calculated through a complicated formula to calculate the systemic resistance. Had Boss Zheng figured it out mentally?
Su Yun was five or six seconds late, and the number he calculated was also the same. He silently cursed in his heart.
"Boss Zheng, why is the cardiac output so low?" Zhao Yunlong asked.
"Prepare to open the chest," Zheng Ren said. "I think there's a problem with the myocardium."
Myocardium … This was a far cry from cardiac tamponade. Zhao Yunlong could think of the reason, but it was a rare situation.
"Boss Zheng, is the blood from the cardiac tamponade seeping into the myocardium?" Chief Zhang Lin asked.
"Yes, we'll know once we open it." Zheng Ren glanced at it and asked, "Is Yiren here?"
"Boss Zheng, Little Xie went to get your surgical equipment. She'll be here soon," the circulating nurse said. "She just contacted me."
Zheng Ren nodded. He crossed his arms and began to look at the patient's last echocardiogram.
Su Yun and Zhao Yunlong positioned the patient and began to scrub and disinfect. Xie Yiren also rushed over with a sterile bag of instruments.
"Old Zhao," Zheng Ren suddenly said in a low voice.
"Yes? Boss Zheng. "Zhao Yunlong signaled that he heard.
"Call the ICU and prepare the isolation room," Zheng Ren said.
Isolation room? Zhao Yunlong was stunned but did not ask why. He had already finished scrubbing and asked the anesthesiologist's assistant to make the call. He poked his head over to contact the ICU about the isolation room.
"Is it a delayed chest closure?" Su Yun asked with a frown. "Is it that serious?"
"It's very likely that the myocardium was damaged more severely after the IABP was administered." Zheng Ren turned around to scrub his hands and expressed his opinion of the patient.
Chief Lang was stunned when he heard Boss Zheng's words. The myocardium was damaged more severely after the IABP … Was he saying that he had made a mistake?
He was a little angry and confused.
If someone said that in Nanshan City, they would definitely be pushing the blame away. However, this was the Imperial Capital, so it should not be the case. Director Zhang Lin was very enthusiastic. She rushed over from her home in the middle of the night and waited for him in the office.
This was not even enough. Chief Zhang Lin also contacted the Nobel Prize winner, Boss Zheng, to perform the thoracotomy.
He was a Nobel Prize winner. Was there a need to push the blame to him? There was no need for that at all. To him, it was a big deal, but to him, it was just an ordinary case.
However, IABP was of great benefit to patients with myocardial ischemia in clinical practice. Chief Lang had already developed this technology ten years ago. It could be said that countless people had been saved.
During the diastolic period, the balloon inflates, the aortic diastolic pressure increases, the coronary artery pressure increases, and the myocardial blood and oxygen supply increases. Before the heart contracts, the balloon deflates, the aortic pressure decreases, the cardiac afterload decreases, the cardiac ejection resistance decreases, and the myocardial oxygen consumption decreases.
IABP can effectively increase myocardial blood supply and reduce oxygen consumption, benefiting patients with coronary heart disease the most.
Why did Boss Zheng say that it was IABP's fault? And what was he going to do? Delayed chest closure? Was the patient supposed to go back to the ward with his chest open and bleeding?
Was Little Zheng not afraid of the patient getting infected after the surgery? To be honest, he did not understand what Professor Su meant by delayed chest closure, but it sounded very unreliable.
All kinds of thoughts intertwined and collided in Chief Lang's mind. He pondered in a daze. At this time, the surgery had already begun.
The surgical equipment box, which was full of metal texture, was so eye-catching. The scrub nurse and the surgeon's cooperation was exquisite. They did not even need to communicate with words.
Under the shadowless lamp, no one spoke. There was only tacit cooperation.
There was not even any eye contact between the surgeon, the assistant, and the scrub nurse. It was as if this kind of surgery had to be done ten or eight times a day. No one had any interest in communicating at all.
Chief Lang went behind Boss Zheng and saw that the sternum saw had been opened, and the pericardium was exposed.
"It's not from a cardiac tamponade," Su Yun said. "There's no problem with the echocardiography."
"Okay." Zheng Ren only said one word at this time.
The moment he lifted the pericardium wall and cut the pericardium, the aspirator was inserted. Chief Lang carefully observed the pipeline of the aspirator. Only a small amount of blood was drawn out.
It was not a cardiac tamponade, but why was the patient's myocardial pulse so weak? Under the effect of norepinephrine and dopamine, the blood pressure still could not rise? Chief Lang was puzzled.
As the pericardium was cut open by a delicate small scissors, a swollen heart appeared in the operative field. The heart was dilated and swollen, and the left ventricle activity was poor.
"Wow!" Su Yun said in surprise. "It's swollen to this extent?"
Zheng Ren did not say anything and continued to search. Soon, he found that the single lance drainage tube for the pericardial puncture had pierced the surface of the left ventricle of the heart. There was a local rupture, and there was still fresh blood on the surface of the heart wound.
As expected, it was his own fault. There was a side injury to the pericardial puncture … When Chief Lang saw this scene, his hands and feet went numb and cold.
Could it be that he had done the pericardial puncture, causing the left ventricular myocardium to be damaged, causing such a similar symptom?
It could not be, he argued for himself in his heart. This was an instinctive human self-defense reaction. It was just to seek benefits and avoid harm. It was the same for everyone.
Why did he do a pericardial puncture? It was because the patient's chest tightness and pain did not ease after the stent was removed.
Chief Lang weakly argued in his heart. Under the shadowless lamp, Zheng Ren had already cut the pericardium with scissors.
The autogenous pericardial patch was continuously sutured along the periphery of the wound, and the damaged part of the puncture point on the surface of the heart was repaired to stop the bleeding.
"Boss Zheng, I'm late." Lao He walked in as he fastened the strap of his mask.
"Oh, you're not late," Zheng Ren said. "The surgery is almost done."
Lao He was stunned for a moment. Was it not too late? Boss Zheng usually did not speak like this. As he said that it was not too late, he told himself that the surgery was almost done …
"Prepare the transesophageal ultrasound," Zheng Ren said.
"Okay." Lao He did not have time to think about it and immediately began to get busy.
"Boss … Boss Zheng, what are you going to do?" Chief Lang stammered and asked in a low voice.
"There's no way to close the chest. Let's do a B-scan to see," Zheng Ren said as he gently closed the chest with both hands.
The chest was not completely closed, but as Zheng Ren's hands exerted force, the sternum wanted to close together. The monitor's alarm rang crazily.
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