sinovels Chapter 1447 Professor Yang (1 sentence)
Chapter 1447 Professor Yang (1 sentence)
Chapter 1447 Professor Yang's One Sentence
After Director He left satisfied, the atmosphere in the operating room relaxed.
Xia Shu walked to Yang Ping's side. Although he was wearing a mask, the respect and closeness in his eyes were unmistakable.
"Professor, what brings you to the operating room today? Is the lab not busy?"
Yang Ping leaned back in his chair, adjusting himself into a comfortable position: "Busy, of course I'm busy, but I can't stay cooped up in the lab all the time. I need to get some fresh air."
"Are Mainstein and Weber settling in well over there?" Xia Shu asked again.
“It’s a habit. This isn’t Mannstein’s first time here; he knows the way like the back of his hand. Weber is used to it too. His wife has learned to shop online and bought a whole house full of flower seeds.” Yang Ping said, a smile spreading across his face above his mask.
Xia Shu laughed, puffing out her mask: "Online shopping is something no one can resist. My Cai Qiaojun is the same, receiving seven or eight packages a day. Mrs. Weber is just doing as the Romans do."
“That’s because you’ve been so indulgent,” a nurse who was checking the equipment chimed in. “Director Xia, you’re completely subservient to Cai Qiaojun. Doesn’t Cai Qiaojun control the finances in your family?”
Xia Shu didn't deny it, chuckled twice, and said in a muffled voice from behind his mask, "A man's money is for his wife to spend. If she's happy, I'm happy."
Yang Ping looked at Xia Shu, feeling a mix of emotions.
"Professor, when would be a convenient time for you to take the scans for that coronary artery bypass surgery?" Xia Shu steered the conversation back to business. He couldn't leave the operating table for too long; the team in the next operating room was already preparing for their turn.
"Let's watch it now, where's the movie?" Yang Ping said.
Xia Shu immediately stood up and took the thick stack of images from the storage cabinet in the corner. He had specially arranged for them to be delivered to the operating room in advance, just waiting for Professor Yang to arrive. He carefully and deftly clipped each image onto the viewing light, as if he were arranging some precious exhibit.
Yang Ping stood up and walked to the film reader.
His brow furrowed as soon as the first film was clipped in.
"Porcelain aorta" refers to the rings of calcification on the aortic wall, like an eggshell, densely covering the entire aorta. Such severe calcification is quite rare.
"This aorta, let alone drilling a hole, could be shattered even with the slightest pinch," Yang Ping said.
Xia Shu nodded: "That's why we dare not perform a standard proximal anastomosis; we must completely avoid the aorta."
Yang Ping didn't respond and continued looking at the next slide.
This is an image from a coronary angiography. The left main coronary artery is 90% narrowed, with only a narrow slit supplying blood. The right coronary artery is completely blocked, and no contrast material is visible on the image. The entire heart's blood supply is supported by a single blunt margin.
"If the blood pressure drops even slightly during anesthesia induction, the patient could die on the spot," Yang Ping said.
"So we plan to perform the anastomosis without cardiopulmonary bypass, while the heart is still beating," Xia Shu said. "This will minimize the disruption to the circulatory system."
Yang Ping nodded and continued reading.
Next, we examined the images of the target vessels. The term "diffuse small vessel disease" was vividly displayed on the images. The coronary arteries, which should have been clearly visible, now resembled a dilapidated water pipe, riddled with narrowing and plaque, with almost no normal vessel segment exceeding one centimeter in length.
"Where is the anastomosis located?" Yang Ping asked.
Xia Shu pointed to several locations on the film. Because he was wearing a mask, his voice was a little muffled, but his tone was very firm: "Here, here, and here, these are three relatively normal sections. But the longest section is only eight millimeters, barely enough to make an anastomosis."
Eight millimeters.
For a normal coronary artery bypass graft, a 1 to 1.5 cm segment of blood vessel is generally required for a secure anastomosis. Eight millimeters is barely acceptable, but even a slight mistake can lead to anastomotic stenosis or occlusion.
"What kind of bypass grafts are used?" Yang Ping asked again.
“The left internal mammary artery is no longer usable; it was ligated during the last surgery. The right internal mammary artery is still usable, and one radial artery can also be harvested. The only remaining option is the great saphenous vein,” Xia Shu said.
Yang Ping considered the options in his mind. One right internal mammary artery, one radial artery, and one or two great saphenous veins would be barely enough. The problem was that all proximal anastomoses couldn't be made on the aorta; they had to be constructed as T-shaped or Y-shaped composite bridges, connecting all the graft vessels together, and then using a common "main trunk" to receive the blood flow from the aorta. Where would this "main trunk" come from? It couldn't just appear out of thin air.
"How do you plan to perform the proximal anastomosis?" Yang Ping asked.
Xia Shu casually pulled a sheet of paper from the printer, pressed it against the viewing screen, and began to draw and talk.
"I plan to use the right internal mammary artery and the radial artery to make two separate in situ bridges. The right internal mammary artery will be anastomosed to the anterior descending branch, and the radial artery will be anastomosed to the obtuse marginal branch. Then, a Y-shaped bridge will be made using the great saphenous vein, with one end anastomosed to the right internal mammary artery and the other end anastomosed to the posterior descending branch and the posterior branch of the left ventricle."
Yang Ping looked at the picture and remained silent for a moment.
“There’s a problem with this plan,” he said.
"What's the problem?" Xia Shu became nervous, her brows furrowing slightly above her mask.
"Is the radial artery long enough as an in situ bridge? You take the radial artery from the wrist and anastomose it all the way to the side of the heart, which is quite a distance. If it is not long enough, forcing anastomosis will create tension, and postoperative spasm or tearing is likely."
Xia Shu paused for a moment. He had indeed considered this problem, but hadn't found a good solution. He rolled his eyes, as if re-measuring the distance in his mind, and then his expression became even more serious.
“There’s another problem,” Yang Ping continued. “Your great saphenous vein Y-shaped graft is anastomosed to the right internal mammary artery. Is the blood flow at this anastomosis sufficient? The right internal mammary artery itself has limited flow. If you branch off another branch to supply the posterior descending artery and the posterior branch of the left ventricle, the blood flow might be insufficient. There might be no problem in the early postoperative period, but in the long term, competition for blood flow can easily occur, leading to occlusion of the graft vessel. In other words, should you consider the long-term effects of this surgery?” Xia Shu’s expression turned serious. Although the mask covered most of his face, the anxiety in his eyes was unmistakable. The two problems the professor raised were more critical than the other.
"Then what do you think we should do?" Xia Shu asked humbly, because she was unsure and felt that her plan was always lacking something, so she wanted to ask Professor Yang for advice.
Yang Ping didn't answer immediately. Instead, he took the pen from Xia Shu, turned over the paper, and redrawn a design on the back. He drew quickly, but each stroke was firm, and the lines were smooth and clear.
“My suggestion is to abandon the in situ radial artery bypass graft,” Yang Ping said while drawing. “You should anastomose the right internal mammary artery to the left anterior descending artery; this is the gold standard and cannot be altered. Then, use the great saphenous vein to create a long graft, anastomosing one end to the right internal mammary artery and the other end to three distal anastomoses, respectively anastomosing to the obtuse marginal branch, the posterior descending artery, and the posterior branch of the left ventricle. As for the radial artery, remove it and create a free graft, anastomosing one end to the great saphenous vein and the other end to the main trunk of the right coronary artery. If the main trunk of the right coronary artery is unusable, anastomose it to the posterior descending artery to create a dual blood supply.”
Xia Shu stared at the newly drawn design, her eyebrows above the mask gradually relaxing, her eyes almost shining.
“This has several advantages,” Yang Ping continued. “First, you only have one proximal anastomosis, the one between the great saphenous vein and the right internal mammary artery; the others are all distal anastomoses, making the procedure relatively simple. Second, the great saphenous vein has a large flow rate, sufficient to supply three distal anastomoses. Third, the radial artery can be used as a free bridge, without length limitations; you can anastomose wherever you want, offering great flexibility. Fourth, the posterior descending artery has dual blood supply; even if one of the bridge vessels fails, the other can take its place, ensuring high safety and redundancy. This kind of surgery is different from ordinary surgeries; we must be mindful of redundancy.”
"Brilliant!" Xia Shu couldn't help but slap her thigh, the sound echoing in the operating room. Several young doctors and nurses who were finishing up looked over, and Xia Shu smiled sheepishly.
Yang Ping put down his pen: "Of course, this plan also has its difficulties. Your great saphenous vein needs to be long enough, at least 20 centimeters or more. A venography must be performed before the operation to assess the quality of the great saphenous vein. If the vein has varicose veins or hardening, this plan cannot be performed."
"Understood!" Xia Shu carefully folded the paper proposal, just like Director He had done earlier, with the same solemnity as if he had received a royal decree.
Looking at Xia Shu's serious expression, Yang Ping felt a surge of warmth in his heart.
They are really growing.
“Professor, there’s one more thing.” Xia Shu took the films off the viewing light one by one, speaking in a slightly lower voice, “This patient has extremely poor coagulation function, with significantly prolonged PT and APTT, and poor platelet function as well. We did a thromboelastography, which showed defects in both coagulation factor function and platelet function. It’s caused by medication.”
"The patient had been taking dual anticoagulants at a hospital in another city for a long time. Later, due to gastrointestinal bleeding, anticoagulants were also used. The combination of several drugs disrupted the coagulation function. After admission, we stopped all anticoagulant and antiplatelet drugs. The coagulation function improved after a follow-up examination, but it was still not ideal."
"The medication has been stopped for five days now."
“However, five days is not enough. It takes at least five to seven days to stop dual antiplatelet therapy and three to five days to stop warfarin. This patient is using multiple drugs in combination, so the metabolism of these drugs in the body may take even longer. We think we should wait two more days and then recheck the coagulation function and thromboelastography. Once the data recovers to a range acceptable for surgery, we will schedule the surgery.”
“But the patient’s angina symptoms are very severe, and he has attacks every day.” Xia Shu’s voice was filled with obvious anxiety.
Yang Ping understood Xia Shu's predicament. Doctors often face difficult choices when making decisions. If they wait, they fear problems will arise for the patient; if they don't wait, they also fear problems will arise. It's like standing on the edge of a cliff; going forward leads to an abyss, and going backward also leads to an abyss. The only thing they can do is choose the relatively shallower abyss and jump in.
“Okay.” Yang Ping came up with a compromise, speaking slowly and explaining each word carefully, “Today and tomorrow, you should complete the preoperative preparations, including preparing blood, platelets, and clotting factors. The day after tomorrow morning, have your coagulation function checked again. If the data is within the normal range, the surgery will be performed the day after tomorrow afternoon; if it is not, wait another day. At the same time, strengthen the medication for angina and try to control the symptoms.”
"it is good!"
Xia Shu was very satisfied with the plan and nodded emphatically.
He had actually considered doing that, but Professor Yang's words made him feel much more at ease.
Yang Ping glanced at the surgical timer on the wall; he had unknowingly been in the operating room for over an hour. He stood up and stretched his somewhat stiff neck.
"Professor, are you leaving already?" Xia Shu also stood up, somewhat reluctant to part.
“I’m not leaving. I’ll go see a neurosurgeon,” Yang Ping said. “Xu Zhiliang has five brainstem tumors on duty today. I’ll just take a look and then leave.”
Xia Shu smiled and said, "Professor, are you going to visit all the departments?"
Yang Ping pushed open the operating room door and walked into the corridor.
The corridor was quiet. He walked along it, passing several operating rooms, each with a red "In Operation" indicator light on its door. Through the small observation window, he could see the busy figures inside.
In one of the operating rooms, a laparoscopic cholecystectomy was being performed. The surgeon was a young man, his movements swift and efficient, clearly demonstrating solid fundamental skills. Yang Ping glanced at him a few more times and recognized him as a new PhD in general surgery, who had only joined the company last year and was already capable of performing laparoscopic surgery independently.
There was a clinic performing knee replacement surgery, and the sound of sawing bones could be heard through the crack in the door, making one's teeth ache.
As Yang Ping looked through the rooms one by one, a feeling he couldn't quite put his finger on suddenly welled up inside him.
Yang Ping walked to the door of the neurosurgery operating room and looked inside through the observation window.
Xu Zhiliang sat in front of the microscope, completely focused on performing surgery. His movements were slow and careful, each incision meticulous, as if defusing a bomb. His assistant, a young neurosurgeon, was carefully suctioning blood from the surgical field with a suction device.
Brainstem tumor surgery is the crown jewel of neurosurgery.
The brainstem is the center of life, controlling breathing, heartbeat, blood pressure, consciousness... Any problem here can be fatal. Therefore, surgeons who perform brainstem surgery must have a strong heart and be able to withstand unimaginable pressure.
Xu Zhiliang has such a big heart.
Xu Zhiliang is now one of the top brainstem tumor surgeons in China. He performs one to two hundred brainstem tumor surgeries a year, with a mortality rate of less than one percent, a figure that is among the best in the world.
Yang Ping stood outside the observation window and watched for a full five minutes.
He didn't go in to disturb them. Brainstem surgery requires absolute concentration, and any interference could have disastrous consequences. He stood there quietly, watching his student display his talent on the operating table through that small pane of glass.