The patient did not have a regular mitral valve prolapse. It was a special type of Barlow's disease! Ordinary mitral valve prolapse is generally a local lesion that only affects a single leaflet or part of the leaflet, and rarely diffuse lesions. However, when the prolapsed mitral valve leaflets have extensive myxoid lesions, leaflet redundancy, and extensive prolapse, it is Barlow's disease! The mitral regurgitation it causes is the most challenging surgery in mitral valve repair! "Oh no, it's Barlow's disease!" "In the case of Barlow's disease, the patient's heart will have more obvious lesions, covering up the ultrasound valve prolapse phenomenon... She has severe commissure prolapse!" "It's troublesome, the chordae tendineae are extended and broken. And some papillary muscles are highly elevated, with multiple heads, some of which are very small, and completely lack the support of the chordae tendineae!" The papillary muscles control the activity of the mitral valve and ensure the normal opening and closing of the mitral valve. The chordae tendineae are fibrous cords connecting the papillary muscles and the valve, which can prevent the valve from entering the atrium when the heart contracts.
And now, both structures have serious problems... Director Zheng's face was heavy, and he said: "It's more serious than ultrasound. If it was before, a combined suture plus inversion suture would have achieved a good repair effect. However, now both 'French shaping' and 'American shaping' are stretched to the limit..." The faces of the doctors present were also very embarrassed. French shaping is the lifelong achievement of the pioneer of cardiac surgery in the surrendered country, and it is a precious treasure left for mitral valve shaping, which means to restore the normal morphological structure of the mitral valve as much as possible from the anatomical point of view. It is not enough to have a large and active organ, but also to be handsome. American shaping does not focus on appearance, as long as the function of the mitral valve is restored. It is enough to have a large and active organ, black and white can be used. And now, Niu Niu's condition is much more serious than expected, Barlow's disease, commissure prolapse, long and broken chords, and even lack of natural chords. In this case, how to do repair surgery? It needs to be cut, repaired, and implanted, and the prolapsed side also needs to be replaced. The worst thing is that the distance between the papillary muscle tip and the leaflet edge is too small, and it is impossible to use new tendons... Under the numerous difficulties, "mitral valve repair" has become an almost impossible task. Director Zheng took a deep breath, and reason told him that he must not do the repair. He whispered: "Don't be stubborn. On the operating table, doctors should not consider money. What we can do is to choose the best solution-do mechanical valve replacement." However, Xu Qiu did not respond. He looked up and saw that Xu Qiu's eyes were moving rapidly, and his eyes kept jumping around the entire heart cavity, as if calculating something... "What are you doing-" Director Zheng was stunned. Xu Qiu did not answer, and all his energy was focused on the operation in front of him. He quickly analyzed a suitable surgical plan. Chordal replacement to repair commissure prolapse.
Carpentier papillary muscle transposition, shortening of grouped chordae, using autologous chordae to repair the chordae absent area! The next moment, Xu Qiu's calm voice sounded: "Continue, mitral valve repair." ... "Gore-Tex polytetrafluoroethylene suture." When Xu Qiu's voice sounded again, everyone came back to their senses from the astonishment, no one questioned, and immediately entered the state of surgery. One by one, the instruments fell into Xu Qiu's hands accurately. He first used a simple U-shaped suture, passing two sutures through the fibrous part of the front head of the medial papillary muscle, and placed a new string. The other one quickly passed through the edge of the prolapsed commissure of the anterior leaf... Before everyone reacted, Xu Qiu turned his hand again, and the suture passed from the left ventricle to the left atrium for the second time. Director Zheng stared at the surgical area intently, and the more skilled the technique was, the more familiar it seemed to him. After Xu Qiu took turns to suture back and forth several times, his pupils shrank suddenly, "This is...mobile chord replacement?!" At this moment, Director Zheng's expression was extremely shocked. Flowing chord replacement is a top repair technique that is highly praised in the country of berries. Its advantage is that it does not require the removal of valve tissue, and can preserve the shape, fluidity and maximum possible opening area of the mitral valve leaflets! However—— This technique is quite difficult, which makes many doctors discouraged. Not to mention the chord support between the fiber muscle and leaflet tissue; the height control of the chord, etc., just to ensure the effect, at least twelve safety knots must be made with Gore-Tex sutures! In such a small place, twelve safety knots are tied in a row... This item alone is enough to make countless doctors shake their heads and give up. "Ten... ten!" "Eleven!" "Twelve!" Suddenly, the rapid counting sound beside him woke Director Zheng. He suddenly came back to his senses, and when he looked at the operation area again, the twelve safety knots were neatly and tightly lying at the junction of the head fiber part and the posterior leaflet prolapse. "..." Director Zheng opened his mouth wide. Just like that? On the other side, Xu Qiu did not give any breathing space.
After completing the replacement, he picked up the scalpel again. To everyone's surprise, Xu Qiu did not perform a wedge-shaped resection of the long tendon. Instead, he made a longitudinal split on the papillary muscle, used a 5-0 suture to bypass the tendon, passed through both sides of the longitudinal groove, tightened the suture to bury the tendon in the groove, and then sutured the papillary muscle incision. Some papillary muscles are very small, Xu Qiu simply performed an "8" suture directly, folding the tendons and fixing them on the papillary muscles. Then, he changed to a 4-0 expanded polytetrafluoroethylene thread, and his wrist drifted slightly. The suture needle sewed from the ventricular surface of the anterior valve edge to the atrial surface, and then passed through the papillary muscle 3mm away from the tip of the papillary muscle. While adding the gasket, he lifted the suture and quickly tied a knot... He was too fast. One stitch after another, his hands flew and moved in the surgical area like a dancer. The suture also shone with a crystal color under the shadowless lamp, as if it was glowing. In the shocked eyes of everyone, Xu Qiu pierced the last stitch and tied a knot easily. So far-- The tendons were successfully implanted to the edge of the leaf that lacked natural tendons, and the head was re-sutured to the lower part of the papillary muscle... This technique seemed to steal the sky and change the day. One split, one implant, and then string support, in an instant, the short place was short, and the place lacking tendons was well supplemented! "Can this work?" "It's like magic, so shocking..." "Repaired? Can such a complicated mitral valve prolapse be repaired?" The doctors exclaimed. Director Zheng couldn't believe his eyes. Could anyone really repair such a difficult mitral valve prolapse? "Check." At this time, Xu Qiu put down the suture needle and urged calmly. Director Zheng couldn't wait to pick up the balloon syringe. It's time to test the effect of the operation - is it really repaired?