Sao Paulo Hospital Cardiac Treatment Center, Brazil.
Dr. Domingo Paul personally collects various data and conducts preoperative evaluation.
Just like doing a math problem, left ventricular volume reduction surgery must first 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 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 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 oxygen consumption, which reduces left ventricular function. He hypothesized that all functions of the enlarged heart were improved by reduction in inner diameter.
The purpose of left ventricular volume reduction surgery is to reduce the diameter of the left ventricle to re-establish a new relationship between left ventricular volume, tension, and diameter.
With the deepening of research, recent studies on the Frank-Starling mechanism cannot be used to explain end-stage heart failure.
Left ventricular enlargement in late-stage cardiomyopathy may be a vicious compensation for myocardial damage, and left ventricular volume reduction surgery may affect the process of this vicious cycle.
In end-stage cardiomyopathy, mitral valve reconstruction alone can also improve the cardiac function of some patients, and other concurrent surgeries, such as coronary artery bypass grafting, can also help with the recovery of the left heart.
After the left ventricle is reshaped, it becomes less spherical, making the left ventricular contraction more coordinated and reducing the twisting of the heart. Other possible influencing factors include changes in blood volume and peripheral vascular tone and drug-assisted treatment.
Theoretical research is just theoretical research, and math problems must be done.
Because there are few heart donors, the Cardiac Treatment Center of Sao Paulo Hospital in Brazil is ranked first in the world in research on left ventricular volume reduction surgery.
The number of surgeries performed each year is also far ahead of other hospitals. Dr. Domingo Paul is one of the leaders. From 1996 when Dr. Randas Batista pioneered left ventricular volume reduction surgery, to the present position, he is the doctor who has performed many such surgeries.
After huge and complicated calculations and surgical simulations, Dr. Domingo Paul was shocked to find that the complexity of this patient's surgery was far beyond imagination.
Left ventricular volume reduction surgery requires removing a lot of myocardium. In a sense, the amount of myocardial tissue removed can prove the difficulty of the operation.
So far, the largest surgery has removed 302g of myocardium.
But according to my own calculations, the patient in front of me needs to remove at least about 330g of myocardium for the operation to be considered a success.
After careful study, Dr. Domingo Paul's first thought was to abandon the operation.
However, he changed his mind after the person who contacted him from the patient side vaguely expressed that he would make a donation to the heart treatment center if the operation was successful.
Especially after seeing the patient's son get the check, Dr. Domingo Paul decided to give it a try.
The patient's condition was very poor because he had flown halfway around the world and had extremely severe symptoms of heart failure. Even with the use of a left ventricular assist system, continued deterioration is inevitable.
On the third day, the critical care medicine team from Johns Hopkins was invited to Sao Paulo, and Dr. Domingo Paul performed the surgery.
The entire operation was extremely difficult, and it took 11 hours and 22 minutes to complete the operation.
Although the operation was successful, Dr. Domingo Paul finally measured the removed left ventricle - it actually weighed 343g!
I have improved my previous record by 41g!
You must know that every 10g more removed is a hurdle, and the difficulty of the operation will increase exponentially.
Because that means the left ventricular hypertrophy is more severe; the patient's health is worse; the surgical and perioperative risks are huge.
but!
Anyway, I successfully completed the surgery.
Dr. Domingo Paulo is proud.
The patient was sent to the intensive care unit for postoperative treatment and care, and was cared for by 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 integration in the world, whether it is surgery or perioperative management. With the best surgeons and the best critical 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, your left ventricular volume reduction surgery is completely mature and you are worthy of being the best in the world." The assistant said happily.
Dr. Domingo Paul believed his assistant was telling the truth.
He is compiling the data and medical records related to the surgery into papers and publishing them. This paper is a bomb that will shock the medical community, Domingo thought to himself.
"Doctor, it is estimated that within 20 years, you will keep the record of myocardial tissue removal during left ventricular volume reduction surgery." His assistant continued, "This is your field, and others cannot get involved at all!"
"Hahaha~" Dr. Domingo Paul smiled happily.
The previous record was held by his competitor Nay Amaral. The operation time doesn't mean anything. Surgery is not a race, and doing it quickly doesn't mean anything.
Moreover, the two of them completed almost the same number of successful surgical cases every year. Nye has always been superior to Dr. Domingo Paul because he performed an operation to remove 302g of myocardium from the left ventricle.
This is a natural chasm that separates Dr. Nay Amaral from other doctors who perform similar surgeries.
This time, Dr. Domingo Paul surpassed the past and improved the record by a full 41g!
Domingo believes that his record can last for 20 years, which is still a conservative estimate. It is no exaggeration to say that this record may remain on the altar forever.
And Nye... is no longer the king of left ventricular volume reduction surgery. The crown of king has fallen on his head.
This time he knew how powerful he was. Domingo smiled happily. Leaving the intensive care unit, I happened to meet Nay Amaral.
Domingo Paul walked over with his head held high, completely ignoring Nye's presence.
This is how Nei treated him in the past, and she can finally look down on him! Domingo couldn't be happier.
"Doctor, I'm starting to sort out the information. Should I send the paper to the Lancet or..." Dr. Domingo Paul's assistant asked for his opinion.
"Let's go with the Lancet." Domingo was in a particularly good mood and said with a smile, "Then I'm more interested in new breakthroughs in surgery."
"This paper will definitely change the views of those stubborn Americans on weight reduction surgery." Dr. Domingo Paul's assistant added: "343g! This is an appalling number. It is estimated that those group of Americans should Questioning the authenticity of our surgery.”