Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Although Lin Yi said so, Zhou Chao looked at him, unavoidably worried.

How can it be so simple to add a new repair material?
After Lin Yi confirmed the lesion again, he said to Zhou Chao:

"It has been confirmed that the cause is the obstruction of the superior and inferior vena cava, let's prepare to operate on the patient immediately!"

After Zhou Chao communicated with the patient's family again and got the signed informed consent for the operation, he immediately prepared to perform the operation on the patient.

Soon, the anesthetist Lao Ma was in place and anesthetized the patient.

Firstly, Zhou Chao was the main surgeon in the operation. He opened the chest from the center of the patient's sternum very neatly.

Then, fully mobilize the right innominate vein, left innominate vein, and inferior vena cava, and at the same time mobilize one side of the femoral vein for backup.

At this moment, Lin Yi stared at Zhou Chao's hand movements.

Although Zhou Chao is the director of the emergency department, he is also very strong in the operation of free veins.

Lin Yi was still thinking about it, but after heparinization, Zhou Chao inserted an arterial tube into the ascending aorta, a venous tube into the femoral vein for drainage of the inferior vena cava, and a catheter for the drainage of the superior vena cava in the right innominate vein, followed by extracorporeal circulation.

Soon, the old horse said:
"Director Zhou, the patient's extracorporeal circulation is normal, and the next operation can be performed!"

However, at this stage, it has to be replaced by Lin Yi.After all, the operation is going to be performed on the patient's heart. This kind of operation requires extremely meticulous operation, so Lin Yi is naturally much better than others.

Zhou Chao naturally understood this truth.

Therefore, after cooperating with the anesthesiologist to complete extracorporeal circulation, he voluntarily gave up the position of the chief surgeon.

Lin Yi was not polite, and stood there, picked up the scalpel Wang Qiaoya had prepared in advance, and cut down on the patient's heart.

The scalpel prepared in advance cut down on the side of the patient's heart.

The volume of the patient's right atrium was relatively small. After Lin Yi cut the superior vena cava and part of the left innominate vein, Zhou Chao immediately helped to clean up the operative field.

Then, everyone looked together and saw that the surface of the pacing wire was extensively endothelialized, and the lumen of the blood vessels was generally thinner.

Wang Qiaoya said.

"My God, it has become like this! It's no wonder it's not blocked!"

Lin Yi continued to cut down the inferior vena cava near the entrance of the right atrium, and saw that the wall tissue of the right atrium was thickened in a ring shape, and the endothelialized pacing wire was curled into a group, resulting in obvious stenosis at the junction of the inferior vena cava into the atrium.

Lin Yi frowned.

"It appears that the embolism was caused by a crimped pacing lead."

Subsequently, Lin Yi quickly removed the endothelialized pacing lead, and then cut off the thickened atrial tissue.

The next step is the critical repair link.

However, the material of this patch...

Lin Yi considered it again and again, and finally decided that it is more suitable to take the pericardium as a patch.

This choice has nothing to do with whether he will be ridiculed by Director Zhang Zicheng of the Department of Thoracic Surgery, but it is more suitable to use the pericardium as a patch in the current patient's condition.

As for the others, it doesn't matter!

Zhou Chao also seemed to see the fluctuation in Lin Yi's heart, and asked softly.

"Lin Yi, it seems that the pericardium is going to be used as the patch this time, right?"

Lin Yi did not deny it.

"Yes, because the location is on the inferior vena cava, superior vena cava and part of the left innominate vein, it is more suitable to use the pericardium as the patch this time."

Lin Yi is very calm, he will never do anything that will damage the patient's health just because of his face or other people's ridicule.

Before Zhou Chao said anything, Wang Qiaoya asked:

"Will it be cheaper for that Zhang Zicheng? Doesn't he hope that this will happen?"

Lin Yi shook his head and said:
"Patient health comes first. We only choose the most suitable solution, and nothing else matters."

After a little preparation, Lin Yi took the patient's own pericardium and trimmed it into a suitable size of pericardium tissue.

Then widen the narrow inferior vena cava, right atrium, superior vena cava and part of the left innominate vein.

After doing this, Lin Yi made a follow-up action that neither Zhou Chao nor Wang Qiaoya expected.

He removed the pacemaker for the patient, and sent the fibrous tissue on the surface of the pacing lead for pathological examination.

Wang Qiaoya asked puzzledly.

"Brother Yi, why did you send the fibrous tissue on the surface of the pacing lead for pathological examination? What's the point of doing this?"

Lin Yi frowned and said.

"I'm worried that the patient's vascular tissue has a tendency to calcify lesions...the condition will worsen in the future, so I must take this opportunity to analyze the case."

"Another point……"

Zhou Chao looked at Lin Yi and asked:

"Another point? What do you want to say?"

"Another point is that the patient's venous embolism this time is directly related to the pacing lead."

Then Lin Yi said.

After hearing what Lin Yi said, Zhou Chao was taken aback.

"Are you trying to say that this was an accident?"

If it is accused of an accident, this problem is big.

Lin Yi shook his head, denying Zhou Chao's speculation.

"No, I didn't say it was an accident, but I was worried that the patient had secretly stopped taking the drug herself, and she was not taking the anticoagulant drug on time and in the right dose.

That's why the venous thrombosis occurred so early.Under normal circumstances, taking the medicine completely according to the doctor's advice will not cause such a serious venous thrombosis so early.

However, this is only my guess.Whether this is the case needs to be communicated and confirmed with the patient again. "

Wang Qiaoya and Zhou Chao kept shaking their heads after hearing what Lin Yi said.

Indeed, it often happens that patients stop the drug without permission and lower the dose of the drug without permission.

This is not an exception.

Zhou Chao had encountered such a situation as a patient.

No matter how much he exhorts and instructs, the patient will still secretly stop the drug on his own.

However, because the patient stopped the drug without authorization, the condition could not be controlled, resulting in recurrence and aggravation of the disease.

In addition, even if the patient seeks medical treatment in time, if the patient does not describe the medical history carefully, it is easier to confuse the real disease with other diseases and delay the timing of treatment.

However, what is surprising is that this kind of private withdrawal generally occurs in elderly patients, such as worrying that taking too much medicine will be bad for their health.Therefore, once the symptoms are relieved, the drug will be stopped on its own, which will unknowingly lead to the aggravation of the condition.

However, Wang Qiaoya looked at the patient in front of her and said:

"Isn't it generally the elderly patients who like to stop the drug without permission? Now it's so complicated that even the middle-aged patients have started to stop the drug on their own?"

After hearing what Wang Qiaoya said, Lin Yi couldn't laugh or cry.

"What's wrong with taking medicine? How can you compare with this thing?"

"I'm afraid it is due to some reasons that the patient stopped the drug without permission. However, these also need to be learned after continuing to communicate with the patient after the operation."

Immediately after Lin Yi performed all the operations, they performed an angiography of the upper and lower vena cava again.

Of course, the purpose of doing this is to check the repair effect after surgery.

Angiography showed that the blood flow of the patient's superior vena cava was smooth after Lin Yi used a pericardial patch to widen it.