Surgery Godfather
Chapter 754 - 673: Devil Level

Chapter 754: Chapter 673: Devil Level

Yang Ping rushed to the operating room of the Intervention Department, changed into his surgical scrubs, put on a sterile cap and mask, and hurled himself into the operating room.

The surgery was underway. Directors Ji and Guan from the Intervention Department were already on stage, suggesting the complexity of this operation.

Director Guan was the chief surgeon and Director Ji the assistant. Several young doctorate holders stood by the operating table, unable to help. All they could do was watch, helpless.

Defibrillate!

Director Guan immediately stopped. The patient had experienced a sudden cardiac arrest, with ventricular fibrillation waves densely appearing on the monitor screen.

The anesthesiologist and nurse immediately started electric defibrillation for the patient.

After several rounds of defibrillation, with the strong electrical stimulation, the patient’s heartbeat returned. Perhaps due to the impact of the electric shock, the patient screamed after coming round.

Outside the operating room, someone was frantically pounding on and kicking the door. Clearly, several people were striking the door simultaneously.

"Xiao Yu, explain to the family what’s happening," Director Guan ordered his doctoral student, Dr. Yu.

Director Ji added, "Don’t open the door. Exit through the changing room."

The experienced directors knew that once the door was opened, confused relatives might rush in, causing chaos and refusing to leave. Their patient would then certainly not be able to be saved.

They didn’t understand the perilous nature of the surgery; hearing their relative screaming, they might even think the doctors were mistreating the patient.

With the return of the heartbeat, Directors Guan and Ji resumed the operation.

"Professor Yang, scrub in!" Director Ji was relieved to see Yang Ping had arrived.

"Chronic total occlusion of the coronary artery, complete blockage of the left coronary artery trunk, both bifurcations - the anterior descending artery and the circumflex artery - are completely blocked with severe calcification. The right coronary artery is 90% blocked. We are trying to perform a rotational atherectomy, but the calcified occlusion is as hard as rock. The condition is extremely dangerous and complicated, which is why we need your help," Director Ji hastily outlined the case.

Director Guan specializes in cardiovascular interventional treatments, while Director Ji is an expert in all forms of interventional treatments, including cranial and tumor-related ones.

Compared to Director Ji, Director Guan is more advanced in cardiovascular intervention, as this is his sole focus.

So, Director Guan was chosen as the chief surgeon for this operation.

Indeed, Director Guan’s back was soaked in sweat. This case, involving severe coronary occlusion combined with hard-as-rock calcification, and not just blockage in the main artery, but complete blockage at two branches, was devilishly complex.

Coronary arteries supply blood to the heart and sprawl across its surface, highly reminiscent of a tree crown. They are like fuel pipes supplying gasoline to a car engine. Once blocked, the heart loses power.

As such, when these left and right fuel lines, i.e., coronary arteries, and their branches undergo atherosclerotic or spasmodic changes, narrowing or blocking of the vascular lumen can occur.

When the coronary artery lumen stenosis exceeds 50%-70%, coronary circulation disorders occur, causing myocardial blood supply to be insufficient and leading to evident clinical symptoms, such as angina pectoris, owing to an imbalance between myocardial oxygen supply and demand. When the coronary artery lumen is completely blocked, myocardial ischemia, hypoxia, and necrosis occur, causing myocardial infarction.

Typically at this point, interventional treatment is necessary, and a stent has to be implanted to clear the blood vessel.

This patient had severe blockage combined with severe calcification. The blockage was as hard as rock. Ordinary equipment couldn’t clear the blood vessels so a special rotational atherectomy device was used to gradually wear away these "rocks", clear the coronary arteries, and then place and expand the stent.

But the problem was the bifurcation lesions, where both the main branch and a side branch were blocked near the fork.

Because the lesion was at the "crossroads" of the heart’s blood vessels, the surgical techniques were particularly complex. Postoperative re-stenosis rates were particularly high. When multiple stents needed to be implanted, if the ends of the stents weren’t well aligned, patients could easily experience a re-narrowing of the blood vessels and the formation of blood clots.

Under these circumstances, if a stent was merely implanted in the main branch, the plaque shift caused by the stent’s pressure may result in a new blockage in the branch vessel, exacerbating the situation.

However, if stents were implanted in both the main and branch vessels, due to the occlusion sites being quite close to each other, there could be an interference between the two stents. As of now, medical technology couldn’t have the stents tailored in advance to fit these bifurcations without causing an interference.

Therefore, the difficulty of treating bifurcation lesions lay in needing to not only implant stents to clear the blood vessels but also ensure that the stents didn’t interfere with each other and cause new blockages.

The procedure of interventional treatment for coronary bifurcation lesions needed to resolve the current problem without introducing new complications, which was an enormous challenge due to its exceptionally high level of operational difficulty.

The rock-hard stiffness, coupled with the complex branching, doubled the difficulty.

"We must use CCTV technology!" Director Guan added.

This is a double stent technique, summarized as "CCTV": C crush series of stent surgery: classical crush, DK-crush, mini-crush, step-crush; C culotte series stent surgery: classical and modified culotte stent surgery; T series stent surgery: classical and modified T stent surgery, V series stent surgery: classical and SKS stent surgery.

For these types of patients, who are completely blocked, the blood vessels must be unclogged as soon as possible so that the ischemic myocardium receives blood supply. Even a glimmer of hope can be regained. Otherwise, if too much time elapses, a large area of the myocardium will necrose. Even if unclogging is successful, it will be in vain.

Yang Ping quickly scrubbed his hands, put on a lead apron, and then with the help of the circulating nurse, dressed in surgical gowns, and wore sterile gloves.

"Professor Yang, Director Ji said you are very skilled. Can you confidently unclog these blockages quickly?" Director Guan asked without hesitation.

Yang Ping only took a glance. Even though he doesn’t pay much attention to intervention in his quotidien duties, he has been trained in the system space as a basic technique.

When he was in the United States, he used intervention technology to rescue astronauts. This is not a difficult task for him.

Once the surgical technique reaches a certain level, it is applicable to any situation.

"It’s not a big problem!" Yang Ping answered decisively.

If it is not a big problem in Professor Yang’s words, then there is no problem.

The patient’s heart has stopped beating again!

Defibrillation! Defibrillation! Defibrillation!

If this patient can be resuscitated today or not, Director Guan has no idea. This is the most difficult and dangerous patient he’s ever dealt with. He dares not be too adventurous with the rotary instrument for fear of rupturing the blood vessels.

Bang bang bang!

The sound of fist fights and kicks echoing from outside the operating room is incessant,

However, ever since Dean Xia implemented the hospital’s security plan, the doors of these operating rooms have all been replaced with explosion-proof ones, no matter how hard they are kicked.

The anesthesiologist and nurse started defibrillating the patient again, and Director Guan shouted: "Xiao Yu! What’s going on?"

Dr. Yu had gone out to explain it to the family, but it apparently had no effect.

"Do not open the door! Prioritize resuscitation!" Director Ji warns the other doctors not to carelessly open the door and let the family rush in, which would ruin everything.

After several defibrillations, the patient’s EKG shows normal QRS waves again. Director Guan promptly makes room for Yang Ping to move in.

Letting Yang Ping lead is a strategy to speed up the process.

"Do you need to use intravascular ultrasound again?" Director Guan reminded Yang Ping.

"No need!" Yang Ping thinks it would be a waste of time to look again.

He took the equipment. The miniature "diamond drill" began to rotate against hard calcified lesions. Compared with Director Guan, he is clearly more radical, more exaggerated. Observing Yang Ping’s exaggerated operations, Director Guan’s heart thumped in his chest.

"It’s okay, he’s confident!" Director Ji comforted Director Guan.

The rotating head always targets the calcified lesions and does not contact the vessel wall. Under bold and aggressive operations, extensive rotations were made, and the first obstruction was slowly cleared.

Immediately afterward, Yang Ping started tackling another blockage.

This operation is undoubtedly akin to racing in a busy downtown area and it is in line with Yang Ping’s usual style.

Director Guan’s throat was dry, he kept swallowing. He was afraid that Yang Ping would grind through the vessel wall. Director Ji seemed very calm and said, "Greater skill comes with more courage, don’t worry."

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