Surgery Godfather
Chapter 933 - 806 Innovation Begins with Boldness and Absurdity

Chapter 933: Chapter 806 Innovation Begins with Boldness and Absurdity

Academician Wang began to lecture everyone on Fontan Surgery.

"Explaining it in three steps seems a bit complicated, so I’ll use a reverse narrative to explain it. Let’s start with the result, which is the target to be achieved in three steps. Why can’t we achieve it in one step? Because after the heart is modified, there’s an adaptation process. If done in one step, the heart can’t handle it and severe complications would occur. We can only proceed step by step, allowing the heart to gradually adapt."

"Look at this case, the Left Ventricle is very small, poorly developed, what do we do? We abandon this Left Ventricle, discard it, and don’t use it. Isn’t there another Right Ventricle in the heart? It can pump blood too. So we connect the Aorta to the Right Ventricle, letting it take over the role of the Left Ventricle. Originally, the Right Ventricle is connected to the Pulmonary Artery, which is the driving force of pulmonary circulation. Since the Right Ventricle is given to the Aorta, what about pulmonary circulation? The essence of Fontan Surgery is right here. Didn’t I mention before? The core of this surgery is the direct anastomosis of the Pulmonary Artery with the Superior and Inferior Vena Cava, bypassing the heart as the power source, and letting the pressure difference between them provide the driving force. Finally, we break down the wall between the left and right atriums, turning them into one chamber. These three points are the results we want, achieved in three steps."

"After the surgery, what does the heart look like?"

"Let’s take a look!"

Academician Wang drew a diagram on the electronic blackboard: "My drawing skills are not as high as Professor Yang’s, but make do with it."

Actually, as far as Medical Illustrations are concerned, Academician Wang was already at a very high level.

"The systemic circulation becomes like this — the oxygen-rich arterial blood returns to the Left Atrium from the Pulmonary Vein, then passes through the surgically created opening between the two atriums into the Right Atrium, and then enters the Right Ventricle. With the heartbeat, it’s pumped through the Aorta to the whole body, and finally, is collected back by the Superior and Inferior Vena Cavas.

"What about the pulmonary circulation? It goes like this — the oxygen-poor blood directly enters the Pulmonary Artery from the Superior and Inferior Vena Cavas, undergoes gas exchange in the lungs, becomes oxygen-rich blood, and returns to the Left Atrium through the Pulmonary Vein.

Look, a man-made circulation has been successfully established, achieving the target: the separation of oxygen-rich and oxygen-poor blood. The heart only handles systemic circulation. This transformation is like using factory-defective parts to reassemble and achieve normal function.

"Compare this with the normal systemic and pulmonary circulation, isn’t it interesting? Such an imaginative method."

Next, Academician Wang detailed the specific methods and stages of the surgery. The first stage is generally completed within a month, the second at six months, and the third between one and one and a half years old.

"In the first step, we have to enlarge the Aorta because it’s connected to the Left Ventricle. Since the Left Ventricle is poorly developed, the Aorta often is too, being very narrow. We need to enlarge the Aorta, then cut off the Pulmonary Artery that’s connected to the Right Ventricle and connect the Aorta to the Right Ventricle instead. This way, the Right Ventricle takes over the systemic circulation from the Left Ventricle. What about the abandoned pulmonary circulation? We create a temporary shunt between the Pulmonary Artery and the Aorta. So actually, at this stage, the circulation is still chaotic, and the oxygen-rich and oxygen-poor blood is mixed. It’s not the final goal yet, but as the first step, it can ensure the child survives until the second surgery is performed. Of course, during this step, we also need to open the septum between the left and right atriums."

"Once the heart adapts, we proceed with the second step at six months old. Before, we had built a temporary bridge between the Aorta and Pulmonary Artery. Now we remove it, and connect the Superior Vena Cava to the Pulmonary Artery. This way, the Pulmonary Artery receives the oxygen-poor venous blood, moving a step closer to the target. However, the blood from the Inferior Vena Cava will still enter the Right Atrium, the Left Atrium, and the Right Ventricle, which acts as the Left Ventricle. So after the second step, the venous and arterial blood will still mix."

"At the age of one to one and a half years, we perform the last step, connecting the Inferior Vena Cava to the Pulmonary Artery. Look, have we now achieved the target we initially discussed?"

Academician Wang, using simple and popular language, made the three steps of Fontan Surgery clear, and with the accompanying illustrations, the young students had fully understood.

"For the entire surgery and postoperative monitoring, we focus on monitoring the Pulmonary Artery pressure, because the entire surgery is based on the pressure difference between the Aorta and Pulmonary Artery. Therefore, if pulmonary hypertension occurs, the surgery’s effect would collapse, and the patient would be in danger. So, if we find any problems, we need to operate to adjust the pressure in the Pulmonary Artery."

"To summarize, our goal is — because the Left Ventricle is unusable, we change the Aorta, which originally connected to the Left Ventricle, to connect to the Right Ventricle, and we connect the Pulmonary Artery, which was connected to the Right Ventricle, with the Superior and Inferior Vena Cavas; and open the septum between the left and right atriums."

"But to allow the heart to adapt, we go slowly, in three steps to achieve the target — first, change the connection of the Aorta to the Right Ventricle, at this point the Pulmonary Artery isn’t connected to the Superior and Inferior Vena Cavas yet, so we temporarily create a pathway with the Aorta; then we connect the Aorta to the Superior Vena Cava; and finally, we connect the Aorta to the Inferior Vena Cava, and we are done!"

"Are there any questions or concerns regarding Fontan Surgery?" asked Academician Wang.

A student raised a hand: "Elder Wang, apart from a heart transplant, will there be new methods to radically treat this condition in the future?"

Academician Wang said, "I’m not certain. With the current level of medical knowledge, there’s no way to radically treat it other than a heart transplant, but this is only as far as we know now, within our current understanding. Wasn’t there also no way to deal with Tricuspid Atresia before? Didn’t Fontan Surgery become a lifesaving procedure? I think the next radical surgery might just come from among you."

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