Cardiac treatment center in Sao Paulo Hospital, Brazil.

Dr. Domingo Paul personally retrieved various data and performed preoperative evaluation.

Just like doing math problems, left ventricular volume reduction surgery first needs to calculate the amount of myocardium to be cut off through various clinical values.

According to laplae's law: t=2pxr, that is, the larger the volume, the larger the 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 dilated cardiomyopathy heart specimens to draw a similar conclusion: m=4.18x, where m is the left ventricular wall tension and r is the left ventricular diameter.

The left ventricular enlargement is approximately disproportionately increased by left ventricular tension and oxygen consumption, which reduces the left ventricular efficacy. He hypothesized that all functions of the enlarged heart can be improved after the inner diameter is reduced.

The purpose of left ventricular volume reduction surgery is to reduce the left ventricular diameter to achieve a new relationship between left ventricular capacity, tension and diameter.

As the research deepens, recent studies of the frank-starling mechanism cannot be used to explain end-stage heart failure.

LV enlargement in advanced cardiomyopathy may be a malignant compensation for myocardial damage, and left ventricular volume reduction may affect this vicious cycle.

In end-stage cardiomyopathy, mitral valve reconstruction can also improve the heart function of some patients. Other concurrent surgeries such as coronary artery bypass are also helpful for the recovery of the left heart.

The left ventricle does not become spherical after reshaping, which makes the left ventricle contraction more coordinated and reduces heart distortion. Other possible influencing factors include changes in blood volume and peripheral vascular tone and drug-assisted treatment.

Theoretical research is just theoretical research, and mathematical problems need to be done.

Because there are few heart donors, the study of left ventricular volume reduction in the heart treatment center of the Sao Paulo Hospital in Brazil is the world's leading research.

The number of surgeries per year is far ahead of other hospitals. Dr. Domingo Paulo is the leader among them. From the time dasbatista initiated the left ventricular volume reduction surgery in 1996, he is a doctor who does more such surgeries.

After huge and complex calculations and surgical simulations, Dr. Domingo Paul was shocked to find that the patient's surgery was far more complicated than he imagined.

Left ventricular volume reduction surgery requires a lot of myocardium to be removed. In a sense, the removed myocardium tissue can indirectly prove the difficulty of the surgery.

So far, the most resection surgery has removed 302g of myocardium.

However, according to one's own calculations, the patient in front of him must remove at least 330g of myocardium before the surgery can be considered successful.

After careful study by Dr. Domingo Paulo, his first idea was to give up the operation.

However, the relevant personnel who were in contact with him vaguely expressed that if the surgery was successful, he would donate to the cardiac treatment center, and he changed his mind.

Especially when he saw the patient's son and got the check, Dr. Domingo Paulo decided to give it a try.

The patient's condition is very poor because he flew half of the earth by plane and his heart failure symptoms are extremely severe. Even if the left ventricular assist system is used, it will inevitably continue to deteriorate.

On the third day, Johns Hopkins' critical care medicine team was invited to St. Paul and Dr. Domingo Paulo for surgery.

The entire operation was extremely difficult, and it was only after 11 hours and 22 minutes that the operation was barely completed.

Although the operation was successful, Dr. Domingo Paulo finally measured 343g of the left ventricle cut!

I have increased my previous record by 41g!

You should know that every extra 10g of resection is a hurdle, and the difficulty of the surgery will increase geometrically.

Because that means that the left ventricular hypertrophy is more severe; the patient's own health is worse; the surgical risk is huge, and the perioperative risk is huge.

but!

No matter what, I successfully completed the operation.

Dr. Domingo Paulo is proud of this.

The patient is sent to the intensive care unit for postoperative treatment and care, and is cared for by a professional team of Johns Hopkins Hospital.

On the third day after the operation, Dr. Domingo Paulo stood outside the transparent isolation room and looked at the values ​​displayed on the monitor, and he was very satisfied with this.

This is the highest level of combination in the world, both in surgery and perioperative treatment. The best surgeons, the best critical care team, and the patient's mortality rate has been greatly reduced.

"It seems that the patient will recover soon." Dr. Domingo Paulo's assistant said happily.

"Um."

"Doctor, left ventricular volume reduction surgery, your surgery is fully mature, and you are worthy of being the number one person in the world." The assistant said happily.

Dr. Domingo Paulo believes that his assistant is telling the truth.

He is sorting out the data and medical records about the surgery into a paper and publishing it. This paper is a bomb that shocked the medical community, Domingo thought to himself.

"Dr., it is estimated that within 20 years, the record of myocardial tissue removal by left ventricular volume reduction surgery will be maintained by you." His assistant continued, "This is your field and no one else can get involved!"

"Hahaha~" Dr. Domingo Paul smiled happily.

The record in the past was maintained by his competitor Ney Amaral. The operation time and other things do not mean anything. The operation is not a race, and it is not a problem to do it quickly.

Moreover, the successful surgery completed by the two each year is almost the same. Ney has been pressing on Dr. Domingo Paulo because he had an operation to remove 302g of myocardium in the left ventricle.

This is a natural barrier that separates Dr. Ney Amaral from other doctors who have performed similar operations.

And this time, Dr. Domingo Paulo crossed and increased the record by 41g!

Domingo believes that his record can be maintained for 20 years, which is still a conservative estimate. It is no exaggeration to say that this record may always be sealed on the altar.

And Ney... is no longer the king of left ventricular volume reduction surgery, the king's crown has fallen on his head.

This time, Domingo knew that he was amazing, and she laughed happily. After leaving the intensive care unit, she happened to meet Ney Amaral.

Domingo Paulo walked over with his head raised, completely ignoring Ney's existence.

This was how Nei treated himself before, and he could finally look down on him! Domingo was extremely happy.

"Doctor, I'll start to sort out the materials, send the paper to the Lancet or..." Dr. Domingo Paulo's assistant solicited his advice.

"It's better to be the Lancet." Domingo was in a particularly good mood and said with a smile: "Then he is more interested in the new breakthrough in surgery."
Chapter completed!