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   Not only is the internal structure of the heart a hindrance to the doctor\'s scalpel, but the coronary arteries, an important blood supply network on the surface of the heart, are also asymmetrically distributed. Doctors need to avoid important blood vessels when cutting.

  How many knives to cut, the less the better, only one knife is the best. As the old saying goes, doctors need to be responsible for every cut they make, and only a stupid doctor will think about making more cuts. Where the knife falls should be planned according to the surgical site prepared before the operation. If it is just a simple mitral valve replacement, the mitral valve is located on the left side, and it is ok to draw a knife directly in the left atrium. In today\'s patient, both mitral and tricuspid valves need to be operated, one on the left and one on the right. According to the experience summed up by predecessors, in this case, the conventional surgical approach starts from the right atrium, and the right atrium is incised, see The atrial septum is then cut up and down in the center of its fossa ovalis, and the mitral valve can be seen.

   After these parts are incised, the doctor lifts the surrounding edges with sutures to expose the surgical field inside.

   The preoperative surgical team only considered the mitral valve and the tricuspid valve before the operation and did not consider any myocardial hypertrophy. The surgical approach used did not consider the latter, and the exposed surgical field of view did not take into account the overall view of the left ventricle. No wonder Dr. Yu was tiptoeing. With such a surgical field of view, he really couldn\'t see how to judge myocardial hypertrophy in the complete left ventricle.

  The chief surgeon has rich surgical experience, and his brain has accumulated more surgical anatomical map databases than his young hospitalization. Maybe he can look at a corner of the picture, like a jigsaw puzzle, relying on brain supplements to judge other parts.

   As for Xie, anyone who knows her will know that she is a different kind.

   Xie\'s only embarrassment now is how to connect the thinking of ordinary people with her special brain, so that everyone can understand the picture sense in her mind.

   After receiving further questions from the chief knife, Xie Wanying continued to organize the language: "Please look at it from this angle, Teacher Du."

   Others listened to her as if the voice broadcast of the navigation system.

"Here, at this point, at a 35-degree angle below the chordae tendineae of the patient\'s original surgery, this muscle is relatively convex, the thickness of the convexity is not obvious, but the area is wide, just involving * *The muscle and the valve orifice."

   This time, not only the main sword can see clearly. Dr. Yu didn\'t need to put his toes on his toes, he tilted his angle of view, and almost exclaimed in his throat: You can see it. It turns out that it is not completely impossible to spy on the whole view of the ventricle in the limited narrow-mouthed field of view, and it is necessary to make full use of the angle of view.

  How to open and close the leaflets of the mitral valve depends on two ** muscles, such as a mechanical opening and closing mechanism that pulls the two leaflets. The ** muscle is connected to the heart muscle of the ventricle and is powered by the rhythm of the heart muscle. When the patient\'s valve has a problem and needs to be replaced with an artificial valve, how to deal with the muscle is a technical problem.

   Relying on the experience of predecessors, the current mitral valve replacement is very mature, and conventional surgery can preserve the sub-mitral valve structure, that is, the chordae tendineae of the **. The specific method is generally to trim the original valve leaflet connected by the chordae tendineae in a sheet shape with the chordae tendineae and chordae tendineae for retention.

   (end of this chapter)