Rebirth of a Doctor Without Regrets

Chapter 129 The Pattern of Deviation

The heartbeat is never a random contraction, but is precisely regulated by instructions from the brainstem.

The cardiac conduction bundle is like a hidden network within the heart. Its core function is to conduct electrical signals from the heart, instructing the atria and ventricles to contract and relax in an orderly manner, thus pumping blood throughout the body. This cycle repeats continuously, maintaining the heart's normal pumping function.

For heart surgery, the conduction bundle is an absolutely vital lifeline that must not be touched; its importance is comparable to that of the brain's nerve center.

It is hidden deep inside the heart muscle, in a concealed and delicate location, and is difficult to distinguish with the naked eye. If it is accidentally damaged or cut during surgery, the consequences are unimaginable.

In mild cases, it can lead to cardiac conduction block, causing the heartbeat to become slow and irregular. Patients will need to wear a pacemaker for life and rely on external devices to maintain their heartbeat.

In severe cases, it can directly trigger ventricular fibrillation, causing the heart to instantly lose its pumping function. If not treated in time, it can lead to sudden death within minutes.

In particular, patients with congenital heart disease and cardiac malformations often have conduction bundles that deviate from their normal anatomical positions, which further increases the difficulty of positioning and protecting them during surgery.

This is also a typical difficult problem that tests the surgeon's skills and experience.

Inside the instrument storage room, Tao Ping quickly moved among the neatly arranged shelves and soon found the special storage cabinet for storing the His beam mapping probes used during surgery.

She carefully took out a disposable probe, unpacked it to check that it was correct, and then hurried to the operating room in the dry ward with the probe in hand.

As soon as I reached the corner of the corridor, I saw Zhu Haiming pacing back and forth impatiently, clearly getting impatient.

"Director Zhu, the probe is here." Tao Ping quickly stepped forward and handed over the probe.

Zhu Haiming's eyes lit up. He took the probe and casually weighed it in his hand. "Alright, you can go back now. Don't delay Gao Ming's surgery. I'll take it over for you."

After saying that, without waiting for Tao Ping's response, he took steady steps and climbed the stairs to the tenth floor.

Inside the operating room, Wang Xiao had already completed the thoracotomy. The sharp scalpel precisely cut open the sternum, exposing the patient's deformed heart.

Hearing the door open, Wang Xiao subconsciously turned around and saw an elderly man with gray hair and a sprightly demeanor, holding the probe he desperately needed.

Judging from the old man's demeanor, Wang Xiao guessed that he must be a superior leader sent by the hospital to inspect the situation. He immediately became more nervous and quickly bowed slightly, speaking respectfully: "Good morning, leader. I am Wang Xiao, the chief surgeon, and I am waiting for the probe to locate the conduction bundle."

Zhu Haiming didn't respond, but simply waved his hand, walked to the operating table, and signaled Wang Xiao to continue the procedure.

The anesthesiologist took the His beam mapping probe from him and helped connect it to the monitor.

Wang Xiao was finally relieved. With the probe, he no longer had to blindly probe and could avoid the risk of accidentally touching the conduction bundle. He then signaled to the extracorporeal circulation teacher to start the extracorporeal circulation machine.

Lin Gaoming had instructed him over the phone to first look at the cardiac MRI scans to determine the approximate location of the conduction bundle.

However, Wang Xiao and Li Wei usually deal with routine heart surgeries and lack the ability to interpret MRI images of congenital heart disease malformations. After looking at the images for a long time, they still couldn't accurately determine the location of the conduction bundle.

Left with no other option, the two agreed to cut open the heart and then use a probe to test point by point near the conventional anatomical location of the conduction bundle until they found the H wave on the monitor.

Once extracorporeal circulation was established and the heart temporarily stopped beating, Wang Xiao carefully pressed and tested each point in the normal area with the His beam mapping probe in hand, his eyes fixed on the monitor screen, afraid of missing any signal.

Li Wei stood to the side, barely daring to breathe, occasionally adjusting the angle of Wang Xiao's camera lens; both of them seemed rather reserved in their movements.

Zhu Haiming stood to the side, arms crossed, his eyes fixed on Wang Xiao's actions, his face expressionless.

In his opinion, Wang Xiao's operation was fairly standard, and his movements were delicate enough, showing that his basic skills were quite solid.

However, he was too nervous, his technique was not skilled enough, and the pace of the test was too slow. Compared with the excellent young doctors he had mentored in the past, he did not stand out in any particular way, which inevitably made him feel a little disappointed.

It seems Lin Gaoming exaggerated.

Time passed second by second, and Wang Xiao had tested more than a dozen points, but the monitor still only showed a flat waveform and no sharp H wave.

His forehead was beaded with sweat, and his palms were damp: "What happened? Has the conduction beam deviated so far from its normal position?"

Li Wei was also starting to panic: "Could there be a problem with the probe? Or are we testing the wrong area?"

"Stop searching aimlessly. If you keep testing like this, you won't find anything even by dawn." Zhu Haiming finally couldn't help but speak up, took a step forward, gently pushed Wang Xiao aside, picked up the probe, and pointed to the defect in the patient's heart.

"You think the conduction bundles in a deformed heart are just drifting around randomly? The positions they deviate from are all based on certain patterns."

Wang Xiao and Li Wei looked at each other in bewilderment.

"The conduction bundle of the perimembranous ventricular septal defect is usually located at the lower posterior margin of the defect;

In cases of atrioventricular septal defect or endocardial cushion defect, the conduction bundle is generally located posterior and superior to the defect.

In tetralogy of Fallot, at the anterior superior margin of the defect;

In cases of transposition of the great arteries or double outlet right ventricle, the conduction bundle is located below the pulmonary valve. Zhu Haiming is very familiar with the various deviations of the conduction bundle.

"Your patient has an atrial septal defect combined with a heart malformation. The conduction tract is definitely above and behind the defect. If you measure in that direction, you will definitely find it."

Wang Xiao was utterly shocked upon hearing this.

He had never heard of such a precise positioning pattern before; no wonder he had been searching for so long without success.

He quickly followed the old director's instructions, carefully moving the probe to the upper back of the heart defect and gently pressing down.

Almost simultaneously, a sharp H wave suddenly appeared on the monitor, clear and distinct, instantly breaking the silence of the operating room.

"Found it! Found it!" Wang Xiao looked at Zhu Haiming with more admiration.

"Once you find it, start the procedure immediately. When suturing, avoid this area, be gentle, and avoid putting tension on this area."

"Understood! Thank you for your guidance!" Wang Xiao nodded quickly, refocusing on the operating table.

With Zhu Haiming's guidance, the surgery proceeded smoothly. After the suturing was completed, Wang Xiao signaled to the nurse to stop the extracorporeal circulation, remove the relevant instruments, and wait for the heart to start beating again.

A few seconds later, the patient's heart slowly resumed beating.

The heart rate on the monitor was stable, all indicators were normal, and there were no signs of conduction block. The surgery was successfully completed.

Zhu Haiming looked at the steady beating heart and a look of approval appeared on his face.

This young man, though inexperienced and somewhat nervous, is highly perceptive and quick to grasp concepts; he is a promising talent.

However, he is far from being a genius.

He glanced at the time, and seeing that the surgery was basically completed, he didn't linger. He turned around quietly and walked out of the operating room.