Chapter 2158: Clarifying

Guo Zhi Hospital Operating Room

Called out to put on surgical gown and stand by the operating table, Xie Wanying helps the teacher observe the surgical field again, verifying the three-dimensional image in her brain, pointing out: "Teacher Du, there are several types of myocardial hypertrophy. This patient has reached the depth of central hypertrophy."

Myocardial hypertrophy, also known as hypertrophic cardiomyopathy, is divided into three types, mainly based on whether there is obstruction of the Left Ventricle outflow tract. Non-obstructive and latent obstruction may be reversible and are not within the scope of surgical indications, hence myocardial hypertrophy does not necessarily require surgery. Only the obstructive type requires surgical intervention.

Obstructive myocardial hypertrophy means the Left Ventricle outflow tract is blocked. This type was previously referred to by doctors as subaortic stenosis. Because previous doctors, upon opening the hearts of patients with this type, found the abnormal hypertrophic part mainly located below the aortic valve.

Beneath the aortic valve is the aortic root, a place that connects to the Left Ventricle, a relatively vast area. If this area has myocardial hypertrophy, it cannot be said to be uniform. The types Student Xie refers to are classifications based on anatomical observation rather than the type mentioned above.

Doctors, through surgery and anatomy, generally categorize myocardial hypertrophy into five types according to the location of hypertrophy. The simplest is the initial discovery of the hypertrophy below the aortic valve, other types are deeper and more troublesome.

Some hypertrophy is a whole patch of interventricular septum muscle thickening, with the hypertrophic part spanning deeply across one side of the Left Ventricle. In some cases, the area below the aortic valve is not hypertrophic at all, and the hypertrophy is found at the heart’s apex, completely overturning doctors’ initial definition and nomenclature for this disease, which is why the original name has become history. Regardless of the location of hypertrophy, these hypertrophies compress the normal volume of the Left Ventricle and create obstacles to healthy hemodynamics. Doctors definitely need to surgically address it.

The point of contention returns to the original place: whether the myocardial hypertrophy of this patient fits Student Xie’s description and belongs to one of the obstructive myocardial hypertrophy structural changes? Or is it like the preoperative examination report didn’t clearly point out such issues, judged as reversible latent obstruction, making it unnecessary for the surgeon to consider surgery in this regard before operation?

Which result is correct?

If the mitral valve area had not been problematic, no one would have thought of this point initially. Sometimes, when a problem occurs somewhere, searching around leads to discovering the crux of another issue.

"Could you explain again, is it the whole interventricular septum hypertrophy?" Du Yeqing continues to confirm what she said.

"Is it like that?" The assistant Dr. Yuh on the stage, in a posture akin to tiptoeing and stretching his neck, trying to observe the heart’s internal structure more clearly in the surgical field.

In heart valve direct-view surgery, the valve is located inside the heart, so doctors need to open the heart to view and operate. This incision must not be made haphazardly; doctors cannot just cut open the patient’s heart fully for convenience of observation and ease of operation.

It’s even less possible to cut the patient’s heart to reveal the entire interior, because the heart is not an apple or pear, it has several chambers, and these chambers and the walls separating them are all asymmetrical—left and right, top and bottom, volume—all without a point of symmetry.