Chapter 1805: 1743, You Still Wouldn't Understand

"The calculation of the inferior vena cava inspiratory collapse rate is (MaxD-MinD)/MaxD×100%." Zheng Ren saw President Zhang's bewildered face and directly explained.

Place the probe below and slightly to the right of the sword, scan plane parallel to the inferior vena cava, the image shows the right atrium, inferior vena cava, and hepatic veins.

In normal state, the inferior vena cava shows obvious collapse with deep inspiration, its diameter ≤2.1 cm and inspiratory collapse rate >50%, which corresponds to 3 mmHg.

When right atrial pressure rises, the diameter can be >2.1 cm and the inspiratory collapse rate <50%, which corresponds to 15 mmHg.

Zheng Ren spoke like a Darin machine gun, finishing in one breath without giving anyone time to think, saying: "The inferior vena cava diameter reaches 2.4 cm, inspiratory collapse rate <50%, clearly indicating pulmonary artery embolism."

"The fifth point, tricuspid regurgitation velocity increases, according to the simplified Bernoulli equation…" He said, Zheng Ren paused, seeing President Zhang's completely bewildered expression, immediately sighed.

"You're not in the medical field, you might not understand; you just need to know that, according to the Bernoulli equation, from the tricuspid regurgitation we can see the clot exists and it's large enough."

President Zhang almost cursed.

What do you mean "I'm not in medicine"? As the president of a prestigious medical university, how could you be so spiteful?!

He thought that but didn't dare say it. President Zhang didn't expect that the experienced boss Zheng, when talking about theory, would be just as systematic.

He felt unconvinced, looked up at Sun Chao, hoping to find reinforcement.

If Director Sun Chao could also say one two three four five, to dispel Boss Zheng's arrogance, how great that would be.

However, what President Zhang saw was… a dazed expression on Director Sun Chao's face.

He knew echocardiography, but not this deeply. What formulas, what equations—are these the things one should say when looking at an echocardiogram?!

Sun Chao knew President Zhang was looking at him, but he… simply didn't understand a thing!

He could only pretend not to see President Zhang's gaze, his eyes dull, staring fixedly at Zheng Ren.

A few days ago, the chief of cardiothoracic surgery, Dr. Tian, wasn't he just as embarrassed as me? People say things I don't understand, how can I fight back?

This is not a battle at all, but a one-sided slaughter!

"The sixth point, in the pulmonary artery forward flow spectrum, a notch appears in mid-systole, accompanied by markedly reduced flow velocity, shortened acceleration time, and the right ventricular ejection period—namely the RPEP period shortening and reduced ratio of ACT to right ventricular ejection time, which is our diagnostic standard—the 'fist sign'."

Not over yet…

After one two three four five, there's actually a six!

Everyone went numb.

There was no echocardiography expert on site; everyone felt Zheng Lao Ban's words were somewhat plausible yet dubious. Wanting to refute, they couldn't produce strong evidence.

Damn it!

Director Sun Chao felt resentful.

But, everything hasn't ended.

"The seventh point, thrombus is the most typical feature of thrombotic pulmonary embolism."

Thrombi in the right atrium or ventricle can vary in shape, while those within the pulmonary artery often appear as large masses extending from the main trunk to one or both pulmonary artery branches.

Thrombus in the right pulmonary artery main trunk is easily shown; the left pulmonary artery, due to shorter visualization, makes thrombus hard to detect. Moreover, one must differentiate thrombus from right heart system tumors!

"In this patient, the thrombus in the right pulmonary artery main trunk is obscured by gas interference, so it's not very clear. But we can roughly estimate its length—at least 10 cm."

Zheng Ren said in a low, rapid voice.

"Part of the thrombus can be seen in the right pulmonary artery main trunk, a smaller part in the right ventricle."

Having said this, he raised his head, glanced at President Zhang, and said: "Regarding the differential diagnosis between thrombus and cardiac tumor, because we're short on time, I won't discuss it here."

President Zhang felt immense contempt.

He thought Zheng Lao Ban's implication was—"I've said it, you damn well don't get it, so I won't say more." Talking to you bunch of useless losers is meaningless, completely meaningless.

Sun Chao was like a mosaic, completely ignored by Zheng Ren.

Really… really damn it!

Sun Chao silently cursed again in his heart.

"The eighth, interseptal motion abnormality…"

"The ninth, reopened foramen ovale…"

However, Zheng Lao Ban's words weren't over yet.

After finishing about the thrombus, Zheng Ren continued with points eight and nine.

After speaking, he placed the document on the office desk, tapped the light box with his finger, making a bang-bang-bang sound.

"The diagnosis is fairly clear: pulmonary artery embolism, thrombus blocking the right pulmonary artery main trunk. From echocardiography we judge the thrombus is long, at least 10 cm. This is one of the contraindications for interventional thrombectomy!"

"Moreover, the patient's condition is urgent; if there were time, I could succeed in thrombectomy within two hours. But now… I estimate the patient's survival is only about one hour. Performing thrombectomy or other tests would surely kill the patient."

"President Zhang, sign!" Zheng Ren frowned, speaking in a commanding tone.

Time is urgent; all that gentle breeze and rain, all that respect for old comrades, are pure bullshit.

President Zhang froze.

Is this a palace coup? Is the time really this urgent?

"Boss, the patient's oxygen saturation is 75%! I'm sending him to the operating room first; that side's surgery is already ready to start." Su Yun pushed the patient, running all the way, and shouted as she passed the office.

"Go ahead." Zheng Ren took out a blank A4 sheet, placed it before President Zhang, and said: "President Zhang, there's no time; the surgical risk is extremely high, the chance the patient cannot get off the operating table is at least 40%."

"……" President Zhang shivered.

Not only him, the vascular surgery department heads from all over the country who came to watch the excitement also shivered.

But the two shivers carried different meanings.

President Zhang's shiver was because the student had a 40% chance of not getting off the table, while the other directors felt astonished that this young man actually had a 60% confidence to pull off the surgery!

This is a surgery of difficulty reaching the clouds; according to his claim, the patient would die within one hour.

One hour, can extracorporeal circulation be established?

He actually still claims he has a 60% chance?

A 10 cm pulmonary artery embolism, cutting the heart, cutting the pulmonary artery, removing the thrombus…

Impossible, that's absolutely impossible!

Unconsciously, many directors did not question the diagnosis, but placed all their distrust onto the Shou Bing success rate.

Impossible, that high!

"Agree to the Shou Bing, please sign here; there's no time left for other preoperative explanations." Zheng Ren said: "After the surgery, I will handwrite this paragraph."

"If you can't make up your mind..." Zheng Ren said, his gaze turning to Lin Ge.

"Zheng Lao Ban, rest assured, what the Medical Department does is to provide escort for the clinic. Dean Zhang can't make up his mind, the Medical Department also approved the Shou Bing!" Lin Ge understood, and without hesitation spoke loudly.