Chapter 2956: 2756 Delayed Sternal Closure

The operation of the built-in floating catheter is simple; Zheng Ren put on sterile gloves and completed the operation within one minute.

A floating catheter was inserted into the right internal jugular vein; at this point, cardiac output measured 6.1 L/min and SvO₂ was 51%.

The anesthesiologist picked up a pen and paper to start calculating, but Zheng Ren said in a low voice, "No need to calculate; the systemic vascular resistance is 760/cm5."

"……" The anesthesiologist and Zhao Yunlong were stunned for a moment. Not only them, but Su Yun was also stunned.

Measuring cardiac output with a floating catheter requires a fairly complex formula to calculate systemic vascular resistance; did Zheng Lao Ban just work it out in his head?

He must have cheated; Su Yun's number, worked out five or six seconds later, was the same, and he silently muttered a complaint to himself.

"Zheng Lao Ban, is the cardiac output really that low?" Zhao Yunlong asked.

"Prepare for thoracotomy." Zheng Ren said, "I suspect there's a problem with the myocardium."

"Myocardium……" This assessment is far from cardiac tamponade. Zhao Yunlong could also figure out the reasoning, but that would be a rare case.

"Zheng Lao Ban, is the blood from cardiac tamponade seeping into the myocardium?" Director Zhang asked.

"Possibly; we'll know once we open up." Zheng Ren glanced over and asked, "Has Yi Ren arrived?"

"Zheng Lao Ban, Xiao Xie went to fetch your surgical equipment; she'll be here soon." The circulating nurse said, "She just contacted me."

Zheng Ren nodded, then began holding his chest while looking at the patient's final ultrasound imaging data.

Su Yun and Zhao Yunlong positioned the patient, began scrubbing their hands, and Xie Yiren rushed over carrying the sterile instrument case.

"Old Zhao." Zheng Ren suddenly said in a low voice.

"Huh?" Zhao Yunlong indicated he had heard Zheng Lao Ban.

"Call the ICU and prepare an isolation room." Zheng Ren said.

"An isolation room?" Zhao Yunlong was taken aback but didn't ask why; having finished scrubbing, he had the anesthesiologist's assistant place the call, and he leaned in to coordinate the isolation room with the ICU.

"Are we going to do a delayed sternal closure?" Su Yun asked, frowning, "Is it really that serious?"

"It's very likely that the myocardial injury worsened after the IABP was placed." Zheng Ren turned to scrub his hands and gave his opinion on the patient.

Director Lang froze after hearing Zheng Lao Ban's words; "Could the worsened myocardial injury after the IABP be referring to my mistake?"

He felt somewhat indignant and bewildered.

"If someone in Nanshan Shi said that, it would definitely be passing the buck, but we're in 912, so it shouldn't happen." Director Zhang was enthusiastic, rushing over from home in the middle of the night and waiting for me in the office.

Even that wasn't enough; Director Zhang also contacted Nobel laureate Zheng Lao Ban to perform the thoracotomy.

"He's a Nobel laureate—do we really need to pin the blame on ourselves? There's absolutely no need for that. To me it seems like a huge deal, but in his view it's probably just an ordinary case."

However, IABP has great clinical benefit for patients with myocardial ischemia; Director Lang had already launched this technology over a decade ago, benefiting countless patients.

During diastolic balloon inflation, aortic diastolic pressure rises, raising coronary artery pressure and increasing myocardial blood and oxygen supply; before systolic contraction, the balloon deflates, aortic pressure drops, afterload decreases, ventricular ejection resistance falls, and myocardial oxygen consumption drops.

IABP effectively increases myocardial blood supply and reduces oxygen consumption, maximizing benefit for coronary heart disease patients.

How can Zheng Lao Ban still say it's the IABP's fault? And what does he want to do? Delayed sternal closure? Are we supposed to let the patient bleed out with an open chest and just send them back to the ward?

Doesn't the young Zheng Lao Ban worry about postoperative infection? Frankly, I don't even understand what Professor Su meant by delayed sternal closure; it just sounds unreliable.

Director Lang's mind was a tangle of competing thoughts as he pondered; meanwhile, the surgery had already begun.

The metallic surgical instrument case was striking; the instrument nurse and surgeon worked together so seamlessly they hardly needed to speak.

Under the shadowless lamp, no one spoke; there was only silent, coordinated teamwork.

Even the surgeon, assistant, and instrument nurse exchanged no glances—as if they performed such surgeries ten or eight times a day and had no interest in communicating.

Director Lang moved behind Zheng Ren and saw the sternal saw open the sternum, exposing the pericardium.

"It's not from pericardial tamponade." Su Yun said, "The echocardiography is normal."

"Hn." Zheng Ren finally spoke his first word—just a single syllable.

As the pericardial parietal layer was lifted and the pericardium cut, the suction device was inserted. Director Lang carefully observed the suction tube's pathway; only a small amount of bright blood was drawn out.

It's not pericardial tamponade, yet why is the patient's myocardial contraction so weak that, despite norepinephrine and dopamine, the blood pressure still won't rise? Director Lang wondered.

As the pericardium was snipped open with a fine pair of scissors, an enlarged heart appeared in the surgical field. The heart showed global dilation and swelling, with relatively poor left‑ventricular function.

"Whoa!" Su Yun exclaimed, "It's swollen to this extent?"

Zheng Ren said nothing, but kept searching. Soon he found that the single‑lumen drainage tube used for pericardiocentesis had pierced the left‑ventricular surface, causing a local rupture, and fresh bleeding was still visible on the wound surface.

Sure enough, it was his own mistake—the pericardiocentesis had caused secondary injury… Seeing this, Director Lang felt his limbs go numb and cold.

Could it be that his own pericardiocentesis damaged the left‑ventricular myocardium, producing these symptoms?

But that couldn't be right; he was defending himself internally. This is a human self‑protective instinct—seek benefit, avoid harm—and everyone is the same.

Why did he perform pericardiocentesis in the first place? It wasn't because, after stent placement, the patient's chest tightness and pain showed any relief.

Director Lang was weakly defending himself in his mind, while under the shadowless lamp Zheng Ren had already snipped away the pericardium, using a 3 × 3 cm autologous pericardial patch to suturing continuously around the wound's periphery, thereby locally repairing and staunching the damage at the puncture site.

"Zheng Lao Ban, I'm late." Lao He walked in while fastening his mask's strap.

"Oh, not late." Zheng Ren said, "The surgery is almost finished."

"……" Lao He was taken aback—"Not late?" Zheng Lao Ban never talks like that. Saying "not late" while telling himself the surgery is almost done……

"Prepare for a transesophageal echocardiogram." Zheng Ren said.

"All right." Lao He didn't have time to think further and immediately got busy.

"Zheng…… Zheng Lao Ban, what are we preparing to do?" Director Lang stammered in a low voice.

"We can't close the chest, so let's do a bedside ultrasound to have a look." Zheng Ren said, gently pressing his hands together to approximate the thoracic cavity.

The thoracic cavity wasn't fully approximated, but as Zheng Ren applied force with his hands, the sternum tried to come together and the monitor began to alarm wildly.