Chinanews.com, Beijing, August 11th. A 4-month-old baby girl with a heart outside the body, an incidence rate of less than 5 parts per million, and three sets of surgical plans...
A series of keywords show the complexity of this operation.
In June of this year, such a highly difficult heart homing operation was successfully completed at the Capital Institute of Pediatrics.
On August 10, Zhang Hui, director of cardiac surgery, performed a postoperative review for Yiyi.
(Photo courtesy of Capital Institute of Pediatrics)
Beautiful female treasures are "outsiders"
This spring, Yiyi (a pseudonym) was born safely, which made the whole family excited. Seeing a piece of meat on the child’s stomach, they thought it was just a hemangioma or abdominal hernia, which could be cured after surgery. So the family came to the Capital Institute of Pediatrics. .
After a series of examinations, Zhang Hui, the director of cardiac surgery, told his parents that Yiyi’s stomach is not an hemangioma, but the heart. This disease is called Cantrell's five signs. It is a very rare congenital malformation in the world, with an incidence of one million. Less than five-quarters.
At present, there are only more than 200 cases of the disease reported worldwide, and only more than 10 cases have been reported in China.
Because the heart grows outside the body, it is also called an "external person".
Yiyi's degree is very serious: right circumflex heart, double outlet of right ventricle, ventricular septal defect, atrial septal defect, pulmonary valve stenosis... After Zhang Hui's detailed explanation, the parents understand that Yiyi's deformity is very difficult to treat, and the prognosis of the disease Mainly depends on the severity of the heart deformity.
Seeing that the child's illness was so complicated, the parents once gave up treatment.
But as Yiyi grew up day by day, the parents couldn't bear it and decided to fight for every opportunity to treat their children.
When Yiyi was 4 months old, the family returned to the Capital Institute of Pediatrics again.
Doctor Zhang Hui cheered for them, and the parents strengthened their confidence and decided to go through the hospitalization procedures for Yiyi immediately.
The MDT team is analyzing the condition and developing a treatment plan.
(Photo courtesy of Capital Institute of Pediatrics)
3 sets of surgical plans developed by multiple departments
After Yiyi was admitted to the hospital on May 24, Zhang Hui immediately launched the MDT diagnosis and treatment model, inviting multidisciplinary experts such as general (neonatal) surgery, thoracic and tumor surgery, anesthesiology, and cardiac surgery postoperative monitoring to fully evaluate Yiyi’s condition. Discuss the development of surgical plans and postoperative treatment plans.
After evaluation and discussion by MDT expert members, Zhang Hui concluded: "Yiyi’s treatment focus and difficulty are two, one is the correction of complex heart malformations, and the other is whether the heart can be smoothly restored into the thoracic cavity. Various heart malformations can be corrected at the same time. The excess left ventricular diverticulum must also be removed, which is a great blow to Yiyi's heart. It is currently unknown whether the sternum defect, diaphragm defect, and abdominal wall defect can be corrected at the same time after cardiac surgery, so that the heart can return to its position."
After repeated discussions, three sets of surgical plans were formulated in detail for possible situations during the operation.
MDT members such as Zhang Hui, Li Long and Pan Shoudong are undergoing surgical treatment.
(Photo courtesy of Capital Institute of Pediatrics)
7 hours of heart return
In the early morning of June 9, the anesthesia was completed and the operation officially began.
In accordance with the surgical plan, the doctor methodically corrects the heart deformity. After 3 hours of heart surgery, Yiyi's small heart beats regularly with the opening of the ascending aorta. This shows that the correction of the heart deformity is very successful.
The next step is to "home" the heart, open both pleuras, cut the residual pericardium, and put the heart back into the chest cavity.
However, the heart is obviously squeezed after being put back, which affects the contraction activity.
After reassessing, several doctors decided: if the thoracic cavity volume is not enough after the first-stage correction of all the deformities, and the heart surgery has just been completed, the myocardium and abdominal organs are in a state of edema, which has a great impact on the heart, and the chest should be delayed for a few days. Repair the remaining deformities.
After Yiyi returned to the cardiac surgery intensive care unit safely, the medical team formulated detailed postoperative treatment measures for her, ranging from maintenance of heart function, stabilization of the internal environment, improvement of respiratory function, prevention of infection, nutritional intake, analgesia and sedation management to complications Disease prevention and so on.
After careful treatment and care, Yiyi returned to the operating room again on June 14 for a second-stage operation.
This operation successfully repaired the deformities in the remaining four parts in only 2 hours.
Faced with the challenges of infection, cardiopulmonary insufficiency, and liver and kidney damage that may occur during postoperative recovery.
For these possible problems, the MDT team had made careful arrangements before the operation, and soon Yiyi removed the tracheal intubation and transferred to the general ward smoothly.
On July 10, Yiyi was discharged from the hospital and went home. From now on, she can study and live normally like other children.
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