The team is performing surgery on Xiaoqi. Photo courtesy of the interviewee.
Since the establishment of the department 8 years ago, the Joint Cardiac Surgery Center of the First Affiliated Hospital of Shantou University has been continuously cultivating in the field of cardiosurgery. Photo courtesy of the interviewee.
Born with only "half a heart", the lips turn purple and breathe is difficult soon after birth, and the incidence is only about 1 6500 in live infants, which seriously affects the brain development of the child and even leads to heart failure ......The First Affiliated Hospital of Shantou University Medical College admitted such a small patient - Xiao Qi. After 5 years, through the unremitting efforts of the team of the First Affiliated Hospital of Shantou University and Wuhan Yaxin Joint Cardiac Surgery Center, the first case of total vena cava and pulmonary artery connection in eastern Guangdong was successfully carried out, creating vitality for Xiaoqi, a child with congenital heart disease. On December 12, Xiaoqi, who had recovered well, was successfully discharged from the hospital accompanied by his family.
This is a complex congenital heart disease called a single ventricle, combined with pulmonary artery stenosis, which is extremely difficult to perform, difficult to design, and a long time span, which is an unprecedented challenge for our entire cardiac surgery center. Wang Xiao, chief physician of cardiac surgery, said.
A timed 5-year surgical plan.
At the end of 2017, Xiaoqi was born in a small town in Shantou City. Soon after birth, Grandpa noticed that his lips were purple and he had trouble breathing, ......At the suggestion of many parties, his family sent him to the First Affiliated Hospital of Shantou University for examination, and the results showed that Xiaoqi had a complex congenital heart disease - a single ventricle with pulmonary artery stenosis.
It is understood that a single ventricle is an extremely rare congenital heart malformation, and its incidence is about 1:6500 in live infants, accounting for about 1 of congenital heart diseases5%。"A normal heart has two ventricles, left and right, while Xiaoqi has only one, which is equivalent to only 'half a heart'. If the operation is not carried out in time, the lack of oxygen caused by the overload of the heart will seriously affect its brain development, and the overload will inevitably lead to its heart failure, and it will not live to be 1 year old. Wang Xiao said.
In order to help Xiaoqi get out of danger, the team of the United Cardiac Surgery Center formulated a thorough surgical plan and decided to perform the operation in stages. In the first stage, bidirectional cavity-pulmonary artery anastomosis was carried out, with the aim of allowing the venous blood of Xiaoqi's upper body to directly bypass the heart and enter the lungs, promote the development of pulmonary arteries while increasing the blood and oxygen saturation of the lungs, achieve a relative balance between systemic circulation and pulmonary circulation, reduce the excessive volume and pressure load of a single ventricle, and improve Xiaoqi's quality of life.
In July 2018, the team of the United Cardiac Surgery Center carried out the first phase of "bidirectional cavity pulmonary artery anastomosis + atrioventricular valvuloplasty" for Xiaoqi as planned, connecting its superior vena cava with the right pulmonary artery. After the operation, Xiaoqi's shortness of breath and cyanosis symptoms improved significantly. Based on Xiaoqi's recovery, the team plans to perform a second stage of surgery around the age of 6, that is, total vena cava and pulmonary artery connection.
4 hours of hard work to win the first case in eastern Guangdong.
Unfortunately, while Xiaoqi was waiting for the total vena cava to pulmonary artery connection, his sister was also diagnosed with pulmonary stenosis and atrial septal defect. Thankfully, this is a relatively mild form of congenital heart disease. In August 2021, the United Cardiac Surgery Center carried out "pulmonary valve correction + right ventricular outflow tract dredging + atrial septal repair" for Xiaoqi's 2-year-old sister. Since the operation, Xiaoqi's sister has been able to live like a normal child of the same age, which has also brought more confidence to Xiaoqi's family.
This year, Xiaoqi's grandfather took him to the United Cardiac Surgery Center again for a follow-up, and the ultrasound results showed that Xiaoqi's common ** ventricular valve (mitral valve, tricuspid valve) had mild lesions, and the single ventricular systolic function was reduced. In this regard, chief physician Wang Xiao said: "According to the plan, Xiaoqi now needs to undergo the definitive surgery of the first single ventricle, that is, the total vena cava and pulmonary artery connection, by using artificial blood vessel pieces to construct an intraatrial plate barrier to reconstruct the atrial septum, or through the extracardiac tube and other ways to guide the inferior vena cava blood into the pulmonary artery, to achieve the connection between the entire vena cava and the pulmonary artery, otherwise he will not live past the age of 12." ”
This kind of surgery has a very high mortality rate, extremely complex surgical operation, and great difficulty in postoperative management and adjustment, so it is also known as the peak of difficulty in the history of modern pediatric cardiac surgery. This is the second time that Xiaoqi is preparing for thoracotomy surgery, which also means that this operation has extremely strict requirements for the entire surgical team such as surgeons, anesthesia, and cardiopulmonary bypass. As surgery approached, the entire cardiac surgery team was filled with a tense and high-pressure atmosphere.
On November 29, 2023, under the leadership of Wang Xiao, the entire surgical team of anesthesia, cardiopulmonary bypass, and ultrasound successfully carried out the first total vena cava and pulmonary artery connection surgery in eastern Guangdong for Xiaoqi after 4 hours of hard work. Through the exquisite surgical design, the team allows the venous blood of the whole body to enter the lungs directly through the extracardiac tube, reducing the burden on the heartAt the same time, a pressure relief valve was designed on the extracardiac tube to facilitate its postoperative recovery.
After the operation, Xiaoqi was sent back to the cardiac surgery intensive care unit. That night, Chen Feng, deputy chief physician of the United Cardiac Surgery Center, stayed up all night, stayed at Xiaoqi's monitoring bedside, paid attention to various indicators, and adjusted the medication in time. The next day, Xiaoqi was successfully removed from the assistance of the ventilator. At present, Xiaoqi has successfully passed the most critical intensive care unit stage after surgery, recovered well, and was successfully discharged from the hospital on the afternoon of December 12.
Just after the successful completion of Xiaoqi's extremely difficult operation, Wang Xiao led the team to carry out difficult emergency surgeries for 4 patients one after another. Time continued to pass until the early hours of the morning, and the surgical team, which had been on the operating table for more than 16 hours, finally ended the day's struggle. The exhausted Wang Xiao could finally sit down and rest for a while, and he glanced at the time - 23:37 on November 29, 2023, 23 minutes before his birthday passed.
Wang Xiao hurriedly took a few bites of noodles, which can be regarded as a successful end to his birthday. When asked how she felt about her birthday, Wang Xiao replied, "I was too busy that day, and I didn't care about thinking about any special feelings, if I had to say it, I was relieved, Xiaoqi's surgery could be completed smoothly, and the big stone that pressed on the bottom of my heart was lighter." It is very meaningful for me to be able to perform such a difficult surgery on my birthday. ”
Team Challenge. "Pyramid tip" surgery.
Since the establishment of the department 8 years ago, the Joint Cardiac Surgery Center of the First Affiliated Hospital of Shantou University has been continuously cultivating in the field of cardiosurgery. At present, the center can carry out all complex congenital heart disease surgeries, including single ventricle, pulmonary atresia, complete pulmonary venous ectopic drainage, complete aortic transfer, descending aorta coarctation, etc., and the medical technology and effect are at the leading level in China, and are committed to improving the quality of life of children with complex congenital heart disease. Tan Hui, the person in charge of the center, said.
It is understood that since 2015, the Cardiac Surgery Center jointly established by the First Affiliated Hospital of Shantou University and Wuhan Asia Heart Hospital has developed rapidly, and has now become the largest cardiac surgery center in eastern Guangdong, successfully completing more than 2,540 cardiac surgeries, ** nearly 760 patients with congenital heart disease, of which complex congenital heart surgery and large vessel surgery account for about 322%。
In addition, as the only center in eastern Guangdong that can independently carry out acute aortic type A dissection surgery, the United Cardiac Surgery Center has matured and routinely carried out more than 100 aortic dissection surgeries every year in the past 8 years, from the first case of aortic dissection in eastern Guangdong to the first case of aortic dissection in pregnant women in eastern Guangdong, and then to the aortic dissection of the oldest patient in eastern Guangdong. So far, it has successfully saved the lives of more than 700 patients with acute type A aortic dissection and more than 110 patients with type B aortic dissection in eastern Guangdong.
According to statistics, the total number of large vessel surgeries in the center in the first 11 months of 2023 accounted for 413%, which greatly reduces the risk and mortality of macrovascular patients, so that critically ill patients in eastern Guangdong do not need to travel to Guangzhou, where they can receive cardiac surgery. The Department of Cardiac and Vascular Surgery of the First Affiliated Hospital of Shantou University was selected as a provincial key specialty construction project in Guangdong Province in 2022.
In addition, the United Cardiac Surgery Center also challenged the "tip of the pyramid" surgery in the field of cardiac surgery and successfully carried out the first total aortic replacement in South ChinaAt the same time, it is also the first time in South China to infect patients with esophageal fistula through "weaving nets to supplement the heart"* aortic stent. Over the past 8 years, the center has continued to carry out public welfare medical treatment, and up to now, a total of nearly 140 children with congenital heart disease have been rescued free of charge, with a cumulative amount of more than 890,000 yuan. Tan Hui said that in the future, the Joint Cardiac Surgery Center of the First Affiliated Hospital of Shantou University will keep pace with social welfare and medical technology, continuously improve, challenge and make breakthroughs, and bring better and warmer diagnosis and treatment services to patients outside the heart in eastern Guangdong.
Zheng Yixin.