A 4-month-old baby in Shenzhen
The right lung looks complete
But there is basically no function
What's going on here?
The baby's 4-month-old right lung has not been "turned on"
Not long after his birth, Xiao Dongdong (pseudonym) developed a lung infection. After a cardiac ultrasound at the local hospital, the diagnosis was patent ductus arteriosus. The doctor recommends that after your child's lung infection is cured, the heart ultrasound is reviewed.
After the full moon of Xiaodongdong, the lung infection also improved. His family took him to Shenzhen Children's Hospital for a review. After the results of the examination came out, the whole family was mixed: the good news was that the ductus arteriosus had closed naturally, but at the same time, it was also found that Xiao Dongdong suffered from a rare congenital heart malformation - the absence of the right pulmonary artery. The early symptoms of such children are often not obvious, and in the later stages, a large number of hemoptysis may occur, and even severe pulmonary hypertension and right heart failure may occur.
Due to the "wrong line" of the right pulmonary artery, the blood supply to Xiao Dongdong's right lung is mainly supplied by the lateral branches of the right subclavian artery. This small, winding vessel has an outer diameter of only 2 mm. In children of this age, the normal right pulmonary artery is almost 7 mm thick. The blood vessels, which are 3 times smaller, obviously cannot meet the blood supply needs of the right lung. There is no normal blood supply, and although the right lung has normal lung tissue, it does not have normal function, so it has been in a "shutdown" state. That is, he can only breathe in his left lung.
Surgery faces two options
Artificial vessels or autologous pericardium?
To save Xiao Dongdong, he must let his right lung "turn on" and rebuild the right pulmonary artery! To this end, the team of Chen Xinxin, director of the Department of Thoracic and Cardiac Surgery of the Municipal Children's Hospital, held many discussions with ultrasound, imaging, cardiology, and cardiac surgery. The key to surgery is to find a suitable "pipe", the distance between the main pulmonary artery and the right lung is far, and a new "pipe" needs to be built. But surgery faces two choices: artificial vessels or autologous pericardium?
The artificial vessels are time-saving and labor-saving, but the texture is hard, does not match the remaining right pulmonary artery, and is likely to bleed uncontrollably. Moreover, artificial blood vessels cannot grow, and children are not suitable when they are older, and need to be replaced by surgery many times.
Autologous pericardium requires the doctor to roll the child's pericardial piece into a small roll, and make this pericardial roll into a "bridge" to connect the right pulmonary artery with the main pulmonary artery, but the operation is difficult and risky, because on the one hand, it is necessary to avoid lumen narrowing, anastomosis leakage, on the other hand, the blood vessel connection after forming is smooth, which requires rich clinical experience and superb surgical skills.
Stitching of new blood vessels to reconstruct the artery smoothly "booted"
After weighing the pros and cons, Chen Xinxin finally chose to "challenge" the self-pericardial sewing. During the operation, Chen Xinxin removed a thin pericardial membrane from the surface of Xiaodong's heart, carefully stitched a section of blood vessel with a thin line thinner than a hair. This "pipe" must ensure that there is no leakage of blood, but also can not be sewn too narrow, otherwise the blood flow will not be smooth, easy to form blood clots. After 20 minutes, the "pipe" about 5 centimeters long and 8 millimeters in diameter was completed. Next, the "duct" is anastomose between the stump of the right pulmonary artery at the right hilar and the aortopulmonary artery. It's not easy either. If you are not careful during the anastomosis process, there will be bleeding from the anastomotic mouth and distorted blood vessels, which will affect the blood supply to the right lung.
The intense 3-hour surgery ended successfully! The newly formed right pulmonary artery is unobstructed and distorted, and there is no active bleeding. After the reconstruction of the right pulmonary artery, the normal blood circulation of Xiao Dongdong's right lung was restored and the "boot" was successfully carried out!
After the operation, Xiao Dongdong recovered smoothly and successfully escaped from the ventilator. It didn't take long for him to recover and be discharged from the hospital.
— Late Night Selection —
Written | Shenzhen Evening News reporter Zhou Qian
Edit | Zhang Yulin