The first case in China! In the 7th year after the combined heart-lung transplant, she gave birth to a healthy baby

Sanxiang Metropolis Daily, December 16 (All-media reporter Li Qi correspondent Sha Lina Zhao Liping) Newborn baby's small eyebrows are sometimes locked, sometimes stretched, small blushing fluttering, like a half-ripe peach, small mouth is upturned from time to time, as a drinking and sucking shape... It's a full moon! On December 15, holding the baby who had just reached the full moon in his arms, 28-year-old Xiaoying (pseudonym) wrote happiness on his face.

Unlike other mothers, Xiaoying is a heart-lung combination transplant patient. Nine years ago, she underwent heart surgery at the Second Xiangya Hospital of Central South University, and 2 years later she successfully underwent a combined heart-lung transplant and regained her life.

Miracles happen again. On November 15, Xiaoying, escorted by multiple disciplines in the hospital, successfully gave birth to a healthy baby girl weighing 3.4 kilograms, bringing her the most beautiful second power of life. So far, she has also become the first patient in China to conceive and successfully deliver a combined heart-lung transplant.

(On November 15, Xiaoying gave birth to a healthy baby at Xiangya Second Hospital, and she was the first heart-lung combined transplant patient in China to have a healthy birth.) Courtesy of the correspondent)

Fantasia Heart Failure Heart-lung combination transplantation was reborn

In 2011, Xiaoying, who was less than 20 years old, frequently suffered from chest tightness, difficulty breathing and even fainting after exercise, and found that due to congenital ventricular deficiency, she had been secondarily developed with severe pulmonary hypertension.

Subsequently, Xiaoying underwent surgery to repair the ventricular septal defect, but secondary pulmonary hypertension had gradually developed into Eisenmenger syndrome, she became breathless, frequent hemoptysis, slightly moved lips and ten fingers, purple hair, and her face became bruised.

In a good case, Xiaoying could survive for a year or two; in a bad situation, she could lose her life at any time. Combined heart-lung transplant surgery is the only effective treatment for the end-stage of "Eisenmenger syndrome". However, this is also a high-risk, difficult, and extraordinarily large surgery recognized by the world medical community, and even in developed countries, the survival rate of patients undergoing surgery for 5 years is less than 50%.

On October 17, 2014, Liu Ai (pseudonym), an 11-year-old boy from Hunan Province, completed his short life journey due to ineffective treatment for brain tumors. His parents donated 7 tissues and organs at once, including the heart and lungs. Fortunately, Xiaoying and Liu Ai were successfully matched. In order to ensure the success of the operation, under the convening of Professor Yuan Yunchang, vice president of the Second Xiangya Hospital, the medical team led by Professor Zhou Xinmin and Professor Hu Jianguo of the Department of Cardiovascular Surgery successfully completed the heart-lung joint transplant operation for Xiaoying in 5 hours.

"This surgery was an uphill battle." Today, Professor Zhou Xinmin recalled that because the patient had previously undergone a heart surgery, it made it more difficult to perform the operation and postoperative rehabilitation.

Eliminate the obstacle of "blocking pregnancy" and prepare to harvest the crystallization of love

In 2018, Xiaoying met the other half of her choice, and in 2020, she entered the hall of happy marriage.

"Daddy Zhou, I want to have a baby." When Professor Zhou Xinmin heard Xiaoying's idea, he couldn't help but be shocked. Even if it is an ordinary pregnant woman, in the process of pregnancy in October, the burden on the heart, liver, kidneys and other aspects will increase, not to mention a patient who has had a combined heart-lung transplant.

Professor Zhou Xinmin immediately found Professor Peng Longkai, director of the Organ Transplant Center, and Professor Huang Jian, director of the Department of Obstetrics, to discuss together: the postoperative pregnancy of the recipient of the heart-lung joint transplant is a high-risk pregnancy, pregnant with a child, equivalent to a heavy physical labor, which greatly increases the burden of the heart and lungs During pregnancy, cardiopulmonary failure may occur, prone to diabetes, pregnancy hypertension, kidney failure and acute rejection and other complications, long-term use of immunosuppressants, may lead to serious infection during pregnancy, As a result, the health of both the mother and the fetus is threatened.

What's more, so far, China has not had a successful experience, which is too risky! Even in foreign countries, many patients with combined cardiopulmonary transplantation have embryos stopped, premature birth, and low birth weight babies, and there are only a few cases of successful delivery.

"Fight again for life, challenge the impossible!" Not tolerating Xiaoying's despair, several experts decided to challenge once. Fortunately, after a full preconception assessment, Xiaoying's heart and lung function is good, and there are no significant abnormalities in various physical indicators, and conception can be considered. Next, it is time to think about the effects that anti-rejection drugs may have on the fetus.

"The regulation of immunosuppressants before pregnancy is very important, and if the amount is small, the risk of organ rejection in patients will increase; if the amount is large, it will increase the risk of infection, and may also cause damage to the function of other organ systems." Professor Peng Longkai, director of the organ transplant center and kidney transplant expert, is the earliest expert in China to explore the pregnancy of organ transplant recipients, he consulted various literature, according to Xiaoying's situation, early withdrawal of drugs that affect pregnancy and fetal development, individualized real-time adjustment of anti-rejection drugs, immunosuppressive programs, for Xiaoying to prepare for pregnancy, pregnancy, and production.

After 1 month of preparing for pregnancy, in early 2021, Xiaoying naturally conceived successfully.

Develop a thorough pregnancy monitoring program Multidisciplinary escort to achieve a "warm miracle"

"There's a chance to be a mother, but every step has to be prepared in advance." In order to help Xiaoying's pregnancy go smoothly, the hospital specially established a "childbirth escort team" WeChat group for her, tao cheng, director of the medical department, as the group leader, gathered experts from obstetrics, cardiovascular surgery, respiratory and critical care medicine, organ transplant center, anesthesia department, surgery department, nursing department related departments, carried out multiple perinatal maternal and fetal cardiovascular MDT consultations, and decided to do their best to create another miracle on the life train.

"Throughout the pregnancy, Xiaoying's experience can be said to be thrilling." Xiaoying's attending doctor, Professor Pi Pixiang of obstetrics, said with emotion that in view of Xiaoying's situation, the medical team closely monitored, on the one hand, to prevent Xiaoying's transplanted heart and lung damage, on the other hand, to prevent fetal growth damage and malformations, at the same time, experts should closely monitor Xiaoying's blood pressure, kidney function, cardiopulmonary function, rejection, infection and other aspects of the state, choose the right time to terminate the pregnancy, so as to take into account the maturity of the fetus and avoid serious complications.

From 8 weeks of pregnancy, the blood volume of pregnant women gradually increased, to 32 weeks to reach a peak, at this time the burden of various organs of the pregnant woman's body gradually increased, Xiaoying's heart rhythm has increased to more than 120 per minute, for Xiaoying to escort the perinatal maternal cardiovascular disease MDT experts have strengthened prenatal monitoring for her, gradually increase the number of obstetric examinations, from once every 2 weeks to once a week, while through electrocardiogram, cardiac ultrasound, myocardial enzyme testing, her heart and lungs are carefully evaluated.

"You must be ready to welcome new life at any time!" When Xiaoying was 36 weeks pregnant, Dean Li Zhihong immediately decided to organize obstetrics, cardiovascular surgery, organ transplantation center, anesthesia department, respiratory and critical care medicine department, surgery department, nursing department for Xiaoying to conduct MDT consultation, carefully "tailored" a thorough delivery plan for her, and decided to perform caesarean section surgery for Xiaoying when she was 38 weeks pregnant.

On the morning of November 15, in the operating room, Xu Junmei, vice president in charge of medical work, also came to the scene, as an anesthesiologist, Xu Junmei immediately chose to perform a caesarean section under lumbar-hard combined anesthesia. At 9:15 a.m., the baby let out the first cry, and everyone present breathed a long sigh and announced the final victory of the pregnancy battle for heart-lung transplant patients.

The examination confirmed that the 3.4 kg baby girl was very healthy, and Xiaoying also became the first patient in the country to successfully deliver a baby's heart-lung combination transplant.

"Xiaoying's successful delivery will also be a very big encouragement for heart-lung transplant patients." Li Zhihong, president of Xiangya Second Hospital, said that as a large-scale comprehensive tertiary hospital, Central South University Xiangya Second Hospital mainly undertakes the task of diagnosis and treatment of critical and difficult diseases, the hospital has set up 40 MDT teams since the establishment of the MDT diagnosis and treatment center in 2015, and the diagnosis and treatment center has built an organizational structure with the deputy dean of medical treatment, the medical department responsible, the outpatient department review, and the special management to provide one-stop high-level medical diagnosis and treatment services for patients with difficult and miscellaneous diseases. The perinatal maternal-fetal cardiovascular disease MDT, which escorted Xiaoying, is one of them. The hospital has always believed that with the continuous improvement of the diagnostic ability of critical and difficult rare diseases, there will be more "miracles" in the future.