Hunan Daily all-media reporter Zhou Yangle correspondent Sha Lina Zhao Liping
Seven years ago, she underwent a heart-lung combination transplant at the Second Xiangya Hospital of Central South University and regained her life; 7 years later, under the multidisciplinary escort of the hospital, she successfully gave birth to a small life, becoming the first patient in China to be pregnant and successfully delivered.
On December 15, the baby was full moon, looking at the little life in her arms, Xiao Ying (pseudonym), a new mother, smiled happily. What made the miracle happen to her twice? On the morning of December 16, the reporter came to Xiangya Second Hospital for a visit.
Combined heart-lung transplantation was reborn
In 2011, Xiaoying, who was less than 20 years old in Loudi, Hunan Province, frequently suffered from chest tightness, difficulty breathing and even fainting after exercise, and found that congenital ventricular deficiency was secondary to severe pulmonary hypertension.
Subsequently, Xiaoying underwent surgery to repair the ventricular septal defect at the Second Xiangya Hospital, but the secondary pulmonary hypertension had gradually developed into Eisenmenger syndrome, and she became breathless, frequent hemoptysis, slightly moved lips and ten fingers, her hair was purple, and her face became blue. However, there is only one effective treatment for the end-stage of Eisenmenger syndrome – a combined heart-lung transplant.
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.
"That operation was an uphill battle!" Professor Zhou Xinmin, Department of Cardiovascular Surgery of Xiangya Second Hospital, recalled that cardiopulmonary combined transplant surgery is recognized by the world medical community as a high-risk, difficult and extraordinarily large surgery, even in developed countries, the survival rate of patients undergoing surgery for 5 years is less than 50%. In addition, Xiaoying has undergone a heart surgery before, which has increased the difficulty of the surgical process and postoperative rehabilitation.
In order to ensure the success of the operation, the hospital has set up a special medical team to escort the whole process. After 5 hours, he finally completed the heart-lung combination transplant surgery for Xiaoying.
After the operation, Zhou Xinmin has been concerned about Xiaoying's recovery and guided her to conduct regular review. Xiaoying also affectionately called Zhou Xinmin "Zhou Da", and was willing to share big things and small things in work and life.
(In 2014, a combined heart-lung transplant.) Courtesy of the correspondent)
Eliminate "pregnancy obstruction" to welcome new students
"Zhou Da, I want to have a baby."
In 2020, when Zhou Xinmin heard Xiaoying put forward this idea, he couldn't help but be shocked.
Postoperative pregnancy of the recipient of cardiopulmonary combined transplantation is a high-risk pregnancy, pregnant with a child, will greatly increase its cardiopulmonary burden, during pregnancy may appear cardiopulmonary failure, but also prone to diabetes, gestational hypertension, renal failure and acute rejection and other complications, and long-term use of immunosuppressants, may lead to serious infection during pregnancy, resulting in the health of the mother and fetus will be threatened.
Zhou Xinmin told her that there was not a single successful case in China, and the risk was too great! In foreign countries, there are only a few cases of successful childbirth, and there are many cases of embryo suspension, premature birth, and low birth weight babies.
"Fight again for life!" Not tolerating Xiaoying's despair, Zhou Xinmin immediately found Professor Peng Longkai, director of the organ transplant center of the hospital, and Professor Huang Jian, director of obstetrics, to discuss it together and decided to challenge the impossible.
After full pre-pregnancy assessment, Xiaoying's heart and lung function is good, and there are no significant abnormalities in various physical indicators, and conception can be considered. However, a difficult problem lies ahead: Xiaoying has been using immune agents for 7 years, how much impact do these drugs 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." Peng Longkai consulted various literature, according to Xiaoying's situation, early removal of drugs that affect pregnancy and fetal development, individualized real-time adjustment of anti-rejection drugs, immunosuppression programs, for Xiaoying to prepare for pregnancy, pregnancy, and childbirth.
After 1 month of preparing for pregnancy, in early 2021, Xiaoying naturally conceived successfully.
(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)
Careful planning to protect new students
After Xiaoying became pregnant, a "childbirth escort team" was established.
The hospital's medical department has gathered experts from the departments of obstetrics, cardiovascular surgery, respiratory and critical care medicine, organ transplant center, anesthesia department, surgery department, and nursing department to carry out perinatal maternal and fetal cardiovascular MDT consultations for Xiaoying for many times.
"Throughout pregnancy, there is no danger." Professor Pi Pixiang of the obstetrics department of the hospital said that from the 8th week of pregnancy, Xiaoying's blood volume gradually increased, and by 32 weeks, the burden on various organs of Xiaoying's body had increased significantly, and the heart rate had increased to more than 120 per minute. "On the one hand, we must prevent Xiaoying's transplanted heart and lungs from being damaged, on the other hand, we must prevent fetal growth damage and deformity, at the same time, we must also closely monitor her blood pressure, kidney function, cardiopulmonary function, rejection response, infection and other aspects."
Choosing when to terminate pregnancy is also a difficult problem, both to take into account the maturity of the fetus and to avoid serious complications of pregnant women. "We had set a small goal of 28 weeks, and then according to the actual situation, we gradually postponed it, and everyone tried everything to find a delicate balance between Xiaoying and the child." Finally, the experts "tailored" the delivery plan for Xiaoying and decided to perform a caesarean section at 38 weeks of pregnancy.
"There is literature showing that internationally, the average gestation cycle of transplanted women is 36 weeks, and the average fetal weight is 2.5 kg. And we have not only achieved a successful delivery, but also a full-term, healthy delivery. Huang Jian, director of obstetrics, was relieved to introduce that at 9:15 a.m. on November 15, Xiaoying gave birth to a healthy baby girl of 3.4 kilograms.
"Xiaoying's successful delivery is a very big encouragement for patients with heart-lung transplantation." Li Zhihong, president of the hospital, said that with the continuous improvement of the diagnostic ability of critical and rare diseases, there will be more miracles in the future.
Source: Hunan Daily New Hunan Client
Editor: Lu Wei