Newborn little baby's small eyebrows are sometimes locked and sometimes stretched, the little face is red and fluttering, like a half-ripe peach, and the small mouth is cocked up from time to time, making a drinking and sucking shape... On December 15, holding the little baby who had just turned 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, due to a congenital heart disease with a huge defect in the ventricular septum combined with severe pulmonary hypertension, he underwent extracorporeal circulation subventricular septal defect repair surgery at the Cardiovascular Department of the Second Xiangya Hospital.
2 years after the operation, pulmonary hypertension continued to exist, and then developed into respiratory failure, right heart failure, and continuous hemoptysis, successfully received cardiopulmonary combination transplant surgery in the cardiovascular surgery department of Xiangya Second Hospital, regained a new life; 9 years later, under the escort of multidisciplinary teams such as obstetrics, cardiovascular surgery, organ transplant center, respiratory and critical care medicine, and anesthesia department of Xiangya Second Hospital, she successfully gave birth to a healthy baby girl weighing 3.4 kg, bringing her the most beautiful second life cube.
So far, she has also become the first patient in China to conceive and successfully deliver a combined heart-lung transplant.
Fantasia Heart Failure Heart-lung combination transplantation was reborn
Born in rural Hunan, Xiaoying has a cheerful, strong and independent personality from an early age. In 2011, when she was less than 20 years old, she frequently experienced chest tightness, breathing difficulties and even fainting after exercise, and went to the local hospital to find that due to congenital ventricular deficiency, she had been secondary to severe pulmonary hypertension.
The normal heart of a person is divided into four chambers, separated by a complete ventricular septum and atrial septum into left and right ventricles and left and right atrium, the heart is like a water pump, through contraction, so that blood flows harmoniously and regularly between the various atriums and ventricles, and Xiaoying's heart, because of congenital malformations, there is a ventricular septal defect, just like the heart has more "heart eye", resulting in abnormal blood flow in the heart chamber causing pulmonary artery congestion changes, increased pressure, in turn, pulmonary hypertension increases the pressure of the heart's ejection, causing ventricular changes, which in turn leads to heart failure.
Gradually, Xiaoying has become difficult to stand, walk, although after undergoing ventricular septal defect repair surgery, still has not been ideally relieved, secondary pulmonary hypertension has gradually developed into Eisenmanngar syndrome, becoming difficult to breathe, frequent hemoptysis, heart rushing, slightly moving lips and ten fingers hair purple, the face has become blue.
According to the past situation, if you are lucky, you may have another year or two of life, and if you are unlucky, you may lose your life at any time. Heart-lung combination transplant surgery, is the only effective way to treat the end of "Eisenmenger syndrome", but also recognized by the world medical community as a high-risk, difficult, extra-large surgery, it represents the comprehensive strength of a hospital, even in developed countries, patients who undergo surgery have a 5-year survival rate of 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. After learning that they were unable to save their children's lives, Liu Ai's parents donated 7 tissues and organs at one time, 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." Professor Zhou Xinmin recalled that because the patient had previously undergone a heart operation, it made it more difficult to perform the operation and postoperative rehabilitation.
After the operation, Xiaoying has been under the guidance of Professor Zhou Xinmin to carry out regular review, take anti-rejection drugs, recover very well, affectionately call him "Zhou Tao", work, life in the big things and small things are shared with him, warm and sunny, good face Xiaoying in the "Zhou Tao" encouragement and support also often participate in volunteer, cultural and sports activities.
Eliminate the obstacle of "blocking pregnancy" and prepare to harvest the crystallization of love
The wheel of time is spinning rapidly, and soon in 2018, Xiaoying's life has also undergone important changes, she met the other half of her choice, and in 2020, they entered the palace of happy marriage.
"Zhou Da, 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. Hearing the doctor's persuasion, Xiaoying almost walked out of Professor Zhou's office with a look of despair.
It was the lonely eyes she had before she left that aroused the compassion of the doctors. "Fight again for life, 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. Next, it is time to think about the effects that anti-rejection drugs may have on the fetus.
Globally, of all transplant patients, kidney transplant patients have the most successful experiences of postoperative pregnancy, as there are more alternative treatments for the kidneys, and similar effects can be achieved by dialysis even if kidney function is affected during pregnancy. And there is no alternative treatment for cardiopulmonary function, Xiaoying has been using immune agents for 7 years, and no one knows how much harm these drugs are to 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.
"We first set a small goal of 28 weeks, and then according to the actual situation, it becomes 32 weeks, 35 weeks, 36 weeks, 37 weeks..." Pi Pixiang introduced, everyone wants to do everything possible to find a delicate balance between Xiaoying and the child.
Since the mother is congenital heart disease, the probability of the baby having congenital heart disease is higher than that of ordinary people. After rigorous prenatal diagnosis such as amniocentesis, ultrasound, embryo chromosomes and genetic testing, the baby's condition was generally stable and normal, and Pi Pixiang encouraged Xiaoying to continue her pregnancy.
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.
Generally speaking, 72 hours after the operation, the increase in the amount of maternal blood returned to the heart, the aggravation of heart load, and due to long-term oral immunosuppressants, Xiaoying needs to specially control the amount of infusion and prevent infection, etc. The obstetric care team actively cooperates with the doctor's treatment and care throughout the process, and the mother and baby are discharged safely 5 days after the operation.
According to a 2019 document by the European Respiratory Association (ERT), internationally, the average gestation cycle of transplanted women is 36 weeks, the average fetal weight is 2.5 kg, and there is a 43% preterm birth rate. And we not only gave birth successfully, but also achieved full-term, healthy delivery. Huang Jian, director of obstetrics, introduced that Xiaoying can be a mother as she wishes, and it is inseparable from the support provided by the hospital's multidisciplinary team.
"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.
(Edit ZS.) ）
Hunan Medical Chat Special Author: Sha Lina Zhao Liping, Second Xiangya Hospital, Central South University
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