Text/Yangcheng Evening News all-media reporter Xu Zhangchao Lin Qingqing
Correspondent Hao Li Zhang Lanxi Jin Ting
Photo/ Zhang Songshan
Different blood types and incompatible, but successfully deceived the immune successful "heart change"? "It's very difficult! But before the 'police station' could send the 'ID card' to the 'residents', we quickly transplanted the heart into it! Wu Min, a core member of the transplant team, decrypted the reporter.
On the afternoon of December 16, the reporter learned from the Guangdong Provincial People's Hospital (hereinafter referred to as the "Provincial Doctor") that the hospital successfully performed a "cross-blood type heart transplant with incompatible ABO blood type" for a 5-month-old infant, setting a record for the minimum age (5 months old) and the lightest weight (6 kg) of successful heart transplantation in South China.
During transplant surgery
2-month-old infants urgently need to "change their hearts"
In August this year, the two-month-old baby Xiaole (pseudonym) often vomited milk, parents began to think that it was just a digestive problem, to the local hospital after examination only to find that it was dilated cardiomyopathy, and then took the child to the Guangdong Provincial People's Hospital for medical treatment. Huang Jinsong, deputy director of the Department of Cardiac Surgery of the Provincial Medical Department, introduced to reporters on the spot that heart failure will occur in the later stages of heart disease development, and the current more mature treatment plan for heart failure is heart transplantation and artificial heart implantation.
But at that time, Xiao Le's heart failure was already very serious, and he was repeatedly admitted to the hospital. When he was only 3 or 4 months old, Xiao Le's heart was already as big as the heart of a 4 or 5-year-old child, and his condition progressed rapidly. Wu Min, deputy director of the provincial medical heart transplant and auxiliary surgery, told reporters.
The heart of the 5-month-old Xiaole is about the same size as that of a 4-year-old child's donor
But it can be difficult for infants and young children to find a heart donor of the right size. Xiaole waited for a month and happened to find the heart of a 4-year-old child, which matched Xiaole's heart very well, but the blood type of the donor heart was different and incompatible with Xiaole.
According to reports, ABO blood group compatibility is usually regarded as a prerequisite and primary principle of organ transplantation, including the same blood type transplantation or different blood type but compatible transplantation (for example, O blood type heart can be given to any blood type recipient, and O type blood is the same as the universal transfusion person), but the case of blood type incompatibility (such as B blood type heart to A blood type recipient, O blood type recipient to accept other blood type heart) is very difficult, which is a challenge to the principle of proportion of transplant red lines.
Is it to miss this heart and wait a long time? Or do you have an ABO incompatible cross-blood type heart transplant right away? This is a problem facing Xiaole's family and the surgical team.
Different blood types and incompatible! But successfully "deceived" the immune mechanism
"The younger the age, the greater the risk of surgery. Therefore, heart transplantation of infants and young children in China, especially low-weight infants and young children, is rarely carried out. "But the Provincial Department of Cardiology has successfully performed heart surgery for ultra-premature babies weighing only 1.09 kilograms, and last year also successfully performed the country's first cross-blood type heart transplant for a 9-month-old baby." Many innovative attempts have been made in heart surgery in infants and young children and low-weight infants, and a large number of successful experiences have been accumulated. After communicating with Xiaole's family, the team decided to perform an incompatible cross-blood group transplant for Xiaole.
Director Huang Jinsong (left) and Vice President Li Yong (right) communicate with the mothers of the children
How do you break through the limits of blood group incompatibility? The immune mechanism in infants and young children is not yet complete, and the transplant team uses this feature to "fool" the immune mechanism. "This is equivalent to us rushing to transplant the heart when the 'police station' has not yet sent the 'ID card' to the 'resident's hand.'" Pretending to be the 'resident' of Xiao Le's body, he deceived the immune mechanism in his body. Wu Min further deciphered for reporters, "We carefully screened the children for anti-B antibodies before surgery, and formulated a safe and effective immune induction program during the perioperative period to ensure that ABO incompatible cross-blood group transplantation can be carried out smoothly." We performed the country's first incompatible cross-blood type heart transplant last year, and the antibody response in the child's body has been negative since the operation, indicating that the 'deception' has been successful. ”
7-hour transplant surgery, 20-day MDT escort successful discharge
"The smaller the child, the smaller the heart volume, which brings great challenges to the surgical process, the requirements for the operator are very high, and the intraoperative operation process is extremely delicate, including the surgical instruments used, sutures, etc. are very 'mini'." Wu Min said that for this reason, the provincial medical heart transplant, extracardiac pediatrics, PICU and extracardiac pediatric monitoring teams have carried out MDT consultations many times.
On November 13, Xiaole was pushed into the operating room for a "cross-blood type heart transplant with incompatible ABO blood groups." With the cooperation of the transplant team led by Huang Jinsong and the extracardiac pediatric team, the transplant operation, which lasted 7 hours, was finally completed.
In order to reduce the damage after the anesthesia of Xiaole's surgery, the heart transplant team also performed "ultra-fast channel resuscitation" for Xiaole, and the endotracheal intubation was removed in the operating room after the operation to reduce complications and promote Xiaole's faster recovery.
After the operation, XiaoLe was sent to the intensive care unit in a sober state, and after 9 days of professional treatment and nursing by the pediatric intensive care team of the Department of Cardiology, Xiaole was transferred to PICU and discharged from the hospital after 11 days of careful maintenance in PICU. "When Xiaole was discharged from the hospital on December 3, he weighed 5.5kg." Guo Yuxiong, director of the Pediatric Intensive Care Unit (PICU), said with relief.
Xiao Le's body recovered well when he returned to the clinic
"Xiao Le returned to the hospital for follow-up after 7 days of discharge, and the antibody response in the body has always been negative, and the body is in a good state of recovery. Next, Xiaole will also face many 'thresholds' such as rejection, infection risk, nutritional development, etc., and we will continue to visit for a long time to continuously improve and improve his quality of life. Wu Min said that from the whole process of preoperative, intraoperative to postoperative, the multidisciplinary team of provincial medical doctors has taken every step very cautiously to escort the 5-month-old baby to restore his health. (For more news, please pay attention to Yangcheng Pie pai.ycwb.com)
Source | Yangcheng Evening News Yangcheng Pie
Editor-in-charge | Chen Hui