Dilated cardiomyopathy was diagnosed at 2 months of age, and the heart was extremely swollen and life-threatening. After entering the organ transplant distribution sharing system at the age of 4 months, after two unsuccessful heart matches, the little guy was matched with a small heart of the right size and shape after waiting for a month. He is only a type B blood, and the matching heart donor is a little angel with type A blood.
In November, the heart transplant team of the Provincial People's Hospital successfully implemented the "Cross-blood Type Heart Transplant with Different and Incompatible ABO Blood Types". Through rapid rehabilitation measures such as rapid postoperative removal of tracheal intubation, this case of the youngest heart transplant child in South China so far has been successfully discharged after 11 days of hospitalization. It is reported that this is the second similar transplant carried out by the heart transplant team of Guangdong Provincial People's Hospital after the first "ABO blood group incompatible cross-blood type heart transplant" was performed for a 9-month-old baby last year.
Guangdong Provincial People's Hospital has sent a strong multidisciplinary team to provide treatment and care for children's cross-blood type transplants.
Babies often spit up
Not a digestive problem is a heart problem
In August this year, 2-month-old Xiao Le (pseudonym) was taken to a local hospital for examination because he often vomited milk. The pediatrician who received the treatment was more alert to a similar situation and, after ruling out gastrointestinal problems, specially tested the child's heart. This investigation really found the cause - dilated cardiomyopathy, one of the most common diseases in children's heart transplantation.
Xiao Le's mother recalled: "At that time, the whole person panicked. In the process of seeking medical treatment everywhere, she learned that the heart transplant team led by Huang Jinsong of Guangdong Provincial People's Hospital has a high success rate of heart transplantation every year and has strong technical support for infant and young child heart transplantation, and she immediately took her child to the provincial doctor for treatment.
Compared with adult heart transplantation, infant and young child heart transplantation is not only a more compact and difficult problem to operate, but also a much more difficult source of heart supply. Wu Min, deputy director of the Provincial Medical Heart Transplant and Auxiliary Surgery Department, told Nandu reporters that thanks to the publicity of the organ transplantation cause in Guangdong Province, organ donation by citizens in Guangdong Province has always been at the forefront of the country, with more than 800 cases of donation throughout the year, making the schedule for adult heart transplantation relatively short. "But the situation of children is different, first of all, the size and shape of the heart will have higher requirements." The second is that the number of children who donate organs is much lower than that of adults. During the one-month waiting period, the child experienced two failed matching attempts, either with a heart too large (the donated child was a ten-year-old angel) or for other reasons that the match was not matched. ”
In order to change Xiaole's heart as soon as possible, under the strong support of Yu Xueqing, president of the Provincial People's Hospital, and the leadership of Chen Jimei, director of the Guangdong Provincial Institute of Heart Research, heart transplantation, extracardiac pediatrics, PICU and extracardiac pediatric monitoring teams have carried out MDT consultations many times. When it came to learning that the child's antibody levels were low, the transplant team made a bold choice to expand donor recipients, including donors with different blood types and incompatible blood types.
"ABO blood type is the basic principle of heart matching, including the same blood type transplant or different but compatible blood type transplants, but the blood type is incompatible cases are very difficult." Wu Min said that the immune mechanism in infants and young children is not yet complete, and this imperfect mechanism gives the opportunity for cross-blood type transplantation. The children were carefully screened for anti-B antibodies before surgery, and a safe and effective immune induction program was formulated during the perioperative period to ensure that cross-blood group transplantation with ABO incompatibility could be carried out smoothly. "In layman's terms, we used medical means to trick Xiaole's immune system and accept a new heterogeneous heart."
Director Huang Jinsong (left) and Vice President Li Yong (middle) communicate with the mothers of the children.
The match was successful
A miniature version of the heart transplant is completed within 7 hours
Performing heart transplants for young infants and young children is more difficult than scaling up an adult heart transplant. Huang Jinsong, director of the heart transplant leader of Guangdong Provincial People's Hospital, said that children's heart transplantation involves the child's preoperative management, the support of intraoperative anesthesia and cardiopulmonary circulation, and the maintenance and support of the postoperative intensive care team. "Children are young and weigh less, and the younger they are, the greater the risk of surgery. Heart transplantation in infants and young children, especially low-weight infants and young children, has been carried out very little throughout the country, and China has accumulated little experience in this regard. Our Department of Cardiac Surgery has successfully performed heart surgery on ultra-preterm infants weighing only 1.09 kg, and last year also performed a heart transplant for a 9-month-old infant with incompatible ABO blood types, accumulating a lot of successful experience in heart surgery for infants and low-weight infants."
A month passed, and Xiao Le waited for the third heart matching information. The organ donor is a 4-year-old child with a heart that is in the right shape and size, but not the right blood type. With early support and argumentation, the surgical team decided to use this 4-year-old healthy heart to transplant Xiaole.
"The smaller the child, the smaller the heart size, which brings great challenges to the surgical operation process, the requirements for the surgeon are very high, and the intraoperative operation process is extremely delicate, including the surgical instruments used, sutures, etc. are all mini." Thanks to the strong support of multiple disciplines, the transplant team led by Huang Jinsong and the extracardiac pediatric team worked together, and the transplant operation, which lasted 7 hours, was finally completed.
On the left is the original heart of the child Xiaole, and on the right is the donor heart.
Strong support from the anesthesia team
Your child has had the endotracheal tube removed when he comes out of the operating room
In order to reduce the damage after the anesthesia of Xiaole's surgery, the heart transplant team plans to perform ultra-fast channel resuscitation for Xiaole.
Ultra-fast channel resuscitation usually refers to the removal of the endotracheal intubation in the operating room at the end of the operation, which is very demanding for the anesthesiologist's ability to control anesthesia, both to maintain an absolutely reliable analgesic effect during the operation and to require the patient to be able to wake up quickly after the operation.
As an important support for the heart transplant team, Liang Jiexian, deputy director of the Second Department of Anesthesia of the Provincial Medical Department, and anesthesia colleagues closely monitored the child's relevant indicators during the operation. "For both adults and children, long-term use of ventilators and endotracheal intubation can trigger problems such as ventilator confrontation and infection. Timely extubation can reduce such problems, and also allow children to resume normal diets as soon as possible and receive nutritional support in a timely manner. ”
Ultra-fast channel resuscitation can reduce the occurrence of complications and promote faster recovery of children, the transplant team and anesthesia team formulated a precise anesthesia plan before surgery, successfully performed ultra-fast channel resuscitation for Xiaole, and was admitted to the intensive care unit in a sober state. After 9 days of professional and meticulous treatment and nursing by the pediatric intensive care team of cardiac surgery, the child was transferred to PICU, and after 11 days of careful maintenance in PICU, Xiaole was finally discharged from the hospital.
The heart transplant team, extracardiac pediatrics, PICU and extracardiac intensive care team have carried out many MDT consultations before surgery, multidisciplinary escort, and accurately control the various processes of the child from preoperative, intraoperative to postoperative, interlocking, each step is cautious, and each step is fine. Dr. Wu Yijin, a heart transplant team, said that the success of the transplant operation is only the first step in the long march. Next, Xiaole also has to face many problems such as rejection, infection risk, nutritional development, etc. How to improve and improve his subsequent quality of life will be our next step.
Xiao Le returned to the hospital for follow-up after 7 days of discharge, and his recovery was in good condition.
Written by: Nandu reporter Wang Daobin
Correspondents Hao Li, Zhang Lanxi, Jin Ting, Ma Danying