When he returned to the Guangdong Provincial People's Hospital for a review, Xiao Le (pseudonym) recovered well, his face was rosy and energetic. 5 months later, he did not know that his "new life" came from a donation of great love and the full efforts of a group of angels dressed in white.
After the operation, the medical staff took care of and guarded Xiaole's recovery
On December 16, the reporter learned from the Guangdong Provincial People's Hospital that the hospital recently successfully performed a "cross-blood type heart transplant with different and incompatible ABO blood types" for a 5-month-old baby, and was currently the youngest and lightest-weight heart transplanted in South China.
Panic: The baby vomited milk for medical treatment, and was diagnosed with dilated cardiomyopathy
In August this year, 2-month-old Xiaole often vomited milk, and Xiaole's mother was not at ease, so she took her child to the local hospital for examination. Fortunately, the pediatrician who received the treatment was experienced and combined with the examination to find the real cause of Xiaole's disease - dilated cardiomyopathy.
"I thought it was a child's digestive problem, and when I heard the diagnosis, the whole person panicked." Xiaole's mother learned that heart transplantation is the key to treating diseases, and she went to Guangdong Provincial People's Hospital to seek medical treatment.
Wu Min, deputy director of the Department of Heart Transplantation and Auxiliary Surgery at Guangdong Provincial People's Hospital, said that cardiomyopathy is the primary cause of heart transplantation in children. Dilated cardiomyopathy sometimes has a relatively insidious appearance, and if parents find that their children's diet, work and rest, mood, demeanor, etc. have undergone unexplained changes, it is recommended to seek medical treatment as soon as possible.
However, clinically, many parents will have some hesitation when they hear about heart transplantation, and some even miss the best transplant time. But the Xiaole family was very determined, and immediately made the decision to do a heart transplant: "Don't give up any hope!" ”
"There are very few heart transplants in infants and young children, especially low-weight infants and young children, and China has accumulated little experience in this regard." Huang Jinsong, deputy director of the Department of Cardiac Surgery of Guangdong Provincial People's Hospital, introduced that the difficulty of infant heart transplant surgery itself is higher than that of adult heart transplantation, coupled with the small age and low weight of children, the greater the risk of surgery.
But at the Guangdong Provincial People's Hospital, Xiaole's mother saw hope. The hospital's cardiac surgery team has successfully performed heart surgery for ultra-premature babies weighing only 1.09 kg, and doctors are already "skilled" in heart surgery for infants and low-weight children.
Challenge: Heart with different blood types, connecting hope for life
After Xiaole was admitted to the hospital, a new problem emerged - the source of heart supply for infants and young children is very scarce, and the heart suitable for 5-month-old babies is even rarer. Xiao Le's condition worsened while waiting.
For Xiaole's mother, waiting for the right offering is a struggle between hope and despair. The first time she received a call from someone who might have a suitable donor, she rushed to the hospital with her child, only to end up being too big to fit the donor's heart; the second time, she went again with hope, but had to wait because the donor's heart was not good.
Is there any other way? Guangdong Provincial People's Hospital's heart transplant, extracardiac pediatrics, pediatric intensive care unit (PICU) and extracardiac pediatric monitoring team conducted many multidisciplinary consultations, and when they learned that the children's antibody levels were low, the transplant team made a bold choice - to expand the source of cardiac supply, including donors with different blood types and incompatible.
ABO blood type is a basic principle of cardiac matching, and if the blood types are incompatible, the transplanter will have a strong immune rejection response after surgery. However, the immune mechanism in the body of children under two years of age is not yet complete, and it is possible to "fool" the immune system by performing cross-blood type transplantation at this time.
"It's like the 'police station' in the body has not yet issued the ID card to the residents, so we transplant the heart into it and pretend to be the residents in the body, so that we have deceived the blood type immune mechanism in the body." Wu Min said.
After expanding the "search scope", Xiaole finally waited for the right heart. The donation of a 4-year-old child is just the right size for Xiaole's heart. However, this heart is blood type B, while XiaoLe is blood type A.
Wu Min introduced that people with blood type A may have anti-B surface antibodies, and if the heart is to adapt across blood types, the anti-B antibodies in Xiaole's body should be low enough. "We carefully screened the children for anti-B antibodies before surgery and developed a safe and effective immune induction program for the perioperative period to ensure that cross-blood group transplantation with incompatible ABO can be carried out smoothly."
"New life": the beating of a heart, the protection of a group of people
On November 13, Huang Jinsong led the transplant team and the extracardiac pediatric team to perform heart transplant surgery for Xiaole.
Surgical scene
The donor's heart is only half the size of an adult's palm, and during the transplant, all the doctor's operations are extremely delicate, and the surgical instruments, sutures, etc. used are very "mini". Despite the difficulty of the procedure, doctors are confident that in 2020, the team performed the nation's first ABO-incompatible heart transplant for a 9-month-old baby. With the first successful experience, the team was more confident to do a second similar surgery.
After 7 hours, the transplant was successfully completed. In order to reduce the damage after the anesthesia of Xiaole's surgery, the anesthesiologist performed "ultra-fast channel resuscitation" for Xiaole.
Liang Jiexian, deputy director of the Second Department of Anesthesia (extracardiac) of Guangdong Provincial People's Hospital, introduced that "ultra-fast channel resuscitation" refers to the fact that after the operation is completed, the doctor removes the tracheal intubation for the patient in the operating room, reduces the complications caused by tracheal intubation to the patient as soon as possible, and allows the patient to recover faster.
But to do this, anesthesiologists need to have a high ability to control anesthesia: both to maintain an absolutely reliable analgesic effect during surgery, but also to require the patient to wake up quickly after the operation. Before the operation, the transplant team and the anesthesia team formulated an accurate anesthesia plan, and Xiaole was also able to pass the "ultra-fast channel resuscitation" and was sent 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, Xiaole transferred to PICU. After 11 days of careful cultivation in PICU, Xiaole was finally discharged from the hospital.
"A successful transplant is only the first step in treatment." Dr. Wu Yijin, a heart transplant team at Guangdong Provincial People's Hospital, said that next, Xiaole also had to face problems such as rejection, infection risk, and nutritional development. The medical staff will work with him to "upgrade and fight monsters" to improve and enhance his subsequent quality of life.
Source: Guangdong Health Headlines South + Client (Reporter Zhu Xiaofeng)
Editor: Huang Yixin
Editor-in-charge: Wang Hui
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