Recently, the Heart Center of Guangdong Provincial Maternal and Child Health Hospital received a letter of thanks from a parent of a child who had been hospitalized for more than 6 months thanking the "dancer on the tip of the knife" for sending their child a "second life".
The child's careful heart (pseudonym) was only two and a half pounds when he was born, combined with complex congenital heart disease and a variety of esophagus, airway, intestinal and deformities, underwent many surgeries, and finally corrected all kinds of congenital malformations when he was 1 year old.
The parents of Careful Heart (pseudonym) sent a thank-you letter to the Guangdong Provincial Maternal and Child Health Hospital. Courtesy of the correspondent
Babies born only 1.2 kg have a variety of congenital diseases
Careful heart is a premature baby born 35 weeks pregnant, only 1.2 kg at birth, belongs to a very low birth weight, shortly after birth was diagnosed with congenital heart disease: aortic coarctation, enlarged ductus, ventricular septal defect, severe pulmonary hypertension, but also suffered from esophageal atresia, esophageal tracheal fistula, duodenal atresia, atresia and other diseases.
Careful heart and physical condition is very poor, life is in danger: heart malformations make her have severe heart failure, if not corrected in time, she will not survive; esophageal atresia and duodenal atresia, so that she can not establish normal feeding, this is a congenital malformation with a high fatality rate, need to be operated on as soon as possible; and esophageal tracheal fistula makes her lower esophageal segment communicate with the trachea, under the continuous reflux of gastric juice, but also caused serious lung infection.
But her treatment is also difficult, if she has esophageal surgery alone, the careful heart may not be able to withstand it, if the heart surgery is done first, then she may face breathing problems and feeding problems that cannot be extubated after surgery.
Too small a weight first to solve the problem of esophageal and intestinal malformations
In order to solve the problem of carefulness more thoroughly, experts such as Sun Shanquan, director of the Heart Center of Guangdong Provincial Maternal and Child Health Hospital, Xiao Shangjie, director of the Department of Neonatal Surgery, and Director Li Kunwei of the Department of Anesthesiology, gathered together to discuss the surgical plan of careful heart, and finally decided to join hands with multiple disciplines.
Because the weight and age of the careful heart at that time did not reach the level of good resistance to receptor external circulation, the doctor decided not to deal with the problem of the ventricular septal defect of the careful heart for the time being, but to treat the urgent deformity first.
Under the anesthesia supervision of Director Li Kunwei of the Department of Anesthesia, Director Sun Shanquan of the Heart Center first performed the main contraction orthodontic surgery of the careful heart under non-extracorporeal circulation, the ductus arteriosus was ligated, and then the esophageal tracheal fistula was cut off, and the end of the esophagus was anastomosis in the first stage, and the director of the Neonatal Surgery Xiao Shangjie performed a duodenal rhombosis on the careful heart under laparoscopy.
Compared with simple heart, esophageal and intestinal surgery, the operation of correcting a variety of complex deformities at the same time is long, difficult and risky, which is a big challenge for both children and doctors.
After reaching the weight standard, surgery to repair the heart and trachea
Successful surgery is only the first step. Careful heart that has just undergone major surgery, the function of the heart and various organs is more fragile, maintaining hemodynamic stability, infection prevention, nutritional support, neuroprotection, coagulation management and other aspects need to be comprehensively taken into account, while also taking into account the patient's tracheal and intestinal problems. The medical staff calculates the rehydration fluids and drugs every day, adjusts the treatment plan in a timely manner, and while ensuring that it can provide enough fluids and energy for the careful heart, it is also necessary to pay attention to avoid increasing the burden on the heart.
After a month and a half of meticulous care, Careful finally lived up to expectations and gained weight to 2.2kg. Due to the presence of tracheomalacia and ventricular septal defects, the careful heart is not yet able to evacuate the ventilator.
Fortunately, her weight and age reached the requirements of receptor external circulation tolerance, and Director Sun Shanquan immediately arranged for her to repair the ventricular septal defect and tracheoplasty surgery.
Be careful after heart (pseudonym) undergoing ventricular septal defect repair and tracheoplasty surgery. Courtesy of the correspondent
A week after the operation, Careful heart successfully evacuated the ventilator, and at the same time established enteral nutrition, so that he could slowly start feeding.
After that, he was discharged from the hospital and returned to neonatal surgery at the age of 1 year old for atresia. At this point, all kinds of congenital malformations of the careful heart have finally been corrected.
It is difficult and rare for a similar child to survive
Sun Shanquan, director of the Heart Center, introduced that it is difficult and rare for such a very low birth weight child with complex congenital heart combined with esophagus, airway, intestinal and deformities to survive, and there are few reports in the world, and the hospital has successfully treated the careful heart through multidisciplinary cooperation, and has also brought hope for many very low birth weight babies suffering from complex congenital heart combined with other congenital diseases, but after discharge, such special premature babies still need multidisciplinary follow-up management to improve the quality of survival of the child's follow-up.
Written by: Nandu reporter Li Wen Correspondent Le Wei Huang Jingsi Lin Huifang