"Not fighting the battle of unpreparedness is the greatest responsibility for the child"
Written by | Yan Xiaoliu
Source | "Medical Community" public account
2-year-old Coco has just undergone a major surgery on the "ultra-luxury lineup".
Three specialties and four directors of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine took the stage to help her solve the thorny heart problem.
"The child is recovering well." On January 26, The director of the hospital's Pediatric Cardiovascular Surgery Department, Lu Yanan, told the "medical community."
3 specialties and 4 directors are waiting in a strict line. /Children's Heart Center of Shanghai Xinhua Hospital
2-year-old children, take 5 kinds of medicines a day to treat arrhythmias
At 6 months of age, cocoa was diagnosed with ventricular tachycardia due to diarrhea.
"It's congenital heart disease. The child initially presents with recurrent ventricular tachycardia and cardiac insufficiency. Director of pediatric cardiovascular medicine Chen Sun said.
Coco has visited two well-known hospitals in China and received arrhythmia drug treatment and radiofrequency ablation surgery.
After radiofrequency ablation, the physician reviewed the ectopain and found that the outer wall of Cocoa's heart bulged outwards, growing a "thumb" with a diameter of 1 cm in size - this is a ventricular wall tumor, which belongs to the ventricular wall bulging, similar to a growing tumor. It is called "tumor", but it is not a tumor, nor is it cancer.
At the same time, the ECG suggests a decrease in ventricular tachycardia, but there are still nearly 1/3 of premature beats.
In order to control the heart rhythm, cocoa of the rigid teeth and teeth had to take 5 anti-arrhythmic drugs every day to control the premature beats to more than 30,000. To make matters worse, Coco's left atrial ejaculation score was only 40%. More than 60% of normal children.
Medication does not resolve ventricular wall tumors. If left unchecked, it may affect ventricular systolic function. Blood flow at the site of local bulge is slow or prone to thrombosis.
The presence of ventricular wall tumors may also lead to disturbances in local electrical activity, thereby increasing the incidence of ventricular arrhythmias. In the long run, due to local thinning, in rare cases, local rupture of ventricular wall tumors may occur, promoting cardiac insufficiency, increasing embolism and malignant arrhythmias, and even life-threatening.
Further treatment is to be taken. Coco's parents took their children to Shanghai Xinhua Hospital.
Their first stop was the outpatient clinic of Director Lu Yanan.
1 procedure, multiple regimens
Director Lu Yanan and Director Chen Sun discussed: "Solving arrhythmias and ventricular wall tumors at the same time is a bit tricky. ”
Surgical removal of the ventricular wall tumor alone may not resolve the arrhythmia. Moreover, it is unclear whether ventricular premature beats are related to ventricular wall tumors. It is best to first perform three-dimensional standard measurement and radiofrequency ablation at the site of the origin of ventricular premature beats by means of internal medicine intervention. This requires the involvement of pediatric cardiovascular medicine.
The combination of internal and surgical procedures is a feature of the Heart Center of Shanghai Xinhua Hospital. The center adopts a multidisciplinary integrated "integrated" diagnosis and treatment model, and is the first unit in China to carry out professional pediatric congenital heart disease diagnosis and treatment.
"After repeated discussions by the cardiothoracic surgery and cardiovascular medicine teams of the Heart Center, we decided on the surgical plan: first the cardiovascular medicine team will perform a three-dimensional standard measurement of the origin site of ventricular premature beats, and if possible, radiofrequency ablation, and then the cardiothoracic surgery team will perform the resection and repair of the ventricular wall tumor." Chen Sun said.
The path of radiofrequency ablation is also planned: the guide wire detects ectopic rhythm points through the right atrial septal foramen channel of the femoral iliac iliac vena cava channel of the left atrial left ventricle to detect ectopic rhythm points to eliminate ectopic rhythm points.
Considering that the foramen of the ovary may be closed, resulting in the guide wire not being able to penetrate the atrial septum, the medical and surgical team made second-hand preparations to "make a channel" on the atrial septum by puncturing the atrial septum.
To this end, the team specially invited Sun Jian, director of the Department of Adult Cardiovascular Medicine, to come to assist. "Ask him to do the compartment piercing." Chen Sun introduced.
This "inside-out," plan is seen as the "best solution." If there is a sudden outbreak, Director Lu Yanan also has a set of "alternatives", directly open chest wall tumor resection, and give atrial septum hole as a channel for subsequent radiofrequency ablation.
The outer wall of the heart bulges outwards and grows a "thumb"-like ventricular wall tumor. /Children's Heart Center of Shanghai Xinhua Hospital
New problems that weren't expected
On the day of the operation, two directors of the Department of Pediatric Cardiovascular Medicine, Chen Sun and Zhao Pengjun, Lu Yanan, director of the Department of Pediatric Cardiology, and Sun Jian, director of the Department of Adult Cardiovascular Medicine, led by 4 directors, waited in the operating room.
Here comes the problem.
Initially, the team thought the most difficult technical level was the compartment piercing, and they were fully prepared to deal with it. However, during the execution, it was found that because Coco had previously undergone radiofrequency ablation surgery and had had a femoral vein puncture, the bilateral femoral vein had been occluded and replaced by many small collateral vessels.
This means that this road is not feasible, and the solution of radiofrequency ablation in internal medicine cannot be realized.
Cardiac catheterography shows narrow iliac veins and small twisted collateral; green arrows are normal vessel diameters, red arrows are severe stenosis, and yellow arrows are fine twisted collateral vessels. /Children's Heart Center of Shanghai Xinhua Hospital
Director Luyanan's "options" were on top in time.
The surgery was successfully completed and the ventricular wall tumor was completely removed. Director Lu Yanan combined with preoperative ECG localization instructions to perform surgical ablation at suspicious ectopic rhythm points. Then, carefully repair the ventricular walls.
"If this set is completed, but the early beat has not changed, we have to find another reason." Chen Told the "medical community" that Coco was lucky. "After the heart resumed, we were pleasantly surprised to find that all the ventricular premature beats on the ECG monitor disappeared and returned to a normal sinus rhythm. The surgical results have reached the most ideal state expected before surgery. ”
Holter ECG 24 hours postoperatively suggests 0 ventricular premature beats. /Children's Heart Center of Shanghai Xinhua Hospital
The Children's Heart Center of Shanghai Xinhua Hospital described Coco's surgery as "gathering multiple specialties and directors, and the result was empty." But "emptying" does not mean that there is no value. Because "not fighting the battle of unpreparedness" is the greatest responsibility for the child, it will have the most ideal therapeutic effect.
>>>>
"A hundred years of youth, together to the future."
Peking Union Medical College Hospital 2022 Chinese New Year Gala
Countdown to 2 days!
The "Medical Community" video number invites you to watch!
On January 30, 20:00 p.m., it will be online on time
For the country's hard-working and busy medical staff
Sincere wishes, auspicious Year of the Tiger!
Source: Medical community
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao