What should I do if the door of my home is broken?
Many people rightly think:
Repair first, repair it badly and then change the door frame together
But in fact, changing the door frame will be involved
Problems such as matching degrees are really troublesome
In the human body, there are also many "doors"
The "Heart Gate" is one of the most famous doors
There are many ways to deal with a broken heart gate
But if it is a heart door that has been changed once, it is broken again
So what to do?
Uncle Lu (pseudonym), a 90-year-old in Hangzhou, has encountered a problem
Finally in the First Affiliated Hospital of Zhejiang University School of Medicine
Cardiac macrovascular surgeons use the "matryoshka" approach
He was given a "door within a door"
01
Ninety-year-old soldiers were tight and angry
The "heart door" that was changed 15 years ago was broken
Uncle Lu is 90 years old this year, the spirit is strong, kind and kind-eyed, he once participated in the War to Resist US Aggression and Aid Korea, he is also a "star" in the community, almost every household knows him, but the old man at the end of 2021 really made the people around him afraid for a while.
It turned out that since November 2021, Uncle Lu felt a little tight and short of breath, as if his breathing was not as free as before. "In the past, I could take the elevator to the garden of the community for a walk, but during that time I felt tired after walking a few steps." The daughter of the old man said that although the old father had a heart operation more than ten years ago, his physique has been good in recent years, and he will appear downstairs in the community almost every day, and he did not go downstairs because of physical discomfort in those days, and many neighbors in the community came to care about whether they were sick.
"In addition to panting, sometimes I have headaches and dizziness, but I can sit down for a few minutes and then ease up." Uncle Lu said that because of these symptoms, he often did not sleep well, resulting in a very poor mental state the next day.
Considering that when Uncle Lu found that the aorta was incomplete 15 years ago, it was these manifestations, and the family did not hesitate to take him to the outpatient clinic of Li Weidong, deputy director of the Department of Cardiac and Macrovascular Surgery of the First Hospital of Zhejiang University.
Chief Physician Li Weidong learned that Uncle Lu had previously replaced the biological valve, and the service life was 10 to 15 years, so it was very likely that the biological valve had a problem again. Subsequent examinations also confirmed the doctor's suspicion that the biological valve was mildly narrowed with moderate to severe closure insufficiency, and the cardiac function rating was grade 3 – resulting in significant restriction of physical activity.
The solution is clear: another valve. However, the risk of changing the flap again is huge, and the risk of life at any time without surgery puts the family in a dilemma and tests the wisdom and technology of the medical team.
02
Surgery is like a "matryoshka doll" game
Minimally invasive "intra-valve" to solve the puzzle
The minimally invasive team of cardiac macrovascular surgery conducted a careful and careful discussion. "The aortic valve is the most important cardiac portal in the human body, and the most important method of valve replacement is to open the chest and replace the valve." The chief physician of the department, Ma Liang, said that the old man is 90 years old, whether it is anesthesia or surgery, it will be a very high challenge, the risk is extremely high, and the family does not agree with this surgical plan. However, the replacement biological valve can not be opened or closed, and the conservative effect is very small, and it is necessary to replace the valve again. Is there a way to open your chest and change the flap again?
Just when the family members were at a loss, the new plan proposed by the Horse Liang team gave them hope.
"We intend to use a minimally invasive interventional 'intra-valve' treatment." Chief physician Li Weidong explained that the biological valve that Uncle Lu replaced before was structurally equivalent to changing a door frame and a door at the same time, after more than ten years of use, there was a problem with the valve in the middle (that is, the door), and this operation can only change the door without changing the door frame.
Schematic diagram of stent valve surgery, web image
Therefore, during the operation, the doctor will send the new valve to the location of the aortic valve through a catheter, "push" the problematic valve to the side, and then release the new valve to fix it, and the valve that is discarded next to it is harmless to the body even if it is not removed.
Simply put, the whole operation is like a "matryoshka doll game", with a new biological valve in the original biological valve. This transcatheter interventional valve replacement surgery (TAVI) is the most minimally invasive technique, and the team of Ma Liang and Li Weidong has successfully completed a large number of cases in recent years and accumulated a wealth of clinical experience.
Li Weidong (first from the right) team operation, courtesy of the department
Minimally invasive intervention, small risk, fast recovery, leading technology... Such programs and technologies have been highly recognized by the family. After making detailed preoperative preparations, Chief Physician Ma Liang and Chief Physician Li Weidong team carried out a minimally invasive intervention "valve in the valve" replacement for Uncle Lu, with the cooperation of the anesthesiology department, operating room and other teams, to overcome the challenges brought by advanced age, large transverse heart angle, etc., through the femoral artery pathway, transported into the stent valve to reach the decaying protozoa valve, accurately implanted a new door in the original door, released a successful matching fixation, perfect position, valve immediately began to work, The new valve portal function index was detected by DSA contrast and ultrasound. The operation was a complete success.
After the operation, Uncle Lu recovered very well, the symptoms of chest tightness and shortness of breath quickly disappeared, all indicators of the body were normal, and he was successfully discharged from the hospital 5 days after the operation.
The patient is taken with the medical team when he is discharged from the hospital, and the department provides a picture
03
Valvular diseases in old age are increasing
The valves without chest replacement are very mature
"With the aggravation of aging, there are more and more elderly valvular diseases, and aortic regurgitation is not all a very common valvular disease" Ma Liang, director of the Department of Cardiac and Large Vessel Surgery of the First Hospital of Zhejiang University, introduced that chronic aortic valve insufficiency can be asymptomatic for a long time, but with the progression of the disease, there will be symptoms such as dyspnea, palpitations, fatigue and fatigue, dizziness, etc., and serious cardiac insufficiency and even heart failure can occur, endangering life safety.
The most important surgical method of valvular heart disease is open-breast valve replacement, and for elderly patients, conventional open-chest surgery is traumatic and slow to recover. In recent years, the minimally invasive team of cardiac and large vascular surgery of the First Hospital of Zhejiang University has innovated and developed, vigorously carried out minimally invasive surgery, and the volume of minimally invasive surgery in the department of valves reached the second place in the country in 2020. More than 220 cases of valvular intervention without opening the chest have been completed in the past three years, including more than 120 cases of TAVI/TMVR surgery (transcatheter aortic valve/mitral valve implantation), 87 cases of perivalular leakage interventional closure, and 13 cases of transcatheter mitral valve intervention repair. Among them, a number of provincial and national first surgeries have been created. For example, in 2019, the first trans-femoral TAVI + staging thoracoscopic lung cancer radical resection was completed, the first transcardiac APIS + simultaneous radical resection of left lung cancer (the same incision) was completed, the first cardiac surgery interventional valve TAVI operation in the province, and the first transceal mitral valve "margin to edge + tendon cord" repair surgery was completed in 2020.
Of course, minimally invasive interventional valve surgery certainly has huge minimally invasive advantages, but the high medical costs often greatly affect the patient's choice. To this end, the Department of Cardiac and Macrovascular Surgery of the First Hospital of Zhejiang University has actively pioneered and innovated, and currently carries out 7 free clinical trial projects in the field of cardiac valve interventional therapy, including aortic valve lesions, mitral valve lesions, tricuspid valve lesions and pre-existing biological valve postoperative decay, etc., and may be admitted to the group for minimally invasive interventional surgery free of charge through assessment. It is hoped that this minimally invasive technology will continue to be developed and popularized, and bring more gospel to elderly patients with valvular disease.