The 37-year-old mother is about to have twin children, which is undoubtedly a happy thing. But more than a month before the due date, the mother suddenly fell seriously ill, and the aortic blood vessels were torn all the way from the heart to the thighs, and she could die at any time...
May 14 is Mother's Day, and Ms. Yin, who lives in Deyang, and the child in her womb are caught off guard by death. Fortunately, the smooth green channel and the multidisciplinary team of Sichuan Provincial People's Hospital worked together to pull Ms. Yin back from the line of death and give birth to a pair of dragon and phoenix babies safely.
"Time bomb"
Sudden aortic dissection in an elderly woman who is pregnant with twins
Ms. Yin, 37 years old this year, lives in Deyang. As an elderly mother, Ms. Yin was 35 weeks pregnant at that time, and a pair of hard-won children were about to be born. But the unexpected happened.
Ms. Yin told Red Star News that on May 14, when she was taking a bath, she bent over, suddenly her back could not straighten, and she felt chest pain, sweating, and dizziness.
"I went to the hospital right away." Ms. Yin said that after a series of examinations at the local hospital, she was supposed to have surgery, and after consultation, the doctor cautiously recommended transferring to a higher-level hospital.
At 4:50 p.m. on May 14, at the Sichuan Provincial People's Hospital, Mei Jie, director of the medical department and obstetrics and gynecology, received a call from the medical department and obstetricians of the lower-level hospital, and the "alarm" sounded.
It turned out that Ms. Yin was diagnosed with "thoracic and abdominal aortic dissection type A", accompanied by pericardial and pleural effusion. What is aortic dissection? This is an extremely dangerous type of acute and serious disease, "the aorta of the heart is our life artery, whether it is the brain, spinal cord, or the blood supply of important organs in the whole body, it is supplied by the aorta." Yu Tao, chief physician of the Department of Cardiac and Macrovascular Surgery of Sichuan Provincial People's Hospital, explained that the aorta is divided into three layers: inner membrane, middle membrane and outer membrane, and aortic dissection is a breach in the inner membrane, blood "pours in" like a mudslide, and the inner membrane and the middle membrane are torn apart like peeling bark, leaving only a layer of outer membrane as thin as a "plastic bag" "bitterly supported". "Once the outer membrane ruptures and bleeds profusely, the patient dies in just a few minutes." Yu Tao described that every beat of the heart may bring rupture, and the closer to the root of the aorta, the greater the beating and pressure, which is a "time bomb". Without surgery, half of all patients with acute aortic dissection die within 48 hours.
More dangerous than ordinary simple aortic dissection, Ms. Yin is pregnant with twins, which undoubtedly adds greater difficulty and risk to rescue treatment.
Imaging data show aortic dissection
A surgical relay full of "contradictions" and dangers
Open the green channel! Referral! Emergency surgery!
At 6:30 p.m. on May 14, the ambulance that sounded the alarm escorted Ms. Yin all the way to the emergency department of Sichuan Provincial People's Hospital, and after perfecting the enhanced CT and other examinations, Ms. Yin was urgently transferred to the operating room, at this time, the anesthesia surgery center, obstetrics and gynecology, cardiac and macrovascular surgery, neonatology, intensive care medicine and other multidisciplinary teams have been waiting for it.
From the impact of the examination results, the severity of Ms. Yin's condition made the doctors sweat: advanced age, late pregnancy, combined with gestational diabetes, the important thing is that the dissection is located at the beginning of the aorta, all the way to the root of the thigh, the right renal artery is torn 50%, the left renal artery is completely torn, the abdominal trunk artery is completely torn, and almost all blood vessels along the way, including carotid arteries and abdominal organ arteries, are involved.
First cesarean section to remove the child, and then heart surgery, the child and adults must be saved! Mei Jie, director of the Department of Obstetrics and Gynecology, Lei Qian, director of the Department of Anesthesiology, Huang Keli, director of the Department of Cardiac and Macrovascular Surgery, and Yu Tao, chief physician, discussed and formulated an emergency surgery plan.
The first to be "put to the test" was the anesthesiologist. "For conventional aortic dissection patients, using deep sedative drugs as soon as possible is conducive to avoiding cardiovascular effects such as emotional stress and reducing the chance of rupture, but not pregnant women, sedative drugs may cause respiratory depression after birth." Lei Qian, director of the anesthesiology department, described the difficulty of surgical anesthesia as "full of contradictions", and blood pressure should not be too low, otherwise it may bring ischemia and hypoxia problems to adults and children, so medication, dosage, and timing need to be carefully balanced.
At 7:27 p.m. on May 14, the cesarean section began, and soon after encountering the first "roadblock", "placenta previa and implantation", there was a risk of heavy bleeding. Fortunately, in about 10 minutes, a pair of dragon and phoenix fetuses were born safely, because they were not yet full-term, and the neonatal department took over.
At 9:45 p.m., the cardiac and macrovascular surgery team that has been "escorting" took over the "baton" and completed complex surgeries such as "ascending aorta replacement with aortic valve artificial vessel" (aortic valve replacement + left and right coronary artery grafting) + total aortic arch replacement + descending aortic stenting", which is simply understood to replace the patient's torn aortic vessel with an artificial blood vessel, re-establish the blood supply channel, and restore heart function. Acute type A aortic dissection is one of the most complex, dangerous and technically demanding procedures in the specialty of cardiac and macrovascular surgery.
"One of the difficulties is bleeding, replacing artificial blood vessels requires thousands of stitches, each of which is sutured on a relatively fragile blood vessel where a hematoma occurs, and once a needle is bleeding, the operation cannot be completed." Yu Tao said that the second is that the operation has a time limit, it must be fast and good, and the operation time is long, and the subsequent complications and infection will increase.
For 5 and a half hours, the "bomb" was finally defused. At 3:30 a.m. on May 15, the patient and the stress were transferred to the SICU team in the Department of Critical Care Medicine. Coagulation disorders, circulatory fluctuations, poor oxygenation in the lungs... Postoperative management remains stressful. "The patient had a valve replacement and needed to take anticoagulants, but at the same time she had a cesarean section, complicated cardiovascular surgery, so her clotting function was very confused." Wang Yiping, deputy director of SICU, said that 13 hours after the operation, the patient was fully awake and conscious, successfully removed the endotracheal intubation from the ventilator, and began lung breathing exercises as soon as possible. Three days after the operation, Ms. Yin was successfully transferred out of the ICU and further rehabilitated in the Department of Cardiac and Macrovascular Surgery.
Emergency surgery
The "culprit" turned out to be Marfan syndrome
On June 5, Ms. Yin was able to leave the hospital and go home, and a pair of dragon and phoenix fetuses had been discharged first. "On the day I left the ICU, the child who happened to be small came out of the incubator and put it next to me and took a look at it from afar, so small." On June 2, Ms. Yin, who was recovering well, was preparing for discharge while looking forward to holding her child in person.
What caused Ms. Yin's sudden aortic dissection? Yu Tao explained that based on the condition and the patient's appearance characteristics, as well as family history, there is a high clinical suspicion of Marfan syndrome.
This is a congenital, hereditary connective tissue disease that mainly affects the three major systems of cardiovascular, bone and eye. "[The patient] is tall, with slender limbs, often accompanied by high myopia and thoracic deformity." Yu Tao said that during the operation, it can be clearly felt that the aortic wall and connective tissue of patients with Marfan syndrome are obviously thinner than ordinary people, which is a congenital "cutting corner", so it is more likely to cause cardiovascular disease.
At present, the Department of Cardiac and Macrovascular Surgery of Sichuan Provincial People's Hospital has successfully completed the emergency rescue of 4 cases of maternal aortic dissection, all of whom are patients with Marfan syndrome.
Red Star News reporter Yu Zunsu According to Sichuan Provincial People's Hospital
Edited by Li Yuyi
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