On the morning of April 15, 2024, Uncle Wen, who had a bed 2 in the fourth ward of Jiangxi Provincial People's Hospital (the First Affiliated Hospital of Nanchang Medical College) and Provincial Cardiovascular Hospital, was discharged from the hospital and sent a pennant and a letter of thanks to the medical team. The letter said: "I would like to express my heartfelt thanks to all the medical staff in the four wards, especially Vice President Lai Hengli and Deputy Chief Physician Cai Xinyong, whose noble medical ethics and superb medical skills have regained my confidence in life and allowed me to pack my bags and start a new journey......
There were twists and turns, and the situation was critical
Rejection of surgery: 74-year-old Uncle Wen, who was found dizzy half a year ago and visited our hospital, underwent cardiac color ultrasound showed severe aortic stenosis, refused to undergo further aortic valve replacement surgery at that time, and began to experience a decrease in activity tolerance in the past two months, and was unable to feel comfortable in daily activities.
Rapid deterioration of his condition: On April 8, 2024, he was admitted to the Department of Gastroenterology of our hospital with re-release of melena and gastrointestinal bleeding, and suffered acute left heart failure during hospitalization, with orthopnea accompanied by profuse sweating. The aortic stenosis is more severe and the cardiac function is reduced. Due to the need of the condition, he was transferred to the Department of Cardiovascular Medicine for treatment.
Overcoming difficulties and using the focus mode to open the hearts of patients: Cai Xinyong's team uses the focus mode to treat and care for patients. Objectively evaluate the patient's condition, focus on Uncle Wen, and maximize the potential of medical staff, and encourage patients and their families to participate in treatment and care. It mainly includes: (1) Describe Uncle Wen's objective problems: the patient's condition is recurrent and continues to deteriorate, is there a chance for the next operation, and will he be so lucky every time the disease occurs? Cai Xinyong introduced the patient's disease in detail, so that the patient and his family can have an objective understanding and accept the current situation;(2) Construct specific and feasible goals: improve Uncle Wen's quality of life, prolong life, reduce the frequency of hospitalization, and reduce the economic burden of readmission due to illness;(3) Problem solving: Transcatheter aortic valve replacement (TAVR) through minimally invasive surgery;(4) Patient feedback: patients from refusal to actively request surgery;(5) Evaluation progress: patients have a particularly strong awareness of active treatment of "heart". The care team uses the focus mode to open the patient's heart knot and gain the patient's trust.
Multidisciplinary discussions to solve the problem of "heart".
When the patient was admitted to the Department of Cardiology, the patient still had melena occult blood and moderate anemia, please go to the team of Director Chen Jianyong of the Department of Gastroenterology for consultation, break through the "barrier" of repeated acute heart failure attacks, give endoscopic diagnosis and treatment, and after drug treatment, it is clear that the gastrointestinal bleeding has stopped. After that, Lai Hengli, executive vice president of the Provincial Cardiovascular Hospital, organized a team to discuss MDT with the team of Xie Aimin of the Department of Cardiac Surgery, Gu Ping, director of cardiac ultrasound, CCU, and anesthesiology team, and clarified the indications for TAVR. Sufficient imaging evaluation was carried out before TAVR surgery, and it was found that the approach to TAVR was difficult, whether it was the femoral artery, axillary artery, carotid artery, and the common iliac artery was small (average diameter 4.4mm), and it was feasible to choose the transcatheter aortic valve replacement system with the smallest internal diameter for surgery. A variety of protocols should be developed to deal with the situation that the valve system with the smallest inner diameter cannot pass, and prepare peripheral vascular stents, transapical approaches or trans-aortic approaches.
The operation was performed on April 10, and the 16F sheath entered the common iliac artery smoothly, and the whole operation went smoothly, from the establishment of the approach to the end of the operation, it took only 1 hour. The postoperative catheter measurement of the residual pressure difference across the valve was only 5mmHg, and there were no peripheral vascular complications and no melena. Follow-up cardiac ultrasound showed that the valve was in good shape and there was no paravalvular leakage.
After meticulous treatment and care by the team, the patient solved the problem of both hearts.
During surgery
The 16F sheath successfully passed through the common iliac artery
Balloon dilator valve implantation without paravalvular leakage
There is no injury to the vascular approach
Expert presentation
Deputy Chief Physician, Doctoral and Master's Supervisor. Jiangxi Province "high-level and high-skilled" double-high leading talents, "Jiangxi Provincial Health Talent Service Group" members, Jiangxi Provincial Coronary Intervention Quality Control Center Secretary-General, Jiangxi Provincial Medical Doctor Association Cardiovascular Physician Branch Standing Committee and Director General, Jiangxi Provincial Medical Association Heart Valve Branch Standing Committee and Secretary-General, Jiangxi Provincial Interventional Cardiology Society Youth Committee Chairman, Central Complex Coronary Interventional Youth Committee Leader, Jiangxi Provincial Department of Science and Technology Project Evaluation Expert. He presided over one national natural project, one provincial key project, two provincial projects, and three health commission projects. He has published 17 SCI articles, 4 Chinese journals, 1 invention patent and 2 soft works. He won the second prize and the third prize of Jiangxi Provincial Science and Technology Progress Award.
Authors: Jiangxi Provincial People's Hospital (the First Affiliated Hospital of Nanchang Medical College)-Provincial Cardiovascular Disease Hospital Cardiac District 4, Zhan Yuliang, Chen Liyan
Correspondent: Le Xiwen Luo Shan
Editor: Huang Menglin
Reviewer: Chen Shirui
Issued: Daley Red
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