Chapter 804 A genius is either crazy, crazy, or both!
After Mai Zijing's operation, her blood pressure was stable and her heart rhythm was normal. The Mai Zijing couple were very excited. They really met a noble person this time, and their family could finally live a normal life.
McGeefu was thinking about how to thank the doctor. He must send a pennant, but also what else should he give. After thinking about it, he remembered that he signed a commitment not to send red envelopes when he was first admitted to the hospital, so he still thought it would be better to send a red envelope, so he secretly
He ran to the director's office and gave Yang Ping a red envelope worth 20,000 yuan to show his appreciation.
But not long after he was sent to the hospital, head nurse Cai handed him a payment slip, and the 20,000 yuan had been paid into Mai Zijing's hospital account.
But McGifford didn't give up and always wanted to do something. He wandered around the general surgical ward to see if he could help buy something. As for money, he didn't really care about spending tens or hundreds of thousands.
So he went to the parent in the next bed and asked, and the parent was also quick to say: "Don't always think about sending things. It's not necessary, and the doctor doesn't need it. You have to really want to show that you can buy a fruit basket and send it to me. It's OK."
Go pick the fruits yourself and pick some fresh ones.”
McGeefe wondered if this was too simple, but then he thought that some things were originally simple, but he thought they were too complicated.
Just give me a fruit basket! McGee decided.
However, Mai Jifu didn't buy it at the fruit shop. He spent some time and asked friends everywhere, and finally asked a fellow who was engaged in fruit wholesale. Through the help of the fellow, he bought several kinds of fresh and good-quality fruits, and made one by himself.
The fruit basket was carried from the car to the ward with my wife.
In this way, by sending your thoughts out, McGifu felt at ease.
Xia Shu, as a Ph.D. student in Xiehe's eight-year program, and recommended by Professor Cao, was quickly admitted to Sanbo Hospital. Sanbo Hospital is in urgent need of such eight-year Ph.D. students, who are young and highly adaptable.
Academician Wang was also impatient. He asked Xia Shu to join the job as soon as possible, saying that if he was late, he would lose a day of knowledge and a lot of surgeries.
With the help of Academician Wang, Xia Shu's formalities in Fuwai were quickly completed, and he arrived at Sanbo Hospital in about three days to join the general surgery department.
At that time, Academician Wang believed that there were two operations that could not be completed. One of them was a baby with left ventricular hypoplastic syndrome who was only one month old and needed Fontan surgery.
Academician Wang personally sent the information on this case to Yang Ping, making it clear that he was overwhelmed and hoped to refer it to Yang Ping.
Yang Ping looked at the case information. If it were not for the reduction of elastic fibers and lack of collagen fibers in the blood vessel wall, this kind of surgery would be nothing to Academician Wang. Professor Chen has also done many such cases, but this factor of vascular dysplasia
becomes a roadblock to surgery.
This child has an unexplained lack of collagen fibers in blood vessels and a reduction in elastic fibers, especially in large blood vessels, resulting in severe embrittlement of large blood vessels. Under such conditions, the risk of complex Fontan surgery is extremely high. All you need to do is shake your hands a little or
If the angle of the needle insertion and exit is wrong, the blood vessel wall will be cut. Even if the anastomosis is barely completed, the suture quality will be slightly poor, and the high-pressure blood will easily tear the needle hole.
At the weekly case discussion meeting a few days later, this case was discussed as a difficult case.
"HLHS, hypoplastic left ventricle syndrome?" Song Zimo blurted out.
Any cardiac surgeon with formal training can make a preliminary diagnosis from images.
"Yes, it's HLHS, a one-month-old baby with severe left ventricular hypoplasia, atrial septal defect, patent ductus arteriosus - a series of congenital heart malformations." Yang Ping confirmed Song Zimo's diagnosis.
"Need to do Fontan surgery?" Xu Zhiliang's opinion.
Yang Ping nodded: "Besides Fontan surgery, there is no other good way. The left ventricle is too small to complete the task of systemic circulation. If I don't do surgery, I'm afraid I won't live long."
"What about heart transplantation? Since this heart is not good and there is no way to cure it, why not transplant it?" Although Li Guodong's knowledge is relatively superficial, he always dares to ask questions.
Song Zimo said helplessly: "Where can I find a heart to transplant for him? Unlike livers and kidneys, which can be taken from living donors, hearts can only be taken from deceased donors. Where can I find a suitable one who has just died a few months ago?"
Older children? Those who can provide a heart for such children are mostly newborn babies with congenital anencephaly, or babies who died during childbirth, and they are simply not found in reality."
"Fontan surgery is the only way to go. There is no other way now."
"Fontan surgery?"
For Song Zimo and Xu Zhiliang, this is just simple basic knowledge, but for orthopedic graduate student Li Guodong, it is indeed a bit difficult. However, he has been reading papers and monographs in various specialties like crazy recently, and he still knows the Fontan surgery very well.
.
“If this surgery can be done in Fuwai, why do you recommend it to us?”
Zhang Lin looks like a teacher at a top hospital.
Yes, Fontan surgery can be performed by Fuwai Anzhen, so why should it be recommended to us? Everyone is also confused.
"This child's blood vessels are congenitally underdeveloped, especially the five large blood vessels. The blood vessels have less elastic fibers and lack of collagen tissue, so they are much more fragile than normal blood vessels. Fontan surgery requires a large movement of the large blood vessels and the effort of anastomosis of the blood vessels.
The requirements are very demanding, and the heart of a one-month-old baby is about the size of a walnut, so it is very difficult to operate on fragile blood vessels. Fuwai has rich experience, so he is so cautious. If he is inexperienced, he can go directly to the operating table and open the chest.
After cutting off the aorta and preparing for transposition suturing, we found that there was no way to perform a normal anastomosis and we could not get off the operating table at this time." Song Zimo explained to everyone.
In general surgery, if the knowledge is not broad or deep, it is impossible to get along. Even Zhang Lin Xiaowu is studying hard now.
"Is it so scary?" Xiao Wu could not imagine what it would be like during the operation.
Yang Ping spoke at this time: "It's so scary! If this kind of blood vessel is cut and anastomosed, it does not have extremely high blood vessel anastomosis capabilities. As long as one needle causes uneven stress distribution or blood leakage, it will tear under the impact of high-pressure blood.
The patient immediately suffered massive bleeding and died."
"Has Director He ever had Fontan surgery?" Yang Ping turned to ask Director He Xiangjun, who had been silent.
Director He is also a doctor of cardiac surgery. When he was studying for his doctorate, he was in the cardiac surgery department of Nandu Provincial People's Hospital. The heart department of Nandu Provincial People's Hospital was ranked among the top five in the country.
However, Anzhen and Fuwai are the only ones, and the others can only be considered second-rate. There is no way, whether you admit it or not, the reality is before you. If you have to surpass Anzhen and Fuwai's cardiovascular specialists, the third place and beyond will have to be ranked.
There is still a long way to go. As Academician Wang said, the establishment of a specialty requires the efforts of several generations.
Cardiac surgery is probably the most difficult field of surgery to develop, so cardiac surgeries in many provincial hospitals can only perform ordinary surgeries. Of course, these ordinary surgeries, as long as the knife is used in the heart, are high-precision.
Therefore, Sanbo Hospital, which is relatively the most backward, is actually cardiac surgery. It does not even have a dedicated cardiac surgery department at all. Instead, it is called thoracic surgery, and the cardiopulmonary, esophageal and tracheal surgeries are all mixed together.
Director He blushed and said: "I haven't done it before. I did it with my tutor before. There are very few cases of this kind and it is usually only done in the imperial capital."
"Yes, there are very few hospitals that can carry out Fontan surgery. To do this kind of surgery well, it is not enough to just follow the instructions and do it. There are many factors to consider. Therefore, a good Fontan surgery not only tests the doctor's
Surgical skills also test the doctor's thinking ability. Song Zimo, please tell us about the history of Fontan surgery. I plan to put this patient here for us to at least make everyone familiar with Fontan surgery."
"For any surgery, I always ask everyone to be familiar with the history of the surgery. Only by understanding its ins and outs can you understand the background of its birth, the difficulties it encountered, and how it developed step by step. Only in this way can you truly understand
Only by understanding the connotation of surgery can we truly perform the surgery well. We surgeons cannot be satisfied with being surgeons."
"To learn Fontan surgery, we have to learn all about it, its past, present and future, its advantages and disadvantages---"
Dr. Li Guodong kept taking notes, as if every word of Professor Yang was a golden rule. He wrote it all down, and then slowly studied and understood it when he had time.
At this time, Song Zimo walked onto the podium, with his hands in his trouser pockets and his white coat unbuttoned and parted to both sides, looking very handsome.
He did not do PPT, nor did he make any preparations. He taught this class based entirely on his usual accumulation.
"Fontan surgery---a genius work of cardiac surgery, the last life-saving straw for children with congenital heart disease!"
Song Zimo wrote this sentence on the blackboard. This is a summary of the Fontan operation. Yes, if you list all the surgical procedures in cardiac surgery and evaluate who is a genius, it must be the Fontan operation. Its bold imagination and meticulous
Thinking is a masterpiece.
"To talk about Fontan surgery, we have to talk about French doctor Francis Fontan---the inventor of Fontan surgery. This doctor lived a long life and lived to be 89 years old."
"In April 1968, 39-year-old Dr. Fontan encountered a special case. A 12-year-old girl was breathless when she was treated. When she was 6 months old, her face and limbs were found to be purple.
, I developed exertional dyspnea and clubbing when I was 6 years old. As I grew up, my cyanosis and dyspnea became more and more serious. My heartbeat was very fast, and my red blood cell count and packed volume far exceeded normal levels. We know that this abnormality
The increase is a compensatory phenomenon."
"Fontan performed cardiac catheterization and angiography on the little girl, and found that the valve between the right atrium and the right ventricle was completely atretic. We know that this valve should be a one-way valve, allowing blood to flow from the atrium to the right ventricle.
ventricle, not the other way around, but now this valve is not a valve, but a completely insulating membrane."
"Tricuspid atresia?" someone called out.
"That's right! Tricuspid atresia!"
Song Zimo expressed his affirmation.
"At that time, the only treatment for this disease was heart transplantation, and the prognosis was very poor."
"Were there heart transplants at that time?" a student asked curiously.
Song Zimo put one hand in his pocket and the other hand with a sensor pen and wrote a time on the electronic blackboard: "In December 1967, Dr. Christian Barnard successfully performed the first human heart transplant in Cape Town, South Africa. Dr. Fontan
This patient was admitted in France in April 1968, that is, four months later."
"Wow - just 4 months later, they knew about heart transplantation. Technology spreads so fast."
"So it is very important for doctors to master the most cutting-edge technology. However, papers and journals lag behind, and monographs lag behind even more. Therefore, we must keep close contact with colleagues around the world and obtain important information at any time."
One girl secretly raised her cell phone to take pictures at the podium, and the girl next to her turned to look.
"Are you taking pictures of the blackboard or Senior Brother Song?"
"I'm taking pictures of the blackboard, okay?"
"Then why are you facing Senior Brother Song?"
"I can shoot wherever I like."
The girl next to her also silently raised her phone.
"The tricuspid valve is atretic. Isn't the cardiovascular circulation interrupted because of the obstruction of the tricuspid valve? How can the patient still live to be 12 years old?"
"There is always a reason for survival. Since there is no door, there must be holes elsewhere. Therefore, such patients usually have either a patent ductus or a ventricular septal defect, and the circulation path is completed through these abnormal channels."
"Understood."
"In order to treat this case, Dr. Fontan summed up people's experience and invented an almost crazy operation---directly anastomose the superior and inferior vena cava to the pulmonary artery, completely abandoning the right ventricle."
"His idea is very clear: Since the tricuspid valve has been atretic, causing the pulmonary circulation to not proceed normally, we know that the pulmonary artery is connected to the right ventricle, and the tricuspid valve atresia prevents blood from the right atrium from entering the right ventricle. At this node, the circulation is forced
If it is interrupted, the blood in the right atrium cannot return to the right ventricle, so how can the blood from the right ventricle be injected into the pulmonary artery to obtain oxygen?"
"Okay, Dr. Fontan announced - abandon the right ventricle, let's just let the heart be responsible for systemic circulation, and use other methods to achieve pulmonary circulation."
"What method is used? Directly anastomose the superior and inferior vena cava with the pulmonary artery. In the past, it was the superior and inferior vena cava---right atrium---right ventricle---aorta. Now I bypass the obstruction and directly become the superior and inferior vena cava---
--Pulmonary artery."
"Without the beating of the heart, how can the blood enter the pulmonary artery? Whether the blood enters the aorta or the pulmonary artery, it relies on the pumping action of the heart. Now there is no pump, how can the blood flow in?" One student really couldn't figure it out.
"It means you are thinking about the problem!"
Song Zimo walked between the rows with his head held high and his chest held high. His white coat was open like a windbreaker. He was 1.86 meters tall and had a handsome face, which fascinated the girls sitting there.
In the name of studying, girls can take photos of Song Zimo with their cell phones without restraint.
"At that time, all cardiac surgeons in the world believed this - pulmonary circulation must rely on the right ventricle pumping blood to the pulmonary artery under the beating of the heart. Without the function of the heart pump, blood cannot enter the pulmonary artery at all. Otherwise, what would the right ventricle and the right atrium do? So this
There's no way this plan will work."
"But genius is genius. Genius is either crazy, mad, or both!"
When he said this, Song Zimo's eyes fell on Yang Ping, stayed for a moment and continued.
"Dr. Fontan's thinking is completely different from others."
"Dr. Fontan was very confident that this plan would work. At this time, Dr. Fontan came up with a middle school physics concept: pressure difference!"
"We know that there is pressure when water flows in water pipes. Blood is a liquid, and of course there is pressure when flowing in blood vessels. The systemic circulation needs to press the blood to the whole body. The pressure is very high, which is a high-pressure circulation. The pulmonary circulation only pushes the blood pressure to the lungs, which is a low-pressure circulation.
circulation, so there is a pressure difference between the systemic circulation and the pulmonary circulation, and this pressure difference ensures that the blood returning from the upper and lower veins will definitely flow to the pulmonary artery."
"The basis of Dr. Fontan's theory is this middle school physics concept."
"And as I just said, patients like this often have perforations in the septum between the left and right atria. After Dr. Fontan short-circuited the blood vessels, and the blood directly entered the pulmonary artery, the blood flow of the left and right atria could be completely separated to avoid mixing."
"Why is this little girl cyanotic? Because of lack of oxygen. Why is there a lack of oxygen? Because of wrong circulation, which causes oxygen-rich blood to mix with oxygen-poor blood."
"Dr. Fontan did not even conduct animal experiments from the time he had the idea for this operation to the time he planned to perform it on the little girl. But the genius firmly believed that he was right. He defied all opinions and performed the operation on the little girl. The operation was very successful."
"Why didn't he buy a few pigs for experiments first, and then use them on humans? He couldn't afford pigs, right?"
A girl asked Song Zimo.
"He can't buy a pig with tricuspid atresia!" A boy argued with a girl.
The girl showed no sign of weakness: "Why does it have to be a pig with tricuspid atresia?"
"If you don't buy pigs with tricuspid atresia, how can you simulate this case?"
"This is your mindset. Normal pigs can also short-circuit the pulmonary artery and the superior and inferior vena cava. If the pig can still live normally after the short-circuit, it means the operation is successful. If it cannot survive, the operation has failed."
When boys and girls form two sides to debate, the students' thinking becomes active and they look like they are quarreling.
Boys have loud voices and girls have shrill voices.
Zhang Lin looked at Yang Ping, ready to stop him, but Yang Ping had a smile on his face, so Zhang Lin immediately gave up the idea and sat down again after leaving his seat.