I run a clinic in the United States

Chapter 367 The twists and turns of the surgical process
First, the child's heart, which is currently working in a single-ventricular state, needs to be returned to the state before the three surgeries to reshape the normal left ventricular and right ventricular structures.

Secondly, the long reversed aorta and pulmonary artery, together with the corresponding aortic valves, are re-excised and sutured to the correct position.

It sounds easy to say, but it is naturally extremely difficult to do, and you will face many challenges.

For example, if a child has had three major surgeries before, the situation after the thoracotomy will be very complicated, which may take much longer than usual and pose great challenges to anesthesia and extracorporeal circulation.

In response to various emergencies that may occur during the operation, Zhou Qiao has conducted many communications and drills with the anesthesia and extracorporeal circulation support teams of the University of California to ensure that nothing goes wrong.

For another example, the child has been in a systemic hypoxic state for a long time, and his preoperative condition is extremely poor, and he has chronic disease anemia, which means that the protection of blood during the operation will be very important.

In response to this situation, Zhou Qiao prepared ECMO in advance for the sake of insurance.

This surgical procedure was created by Zhou Qiao and Murphy on the spot, and is the first of its kind in the world. Therefore, before the operation, Zhou Qiao communicated with the parents of the child and informed them that the success rate of the operation was about 60%, and there was a certain chance of failure. possible.

The parents of the children also understand their children's condition and accept the risks involved. From another perspective, they feel that such a high success rate is worth looking forward to.

In fact, Zhou Qiao was a little more conservative in his words. He had at least a 90% success rate, but he couldn't talk too much and had to leave room for himself.

In the operating room, Zhou Qiao is the surgeon and Murphy assists.

As expected during the preoperative consultation, the thoracotomy was met with surprise.

The other doctors observing on site and in the monitoring room all had their hearts in their throats.

Because the child had undergone three surgeries before, and not long ago, he had the latest major surgery in less than a month.

At this time, the postoperative complications are most serious. Tissue adhesion and edema are very serious, and the child's heart cannot be exposed for a long time.

This kind of work is delicate, and all the organs of the child are relatively small. If it were an ordinary doctor, a lot of people would be panicked at this time. I didn't dare to speed up because the "road conditions" were not good and if I went a little faster, I might get into a car accident.

And if you delay in front for a long time, the longer you delay, the greater the risk. Because this kind of surgery requires cardiac arrest, extracorporeal circulation is an advanced technology, but it also has side effects. The longer it takes, the greater the impact on the human body and the higher the sequelae.

In severe cases, it may even affect the success of the heart's re-beating.

In the monitoring room, an expert from the cardiac surgery department at the University of California Medical Center muttered secretly: "Based on this situation, it will probably take two hours to open the chest."

Normally at this time, the heart would have been fully opened and stopped, allowing internal heart surgery to be performed, but now we haven't even seen it yet.

The doctors on the side also looked worried: "The thoracotomy only takes two hours, plus the operation time, how long will it take? Can the child bear it?"

"Doctor Zhou won't capsize this time, right?"

Just as they were worried and worrying about Zhou Qiao and Murphy, Zhou Qiao and Murphy looked at each other, understanding each other, and speeded up their movements in unison.

Other doctors did not dare to speed on such bad "road conditions", but Zhou Qiao and Murphy cooperated with each other and drove as fast as a racing car.

The wild mode of the Iris Group is on!
It was a thrilling journey, but it did not cause any additional harm to the child, which is amazing.

"This is simply god-like hand speed and skill!"

“This is the Lord’s favor!”

Only after more than ten minutes, some tissues and blood vessels on the surface of the child's heart appeared. Then, after another ten minutes of free movement, the child's small heart was seen.

Experts originally estimated that it would take two hours to complete the preliminary actions, but Zhou Qiao and Murphy only took more than 20 minutes, which must be said to be extremely fast.

For this kind of extremely risky surgery, every minute and every second is considered prime time, and every inch of time is worth every inch of gold.

Suddenly, something unexpected happened.

Everyone was frightened, really afraid of what might happen.

I saw that the child's subclavian artery suddenly cracked, and blood gurgled out.

This was not caused by Zhou Qiao's misoperation or quick operation, but because the child's own blood vessels were too fragile and suddenly burst.

In an instant, the child's blood pressure plummeted to 56/30mmHg.

The situation is extremely critical.

Fortunately, Zhou Qiao had made a plan for this situation in advance. At this time, following Zhou Qiao's order, the anesthesia team immediately followed the previous emergency plan and quickly, manually, and inject a large amount of blood.

Meanwhile, Murphy stopped the bleeding.

Blood pressure rises and stabilizes.

No near misses.

The heart exposure was finally completed, the extracorporeal circulation machine began to operate slowly, and the child's heart stopped.

Even if Zhou Qiao and Murphy took action at a flying speed, it still took twice as long as the "usual" surgery.

Zhou Qiao and Murphy worked together to perform the intracardiac surgery, and the complex condition of the child's heart was finally fully exposed.

According to the previous plan, Zhou Qiao and Murphy repaired the ventricular septal defect of the child and reshaped the structure of both ventricles of the heart.

In addition, the child also had an atrial septal defect and tricuspid regurgitation, which were also repaired through surgery.

Since you have to do it, do it all at once without leaving any flaws.

In the double-artery double-root transfer, the child still had pulmonary artery stenosis. While changing the position, Zhou Qiao and Murphy also used external tubes to enlarge the pulmonary artery.

This is really a huge project. It can be said that after the entire operation, only the mitral valve of the child's heart remained intact, and all other parts of the heart were surgically corrected.

At 13:00 in the afternoon, everyone did not eat and continued to fight.

The operation has been going on for more than four hours, and the child's heart has almost reached its upper limit of cardiac arrest, with up to an hour left. If it takes longer, the operation can be successful, but the damage to the child's myocardium will be irreversible and may leave lifelong sequelae.

At this time, this complex surgery was only halfway done.

Zhou Qiao and Murphy looked at each other, and the two of them once again connected with each other and started the crazy super god mode.

Finally, at around two o'clock in the afternoon, the intracardiac surgery was completed. Before the myocardial arrest protection solution expired, the extracorporeal circulation machine was removed and the heart restarted successfully.

Eight years after his birth, this child's heart beat normally for the first time. "Dong~, dong~, dong~"

Although weak, it is quite rhythmic. This is a normal rhythm, full of vitality, just like the sun at eight or nine o'clock in the morning. It was originally covered by thick dark clouds, and it is estimated that it will not be able to "stand out" all day long. This At that moment, under the skillful hands of Zhou Qiao and Murphy, it suddenly broke through the clouds, burst out vigorously, and shed thousands of golden lights.

In the operating room and monitoring room, the observing experts from the University of California Medical Center and the medical staff involved in the operation all applauded and cheered.

A beautiful anesthesiologist kept screaming, whistling, and dancing to express her excitement.

Everyone admired it, and many people gave it a double thumbs up at the same time!

Because, Dr. Zhou and Dr. Murphy did a great job!

A highly difficult and complex operation that originally took more than ten or twenty hours to succeed was actually completed in more than five hours!
Simply a miracle!

Iris Clinic once again created a miracle!

In fact, the difficulty is really very high. If it were not so difficult, Zhou Qiao and Murphy would never have spent such a long time working together.

"Stay steady, the danger is not really over yet." Zhou Qiao warned the team members.

Everyone looked at each other, their hearts beating successfully again, what else is there to worry about?
Now that the difficult moments have passed, no matter how dangerous the future is, what does it matter?

Everyone disagreed.

Because Zhou Qiao and Murphy were too tired after a long operation, several senior doctors from the Department of Cardiac Surgery at the University of California Medical Center volunteered to do the finishing work. They were very active and senior doctors, so Zhou Qiao asked them to do it. Come and do it. He and Murphy went to rest for a while, drink water, and use the toilet.

Before Zhou Qiao and Murphy left, they couldn't help but warn: "The child's tissue is too brittle, and there may be tearing and bleeding after re-jumping, so we must pay attention."

"OK, don't worry, Dr. Zhou, we will add biological tissue pads to the weak areas to make up for the fragile tissue." The doctors on behalf of him were full of confidence.

Zhou Qiao and Murphy left.

In the bathroom, the two of them had a little intimacy. After all, they were too tired. Although it had only been more than five hours, even they were still nervous and it was a bit too much.

This is not a marathon, but a sprint for five consecutive hours, which consumes a lot of physical energy and energy. At this time, a hug and tenderness can make people relax.

However, they dare not really "rest" for too long, because the danger has really not passed.

When they returned to the operating room, sure enough, the surgeons were sweating profusely.

The heart was restarted successfully. However, due to the large scope of the heart surgery, thousands of stitches, and the long period of cardiac arrest and extracorporeal circulation, the child's coagulation function dropped significantly, and almost all anastomoses continued to leak. Blood, closing the chest encounters obstacles.

Even though the surgeons added biological tissue pads and reinforced each anastomosis when suturing it. However, the bleeding situation was still not optimistic, and the child even developed ventricular rhythm.

This is not a problem of their level, but that the children are really too fragile!
The soft tofu is carved, but after a long time, the soft tofu itself will not be able to support it due to "gravity".

"Dr. Zhou, what should I do now?" One of the surgeons was very ashamed. He had previously patted his chest and said that there was no problem, but now, he couldn't even handle such a "little thing" as closing his chest.

Zhou Qiao pondered for a few seconds and said, "Let's get on ECMO."

So, ECMO was started.

I was prepared beforehand.

At the same time, Zhou Qiao and Murphy went into battle at the same time, once again taking over the banner, applying gauze compression to the child's fragile heart to stop the bleeding.

We were busy until the sun set over the Pacific Ocean and the sky darkened. With the assistance of ECMO, 28 pieces of gauze were filled in the child's heart. The bleeding was temporarily controlled and he returned to the PICU with delayed chest closure.

Under the close monitoring of the PICU, the child's coagulation function improved significantly 24 hours after the operation.

However, an accident happened again. When ECMO was removed, the child suddenly suffered from malignant arrhythmia.

Zhou Qiao and the others never left, and quickly went into battle. Together with the monitoring team of the University of California Medical Center, they quickly implemented defibrillation, volume expansion, fever reduction and other measures to rescue the patient. In the end, they passed the test without any danger.

The chest closure was completed 46 hours after the operation, and the patient was weaned from the invasive ventilator on the 5th day after the operation. The condition was getting better day by day, and discharge was just around the corner.

The parents of the child don't know how happy they are.

While everyone was happy for their family, they also felt very lucky that it was the child's luck to have met Dr. Zhou, one of the top doctors in North America. Otherwise, it's another story.

……

At Iris Clinic, Chiba Nanako re-examined the four-year-old child. The child had not grown in six months, but only gained weight. The situation was naturally quite abnormal.

The mother took her baby for a check-up, and when the report came out, she took her baby for a follow-up visit.

Chiba Nanako said: "The baby's condition should not be underestimated. Consider Cushing's syndrome."

"Cushing's syndrome?" Mom was confused and had never heard of it.

Chiba Nanako smoothed her long, straight black hair and explained to her: "The report shows that his blood cortisol is 900nmol/L, ACTH 59.60pg/mL, and 24-hour urine free cortisol content is 471.4ug/24h , were significantly higher than normal. In addition, he had slow growth, was significantly overweight, with a BMI as high as 29.99kg/m2, a round face, but small limbs, abdominal obesity, fat pads on his back, thick eyebrows, and increased hair on his forehead and nape. Purple streaks are seen on the skin of both lower limbs and thighs, which are typical clinical manifestations of Cushing's syndrome."

"What should we do?" When Bao's mother heard about this situation, she was so anxious.

Chiba Nanako comforted her and told her not to worry: "Further examination is needed."

"Do you still need to check? Don't you know the disease? Can't you treat it immediately?" Bao's mother asked puzzledly.

She really didn't want to wait any longer.

Chiba Nanako explained patiently: "This disease is a rare disease, especially in young children. There are many causes, and a clear and accurate diagnosis is very important. For example, adrenal gland origin, ectopic origin, pituitary gland origin...all will Different causes of Cushing's syndrome have different treatments and prognosis, so further examination is necessary to find out the real cause before the right medicine can be prescribed."

"Then hurry up!" Bao's mother urged.

Chiba Nanako then arranged an auxiliary endocrine examination for the child. According to the examination results, it was more likely to find a pituitary tumor, but the imaging was not typical.

Although she continued to figure it out alone and was finally able to diagnose, for the sake of the children and to clarify the condition more quickly, Chiba Nanako had to turn to the team for help and called Zhou Qiao, Murphy and Stephanie to discuss it together. .

There is strength in numbers.

(End of this chapter)