Wang Ge's parents finally arrived at the hospital. After communicating with their son for a few minutes, they were also frightened by this state of raising the bar all the time.

"This kid ...... It can't be that he was given something to get on him, right?" Although they were all born in New China and grew up under the red flag, Wang Ge's parents still muttered a little psychologically when they saw the sudden change in the temperament of the child they knew well. Sun Lien listened to the couple muttering in a low voice outside the door, "Do you want to find a master to exorcise evil spirits?"

Sun Lien could only smile bitterly beside him, and when Wang Ge's parents had almost communicated, he said loudly, "You two come to the office with me, it's not convenient to talk here." ”

In the conference room, Sun Lien found a stool and sat down, and began to relay the current situation to Wang Ge's parents, "He was sent to the hospital when he was playing basketball when his chest suddenly tightened and he was weak. After our examination, it was confirmed that all three major blood vessels in his coronary arteries were narrowed – 99% narrow, which is already very serious. ”

In order to show the severity, Sun Lien specially prepared a color map of the anatomy of the heart, "Here, here, and here, this is the area of Wang Ge's lesion." These three blood vessels are responsible for about 70% of the blood supply to the heart of the average person. After his three lesions, 70% of his blood could not be supplied normally. Sun Lien put down the picture and said seriously, "But in the emergency examination, we found that he was not the same as the traditional coronary heart disease patient." His blood lipids are normal. ”

"Normal lipids mean that it is not arteriosclerotic plaque that is causing coronary artery stenosis. It's something else...... At the moment, the most likely ones are vasculitis and immunosedimentation substances. "According to this report, we think he has systemic lupus erythematosus, but this alone can't explain all the symptoms in his body—including his personality changes." ”

Wang Ge's parents glanced at each other and asked cautiously, "Do you think...... Is he the way he is because he is sick?"

"Of course. Sun Lien smiled bitterly and nodded, "If it's a ghost, we can't be doctors with the law." ”

Sun Lien explained the similarities and differences between granulomatous vasculitis and systemic lupus erythematosus for a long time, and he didn't know if Wang Ge's parents understood it.

"In short, we think he has two very similar, but slightly different, autoimmune diseases. Sun Lien finally said directly, "Both of these diseases may pose a direct threat to his life, and the treatment method is hormone shock." ”

"Then use. Wang Ge's father made a decision very happily, "As long as it can cure the disease, we will use it." ”

"But there's one thing I have to tell you about earlier. Sun Lien found out the informed consent form for hormone pulse therapy, "The hormone shock may have a negative impact on his current cardiovascular system." If hormones were used, his current normal blood lipids would most likely rise rapidly — and at worst, a heart attack. ”

"Huh?" Wang Ge's father suddenly changed color, "Isn't that particularly dangerous?"

"Yes. Sun Lien nodded, "Although we will give him life monitoring, in case of a heart attack, we will definitely do our best to treat him." But this risk still exists - some very serious heart attacks can be turned into safety after treatment, but some heart attack patients just can't be saved. ”

In all fairness, Sun himself felt that this was a very difficult choice to decide. If there is no hormone pulse therapy, just the use of traditional immunosuppressant regimens such as hydroxychloroquine, granulomatous vasculitis will continue to develop, and Wang Ge is likely to not survive the discharge. With the use of hormone pulses and immunosuppressants, Wang Ge may have another heart attack, or may die during the hospitalization.

"I have a suggestion. Sun Lien thought for a moment and proposed, "If you two agree, I'll call a cardiac surgeon first." Let the doctor of the cardiac surgery evaluate it and see if he can perform bypass surgery for Wang Ge first. After the bypass is done, the hormone shock is given. Although this increases the risk of infection, his heart is at least safe. ”

·

·

·

"As long as the kidneys think the patient can tolerate the trauma of the surgery, then we can give it a try. "The Department of Cardiac Surgery attaches great importance to the consultation request of the Comprehensive Diagnostic Center, and Director Tong Chunlai personally came to the Comprehensive Diagnostic Center to participate in the consultation. "But there's a problem...... What is the quality of this patient's other blood vessels?"

There are generally three routes to heart bypass surgery, each of which involves removing a section of blood vessel directly from the patient and then suturing it at the proximal and distal ends of the coronary artery stenosis. The great saphenous vein is traditionally used, but because it has a valve in the saphenous vein, blood flow is blocked. Therefore, the likelihood of postoperative occlusion is much higher than that of internal thoracic artery bypass and radial artery bypass.

Internal thoracic artery bypass and radial artery bypass, as the name suggests, are both arteries that are removed for bypass sutures. In terms of effect, internal thoracic artery bypass has the best effect. Not to mention that the ten-year patency rate is greater than 90%, and it can even regulate blood flow according to the physiological needs of myocardial blood supply.

The history of radial artery bypass is almost as old as saphenous vein bypass. Although the radial artery is more prone to spasm, which leads to functional closure, it was temporarily abandoned. However, with the application of calcium antagonists to relieve spasms and prevent spasticity, this once-abandoned regimen has returned to the scope of first-line clinical use.

For patients with three-vessel disease, both radial artery bypass and internal thoracic artery bypass alone are unrealistic designs – both of which have very limited vessel lengths, especially the most effective internal thoracic arteries. Therefore, in the current coronary artery bypass grafting, a composite method is generally adopted. The saphenous vein, internal thoracic artery, and radial artery are used simultaneously.

However, not all patients are able to remove blood vessels that are suitable for bypassing. This kind of problem has become particularly real for Wang Ge.

Granulomatous vasculitis invades blood vessels throughout the body, it affects arteries, veins, and capillaries. It is even possible to involve the large arteries. In the presence of granulomatous vasculitis, it is likely that Wang Ge will not be able to take out even a single usable blood vessel on his body.

"His granulomatous vasculitis...... We haven't been able to fully diagnose it yet. Sun Lien was a little embarrassed, "The quality of blood vessels is really hard to say, do you need to do a biopsy to assess the availability of blood vessels?"