Mai Zijing's blood pressure was stable and his heart rhythm was normal after surgery, and Mai Jifu and his wife were very excited, this time they really met a nobleman, and their family could finally live a normal life in the future.

Mai Jifu thought about how to be grateful to the doctor, the pennant must be sent, what else to send, thought about it, remembered that when he was first admitted to the hospital, he signed a letter of commitment not to send red envelopes, so he still felt that it was better to send a red envelope, so he secretly ran to the director's office and gave Yang Ping a red envelope of 20,000 yuan to express his gratitude.

But not long after it was delivered, Nurse Cai handed him a payment slip, and the 20,000 yuan had been paid into Mai Zijing's hospitalization account.

But McGie Fu didn't give up, he always wanted to do something, he walked around the general surgery ward to see if he could help buy something, as for the money, he didn't care much about spending tens of thousands of dollars.

So he found the parent next to the bed and asked, this parent is also fast: "You don't always want to send things, it's not necessary, and the doctor doesn't need it, you really want to say, go buy a fruit basket and send it, just get the heart, pick the fruit yourself, pick some fresh." ”

McGiff wondered if this was too simple, but then he thought that some things were too simple and too complicated for himself.

Just get a fruit basket! McGifu decided.

However, McGie Fu did not buy it in the fruit store, he spent some thought, asked friends everywhere, and finally asked a fellow who was engaged in fruit wholesale, through the help of the fellow, he bought several fresh and high-quality fruits, made a fruit basket by himself, and personally carried it from the car to the ward with his wife.

In this way, sending his heart out, McJifu is at ease.

Xia Shu, as an eight-year doctor of Xiehe, was recommended by Professor Cao, and was quickly admitted to Sanbo Hospital, which is now in urgent need of this eight-year doctorate, young and malleable.

Academician Wang is also anxious, he asked Xia Shu to join the company quickly, saying that if he is one day late, he will learn one less day of knowledge and see a lot of surgeries.

With the help of Academician Wang, Xia Shu's procedures in Fuwai were quickly completed, and he rushed to Sanbo Hospital in about three days to join the company, and he couldn't wait to appear in the comprehensive surgery.

At that time, Academician Wang thought that there were two surgeries that could not be completed, one of which was a baby with left ventricular dysplasia syndrome, who was only one month old and needed to undergo Fontan surgery.

Academician Wang personally sent the information of this case to Yang Ping, making it clear that he had more than enough strength and hoped to refer it to Yang Ping.

Yang Ping took a look at the case data, if it were not for the reduction of elastic fibers in the blood vessel wall and the lack of collagen fibers, this kind of surgery would be nothing to Academician Wang, and Professor Chen has also done many such cases, but this factor of vascular dysplasia has become an obstacle to the operation.

This child has unexplained vascular collagen fiber deficiency, elastic fiber reduction, especially large blood vessels are more obvious, resulting in serious brittleness of large blood vessels, under this condition to do complex Fontan surgery, the risk is extremely high, as long as the hand shakes a little or the needle in and out of the needle angle is not right, the blood vessel wall will be cut, even if the anastomosis is barely completed, the quality of the suture is slightly worse, and the high-pressure blood is easy to tear the needlehole.

A few days later, at the weekly case discussion meeting, the case was discussed as a difficult case.

"HLHS, Left Ventricular Dysplastic Syndrome?" Song Zimo blurted out.

Any properly trained cardiac surgeon can make a preliminary diagnosis from the images.

"That's right, it's HLHS, a one-month-old baby with severe left ventricular dysplasia, atrial septal defect, patent ductus arteriosus -—— a series of congenital heart malformations." Yang Ping affirmed Song Zimo's diagnosis.

"Need Fontan surgery?" Xu Zhiliang's opinion.

Yang Ping nodded: "In addition to the Fontan operation, there is no other good way, the left ventricle is too small, and it is impossible to complete the task of systemic circulation, if you don't do surgery, I'm afraid you won't live long." ”

"What about a heart transplant, since this heart can't be done, and there is no way to cure it, why not transplant it?" Although Li Guodong's understanding is relatively superficial, he always dares to ask questions.

Song Zimo said helplessly: "Where to find a heart to transplant him, unlike liver and kidney, which can be taken from living bodies, the heart can only be taken from a dead donor, where to find a suitable child who has just died a few months old?" Most of the babies who can provide hearts for this kind of children are newborn babies with congenital anencephaly, or babies who died of dystocia, and they cannot be found in reality. ”

"There's only one way to go, there's no other way to go."

"Fontan surgery?"

For Song Zimo and Xu Zhiliang, this is just a simple basic knowledge, but for Li Guodong, a graduate student in orthopedics, it is indeed a bit difficult, but he has recently read papers and monographs in various specialties like crazy, and he still knows a lot about Fontan surgery.

"If this operation can't be done outside Fuwai, why do you still recommend it to us?"

Zhang Lin is a teacher in a top hospital.

Yes, Fontan surgery, Fuwai Anzhen can be done, why push it 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 the collagen tissue is lacking, so they are much more brittle than normal blood vessels, and the Fontan operation requires a large blood vessel to be moved, and the requirements for vascular anastomosis are very harsh, and the heart of a one-month-old baby is about the size of a walnut, and the operation of brittle blood vessels is very difficult. If you are inexperienced, go directly to the operating table, open the chest, cut off the aorta, and find that there is no way to perform normal anastomosis when you are ready to transpose and suture, and you can't get off the operating table at this time. Song Zimo explained to everyone.

In comprehensive surgery, the knowledge is not broad or deep, and there is no way to mix it at all, and even Zhang Lin Xiaowu is now desperately reading and studying.

"Is it so scary?" It's hard for Xiao Wu to imagine what the situation was like during the operation.

Yang Ping spoke at this time: "It's so terrifying! If this kind of blood vessel is cut for anastomosis, there is no extremely high vascular anastomosis ability, as long as a needle causes uneven stress distribution or blood leakage, it will tear under the impact of high-pressure blood, and the patient will immediately have massive bleeding and die. ”

"Has Director He had Fontan surgery?" Yang Ping turned his head and asked Director He Xiangjun, who had not spoken.

Director He is also a doctor of cardiac surgery, and when he was a doctoral student, he was in the cardiac surgery department of Nandu Provincial People's Hospital, and the heart of Nandu Provincial People's Hospital was among the top five in the country.

But Anzhen and Fuwai are the only class, and the others can only be regarded as second-rate, no way, whether they admit it or not, the reality is in front of them, to surpass Anzhen and Fuwai's cardiovascular specialty, there is still a long way to go in the third place and the subsequent rankings, as Academician Wang said, the establishment of a specialty requires the efforts of several generations.

Cardiac surgery is probably the most difficult to develop in surgery, so the cardiac surgery of many provincial hospitals can only do ordinary surgery.

Therefore, Sanbo Hospital, which is relatively the most backward, is actually cardiac surgery, and there is no special cardiac surgery at all, but it is called thoracic surgery, and the heart, lungs, esophagus, and trachea are mixed together.

Director He blushed and said: "I haven't done it, I have done it with my mentor before, and this kind of case is rare, and it is generally carried out in the imperial capital." ”

"Yes, there are very few hospitals that can carry out Fontan surgery, and this kind of surgery should be done well, not just by relying on the gourd to make the operation, which has many factors considered, so a good Fontan surgery not only tests the doctor's surgical skills, but also tests the doctor's thinking ability. Song Zimo, you can tell you about the history of Fontan surgery, I plan to put this patient with us, at least let everyone be familiar with Fontan surgery first. ”

"For any operation, I always require everyone to be familiar with the history of the operation, only by understanding its ins and outs, can we understand the background of its birth, the difficulties he encountered, how he developed step by step, and only in this way can we truly understand the connotation of surgery, only by understanding the connotation of surgery, can we really do a good job, we surgeons can not be satisfied with being surgical openers."

"To learn about the Fontan procedure, we learn everything about it, its past, present and future, its advantages and disadvantages—"

Dr. Li Guodong kept taking notes, as if every sentence of Professor Yang was a golden rule, he recorded all of them, and then had time to study and experience them slowly.

At this time, Song Zimo walked up to the podium, his hands were in his trouser pockets, and his white coat was unbuttoned and separated to both sides, looking very handsome.

He didn't do a PPT, nor did he make any preparations, and he came to this class completely with his usual accumulation.

"Fontan surgery - a genius work in cardiac surgery, the last straw for children with congenital heart disease!"

Song Zimo wrote this sentence on the blackboard, this is a summary of Fontan surgery, yes, if you list all the surgeries in cardiac surgery and evaluate who is a genius, it must be Fontan surgery, its bold imagination, careful thinking, can be called a must.

"If you want to talk about the Fontan operation, you have to talk about the French doctor Francis Fontan, the inventor of the Fontan operation, this doctor lived a long life, lived to be 89 years old."

"In April 1968, 39-year-old Dr. Fontan encountered a special case, a 12-year-old girl, when she was treated, she was out of breath even to speak, she was found to have purple face and limbs when she was 6 months old, exertional dyspnea and clubbing at the age of 6, as she grew older, cyanosis and dyspnea became more and more severe, the heartbeat was very fast, the number of red blood cells and hematocrit far exceeded normal levels, and we knew that this abnormal increase was a compensatory phenomenon."

"Fontan did cardiac catheterization and angiography on this little girl, and it turned out that the valve between the right atrium and the right ventricle was completely atresia, and we knew that this valve was supposed to be a one-way valve that allowed blood to flow from the atria to the ventricles, not the other way around, but now this valve is not a valve, but a completely isolated membrane."

"Tricuspid atresia?" Someone called out.

"That's right! Tricuspid atresia! ”

Song Zimo said yes.

"At the time, the only treatment for this disease was a heart transplant, and the prognosis was very bad."

"Was there a heart transplant at that time?" One of the students asked curiously.

Song Zimo put one hand in his pocket and held a sensor pen in the other, 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, and Dr. Fontan saw this patient in France in April 1968, that is, four months later. ”

"Wow – just four months later, they knew about heart transplants, and the technology spread so fast."

"So it's very important for doctors to be on top of the latest technology, while journals are lagging behind, and monographs are lagging behind, so we need to keep in close contact with our peers around the world and get important information at any time."

A girl secretly raised her mobile phone to take a picture at the podium, and the girl next to her turned her head to look.

"Are you shooting the blackboard, or are you shooting Senior Brother Song?"

"I'm shooting 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 mobile phone.

"The tricuspid valve is closed, isn't the cardiovascular circulation interrupted by the tricuspid valve? How can a patient live to be 12 years old? ”

"There is always a reason for surviving, since there is no door, there must be a hole elsewhere, so such patients generally either have a patent duct or a ventricular septal defect, and complete the circulatory passage through these abnormal channels."

"Understood."

"To treat this case, Dr. Fontan summed up his experience and invented an almost crazy procedure – directly anastomoses the superior and inferior vena cava with the pulmonary artery, completely abandoning the right ventricle."

"His thinking is very clear: since the tricuspid valve has been occluded, resulting in the pulmonary circulation can not proceed normally, we know that the pulmonary artery is connected to the right ventricle, and the tricuspid valve atresia causes the right atrium blood to not enter the right ventricle, at this node, the circulation is forced to interrupt, the blood in the right atrium can not return to the right ventricle, so how can the right ventricle have blood into the pulmonary artery to obtain oxygen?"

"Well, Dr. Fontan declares that instead of the right ventricle, we'll just let the heart be responsible for systemic circulation, and use other means to achieve pulmonary circulation."

"In what way? Directly anastomoses the superior and inferior vena cava with the pulmonary artery, which used to be the aorta -——-—— the superior and inferior vena cava -—— right ventricle, but now I bypass the site of the blockage and directly become the superior and inferior vena cava - pulmonary artery. ”

"Without the beating of the heart, how can blood get into the pulmonary arteries? Whether blood enters the aorta or the pulmonary artery, it depends on the heart's pumping, and now there is no pump, how can blood flow in. "One student really couldn't figure it out.

"Shows you're thinking about something!"

Song Zimo held his head high, walked between the lines, his white coat was open like a windbreaker, and his 1.86 meter tall man with a handsome face made the girls sitting fascinated.

In the name of learning, the girls' mobile phones can take pictures of Song Zimo unscrupulously.

"At that time, all cardiac surgeons in the world thought so-pulmonary circulation must rely on the pumping of blood from the right ventricle to the pulmonary artery under the beating of the heart, without the effect of heart pumping, blood cannot enter the pulmonary artery at all, otherwise what would the right ventricle and right atrium do? So this solution is not going to work. ”

"But genius is genius, and genius is either mad, mad, or both!"

When he said this, Song Zimo's gaze fell on Yang Ping, and he stayed for a moment to continue.

"Dr. Fontan thinks completely differently than anyone else."

Dr. Fontan was so confident that this solution would work, and that's when Dr. Fontan came up with a middle school physics concept: pressure difference!

"We know that there is pressure when water flows inside the pipes, and blood is liquid, and there is pressure when it flows inside the blood vessels. The systemic circulation needs to press the blood to the whole body, and the pressure is very high, which belongs to the high-pressure circulation, while the pulmonary circulation only puts the blood pressure to the lungs, which belongs to the low-pressure circulation, so there is a pressure difference between the systemic circulation and the pulmonary circulation, and this pressure difference ensures that the blood of the upper and lower veins will flow to the pulmonary artery. ”

"Dr. Fontan's theory is based on this concept of middle school physics."

"And as I just said, this kind of patient often has a perforation between the left and right atrium, and Dr. Fontan uses this kind of shorting of blood vessels, and if the blood enters the pulmonary artery directly, it happens to completely separate the blood flow from the left and right atrium, so as to avoid mixing."

"Why did this little girl have cyanosis, because of the lack of oxygen, why the lack of oxygen, because of the wrong circulation, the oxygen-rich blood mixed with the oxygen-poor blood."

"Dr. Fontan has never done animal experiments on the little girl from the idea to the preparation of the operation, but the genius firmly believes that he is right, and he overcomes public opinion and performs the operation on the little girl, and the operation is very successful."

"Why didn't he buy a few pigs for experiments and then use them on humans, he wouldn't be able to afford pigs, right?"

A girl asked Song Zimo.

"He can't buy a pig with tricuspid atresia!" There was a boy debating with a girl.

The girl did not show weakness: "Why do you have to be a pig with tricuspid atresia?" ”

"If you don't buy a pig with tricuspid atresia, how can you simulate this kind of case?"

"You are a mindset, normal pigs can also short the pulmonary artery and the superior and lower vena cava, if the pig can still live normally after the short connection, it means that the operation is successful, if it can't live, the operation will fail."

Boys and girls form two sides of the debate, and the students' thinking is active, and they quarrel.

The boys are loud and the girls are high-pitched.

Zhang Lin looked at Yang Ping and was about to stop him, but Yang Ping had a smile on his face, Zhang Lin immediately dispelled this idea, and sat down again.

(End of chapter)