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, and the normal left and right ventricular structures need to be reshaped.

Next, the aorta and pulmonary artery in the long reverse position, together with the corresponding valve, are re-excised and sutured to the correct position.

Easier said than done, it is extremely difficult to do, and there are many challenges.

For example, if a child has undergone three major surgeries before, the situation after thoracotomy will be very complicated, resulting in a much longer than usual operation time, which is a great challenge to anesthesia and cardiopulmonary bypass.

In view of various emergencies that may occur during the operation, Zhou Qiao has communicated and practiced many times with the anesthesia and cardiopulmonary bypass support team of the University of California to ensure that nothing goes wrong.

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

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

This operation was created by Zhou Qiao and Murphy on the spot, which is the first in the world, so before the operation, Zhou Qiao communicated with the child's parents and informed them that the success rate of the operation was about 60%, and there was a certain possibility of failure.

Parents are also aware of their child's condition and accept the risks. From another point of view, they feel that it is worth looking forward to having such a high success rate.

In fact, Zhou Qiao spoke conservatively, he had at least a 90% success rate, but he couldn't be too full, and he had to leave room for himself.

In the operating room, Zhou Qiao was in charge of the surgery, and Murphy assisted.

As expected during the preoperative consultation, the thoracotomy was unexpected.

The other doctors who observed the scene and the monitoring room all raised their hearts to their throats.

This is because the child has undergone three surgeries before, and not long ago, less than a month ago, he had a recent major surgery.

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

This kind of work is delicate work, and the various organs of the child are relatively small, if you change the general doctor, it is estimated that you will panic at this time. I don't dare to speed up, because the "road conditions" are not good, and if the speed is a little faster, it may be "accidental".

And the longer the delay, the greater the risk. Because this surgery requires cardiac arrest, cardiopulmonary bypass is an advanced technology, but it also has side effects, the longer the time, the greater the blow to the human body, and the higher the sequelae caused.

In severe cases, it may even affect the success of the heart's rebeat.

In the monitoring room, an expert in cardiac surgery at the University of California Medical Center muttered secretly: "According to this situation, it is estimated that it will take two hours to open the chest." ”

At this time, the heart is already fully open and stopped, and the inside of the heart can be operated on, but now I haven't even seen it.

The doctors on the side also looked worried: "It takes two hours to open the chest, plus the operation time, how long does it take?" Can the child handle it? ”

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

Just when they were worried and sweating for Zhou Qiao and Murphy, Zhou Qiao and Murphy glanced at each other, and they had a good understanding of each other, and they invariably accelerated the movements of their hands.

Other doctors didn't dare to speed in this bad "road condition", but Zhou Qiao and Murphy cooperated with each other and raced at a speed like a racing car.

Iris Celestial's Hurricane Mode is on!

The journey was thrilling, but it didn't cause any additional damage to the child, which had to be amazing.

"It's god-like hand speed and skill!"

"This is the Lord's favor!"

I saw that only more than ten minutes later, some tissues and blood vessels on the surface of the child's heart appeared, and then, after more than ten minutes of freeness, I saw the child's small heart.

Originally, the preliminary action that experts expected would take two hours to complete, Zhou Qiao and Murphy only took more than twenty minutes, and they have to say that they are fast.

And this kind of extremely risky surgery, any minute and second belongs to the golden time, and every inch of time is gold.

Suddenly, the unexpected happened.

Everyone was terrified, and they were really afraid of something.

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

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

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

The situation is critical.

Fortunately, Zhou Qiao formulated a plan for this situation in advance, and at this time, with Zhou Qiao's order, the anesthesia team immediately pushed into the blood quickly, manually and in large quantities according to the previous emergency plan.

At the same time, Murphy stopped the bleeding.

Blood pressure rises and stabilizes.

There is no danger.

The exposure to the heart is finally complete, the cardiopulmonary bypass machine begins to run slowly, and the child's heart stops.

Even if Zhou Qiao and Murphy made a move, the speed of flying still took twice as long as the "usual" operation.

Zhou Qiao and Murphy worked together to perform their tricks, and when they reached the inner part of the heart, the complex condition of the child's heart was finally completely exposed.

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

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

Since we want to do it, we should do it all together and leave no flaws.

In the double artery and double root transfer, the child also had pulmonary artery stenosis, and Zhou Qiao and Murphy also enlarged the pulmonary artery with the help of external ducts while reversing the position.

This is really a super project, it can be said that after the whole operation, only the mitral valve of the patient's entire heart remained in its original state, and all other parts have been 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 is almost at the limit of its arrest, with a maximum of an hour to go. In the long run, the surgery can be successful, but the damage to the child's heart muscle will be irreversible, and it may leave a lifetime of sequelae.

At this time, the progress of this complex operation is only more than halfway.

Zhou Qiao and Murphy glanced at each other, and the two of them had a clear heart again, and turned on the Hurricane Super God Mode.

Finally, at about two o'clock in the afternoon, the operation of the intracardiac part was completed, and before the expiration of the myocardial arrest protective solution, the cardiopulmonary bypass machine was withdrawn, and the heart rebeat successfully.

For the first time in the eight years since birth, the child's heart was beating in a normal form.

"Knock~, knock~, knock~"

Although weak, but all at once, quite rhythmic, this is a normal rhythm, full of vitality, as if the sun at eight or nine o'clock in the morning, originally submerged by thick dark clouds, it is estimated that it will not be able to "come out" all day, at this time, under the skillful hands of Zhou Qiao and Murphy, suddenly drill through the clouds, vigorously, sprinkled ten thousand golden lights.

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

A beautiful anesthesiologist screams, whistles, and dances incessantly to express her excitement.

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

Because, Dr. Chow and Dr. Murphy did a fantastic job!

Originally, the difficult and complex surgery that might not have been successful in more than ten or twenty hours was completed in more than five hours!

It's a miracle!

Iris Clinic, once again a miracle!

In fact, the difficulty is really very big, if it wasn't big, Zhou Qiao and Murphy would definitely not have taken so long to make a joint move.

"Steady, the danger is not really over." Zhou Qiao told the team members.

Everyone looked at each other, their hearts were beating successfully, what else was there to worry about?

So the difficult times have come, no matter how dangerous it is, what is it?

Everyone was unimpressed.

Because Zhou Qiao and Murphy had been operating for a long time and were too tired, several senior doctors from the Department of Cardiac Surgery at the University of California Medical Center volunteered to do it for them, and the other party was very active and a senior doctor, so Zhou Qiao asked them to do it. He and Murphy went to rest for a while, drank saliva, and went to the toilet.

Before Zhou Qiao and Murphy left, they couldn't help but advise: "The child's tissue is too brittle, and there may be tears and bleeding after the rejump, so you must pay attention." ”

"OK, don't worry, Dr. Zhou, we will add biological tissue spacers to the weak areas to make up for the fragility of the tissue." The doctors who do it are full of confidence.

Zhou Qiao and Murphy left.

In the bathroom, the two also made out a little, after all, they were too tired, although it was only more than five hours, but even they had been nervous and a little unbearable.

This is not a marathon, but a five-hour sprint in a row, and the physical and energetic consumption is very large.

However, they did not dare to really "rest" for too long, because the danger really did not pass.

When they came back to the operating room, sure enough, the doctors who saw the surgeon were sweating profusely.

The cardiac rebeat was successful, but due to the large scope of cardiac surgery, thousands of stitches, coupled with long-term stopping and cardiopulmonary bypass, the child's coagulation function decreased significantly, and almost all anastomoses were constantly oozing blood, and the chest was blocked.

Even so, the surgeons added biological tissue spacers and reinforced them during the suturing of each anastomosis. However, the bleeding situation is still not optimistic, and the child even has ventricular rhythm.

It's not a matter of their level, it's that the child is really too vulnerable!

The tender tofu is carved on it, but after a long time, because of the "gravity", the tender tofu itself will not be able to support it.

"Doctor Zhou, what now?" A surgeon was ashamed, patting his chest and saying it was okay, but now, he couldn't even handle such a "trivial matter" as chest closure.

Zhou Qiao pondered for a few seconds and said, "Let's go to ECMO." ”

So, ECMO started.

Beforehand, there was preparation.

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

I was busy until the sun set in the Pacific Ocean and when it was dark, with the help of ECMO, the patient's heart was filled with 28 pieces of gauze, and the bleeding was temporarily controlled, and the patient returned to the PICU with a delayed chest closure.

Under the close supervision of the PICU, the child's coagulation status improved greatly 24 hours after surgery.

However, the accident happened again, and when ECMO was withdrawn, the child had a sudden malignant arrhythmia.

Zhou Qiao and the others never left, and quickly went into battle, and together with the monitoring team of the University of California Medical Center, they quickly defibrillated, expanded, and reduced fever and other measures to rescue, and in the end, they survived this hurdle without danger.

After 46 hours of surgery, the chest closure was completed, and on the 5th day after the operation, he was removed from the invasive ventilator, and his condition was getting better day by day, and he was just around the corner for discharge.

The parents of the child were unfrenetted.

While everyone was happy for their family, they also felt very fortunate that it was the luck of the child to meet Dr. Zhou, the top in North America. Otherwise, it's a different story.

……

Iris Clinic, Nanako Chiba re-examined the four-year-old child, and the other party has not grown for half a year, only gaining weight, and the situation is naturally quite abnormal.

The mother took the child for a check-up, and when the report came out, she brought the baby to the follow-up again.

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

"Cushing's syndrome?" Bao's mother was confused, she hadn't heard of it at all.

Nanako Chiba stroked her long black straight 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, all of which are significantly higher than normal, in addition, he is stunted, obviously overweight, BMI is as high as 29.99kg/m2, his face is round, but his limbs are small, his abdomen is fat, there are fat pads on his back, his eyebrows are thick, and his forehead and back hair are increased. Purple striae on the skin of both lower extremities and thighs are typical of Cushing's syndrome. ”

"So what to do?" When Bao's mother heard this, she was in a hurry.

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

"Still need to check? Don't you know about the disease? Can't it be treated right away? Bao Ma asked puzzled.

She really didn't want to wait for a moment.

Nanako Chiba patiently explained, "This disease is a rare disease, especially in young children, and there are many causes, so it is very important to have a clear and accurate diagnosis. For example, adrenal origin, ectopic origin, pituitary origin...... Different causes have different treatment methods and different prognosis, so further examination is necessary to find out the true cause before the right medicine can be prescribed. ”

"Hurry up, hurry up!" Bao Ma urged.

Nanako Chiba then arranged an endocrine auxiliary examination for the child, and according to the results of the examination, it was more likely that a pituitary tumor would be found, but the imaging was not typical.

Although she continued to ponder alone and could eventually be diagnosed, for the sake of the child and in order to clarify the condition faster, Nanako Chiba had to turn to the team and called Zhou Qiao, Murphy and Stephanie to discuss together.

There is a lot of power in numbers.

(End of chapter)