Chapter 2050

DIDU women's and children's hospital is one of the few gynecological and pediatric hospitals in DIDU and even the whole country.

About 15000 newborns are delivered every year.

It is bustling and bustling all year round. Even during the Chinese new year, other large class III hospitals are deserted, and it is still lively here.

Different from other large-scale third class general hospitals, the vast majority of people here are jubilant rather than depressed.

After all, it's a good thing to import.

There are more than a dozen obstetric wards in the women's and children's hospital. In the doctor's office of each ward, there are too many brocade flags to hang.

When people are happy, their spirit is cool, and their mother and son are safe. It is also reasonable to send wedding money and brocade flags.

It's just that there's something wrong with the atmosphere in maternity ward 1 today.

The door of the doctor's office is closed. People who have not undergone surgery sit in the office. Experts and professors from other hospitals and leaders of our hospital sit in the office.

The air was stagnant, as if there had been a major medical accident, and no one spoke.

It happened more than two months ago.

A 39 year old pregnant woman found that her child suspected of congenital aortic stenosis during examination.

At that time, the fetus was only 24 weeks old, and congenital aortic stenosis could be seen. It can be said that the level of women's and children's hospital was quite high.

Seeing the examination results, the doctor explained the condition with the patient and the patient's family at that time.

Left ventricular outflow tract obstructive heart disease caused by congenital abnormal development of aortic valve accounts for about 3% - 6% of congenital heart disease.

If the fetus has aortic stenosis in the early and middle trimester of pregnancy, the filling blood volume of the left ventricle will be affected and continue to decline with the extension of pregnancy.

Finally, it may lead to progressive dysplasia and heart failure, forming left ventricular dysplasia syndrome.

Children face new dangers every day from birth to treatment, even in their mother's womb.

Every step is a barrier, and the wrong step is the gate of death.

There is a great possibility of stillbirth. Even if you are born alive, you have to face countless troubles.

The doctor suggested induced labor, which is the most suitable choice for the current situation.

But the pregnant woman herself is nearly forty. She has paid a lot in order to have a child and realize her dream of being a mother. In the case of pregnancy induced hypertension, it continues to persist.

For her, giving up this option does not exist.

After listening to the doctor's gentle narration, the pregnant woman herself resolutely refused to induce labor, crying and looking forward to a miracle.

Perhaps with the process of pregnancy, the child's condition is not aggravated, but relieved. This situation is not impossible, but the possibility is very low, so low that it doesn't need to be considered at all.

After choosing to protect the fetus, pregnant women travel all over the imperial capital. As long as the level of hospitals is high, the final conclusions are consistent.

This time, it was found that the fetal condition was deteriorating during yesterday's prenatal examination.

The aortic valve differential pressure gradually increased from 22 mmHg to 85 mmHg. The ratio of left and right ventricles was gradually maladjusted. During the observation, fetal pericardial effusion and mitral regurgitation appeared one after another.

All signs show that the congenital aortic stenosis in children is developing very severely, with heart failure and other manifestations.

Just 32 weeks pregnant

The pregnant woman still disagreed with induced labor. She disagreed at 24 weeks. After 8 weeks, her attitude was more firm.

Although she knows that after caesarean section, the child may have to undergo continuous major surgery and even die, she still doesn't give up.

After the discussion of expert groups inside and outside the hospital, three treatment methods were summarized.

First, close observation and conservative treatment.

In fact, there is no way. The child's current state can't last until 38-40 weeks of natural delivery.

Second, prepare for caesarean section. After the child is delivered, go directly to another operating table for thoracotomy to treat his congenital aortic stenosis.

This treatment is risky.

The growth of children in pregnant women is not very good. Only 32 weeks, they have the symptoms of pericardial effusion and heart failure.

The operation is easy to do... It is very difficult, but compared with the postoperative recovery of children, it has become a very simple and easy operation.

This step is also voted by almost all doctors.

The doctor of the operation, the hospital also invited the nationally famous doctor Liu Cixi to take the lead.

Dr. Liu Cixi has done the most successful operations in China. But even so, the success rate of surgery is less than 30%.

To be honest, if you choose to keep children, you are likely to face the end of empty money and people at home.

Ultra difficult surgery, ultra-low success rate and massive expenses every day are all problems.

In addition, there is a third surgical method - the development of neonatal cardiac surgery and catheter intervention technology, which can be used for intrauterine intervention.

It sounds like an impossible treatment.

The principle is very simple. Interventional surgery is used to treat congenital aortic stenosis. Open the stenosis as soon as possible and improve the aortic blood flow as soon as possible.

It can promote the development of fetal left ventricle and create opportunities for biventricular circulation after birth.

And if the operation is perfect, the fetus can continue to grow in the mother and give birth naturally for 38-40 weeks.

The next month and a half to two months are very important to the fetus!

But,

Just,

Sounds beautiful.

The time of intrauterine interventional therapy is not long.

In 1991, the world's first relevant treatment case was first reported by Maxwell D et al. The literature was published in the case report of New England magazine, which attracted the attention of many interventional doctors at that time.

So far, more than 200 clinical cases have been reported internationally, mainly in western countries. Balloon dilatation of aortic valve accounts for the majority, and the technical success rate is more than 50%.

Well, more than 50%, in other words, the mortality rate is more than 40%, nearly 50%.

Compared with cardiothoracic surgery after laparotomy, this mortality rate is also barely acceptable.

But!

Intrauterine interventional surgery has a high risk.

In addition to the fetus, there are risks for pregnant women.

In the second scheme, pregnant women are sure to have no problem. However, to choose intrauterine intervention, pregnant women share half of the life risk of the fetus.

At this time, there are differences between patients and their families.

The pregnant woman herself insisted on the third kind of intrauterine intervention, while the family members asked for the second kind of operation.

It is an old proposition to protect adults or children.

When the medical level is underdeveloped, dystocia is fatal. There was no caesarean section at that time, so there would be such a proposition.

However, with the rapid development of medical technology, it has become a false proposition to protect adults or children.

But when this ancient choice was put on the table, all doctors were helpless to find that it really existed.