Three of the four \”doors to the heart\” were broken, but the cardiac surgeon successfully repaired them

Cover news reporter Su Dingwei and intern Li Li

A few days ago, the Cardiac and Vascular Surgery Department of the Affiliated Hospital of North Sichuan Medical College completed a case of \”three heart valve repairs\”! Cases of simultaneous repair of rheumatic mitral valve, aortic valve, and tricuspid valve are very rare! Behind this heart portal repair surgery is a highly skilled cardiac surgical team. Under the leadership of Professor Lai Yinglong, this team re-restores people\’s \”heart gates\”, reduces patients\’ financial burden, gives the \”heart gates\” a chance to be reborn, and allows the flower of life to bloom.

The 55-year-old grandmother was out of breath after climbing to the second floor. Three doors were broken

In March this year, a 55-year-old grandmother from Guizhou, accompanied by her daughter and son-in-law, came to the Cardiac and Vascular Surgery Department of the Affiliated Hospital of North Sichuan Medical College. Professor Lai Yinglong, the director of the department, told about her condition. She had been helping her daughter take care of the dolls, but now she obviously felt that she was losing strength. “I used to not be out of breath even when I went to the 5th floor, but now I can’t get out of breath when I go to the 2nd floor. I feel so tired that I can’t stand it anymore, and sometimes I feel flustered and short of breath. I can’t even carry my grandson very easily. There must be something wrong with my body.”

Color ultrasound examination revealed that this is rheumatism. Patients with sexual heart disease were diagnosed with severe mitral valve stenosis with mild regurgitation, mild aortic valve stenosis with moderate to severe regurgitation, mild to moderate tricuspid valve regurgitation, atrial fibrillation, significant enlargement of the left and right atria, and left Atrial thrombosis.

In order to let the patients understand their condition more clearly, Director Lai Yinglong explained to the patients that there are four sets of valves in the human heart, namely the aortic valve, pulmonary valve, mitral valve, and tricuspid valve. It has the function of a one-way valve, which is equivalent to the door in the house. There are four \”heart doors\” in total.

The mitral valve is a very important \”door\” of the heart. There are two \”doors\”. If there is a problem with any one of the \”doors\”, it will cause the \”door\” to be unable to be closed tightly or unable to be fully opened. . The blood from the left atrium during diastole cannot smoothly pass through this \”door\” to reach the left ventricle, or when the blood from the left ventricle during systole is injected into the aorta, part of the blood will enter the left atrium through this \”door\” that is not closed, thus Leading to a series of problems such as lung insufficiency and heart failure. There are a total of four \”heart gates\” in the human heart, and this female patient had three broken ones.

Professor Lai Yinglong leads the heartThe surgical team, with the multi-disciplinary cooperation of cardiovascular anesthesia, extracorporeal circulation, cardiac ultrasound and the extracardiac nursing team of the surgery center, successfully repaired all three broken \”heart gates\”, including mitral valve repair + aortic valve repair + The tricuspid valve was repaired, and left atrial thrombus removal + atrial fibrillation radiofrequency ablation + left atrial appendage closure were performed at the same time. After the operation, the patient was converted to sinus rhythm, and the mitral valve and aortic valve functions recovered well.

Through the return visit, Professor Lai Yinglong heard the patient happily say on the phone: \”Now I can hold my grandson again, eat, sleep and climb stairs. I am very grateful to the doctors and nurses for allowing me to recover.\” Healthy! ”

Leading the country in repair surgery, heart valve The membrane can be \”repaired\” but not \”replaced\”

The Department of Cardiac and Vascular Surgery of the Affiliated Hospital of North Sichuan Medical College, formerly known as the Department of Cardiothoracic Surgery of the Affiliated Hospital of North Sichuan Medical College, was founded in 1985 and is the largest hospital in the province. One of the earliest cardiothoracic surgeries in Jianke Branch. Correction of congenital heart disease and valve replacement surgery were carried out in the late 1980s, coronary artery bypass surgery was carried out in the 1990s, and major vascular surgery was carried out at the beginning of this century.

After more than 40 years of development, in May 2021, cardiac and major vascular surgery was separated from cardiothoracic surgery and officially became an independent department. It now routinely performs various types of cardiac and major vascular surgeries, with an annual operation volume of more than 600. Every year, we receive a large number of hospitals in Northeast Sichuan and neighboring provinces and cities. Difficult and critical patients were referred, and a number of characteristic technologies have filled the gaps in related fields in Northeast Sichuan and even the entire province. The technical strength is among the advanced ranks in the province, especially the mitral valve repair technology for rheumatic heart disease, which is at the leading level in the country. The diagnosis and treatment capabilities of vascular diseases are at the domestic advanced level. In 2022, it will be approved as a key medical specialty construction project in Sichuan Province.

What kind of technology is mitral valve repair for rheumatic heart disease? The heart has four \”heart doors\”: mitral valve, aortic valve, tricuspid valve and pulmonic valve. The heartbeat of a normal adult is 60-100 times per minute, and the heart beats about hundreds of thousands of times a day, which means these four \”heart gates\” It has to be opened and closed hundreds of thousands of times every day, and it is easy to cause problems.

If there is a problem with the \”door\”, wouldn\’t it be better to just replace it with a new one? What about the technically complex and difficult valve repair surgery? Professor Lai Yinglong told the cover news reporter that if an ordinary door is broken, just replace it with a new one, which is efficient and simple, but this is not the case for the \”heart door\”. Patients after valve replacement Long-term or lifelong use of anticoagulants is required Drugs can easily lead to anticoagulation-related complications and are not the most ideal treatment for valvular disease.

Currently, valvular heart disease is a major disease that seriously affects human health and survival around the world. In foreign countries, such as Thailand, Heart disease treatment centers in Malaysia, India and other countries have carried out valve repair surgery earlier. Their long-term postoperative follow-up results of more than 20 years show that the prognosis of valve repair surgery is significantly better than that of valve replacement surgery. Direct replacement is not the best option.

According to reports, in my country, due to limitations of treatment concepts and technical difficulties, there are only a few cardiac surgeries that can routinely perform rheumatic valve repair, and most patients are not interested in repair surgery. The advantages over valve replacement are not well understood, and many patients do not receive optimal treatment. It is understood that currently less than 10% of patients in China have the opportunity to undergo valve repair surgery for rheumatic heart disease.

Rheumatic heart disease valve repair technology can restore vitality to the heart

Research shows that valve replacement surgery removes or destroys the subvalvular structure. It will affect left ventricular function and face valve failure and regeneration in the long term after biological valve replacement. Secondary surgical issues require lifelong anticoagulant medication after mechanical valve replacement. Improper anticoagulant treatment can lead to complications such as bleeding and embolism, seriously reducing the patient\’s life or quality of life.

Valve repair surgery retains the risk. The structural integrity of the native valve preserves left ventricular function to the greatest extent, and the patient\’s cardiac function recovered well after surgery.The surgical mortality rate is low, long-term anticoagulation is not required after surgery, and the occurrence of anticoagulation-related complications is avoided. It is the closest treatment method to cure rheumatic valvular disease. It is suitable for patients of any age and better protects heart function. The quality of life is also higher, saving financial expenses for patients and saving medical insurance resources for the country.

Heart valve repair surgery does not require long-term anticoagulant medication after surgery, and there are few complications. Is every patient suitable for this surgery? Professor Lai Yinglong said that valve repair surgery requires certain basic conditions. Whether valve repair surgery can be performed requires an experienced doctor to make a comprehensive evaluation based on the patient\’s condition, otherwise it may be counterproductive. It is worth mentioning that some patients avoid medical treatment and do not go to the hospital for examination when they are sick. They put it off again and again, and finally go to the hospital when they have no other choice. The patient\’s \”heart door\” disease was already very serious when he saw the doctor. At this time, the doctor\’s scalpel alone could no longer help the patient repair the valve, so he had to perform valve replacement surgery.

Professor Lai Yinglong emphasized that if there is a heart problem, you must go to the hospital in time. Early detection, early diagnosis, and timely treatment are required to avoid worsening of the condition or even losing the chance of valve repair, and the only choice is valve replacement.

Extended reading:

Professor Lai Yinglong, Chief Physician, Director of Cardiovascular and Vascular Surgery Affiliated Hospital of North Sichuan Medical College, Master’s Student Mentor, winner of the May 1st Labor Medal of Sichuan Province, visiting scholar at the Berlin Heart Center in Germany, reserve talent for academic and technical leaders of the Sichuan Provincial Department of Health, and member of the Chinese branch of the Asian Valvular Heart Disease Society.

Having been engaged in cardiac and macrovascular surgery for more than 30 years, I personally perform more than 300 cases of various types of cardiovascular surgeries per year. I am good at various micro-surgeries such as heart valve disease, coronary heart disease, thoracic aortic aneurysm, and chronic atrial fibrillation. He has performed invasive cardiac surgery, etc., and has gone to heart centers in Berlin, Germany, Canada, Bangkok, Thailand, Beijing, and Shanghai for further study.

His team took the lead in carrying out Fontan surgery, rheumatic heart valve repair, transcatheter aortic valve replacement, transapical edge-to-edge mitral valve repair, aortic root surgery in Northeast Sichuan Reconstruction, coronary artery bypass grafting Surgery, ascending aorta and total arch replacement + stent elephant trunk surgery, endoscopic atrial fibrillation radiofrequency ablation modified maze surgery, endoscopic valve replacement, endoscopic cardiac tumor resection, endoscopic congenital heart disease correction, pure ultrasound guidance Percutaneous transthoracic atrioventricular septal defect closure, etc. (Photo provided by the hospital)

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