The door at home is broken, what should I do?
Many people take for granted:
Fix it first, and then replace the door frame if it is not repaired.
But actually, changing the door frame will involve
Matching and other issues are really troublesome
In the human body, there are also many “doors”
“Heart Gate” is one of the most famous gates
There are many ways to deal with a broken heart
But if the heart door that has been changed once is broken again
So what to do?
Hangzhou 90-year-old Uncle Lu (pseudonym) encountered a problem
Finally at the First Affiliated Hospital of Zhejiang University School of Medicine
Cardiac and vascular surgeons take a “marriage doll” approach
Give him a “door within a door”
01
September Veteran’s chest tightness and shortness of breath
The “heart door” changed 15 years ago is broken
Uncle Lu is 90 years old this year. He is full of spirit and kind-hearted. He has participated in the War to Resist U.S. Aggression and Aid Korea. He is also a “star” in the community. Almost every household knows him. At the end of the year, it really scared the people around him for a while.
It turned out that from November 2021, Uncle Lu felt a little tight in his chest and short of breath, as if his breathing was not as smooth as before. “I used to be able to take the elevator to the community garden for a walk, but I felt tired after walking a few steps during that time.” The old man’s daughter said that although the old father had a heart operation more than ten years ago, his physique has not changed in recent years. Yes, I would show up downstairs in the community almost every day. I didn’t go downstairs because of physical discomfort in those days. Many neighbors in the community came to ask if they were sick.
“In addition to shortness of breath, I sometimes have headaches and dizziness, but after sitting down for a few minutes, it will be relieved.” Mr. Lu said that because of these symptoms, he often couldn’t sleep well. Caused a very poor mental state the next day.
Considering that when Uncle Lu discovered aortic insufficiency 15 years ago, it was these manifestations. The family did not hesitate to take him to the meeting of Chief Physician Li Weidong, Deputy Director of the Cardiac and Great Vascular Surgery Department of the First Hospital of Zhejiang University. Outpatient visit.
Chief Physician Li Weidong learned that Uncle Lu had previously replaced a biological valve with a service life of 10 to 15 years, so it is very likely that the biological valve has a problem again. Subsequent examinations also confirmed the doctor’s suspicions: the bioprosthetic valve had mild stenosis with moderate to severe insufficiency, and the heart function was rated at grade 3 – leading to significant limitations in physical activity.
The solution is very clear: re-replace a valve. However, the risk of another valve replacement is huge, and there is a life-threatening danger at any time without surgery, which puts the family in a dilemma and tests the wisdom and skills of the medical team.
02
Surgery is like a game of nesting dolls
Minimally invasive “flap-in-flap” solution
The minimally invasive cardiac and vascular surgery team had a serious and careful discussion. “The aortic valve is the most important heart door of the human body. At present, the most important method for valve replacement is to open the chest and replace the valve.” Chief Physician Ma Liang, director of the department, said, but the old man is already 90 years old. Whether it is anesthesia or surgery, it will be a A very high challenge, very risky, and the family did not agree with this surgical plan. However, the replaced biological valve cannot be opened or closed, and the conservative effect is minimal, so it is necessary to replace the valve again. Is there a way to replace the valve again without opening the chest?
As their families were at a loss, the new plan proposed by the Ma Liang team gave them hope.
“We plan to use a minimally invasive ‘valve-in-valve’ treatment method.” Chief Physician Li Weidong explained that the biological valve previously replaced by Uncle Lu is structurally equivalent to being replaced at the same time. A door frame and a door. After more than ten years of use, there is a problem with the valve in the middle (that is, the door). This operation can only replace the door without changing the door frame.
Schematic diagram of stent-valve surgery, online picture
Therefore, during the operation, the doctor will send the new valve through the catheter to the place of the aortic valve, “push” the faulty valve to the side, and then release the new valve and fix it, and A discarded valve is harmless to the body even if it is not removed.
Simply put, the entireThe operation is like a “Matryoshka game”, in which a biological valve is re-inserted into the original biological valve. This transcatheter interventional valve replacement (TAVI) is the most minimally invasive technique. The team of Ma Liang and Li Weidong has successfully completed a large number of cases in recent years and accumulated very rich clinical experience.
Li Weidong (first from right) team during surgery, photo courtesy of the department
Minimally invasive intervention, low risk, fast recovery, leading technology… Such plans and technologies have been highly recognized by family members. After detailed preoperative preparations were made, Chief Physician Ma Liang and Chief Physician Li Weidong’s team carried out “valve-in-valve” replacement for Uncle Lu without thoracotomy and minimally invasive intervention. Due to the challenges brought about by the large transverse heart angle, the stent valve was delivered through the femoral artery to the decayed original valve, and a new door was accurately implanted in the original door. The release was successfully matched and fixed, and the position was perfect. The valve began to work immediately, and the new valve door function indicators were excellent by DSA angiography and ultrasonography. The surgery was a complete success.
After the operation, Uncle Lu recovered very well. The symptoms of chest tightness and shortness of breath disappeared quickly. All physical indicators were normal. He was discharged from the hospital 5 days after the operation.
Patient with medical team on discharge, photo courtesy of department
03
Valvular disease on the rise in the elderly
Open chest valve replacement is very mature
“With the aggravation of aging, there are more and more valvular diseases in the elderly, and aortic insufficiency is a very common valvular disease” Ma Ma, director of the Department of Cardiac and Great Vascular Surgery, First Hospital of Zhejiang University According to Dr. Liang, chronic aortic insufficiency can be asymptomatic for a long time, but as the disease progresses, symptoms such as dyspnea, palpitations, fatigue, and dizziness may occur, and in severe cases, cardiac insufficiency and even heart failure may occur. Life-threatening.
The most important surgical method for valvular heart disease is thoracotomy. For elderly patients, conventional thoracotomy is traumatic and the recovery is slow. In recent years, the minimally invasive team of the Cardiac and Great Vascular Surgery of the First Hospital of Zhejiang University has innovated and developed, and vigorously carried out minimally invasive surgery. In the past three years, more than 220 cases of valve interventional surgery without thoracotomy have been completed, including more than 120 cases of TAVI/TMVR surgery (transcatheter aortic valve/mitral valve implantation), 87 cases of paravalvular leakage interventional closure, and transcatheter valve leakage. 13 cases of mitral valve interventional repair. Among them, many cases of the first operation in the province and the country were created. For example, in 2019, the country’s first transfemoral TAVI + staging thoracoscopic radical resection of lung cancer, the country’s first transapical TAVI + simultaneous left lung cancer radical resection (same incision), and the province’s first cardiac surgery interventional valve-in-valve TAVI operation will be completed in 2020 The country’s first transapical mitral valve “edge-to-edge + chordae tendinea” repair operation, etc.
Of course, minimally invasive interventional valve surgery has huge minimally invasive advantages, but the high medical costs often greatly affect the choice of patients. To this end, the Department of Cardiac and Great Vascular Surgery of the First Hospital of Zhejiang University is actively pioneering and innovating. Currently, 7 free clinical trials are carried out in the field of cardiac valve interventional therapy, including aortic valve disease, mitral valve disease, tricuspid valve disease and previous bioprosthetic valve surgery. Failure, etc., may be included in the group for free minimally invasive interventional surgery through evaluation. It is hoped that this minimally invasive technology can be continuously developed and popularized to bring more good news to elderly patients with valvular disease.