Heart failure patients successfully averted danger, Zhongshan Hospital completed the world's first "one-stop" native three-valve interventional surgery
Recently, the team of Professor Wang Chunsheng and Chief Physician Wei Lai from the Cardiac Surgery Department of Zhongshan Hospital of Fudan University successfully performed the world's first "one-stop" native three-valve interventional surgery, correcting the "reverse flow" problem of the three blood delivery valves in the heart for the patient. , turning danger into safety. The patient, Mr. Li, was followed up for the first time two months after the operation. All three valves returned to normal function. After successfully escaping, he was finally able to sleep peacefully.
Mr. Li, 66, has been suffering from chest tightness and asthma for the past five years. He has difficulty falling asleep at night and can only be relieved by sitting up. After a pacemaker was implanted in a local hospital a year ago, his symptoms did not improve significantly and even continued to worsen. In August this year, Mr. Li came to the Cardiac Surgery Department of Zhongshan Hospital for help. Chief Physician Wei Lai who treated the patient found that the patient had severe aortic and mitral valve regurgitation, extremely severe tricuspid valve regurgitation, enlarged whole heart, and left ventricular ejection fraction of only 29%.
Due to long-term heart failure, Mr. Li's lower limbs were swollen and hard like "elephant skin legs". His skin was broken and infected in many places, and he was complicated by liver and kidney failure. He also had a history of gastric bleeding and intestinal perforation repair surgery in the past, and his condition was very critical. Based on the medical history and examination, the heart team discussed that the risk of performing a thoracotomy on Mr. Li was very high, and the only hope was to treat three valves at one time through minimally invasive interventional surgery.
Experts explain: There is one room and one chamber on each side of the heart. The "automatic gate" of the valve between the chamber and the chamber controls the "one-way" transport of blood from the chamber to the chamber. The "gates" on the left and right sides are the mitral valve and the tricuspid valve respectively. The "gate" that controls blood flow from the left ventricle to the aorta is called the aortic valve. These "doors" are held in place by a "door frame" called the annulus. If there is a problem with the "door" and it is not fully closed, blood will flow back, causing "crowded room". When several doors have problems at the same time, it can cause the entire "house" to swell and cause heart failure.
In the past, due to the lack of corresponding interventional equipment, aortic valve and tricuspid valve regurgitation once became a "forbidden area for interventional surgery" and could only be repaired through thoracotomy. There is no precedent for simultaneous interventional surgery for three valve regurgitation.
Fortunately, with the continuous development and innovation of domestic devices, domestic interventional devices targeting aortic valve, mitral valve and tricuspid valve regurgitation have recently been officially put into clinical use. It is reported that Dr. Wei Lai has successfully performed simultaneous three-valve "valve-in-valve" surgeries and simultaneous interventional surgeries for double-valvular regurgitation many times, and has rich experience in the diagnosis and treatment of valve regurgitation. His condition was urgent, so he decided to take the lead. The heart team immediately formulated a detailed surgical plan and emergency plan for Mr. Li.
During the operation, it was discovered that Mr. Li's three valve annulus were loose and crumbling due to their large area. Once this "threshold" became loose, the implanted valve could only be removed through thoracotomy, which would very likely cause intraoperative cardiac arrest or intraoperative cardiac arrest. Recovery was difficult. Mr. Li also suffered from an oversized heart and severe tethering of the posterior mitral valve leaflets, which also increased the difficulty of clamping. There were many difficulties, and even the slightest mistake would lead to failure.
With the assistance of Deputy Chief Physician Dong Lili of the Department of Cardiac Ultrasound Diagnosis, Chief Physician Guo Kefang of the Department of Anesthesiology, Chief Nurse Zha Wanjun and Nurse Wang Chenghao of the operating room, Chief Physician Wei Lai led the attending physicians Yang Ye and Wang Wenshuo to The apical puncture point is exposed through a minimally invasive incision on the left chest, and the artificial aortic valve is sent to the "failure point" through the guide wire to be released, replacing the original "bad door". Subsequently, the mitral valve clamp was inserted through the original apical puncture point, but the "door gap" of the mitral valve was too large and the clip could not capture the "door panels" on both sides at the same time. Experts used original valve retraction technology to push the clipper against one side of the "door panel" and pull it closer to the other side of the "door panel" to successfully clamp the mitral valve. After inserting the second clip, the mitral valve reversed. Flow dropped significantly. Finally, the replacement tricuspid valve was punctured through the right atrium and successfully released.
After 5 hours, the "three doors" were all repaired at once, and the operation was successfully completed.
It is reported that under the leadership of Academician Ge Junbo and Director Wang Chunsheng, Zhongshan Department of Cardiology and Surgery worked closely together to perform various interventional and surgical valve surgeries on complex and high-risk patients. The successful implementation of the world's first "one-stop" TAVRTEERTTVR surgery will bring new hope to more patients with combined valve disease.
