world famous doctor

Chapter 97 Dextrocardia and Tetralogy of Fallot
Zhou Chen raised his head and looked at Dr. Zhang Jian.

They continued to actively perform CPR rescue measures on the little boy.

A series of rescue measures were used.

Probably another hour or so passed.

The little boy's condition gradually stabilized, no more convulsions, and his consciousness gradually became clear.

The entire face also gradually turned rosy, and the heart rate was 94 per minute, and the heart was strong.

spo2 rises to 0.99.

After seeing the little boy turned from danger to safety, all the medical staff breathed a sigh of relief.

Especially Dr. Zhang Jian.

The solemn look between his brows gradually dissipated.

"Xiao Zhou, you are doing well!"

At the same time, he gave Zhou Chen a thumbs up and praised.

Zhou Chen looked at him with a faint smile and said:

"Pay close attention to the electrocardiogram, myocardial enzymes, and serum electrolytes!"

They walked out of the emergency room, and the little boy's parents sat on a bench in the corridor with their heads bowed.

Until now, their heads are still covered.

A nurse said: "The child is fine now!"

After hearing the sound, they raised their heads and rushed forward.

It could be seen that the little boy's father had just cried.

His eye sockets were bright red.

Hearing the news, he was filled with gratitude.

"Doctor, thank you so much."

"There is no need to worry too much. The child is fine now. It is estimated that after another four or five days of observation, he will be discharged from the hospital after the infusion."

While Zhou Chen was talking, he turned his head and told the nurse, "Next, we will instill 10ml of 250% glucose every day, plus two grams of vitamin C..."

"Good Doctor Zhou." The nurse replied.

The little boy's father came forward and held Zhou Chen's hands excitedly, repeating over and over again:

"Doctor, thank you so much for saving my son's life..."

Zhou Chen smiled lightly.

system hint:

"Heal the wounded and save lives, get praise +6600"

"Amount+5000"

"A senior doctor has been promoted to a junior doctor, and the task progress has been completed by 40%..."

I checked the time, it was almost 1:00 in the morning.

Zhou Chen was just about to go back to the lounge to take a nap.

At this time, another middle-aged patient, about 40 years old, came to the emergency room.

His mental state is poor.

After walking into the emergency room, Zhou Chen found that he was out of breath.

Zhang Jian also sighed secretly.

It seems that there is no need to rest tonight.

"What's wrong with you?" Zhou Chen asked first.

The middle-aged patient came to the consultation table and sat down.

He handed over the previous checklist and various case reports in his hand.

Doctor Zhang Jian took a look.

This is a patient with mirror dextrocardia and tetralogy of Fallot three months after tof radical operation.

Seeing this, Zhou Chen couldn't help but feel his heart sink.

The middle-aged patient said slowly:
"After this operation, I feel chest tightness and shortness of breath, especially after activities..."

Immediately afterwards, Zhou Chen gave him a physical examination.

Examination revealed:
The nutritional status of the middle-aged patient was poor, the breath sounds of both lungs were coarse, and a small amount of moist rales could be heard at the bilateral lung bases.

The heart rate is 79 beats per minute, the heart rate is equal, and the lower limbs are swollen...

At the same time, according to the previous checklist of the middle-aged patient, systolic tremor was palpable in the precordial area of ​​this middle-aged patient, and the border of cardiac dullness expanded to the right.

According to his chest x-ray:
The right ventricle of the dextrocardia was enlarged, and there was a small amount of pleural effusion on the left side. The electrocardiogram showed a pacing heart rate. The pacemaker felt and drove well, and the pacing frequency was 80 beats per minute.

Diagnosis: mirror dextrocardia with residual ventricular septal defect after tof radical resection, cardiac function grade [-].

Zhou Chen and Dr. Zhang Jian looked at each other.

They began to discuss the need for treatment of residual ventricular septal defect.

General literature shows that after tof radical resection, the incidence of residual ventricular septal defect is generally between 10% and 35%.

It is related to the location and size of the VSD before surgery, intraoperative surgical technique and other factors.

In general, most of the smaller residual defects have the possibility of self-closing due to mechanisms such as cell covering thrombosis, tissue fibrosis, etc.

However, for larger residual defects, it is often difficult to close by itself.

Zhou Chen thought for a while and expressed his point of view.

"I think... an interventional treatment should be carried out..."

Dr. Zhang Jian has a rigorous attitude towards medical treatment.

He carefully read the middle-aged patient's medical records and previous examination reports from beginning to end.

The report showed in detail that the obstruction of the right ventricular outflow tract of this middle-aged patient had been relieved after tof radical operation, and a large amount of residual shunt would further increase pulmonary hemorrhage, easily lead to pulmonary edema, and lead to cardiopulmonary insufficiency.

Moreover, residual defects that cannot close by themselves may also cause infective endocarditis.

Dr. Zhang Jian did not reply.

Zhou Chen took over the middle-aged patient's previous surgery materials and looked at them.

His ratio of pulmonary flow to systemic flow was 2.3, which is one of the indications for surgery.

He bent down, leaned close to Dr. Zhang Jian's ear and whispered:

"In my opinion, this patient must undergo another operation, but the method of operation is still open to discussion. My personal opinion is interventional treatment."

After some thinking, Dr. Zhang Jian nodded and responded:
"There are currently only two treatments for his disease, interventional therapy and thoracotomy."

Zhou Chen frowned and analyzed comprehensively:
"Because he has already had an operation, if we have another thoracotomy, the operation will be more difficult due to factors such as tissue adhesion, and the risk borne by the patient and us will be relatively large. Reports have shown that congenital heart disease two Surgical mortality and major complication rates were as high as 7.6% and 24% respectively…”

"Then what do you mean, just give him cardiovascular interventional treatment?"

Zhang Jian stared at Zhou Chen closely and asked.

"Yes." Zhou Chen nodded.

In recent years, with the development of cardiovascular interventional therapy technology, transcatheter closure of VSD has become increasingly mature.

Compared with surgical thoracotomy, the efficacy of transcatheter closure is comparable.

It also has the advantages of small surgical trauma, no scars, short hospitalization days, quick postoperative recovery, and few complications.

Zhou Chen considered that the middle-aged patient in front of him was in poor physical condition and had serious heart failure.

If reoperation, the risk is indeed particularly high.

Moreover, echocardiography suggested that the location and size of the residual defect was only suitable for transcatheter closure.

Therefore, Zhou Chen decided to use interventional methods to treat him.

Zhang Jian got up and briefed the middle-aged patient on the price of the occluder used in the interventional surgery.

There are imported occluders and domestic VSD occluders.

The efficacy of domestic VSD occluders is similar to that of imported products, but the price is only about half of that of imported products.

The middle-aged patient seemed to come from a rural area. Due to financial constraints and years of illness and treatment, he could only choose a domestic VSD occluder at the moment.

(End of this chapter)