Release date: 2017-07-31 How powerful is the fetus? In November 2003, a photo of a 21-week-old fetus was reprinted on several foreign news sites. The little baby named Samuel Alexander Armas was diagnosed with spina bifida in his mother's womb. This means that if you don't do anything, it may not live until birth. After his parents and doctors discussed it in detail, they made a very courageous decision: to do a repair operation in the palace! When the uterine cavity was opened, a small hand came out of the uterus to hold the doctor's hand. The signal from this tenacious life touched countless people including the attending doctor. The small hand that protruded from the uterine cavity held the surgeon's finger And not long ago, another baby created a miracle of life, which occurred in China, in Beijing Anzhen Hospital. On June 8, 2017, Professor Zhu Junming, who was on the cardiac surgery table, received the good news from the operating room of the gynaecology department downstairs. The magical baby was born and was a healthy baby girl. The surviving baby is the first in China and the third in the world to be verified, previously in 2002 and 2008. When visiting the mother and daughter in the maternity ward, Professor Zhu Junming, who is joking, said: "This child is too big and will be able to become a pillar of the country in the future." Where is the "magic place" between her and her mother? Pregnancy with aortic dissection She is the 4th pregnant child of a 28-year-old mother with a sister in front. More than 4 months before birth, on the 29th of January, 2017, she was a 16-week fetus, and her mother could just feel her fetal movement. In the early morning, my mother suddenly suffered from severe chest pain and was diagnosed with an acute aortic dissection. She accompanied her mother from Langfang to Anzhen Hospital in Beijing. At 9 o'clock in the morning, they were lying on the operating table, only 8 hours from the onset of the disease. Anzhen Hospital is the referral center for patients with heart disease in pregnancy. Professor Zhu Junming’s team received an emergency notice immediately and rushed to the hospital. The hospital’s anesthesia, cardiopulmonary bypass, obstetrics and gynaecology, fetal ultrasound, new pediatrics and other multidisciplinary emergency consultations. Professor Zhu Junming is the director of the 7th ward of Cardiovascular Surgery at Anzhen Hospital and a well-known cardiovascular surgeon at Sun Lizhong's aortic team. In the treatment of pregnancy with aortic dissection, the team has the largest single center experience in the world to date. Her mother was suffering from one of the most critical conditions in the acute aortic dissection, the type A aortic dissection, and the entire aorta was torn from the head to the tail. Aortic schematic The aorta is the "Yangtze River Yellow River" of the human body. It is shaped like a walking stick. One end is connected to the heart. The blood comes out of the heart and enters the aorta. It is then diverted to the arteries of each branch to supply blood to the brain and organs. Today, her mother's aortic wall has broken a small mouth, blood rushed into the blood vessel wall from the breach, tearing off the entire aortic wall, and the mother's severe chest pain is derived from this. The thick and sturdy blood vessel wall now has only a thin layer left and can break at any time. Once the aorta ruptures, the blood is like the water of the Yangtze River, and her mother and her mother will die instantly. The only way for a mother to be rescued is to have surgery immediately. Otherwise, the probability of death increases by 1% for every hour of delay, 50% for 48 hours, and 65% to 75% for two weeks. It is almost impossible to live for one year. In just a few hours, she and her mother fell into the realm of life and death. Bad luck: Unable to prevent miscarriage during surgery After the doctors analyzed the analysis, the mother needs to stop cycling for about 30 minutes during the operation. That is to say, for a long time, all the organs under the mother's chest will be blocked, including her uterus. To make matters worse, my mother's body temperature will be reduced to below 25 degrees to reduce the body's metabolism and protect her mother's brain cells. However, her mother's low body temperature is a heavy blow to her. This operation is a life-saving for her mother, but it is fatal to her. The team of Professor Zhu Junming who implemented this operation is the most experienced team of doctors who perform such surgery throughout China and the world. Professor Sun Lizhong, the leader of his team, made the first pregnancy in China with aortic dissection in June 1998. By 2015, the team accumulated 25 experiences of pregnancy and aortic dissection, and published the experience. In April 2017, The Annals of Thoracic Surgery (ATS), the world's most authoritative magazine for thoracic surgery. The principle of pregnancy combined with aortic dissection is to save the mother's life, and to ensure the survival of the fetus as much as possible. Whether the fetus can survive depends mainly on the location of the mother's aortic lesion and the gestational age. She and her mother are very unlucky, and they have the worst sign. Not only is the mother the most dangerous type A aortic dissection, but also the largest range of lesions. She can't have a baby during surgery. She left her mother for 16 weeks. May be alive. Everyone is hanging in this surgery. She has had surgery and passed the anticoagulant. Professor Zhu Junming had already had in-depth communication with her relatives before the operation. The doctor would take some measures to prevent miscarriage during the operation. I hope that the miracle can happen, but the hope is not great. My mother's aortic surgery went very smoothly. The doctor sutured the aorta, the blood was injected into the heart, and after the heart beat again, the doctor removed the extracorporeal circulation machine and the mother was saved. According to the plan, a few days later, the obstetrician will do induction of labor, she is about to leave her mother. However, on the day of the operation, the ultrasound doctor heard the fetal heart sound from the ultrasound - she is still alive! The miracle really appeared! That is like a horseshoe rushing a strong and stable fetal heart sound, so that everyone is excited. Perhaps, she and her mother have never met before, she is not reconciled, so when her mother's heartbeat resumes, the blood re-injects into the uterus, her heart also re-bounces. Mother strongly urged to leave her, although this decision is very risky for the mother who has just undergone a major surgery; for her "dead" and reborn, it is equally risky because her mother needs to take a lot of anti-surgery after surgery. Condensed medication may cause her cerebral hemorrhage. Such a precedent, Professor Zhu Junming encountered in 2014. At that time, the doctors took a lot of effort to do aortic dissection for the mother and the fetus was successful, and the mother was able to continue the pregnancy. But by the 29th week of pregnancy, fetal cerebral hemorrhage, pregnancy terminated. But this time, she was very fortunate, not only had surgery, but also had anticoagulants. Under the escort of obstetrics and gynaecology and fetal ultrasound medical doctors in Anzhen Hospital, she was healthy in her mother's stomach for 34 weeks. On June 8, 2017, she was born safely, 2680 grams, and the newborn Apgar scored 10 points. (Note: After the child is born, the scores are based on skin color, heart rate, respiration, muscle tone, and five signs of exercise and reflex. , the full 10 points for normal newborns). The surviving baby is the first in China and the third in the world to be verified, previously in 2002 and 2008. Strong baby But until now, what is the reason for them to survive stubbornly, medicine has not found an answer. After the incident, Professor Zhu Junming said in an interview: This life is too great. She is encouraging us doctors. I will encounter such patients in the future. I can’t be as negative as before. Every life should not give up easily. Every challenge can’t be given up. The limit of life is endless. Mirror, the doctor must face the challenge. She can't survive. She is trying to survive. It reminds us of these doctors. There are still many things we can do. We need to further study, in the future, we can technically explore a path to make the survival of such children no longer accidental, but inevitable. I also want to say that her efforts to survive is a miracle of life. It reminds us all, cherishes the value of life, and grateful and encourages doctors to make unremitting efforts for life. Talk to the surgeon Dai Dai: Before the onset, did this pregnant woman know that she had a problem with her aorta? Zhu Junming: She does not know that this disease is an acute attack. Dai Dai: The doctor's diagnosis in Langfang is very accurate. Zhu Junming: She has severe chest pain. In general, patients with chest pain go to the emergency department. The doctor must first eliminate the fatal emergency of coronary heart disease, pulmonary embolism, and aortic dissection. And if you do an electrocardiogram, check myocardial enzymes, do heart ultrasound and CT, you can easily diagnose it. . In recent years, with the popularization of knowledge, many primary doctors can think of the aortic dissection when they have severe chest pain. Dai Dai: In 2014, I recorded your pregnancy with aortic dissection in the operating room. The pregnancy was 18 weeks and the operation was successful. This child should be two or three years old too? Zhu Junming: This child has not survived. The operation of the fetus was successful in the operation, but because the mother had to take anticoagulants after the operation, the fetal brain was bleeding at 29 weeks of pregnancy, and the child was finally gone. Dai Dai: Have you taken various kinds of miscarriage measures in this operation this year, as in the case of 2014? I remember that there was an ultrasound doctor in the operating room who monitored the fetal heart throughout the operation. I was particularly impressed by the fact that the sonographer was kneeling on the ground. Zhu Junming: The two cases are different. In 2014, the mother's aortic surgery did not stop the circulation, that is, the uterus can always maintain blood supply. In principle, it can prevent miscarriage, so we have taken many measures to protect the fetus. But this year, in the mother's aortic surgery, it is necessary to stop cycling for 30 minutes. During this period, the uterus has no blood supply, and the fetus is theoretically impossible to survive. However, compared with the previous circulatory surgery, we have made some improvements in this operation, and took some extra measures to prevent miscarriage. I did not expect this child to survive, like "death" and resurrected. Dai Dai: This child has a big life. Zhu Junming: Yes, it is a miracle, so I joked with this family that this child can grow up to be the pillar of the country. Dai Dai: So, this case may be an accident of "unintentional?" Zhu Junming: There is this possibility. During the operation, although we took some measures, we did not expect the child to survive. When the fetus is still alive after the operation, in order to allow the mother to continue the pregnancy, the relevant departments of the Anzhen Hospital have made great efforts. In particular, obstetrics and gynaecology and fetal overgrowth, pregnant women are regularly reviewed every month, doctors are very detailed in the guidance of fetal growth and pregnancy. It now appears that in this case the child is not only alive, but is born to be good, with a score of 10 points. Before they left the hospital, I went to see and took a lot of photos. We will continue to follow up this child. Dai Dai: Can this miracle be copied? Zhu Junming: There is also this possibility. We checked the literature. There are only 2 cases that can be found in the world. We are the third case and the first case in China. In fact, I have encountered a case before. In 2015, I had an operation in a hospital in Harbin. At that time, the fetus had been used for 6 months. After the operation, we had induced the child from the obstetrics and gynaecology department of our hospital. As a result, they The next day I found out that the child is alive. At that time, I was worried that the pregnant woman had just finished such a major operation and continued to have such a big belly. It was easy to have an accident and suggested that they terminate the pregnancy. But the family insisted on keeping it, and the child was raised in the stomach. After ten days, the patient was discharged from the hospital. In the morning, the food suddenly stopped suffocating. After the rescue, the mother became a vegetative person and the child was gone. I was particularly uncomfortable at the time. The uterus has no blood for the fetus to survive. Although we have not found out the cause yet, this fact at least tells us that even if the uterus has no blood supply for 30 minutes, the child may survive. The 2015 Harbin case tells us that this kind of child is likely to survive; and the “magic baby†in 2017 tells us that this child may not only survive, but may also be born. There are accidental factors, but there must be inevitable factors, such as whether we have been unscrupulous in the course of surgery, which requires further research. Dai Dai: Pregnancy with aortic disease, your team has the largest group of cases in a single center worldwide. Zhu Junming: Yes. From June 1998 to February 2015, we summarized 25 cases in 7 years. Foreigners feel very skeptical that they have rarely encountered a case in their lifetime. Why do we have so many in just a few years? This is the advantage of Chinese doctors, there are more patients, and Anzhen Hospital is a national referral center for pregnancy and heart disease. Our article has written every source very clearly, and 10 of them are the ones that hospitals across the country have invited me to do. In the article, we listed each hospital and doctor who provided the case, thanked them, and paid tribute to their hard work. Of the 25 patients, 19 had a type A dissection. Although the patients were not from the same hospital, all the operations were performed by a fixed doctor of our Sun Lizhong aortic team. The concept and procedure of the surgery were the same. This statistic is as of February 2015, and we have done several more cases in the past two years, which has exceeded the number of articles summarized. Dai Dai: This kind of surgery, every case is thrilling, talk about your most impressive. Zhu Junming: China's first pregnancy with aortic dissection was done by Professor Sun Lizhong at the Fuwai Hospital on June 2, 1998. I made a particularly interesting case before the Spring Festival this year. A patient who had a type A mezzanine in the 20th week of pregnancy came to the hospital. Her heart grew to the right, and we were against it. All her organs were reversed. This is the first patient with a right aortic dissection in the aortic dissection in China. The operation is very difficult, which is equivalent to my left hand surgery. The last operation was very successful, my mother lived, but the child did not survive. Dai Dai: Although there are very few such operations, one example is an example. Zhu Junming: Yes, for patients with pregnancy and dissection, the highest mirror is to keep both the mother and the child. To achieve this goal, we must rely on a case to explore, and truly make every case based on the previous case. From the very beginning, mothers and children may not be able to keep it; later, they can keep their mother but give up their children; Later, pregnant mothers who have been pregnant for less than 7 months will abandon their children, and mothers and children will survive if they are pregnant for more than 7 months. Because they can be operated concurrently with obstetrics and gynaecology, they will be taken out and sent to the incubator for maintenance. , we will do aortic surgery for my mother; Later, for pregnant women under 7 months, if the aortic surgery does not need to stop the circulation, you can also keep your mother and children; Now, for children under 7 months of pregnancy, even in the aortic surgery, the deep-low temperature stop circulation, even the child can miraculously survive in the belly. In addition, for more than 7 months of pregnancy, although the mother can be guaranteed, we are also improving every case. For example, in the early stage, the uterus should be removed at the same time as the child is removed, because the drugs used in the aortic surgery will cause massive uterine bleeding, which will lead to the death of the mother. Later, the technology was improved, and the balloon can be used to solve the problem of big blood in the uterus. If we do similar surgery, we can not only save our lives but also keep the uterus. In short, the general principle of our current treatment is to save the mother's life, and to ensure the survival of the fetus as much as possible. Dai Dai: In addition to this year's "magic baby", have you succeeded in giving birth and then giving birth smoothly? Zhu Junming: Yes, it is the first example of our successful pregnancy. In 2010, I was at the Affiliated Hospital of Guilin Medical College. However, unlike this year's "magic baby", Guilin did not stop the circulation in this operation, which means that the whole process of surgery, the uterus has blood supply, the fetus has been heartbeat, is alive. At the time of the operation, it was 4 months pregnant and continued to be pregnant for 8 months. The child was born and was a girl. Now she is 7 years old and has gone to elementary school. Dai Dai: Under what circumstances can you protect your baby? Zhu Junming: Pregnancy is to meet certain conditions. Only in the case of Guilin, the location of the mother's aortic lesion is limited to the ascending aorta. There is no need to stop the circulation during the operation, and the uterine blood supply can be maintained before the pregnancy can be considered. I have encountered a case in the past. My mother is a basketball player. She was dissected for more than 6 months of pregnancy, but she had to wait for the fetus to complete surgery after 7 months, so that the chance of survival was greater. How can we persuade it is useless, her parents and lover even ask her to hurry, she insisted on waiting. During the waiting period, I stayed in our ward. One morning, she sat on the bed and ate breakfast. She suddenly fell to the ground and the aorta was broken. In half a minute, the person was gone and there was no chance to rescue. It's really a pity that if she had surgery in time, she would definitely be alive. We told her that the type A mezzanine couldn't wait, the death rate was too high, and the death rate per hour increased by 1%, but she insisted on waiting. So the mother is really great, so that the child can fight for life. Source: Doctor Medical Affairs Foot and leg massager Foot and leg massager Shenzhen Jie Zhong Lian Investment Co., Ltd. , https://www.szmeizon.com