Chapter 4579【668】Who is the key to find?
Dr. Fu Xinheng must have heard Professor Fang’s explanation above, and his silence is equivalent to an attitude of agreement.
In this way, the patient in front of me belongs to the unfortunate group in the above situation.
The resident doctor below sent the patient’s medical records. Dr. Fu Xinheng had already had a general understanding of it and submitted the medical records to subordinate Xie for review.
Professor Fang continued to verbally introduce some of the medical conditions of patients. Some things cannot be written in medical records, not because it is a question of whether they can be written, but because medical records have regulations on writing medical records, and irrelevant things cannot be written in medical records.
According to a review of the patient's past medical history in the medical record, the patient was in his fifties, male, and had undergone mechanical mitral valve replacement at Guoxi Hospital due to heart disease more than ten years ago.
Professor Fang said: "The person who performed the operation on him was Director Liu, the famous surgical director of our cardiac surgery department. Now he has retired. The operation was very successful."
The success of the surgery is unmistakable, as the patient's condition improves after surgery and lasts for nearly ten years.
Many surgeries cannot be called cures, which is very different from laymen’s ideal idea that surgeries are drastic and therefore can cure the source of human diseases.
The good impression of surgery in the hearts of ordinary people is based on the failure of internal medicine. Once surgery fails to be effective, the people will complain to death.
Patients’ comments such as “I knew I wouldn’t have done this surgery” are often heard among the public and are a well-known silent stain in the surgical field.
In fact, many medical measures allow human beings to continue to live. Human beings need to thank God for medicine.
Medicine is really not theology, it is really not divine, and it is bound to be criticized for its uselessness in many cases.
Fortunately, most patients can eventually understand this and seek medical treatment again based on the symptoms reported by the doctor for active follow-up treatment.
As for the problems of mechanical valves, there have been cases mentioned before, and it seems that biological valves are much better. The problem that current patients are having is no different from mechanical bioprosthetic valves or interventional valves that can be used in current interventional surgeries. It is a complication after valve replacement that can occur: paravalvular leakage.
Paravalvular leakage is really too common. Anyone who mentions cardiology will know that the incidence rate can reach more than ten percent of surgical patients according to foreign statistics.
If you have no idea about this number, here is a more detailed figure. For example, in a foreign country, the total number of patients undergoing valve replacement surgery every year is 60,000, and more than 10%, or nearly 10,000, suffer from this complication.
This number must be incredible in the country. Due to the improvement of domestic medical technology and the increase in the number of patients who can be diagnosed and treated with surgery, the number of such complications in the country will only increase.
Sounding scary numbers, why are so few outside the medical circle hearing about them?
This is about the classification of paravalvular leakage. Paravalvular leakage is divided into large, medium, small and single and multiple types.
According to the definition of paravalvular leakage: Paravalvular leakage refers to the abnormal channel around the artificial heart valve, which allows the blood in the heart to continue to flow retrogradely through the abnormal channel after the artificial valve closes the valve. This may eventually cause the artificial valve to fail and cause the patient's heart attack. Serious problems such as hemolysis and even sudden death.
From the above definition, it can be inferred that large paravalvular leakage and multiple paravalvular leakage have the most severe symptoms. In actual cases, most paravalvular leaks are small to medium-sized and single type, so the symptoms can be mild to no clinical manifestations, which is not a cause for concern. Therefore, there is no need to re-intervene such patients medically.
The number of cases requiring further medical intervention only accounts for one to three percent of these cases.
The horror value has suddenly been reduced a lot. However, it has to be said that in medicine, for individual patients, there are always only two numbers: zero and 100%.
First of all, it must be said that this patient's surgical operation was absolutely successful. Severe paravalvular leakage complications usually occur within six months after surgery and most of them are due to surgical reasons. Obviously this patient is not, but is due to physical aging caused by age. It is caused by factors such as problems and inherent diseases of the body such as diabetes that are not well controlled.
For severe paravalvular leakage, doctors definitely recommend early treatment. Treatment options are often ineffective and require secondary surgery.
Most people take it for granted that secondary surgery involves reopening the patient’s chest, replacing the valve, or surgically repairing the abnormal passage. However, for older patients with severe paravalvular leakage, the risk of secondary thoracotomy is very high. If there is an opportunity to use other methods, doctors and patients will definitely not choose to take the risk of dying on the operating table.
In medicine, patients are often told that every extra day they live is their hope, which is reflected here. Contemporary medical technology is becoming more and more advanced. In the past, only surgical thoracotomy was possible, but now minimally invasive intervention is possible, and more and more types of minimally invasive interventional devices are being invented to solve clinical problems.
For patients with paravalvular leakage, medical device companies have invented interventional occluders, and more and more doctors at home and abroad are performing low-risk interventional surgeries.
Professor Fang said: “Dr. Li, the academic leader of the interventional group of our heart center, led a team to support the disaster area.”
Can only one interventional surgeon at Tangtang Guoxi Heart Center perform the surgery?
What needs to be said honestly here is that many domestic technologies belong to the post-catch-up era in this era. There are not many paravalvular leakage sealing device surgeries in China at this stage. The one with the highest success rate is definitely not in Guoxi but in Guozhi.
“Dr. Li is one of the few doctors in our interventional team who has done it successfully.” Professor Fang said, “I have considered transferring the patient to Guozhi for treatment before, but the problem is that you all know the current traffic situation—”
To put it bluntly, the traffic in the disaster area is now that everything is making way for disaster relief. The transportation capacity of ordinary relief supplies is insufficient. It is impossible to open a special green channel for a certain patient as usual. Moreover, it was impossible for the patient to travel long distances to the capital for medical treatment after his condition deteriorated.
At this point another question arises.
If the patient's condition needs to be transferred to Guozhi for treatment, he can find Dr. Guozhi to help. Dr. Shen Youhuan was in the disaster area, and she was in the same place as Dr. Xie. It was strange that these people didn't look for Dr. Shen, but they came to find her, Dr. Xie?
Professor Fang said: "Dr. Fu is here with us. Dr. Fu is the famous director of cardiac surgery of the Chinese Association of Chinese Medicine, and we all know that the Chinese Medical Association and Guozhi are fraternal units, and their academic exchanges are very close."
It means that Professor Fang first asked Dr. Fu for his opinion and asked whether he should ask Dr. Shen to come over to treat the patient. Dr. Fu's opinion was: It would be better to ask his subordinate Xie to come over.
Could it be that Dr. Fu Xinheng plans to compete with Guozhi and seize the opportunity to use this business to make his own people better than Guozhi?
(End of this chapter)
