Dr. Fu Xinheng must have heard Professor Fang’s explanation above, and his silence was tantamount to his agreement.
In this sense, the patient in front of us belongs to one of the unfortunate group mentioned above.
The resident doctor sent the patient's medical records over. Doctor Fu Xinheng had already taken a general look at the medical records and handed them to his subordinate Xie for review.
Professor Fang continued to verbally introduce some of the patient's medical treatment. Some things cannot be written in the medical record, not because of the question of whether it can be written, but because the medical record has its own rules for writing medical records, and irrelevant things cannot be written in the medical record.
According to the review of the patient's medical history in the medical record, this patient is a male in his fifties who had undergone mechanical mitral valve replacement surgery at Guoxi Hospital for heart disease more than ten years ago.
Professor Fang said: "The person who performed the operation on him was Director Liu, the famous chief of our cardiac surgery department. He has retired now. The operation was very successful."
The conclusion that the operation was successful was correct, as evidenced by the patient's condition improving to the point where it lasted for nearly ten years.
Many surgeries cannot be called cures, which is very different from the layman’s ideal that surgery is drastic and can therefore cure the root causes of human diseases.
The good impression that surgery has on ordinary people is based on the fact that internal medicine has failed to work. Once surgery fails to work, people will complain about it to death.
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Complaints from patients such as "I should have known I would not have had this surgery" are often heard among the public and are a well-known, silent stain in the surgical community.
In fact, there are many medical measures that allow humans to continue to survive, and humans should be grateful to medicine.
Medicine is not theology, it is really not divine, and it is often criticized for being useless.
Fortunately, most patients will eventually understand this and return to see a doctor again if they have symptoms as described by the doctor and actively receive follow-up treatment.
Regarding the problems of mechanical valves, there have been cases mentioned before, and it seems that biological valves are much better. The problems that the current patients suffer from should be said to be no different from those of mechanical valves, biological valves, or interventional valves that can be made by current interventional surgery. They can all have a complication after valve replacement: paravalvular leak.
Paravalvular leak is really too common. Anyone who knows about cardiology will understand it. Foreign statistics show that the incidence rate can reach more than 10% among surgical patients.
If you have no idea about this number, here is a more detailed explanation. For example, in a certain foreign country, the total number of patients who undergo valve replacement surgery each year is 60,000, and more than 10%, or nearly 10,000 people, have this complication.
This number would be incredible in China. As medical technology improves, the number of patients who are diagnosed and can undergo surgery increases, and the number of complications that occur in China is only increasing.
These numbers sound scary, but why are they rarely heard of outside the medical community?
This has to do with the classification of paravalvular leaks, which are divided into large, medium, small, and single or multiple types.
According to the definition of paravalvular leak: paravalvular leak refers to the abnormal channels that appear around the artificial heart valve, which allows the blood in the heart to continue to flow back through the abnormal channels after the artificial valve closes the valve, and may eventually cause the artificial valve to fail and cause serious problems such as heart failure, hemolysis, and even sudden death in the patient.
As can be inferred from the above definitions, large paravalvular leaks and multiple paravalvular leaks are the most severe.
In actual cases, most paravalvular leaks are small to medium-sized and single-type, so the symptoms may be so mild that they do not manifest clinically and are not a cause for concern. Therefore, there is no need for medical intervention for such patients.
Only one to three percent of these cases require further medical intervention.
The terrifying value dropped a lot at once, but it must 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 the surgical operation on this patient was absolutely successful. Severe paravalvular leakage complications usually occur within six months after the operation and most of them should be caused by the surgery. Obviously, this patient was not the case. It was caused by physical aging problems caused by aging and inherent diseases of the body such as diabetes that were not well controlled.
For severe paravalvular leak, doctors will definitely recommend early treatment. Treatment drugs are usually ineffective and require a second surgery.
Most people think that the second surgery is to open the patient's chest again, replace the valve or surgically sew up the abnormal channel to end it all. However, for elderly patients with severe paravalvular leak, the risk of a second surgery is very high. If there is a chance to use other methods, doctors and patients will definitely not choose to take the risk of dying on the operating table.
Medical experts often tell patients that every extra day they live is a sign of hope. Contemporary medical technology is becoming more and more advanced. Previously, only thoracotomy was possible, but now minimally invasive interventions are possible. In addition, more and more types of minimally invasive interventional devices have been invented to solve clinical problems.
For patients with paravalvular leak, medical device companies have invented interventional occluders, and more and more doctors at home and abroad are adopting low-risk interventional surgeries.
Professor Fang said: "Dr. Li, the academic leader of our Heart Center Intervention Group, led a team to support the disaster area."
Is it possible that the prestigious Guoxi Heart Center only has one interventional doctor who can perform surgery?
What needs to be said honestly here is that many domestic technologies are in the late-catch-up era at this time. There are not many paravalvular leak occluder surgeries performed in China at this stage. The one with the highest success rate is definitely not in Guoxi but in Guozhi.
"Doctor Li is one of the few doctors in our interventional team who has done this successfully." Professor Fang said, "We had previously considered transferring the patient to Guozhi for treatment, but the problem is that you all know the current traffic conditions-"
To put it bluntly, the transportation in the disaster area is now in a state of emergency. There is not enough transportation capacity to transport ordinary relief supplies, so it is impossible to open a special green channel for a patient as usual. Moreover, after the patient's condition worsened, it was impossible for him to travel a long distance to the capital for treatment.
At this point another question arises.
If the patient's condition needs to be transferred to Guozhi for treatment, they can find Guozhi's doctors to help. Dr. Shen Youhuan is in the disaster area, in the same place as Dr. Xie. It's strange that these people don't look for Dr. Shen but come to Dr. Xie?
Professor Fang said: "Dr. Fu is here with us. He is the famous director of cardiac surgery at the National Association. We all know that the National Association and Guozhi are sister institutions, and their academic exchanges are very close."
What this means is that Professor Fang first asked Dr. Fu for his opinion and asked whether he should ask Dr. Shen to come and treat the patient. Dr. Fu’s opinion was: it would be better to let his subordinate Xie come.
Could it be that Dr. Fu Xinheng intends to compete with Guozhi and seize the opportunity to give this business to his own people so that they can gain face over Guozhi?
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