Tuesday was also a busy day for Yu Zhiming.
As soon as he arrived at the Zhizhen Building of the hospital, Yu Zhiming conducted a full body and heart examination on the five-year-old girl, a bank colleague who was introduced by Yao Hui, the director of the community property owners' committee.
It has to be said that this little girl's heart deformity is the most serious one Yu Zhiming has ever examined.
Affected by heart deformity, the little girl's cardiac ejection fraction was only 30%, far below the normal lower limit of 55%.
Yu Zhiming also found that the little girl's lungs, kidneys and other organs had been damaged due to insufficient heart pumping function.
If things continue like this, even with effective auxiliary treatment, as long as the heart deformity cannot be cured, the patient can only survive for more than a year at most.
Given the severity of the little girl's heart defect, Yu Zhiming was rather vague in his explanation to her parents. Whether surgery was possible would only be determined after careful research.
It took Yu Zhiming more than two hours to draw the perspective diagram of the little girl's heart. He then took a photo of the drawing and sent it to Dr. Luo Yu of the PLA General Hospital.
Then he went to the soundproof inspection room next door.
On the experimental operating table in the center of the room, there is a one-to-one scale half-body model of a pregnant woman about to give birth.
This is a bionic prop used to train medical staff in delivery and caesarean section.
Nowadays, human body models used in medical teaching are made to be quite realistic. The higher-end ones are almost indistinguishable from the real ones, which makes up for the shortcomings of cadaver teachers to a large extent.
In a corner of the operating table, there was a cage with three shivering little white rabbits in it.
Yu Zhiming looked at Duan Yi and Zhou Mo and said, "Let's get started."
After hearing the order, Duan Yi reached into the cage with one hand, grabbed a rabbit by the back, pulled it out, and pressed it on the experimental table.
At the same time, she grabbed the anesthetic needle with her other hand and stabbed it directly into the little white rabbit's shoulder.
The anesthetic is injected in one push.
Duan Yi's movements were smooth and flowing, and one could tell at a glance that she had done similar things many times before.
Zhou Mo's heart ached as he watched, and he couldn't help but say, "Doctor Duan, please be gentle. Rabbits also feel pain."
Duan Yi grinned and said, "We used to do experiments on rabbits. After the experiment was completed, the last step was to give the rabbits an air injection for euthanasia."
Zhou Mo hummed, "These three are the best-looking rabbits I carefully selected at the Experimental Animal Center."
"Doctor Yu has already said that after the experiment is completed, I can take them home to raise them."
"Doctor Duan, please don't hurt them."
Yu Zhiming added: "The premise is that my surgical trial goes smoothly and they survive."
As he spoke, Yu Zhiming had already lifted up the pregnant woman's soft silicone belly, then the uterus, and took out the fetus model curled up inside.
Then he took the anesthetized and unconscious little rabbit from Duan Yi and stuffed it into her uterus.
Then, Yu Zhiming adjusted the rabbit's position so that its chest was facing up and not covered by its legs.
In a true intrauterine interventional surgery, the fetus being in the correct and appropriate position is a prerequisite for the smooth start of the operation.
Adjusting the fetal position was extremely simple for Yu Zhiming.
After covering the uterus and closing the belly of the pregnant woman model, Yu Zhiming placed his hands on the belly of the model, simulating the first step of the operation to confirm the fetal position and the exact location of the fetal heart.
Then, Yu Zhiming stretched out his hand.
Duan Yi, who had been prepared on the side, placed a 17-centimeter-long thin puncture needle in his hand.
Duan Yi picked up the interventional guidewire and dilation balloon that would be used next, and looked at Yu Zhiming again.
At this time, Yu Zhiming was holding the puncture needle in his hand and had not yet taken the next step, but the feeling he gave Duan Yi was no longer as casual as before.
Duan Yi believed that Yu Zhiming at this moment was like a warrior, building up his strength for the upcoming duel, which was awe-inspiring.
Duan Yi also unconsciously slowed down her breathing and dared not blink, for fear of affecting Yu Zhiming's performance.
The next moment, Yu Zhiming moved.
He raised his hand and the needle went straight into the model's belly.
Because there was no ultrasound imaging equipment, Duan Yi could not see whether the puncture needle had entered the exact position.
Yu Zhiming could feel very clearly that the puncture needle pierced the pregnant woman's belly and uterus.
Then, the puncture needle passed through the fetus's intercostal space and the fetus's right ventricular wall without any hindrance, and successfully reached and passed through the pulmonary valve stenosis.
At this point, the important puncture step is completed.
Without any delay, Yu Zhiming took the interventional guidewire and the expansion balloon with a diameter of only 3.5 mm from Duan Yi, and sent them into the pulmonary artery through the central channel of the puncture needle.
When the center of the balloon was straddling the pulmonary valve, Yu Zhiming used the pressure valve to pressurize and expand the balloon. After rapidly expanding it twice, he quickly withdrew the balloon.
Next is to withdraw the guide wire and the puncture needle.
At this point, the intrauterine interventional surgery is completed.
From the insertion of the puncture needle to its withdrawal, the entire interventional procedure took no more than eight seconds.
After completing the operation, Yu Zhiming stood in front of the laboratory table. Without any further movement, he closed his eyes slightly and began to review the surgical process.
Zhou Mo, who was standing aside, looked a little dazed.
She pulled Duan Yi a few steps away from Yu Zhiming and asked in a low voice, "Is the operation over?"
"So soon?"
Duan Yi also explained in a low voice: "This operation requires speed and a quick conclusion."
"The fetus will not sit still in the womb, especially when it is stimulated."
"If the fetus is suddenly startled, the consequences will be disastrous."
"Also, this is surgery on the incredibly delicate heart of a fetus. The balloon expansion also requires blocking the pulmonary artery. To avoid triggering an overreaction in the heart, we need to minimize stimulation and operate quickly."
Zhou Mo uttered a half-understood "Oh" and glanced at Yu Zhiming, who seemed lost in thought. "This operation only took a few seconds, but it looked quite easy for Doctor Yu."
Duan Yi glanced at this ignorant and fearless guy.
"Looks easy?"
"Let me tell you, there are no more than five teams in the country that can perform this intrauterine interventional surgery."
"I can also tell you that even with a mature international team, 50% of cases of intrauterine intervention will experience various fetal complications."
"10-20% of them are intrauterine deaths..."
Duan Yi was about to cite some data when she saw Yu Zhiming open his eyes and quickly ran over.
"Doctor Yu, continue?"
Yu Zhiming shook his head and said, "No need. One test is enough. I have already obtained the data I want."
"The little rabbit won't have to suffer anymore."
This made Zhou Mo smile. She pointed at the belly of the pregnant model and asked, "The one inside?"
Yu Zhiming replied: "It's okay."
As he spoke, he took out the rabbit from the model's belly and handed it to Zhou Mo.
"When the anesthetic effect wears off, it's still a lively little white rabbit."
Zhou Mo held the motionless little rabbit in his arms and asked, "Doctor Yu, after this operation, will the fetus recover?"
Yu Zhiming smiled and said, "How can it be that simple and easy? This is not a radical surgery."
"After this intrauterine dilation and intervention, we hope that the fetus will be able to compensate for the hypoplastic right ventricle caused by severe pulmonary artery stenosis during subsequent development."
After a pause, Yu Zhiming added: "If the heart's corrective development is not in place, the fetus will need heart deformity correction surgery after birth."
Zhou Mo sighed softly and said, "We're taking such a big risk to do this intrauterine surgery, and the outcome is still uncertain."
"Hey, what is the final effect of this operation?"
Yu Zhiming replied: "According to current statistics, the success rate of intervention is around 60%."
Zhou Mo was puzzled and asked, "With such a huge risk and only a 50% success rate of intervention, why not just wait until the baby is born and perform heart deformity correction surgery at the same time?"
Yu Zhiming rolled his eyes and ignored this guy.
Duan Yi patiently explained: "Zhou Mo, if we don't do this intrauterine intervention, a large number of fetuses will lose the opportunity for surgery after birth."
"Even if surgery is possible, it is extremely risky and the cost of treatment is staggering."
Yu Zhiming spoke again: "For example, the little girl with heart deformity this morning. If it could have been discovered while she was still a fetus, active intrauterine intervention could have been carried out..."
"If there were some effect, corrective heart deformity surgery wouldn't be so risky nowadays, which is why no cardiac surgeon dares to perform the surgery."
Zhou Mo understood what was said.
"So, can fetal heart defects be treated in utero?"
"Also, is it easier to perform surgical intervention in utero than corrective surgery after birth?"
Yu Zhiming explained: "Not all, but most heart malformations can be treated with intrauterine intervention."
"The advantage of intrauterine intervention is that it can induce the fetal heart to correct itself during development."
Zhou Mo thought of something and said excitedly, "Doctor Yu, since you have completed this operation, does it mean that you can perform intrauterine intervention for fetal heart defects?"
"It's like cancer. In the early stages, you can deal with it. In the late stages, there are also ways to treat it."
"This is a heart malformation. In the late stages, you can work with experts like Luo Yu. And for the early stages of the fetus, you can also do it."
Yu Zhiming chuckled and sighed softly.
"Given the high risks of intrauterine intervention and the uncertainty of its success rate, I personally believe that the best decision is to terminate the pregnancy."
Zhou Mo hesitated and struggled for a moment before he finally spoke up and asked, "Do doctors become cold-blooded after working for a long time?"
"Doctor Yu, why do I feel like you're speaking so lightly about the decision to terminate the pregnancy?"
"By six or seven months of development, a baby can respond to its mother in the womb and is already a flesh-and-blood baby with emotions."
Yu Zhiming didn't want to bother with Zhou Mo anymore.
Duan Yi further explained: "In our country, a fetus is not a complete natural person until it is born."
After a pause, she continued, "Zhou Mo, have you ever seen anyone give up treatment just because of a mere twenty or thirty thousand yuan in medical expenses?"
"I have seen it, more than once."
"This intrauterine interventional surgery costs between 100,000 and 200,000 yuan. Postnatal heart deformity correction surgery usually costs hundreds of thousands, or even millions."
"Zhou Mo, is there even one percent of families in our country that can come up with that much money?"
"Even if the corrective surgery is successful, many children will still have some deficiencies in their heart function, which will have a significant impact on their future growth and development..."
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