An An (pseudonym) was admitted to the hospital on the 3rd day after birth, because of neonatal pneumonia. The examination revealed that he had a range of serious conditions: congenital pulmonary sling, severe long-segment tracheal stenosis, as well as atrial septal defect and patent ductus arteriosus. A month ago, An An developed symptoms such as lung infection and difficulty breathing, and needed a ventilator to maintain her breathing.
After the child was urgently transferred to Shenzhen Children’s Hospital, the thoracic and cardiac surgery team solved these four major problems at one time during the operation. On the second postoperative day, An An successfully removed the ventilator. At present, the little one is breathing steadily, and the fiberoptic bronchoscopic airway is unobstructed and has no stenosis, and is undergoing further recovery.
The newborn’s trachea is “choked” and life-threatening after a cold
In April this year, An An was born in Lufeng City, Shanwei. On the 3rd day after birth, he was transferred to the neonatal department of Shenzhen Children’s Hospital for treatment because of neonatal pneumonia. Examination found that in addition to pneumonia, he had neonatal hyperbilirubinemia and atrial septal defects. To make matters worse, he also suffers from rare pulmonary artery slings and tracheal stenosis.
“The most dangerous thing here is the pulmonary artery sling”, Wang Pengcheng, a thoracic and cardiac surgeon at Shenzhen Children’s Hospital, said, normally, the main pulmonary artery sends out the left pulmonary artery and the right pulmonary artery to the left and right, respectively, and enters the left and right pulmonary hilus respectively. In children with pulmonary artery sling, the left pulmonary artery abnormality originates from the right pulmonary artery, and passes between the trachea and esophagus into the left pulmonary hilus, forming a “sling” that jams the trachea. This is like a “devil’s claw” that jams the patient’s throat.
The incidence of pulmonary sling is not high, but babies with this condition and severe airway stenosis have a very high mortality rate within 1 year of age. If such a child catches a cold, a mouthful of phlegm may suffocate him. Moreover, such patients often have structural malformations within the heart. The operation not only transplants the left pulmonary artery of abnormal origin back to its normal position, but also corrects tracheal stenosis and intracardiac malformations at the same time, which is not small in risk and difficulty.
After the diagnosis, the doctor and An An’s parents determined the operation time, and planned to operate on the child at the end of July this year. Unexpectedly, in early July, An An also developed cough and fever after contacting her sister who had a cold and cough at home. After being treated in Lufeng City, his condition did not improve, so he was urgently transferred to Shenzhen Children’s Hospital.
(The thoracic and cardiac surgery team of Shenzhen Children’s Hospital is performing surgery for An’an.) ）
“Defusing bombs” 4 places at a time, it is no longer difficult for newborn babies to breathe
At the time of admission, An An had a severe lung infection, strenuous breathing and severe asthma, and needed a ventilator to maintain breathing. Fortunately, after 16 days of careful treatment, his lung infection was controlled and he was ready for surgery.
On July 22, An An went to the operating table. Chen Xinxin, a top expert in pediatric congenital heart disease in China, led the cardiac surgery team of Shenzhen Children’s Hospital to complete multiple “bomb defusals” for him at one time: pulmonary artery sling correction + tracheal sliding plasty + atrial septal defect repair + ductus arteriosus suture cutting.
The first thing to solve is the problem that the trachea is “stuck”. After anesthesia, doctors first free the trachea behind the heart and large blood vessels. During the free process, extremely small blood vessels and nerves must be protected, which puts forward strict requirements for the surgeon’s surgical operation. After the free is completed, the ductus arteriosus is ligated and connected to the extracorporeal bypass machine. After the artificial heart-lung machine is started, it can replace the heart and lung function, leaving time for tracheoplasty surgery. Subsequent intraoperative exploration confirmed that the child had a pulmonary sling and a narrowing of the trachea, which was about 3 cm long. Even a fiberoptic bronchoscope with a diameter of only 0.28 cm cannot pass through the tracheal stenosis.
After the condition is discovered, the correction of the pulmonary sling begins: the doctor first incises the “wrong” left pulmonary artery and then transplants it back into place. The ensuing tracheal slide plasty is the most important part of the operation: the doctor first excises the narrowest 3 cm tracheal segment, makes a longitudinal incision of the wrong margin in the upper and lower segments of the remaining tracheal stump, drags it up and down to slide closer, and then uses an absorbable slide line smaller than an adult hair for precise anastomosis. After some manipulation, the inner diameter of the trachea doubled and the stenosis problem was solved. Next, the problem of atrial septal defect is solved, and the doctor skillfully fills the “gap” in the heart for him. After a series of actions are completed, it is also necessary to “accept”. When the doctor reviewed with a 3cm flexible bronchoscope, the whole road was unimpeded and the operation was successfully completed.
It is reported that the biggest risk in the early postoperative period is infection, if there is infection, the trachea will not grow well, and anastomotic fistula will appear; Secondly, the postoperative anastomosis is prone to granulation tissue hyperplasia, resulting in tracheal restenosis. Fortunately, under the close supervision of the medical team, An An recovered well and successfully removed the ventilator. The results of re-examination 10 days after surgery showed that the anastomotic mouth was unobstructed and no granulation tissue hyperplasia was seen. At present, the little one has normal appetite and sleep, breathing steadily, and is undergoing further rehabilitation.
(After surgery, An An is recovering.) ）
Source | Crystal News APP
Reporter: Bai Fan
