Repairing heart doors without surgery

Recently, Guo Yansong's team from the Department of Cardiology of Fujian Provincial Hospital successfully replaced the heart door (aortic valve) of a 92-year-old woman with complex and critical condition in a precise, minimally invasive and non-thoracic way.

Hospital visits due to illness

The old lady's daughter told her that in the past year, she often found that the old man had chest tightness, breathing difficulties, and could not catch his breath when he spoke.

Outpatient encounter with a good doctor

After arriving at the hospital, Prof. Guo Yansong found through careful consultation and detailed physical examination that the old lady heard a very loud murmur at the gate of her heart, and initially considered it to be "aortic stenosis". Severe stenosis of the aortic valve is a more common heart disease that seriously endangers the health of the elderly, and a severely narrowed heart gate prevents blood supplying the whole body from passing through the gate. The prognosis is extremely poor, with a 50% sudden death rate within 2 years and a 75% sudden death rate at 3 years, when the patient is untreated or treated conservatively with internal medicine after discomfort. The only way to save the old lady was to open the heart door. Considering that the old lady was 92 years old and had many underlying diseases, she could not tolerate open-heart surgery, so she was recommended to have a minimally invasive interventional aortic valve replacement (TAVR) without opening her chest. At the same time, an emergency hospitalization was arranged for the old lady through the green channel to evaluate her treatment.

Pre-operative meticulous evaluation

After hospitalization, further examination revealed that the old lady also had multiple organ insufficiencies such as lung infection, respiratory failure, abnormal liver function, renal failure, thrombocytopenia, and dry syndrome; she had previously undergone radical breast cancer surgery 51 years ago and skin cancer resection 21 years ago, which resulted in the removal of many ribs in the thorax and collapse of the thorax with the loss of some ribs, aggravating the lung He had undergone a permanent pacemaker implantation 6 years ago for a slow heart rate. The condition was complex and critical. After a detailed preoperative evaluation of the cardiac structure, it was found that the old lady not only had severe aortic stenosis and moderate insufficiency, but also severe stenosis of the heart vessels (95-99% stenosis of the middle lumen of the right coronary artery, which is called "life hanging by a thread"), and most troublesome was the combination of a very rare "porcelain aorta The most troublesome thing was the combination of a very rare "porcelain aorta".

The so-called porcelain aorta refers to diffuse calcification of the ascending aorta, which has an eggshell-like appearance, commonly referred to as the aorta being as fragile as porcelain. The aorta was porcelain and the heart gate was also severely calcified, and the calcification continued to extend down to the left ventricular outflow tract and mitral valve root, further increasing the difficulty of manipulation and the risk of complications. In addition, the difficulty of performing TAVR is also demonstrated by the small diameter of the large arteries throughout the body of the old woman, with the smallest diameter of the left femoral artery being only 2.7 mm and the smallest diameter of the right femoral artery being only 4.7 mm, which requires a normal femoral artery diameter of 6 mm for TAVR; if it is less than 6 mm, the risk of rupture is extremely high when performing TAVR through the femoral artery; the diameter of the three aortic sinuses is only 24 to 26 mm, which should be about 30 mm; and the sinus diameter is only 24 to 26 mm. The three aortic sinuses are only 24 to 26 mm in diameter, whereas normal should be about 30 mm; the sinotubular junction is 19 mm, whereas normal is about 26 mm.

In porcelain aortic conditions, coupled with the small anatomical structure of the old lady, there is little space for a relatively fixed size valve, making it difficult to place the valve, which may lead to perivalvular leakage or valve displacement; in addition, the porcelain aortic vessel wall is calcified, with many plaque attachments, making it easy to calcify and dislodge the plaque during the operation, with complications such as stroke (see figure below); the patient's heart chamber is enlarged, and the apical part is seen to be locally The patient's heart cavity was enlarged, and localized myocardial weakness was seen in the apical region, which could easily lead to myocardial perforation and rupture during operation. The evaluation results suggested that the patient was extremely risky and difficult to operate, but there was really not much time left for the old lady and the doctors.

After being admitted to the hospital, the above symptoms did not improve significantly and the condition worsened day by day with less and less urine output and further worsening respiratory distress. At the same time, President Guo's team repeatedly communicated with the patient's family and informed them of the severity of the patient's condition and the complexity of the surgery. Prof. Guo Yansong led the TAVR team members to develop a thorough surgical plan through scientific analysis and meticulous medical evaluation.

The wonderful hand in surgery

After the old lady was transferred to the cardiac intensive care unit and underwent a combination of continuous renal replacement therapy (CRRT) and transnasal high-flow oxygen administration (OPTIFLOW), her body's internal environment was slightly improved, and Prof. Guo Yansong's TAVR team decided to seize this opportunity to perform TAVR + PCI (coronary intervention) on her. Both important cardiac procedures required no chest opening and could be performed with a single puncture site of less than 6 mm. The surgery was performed by Prof. Guo Yansong himself, with close cooperation and meticulous operation by the team members and close multidisciplinary collaboration, and was successfully completed with blood vessel reconstruction and heart valve implantation for the "life-threatening" heart vessel and the severely stenosed aortic valve (see figure below). The operation was completed successfully with the joint efforts of all medical and nursing staff.

Post-operative care and attention

On the first day after the operation, Prof. Guo Yansong personally visited the old lady in her bed, who happily told Prof. Guo Yansong that her breathing difficulties had improved significantly and her appetite was better than before. In the following days, after the joint treatment and care by the medical staff of the Intensive Care Unit and the Third Department of Cardiology, the function of all system organs improved significantly and the old lady was finally discharged from the hospital successfully.

Insisting on the blessing of life, determined to save lives and help the injured

As one of the mature heart valve centers in China, the Heart Valve Center of Fujian Provincial Hospital, led by Professor Guo Yansong, treats every surgery with the best humanistic care, exquisite medical skills and the highest standards; fully demonstrating the rich experience and surgical strength of Fujian Provincial Hospital in the field of heart valves and bringing quality medical services to patients with heart valve diseases.

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Heart valve disease specialists at Fujian Provincial Hospital

Fujian Jinshan Hospital, Vice President, Chief Physician, Professor, Doctoral Supervisor, FACC

President of Cardiovascular Physicians Branch of Fujian Physicians Association

Director of Health Management Branch of Fujian Medical Association

Vice Chairman of the Cardiovascular Disease Branch of Fujian Medical Association

Head of Cardiovascular Critical Care and Chest Pain Group, Cardiovascular Disease Branch, Fujian Medical Association

Member of Fujian Provincial Medical Association Internal Medicine Branch

Council Member of Fujian Medical Doctor Association

Council Member of Fujian Provincial Medical Association

President of Haixi Heart Failure Institute

Chairman of Fujian Heart Failure Center Alliance

Director of Fujian Cardiovascular Interventional Treatment Quality Control Center

Director of Training Base (Coronary Heart Disease), Fujian Provincial Hospital, Cardiovascular Diagnosis and Intervention, Ministry of Health

Chairman-elect of Chinese Society of Cardiothoracic and Vascular Anesthesia, Precision Medicine Branch

Standing Committee of Heart Failure Committee of Chinese Physicians Association

Member of the Youth Committee of the Cardiovascular Disease Branch of the Chinese Medical Association

Vice Chairman of the Youth Committee of the Cardiovascular Disease Branch of the Chinese Society of Integrative Medicine

Member of Cardiovascular Disease Committee of Chinese Society of Integrative Medicine

Standing Committee of the Chinese Stroke Association, Cardiovascular Disease Branch

Executive Director of Rare Diseases Association of China Research Hospital Association

Vice President, China Heart Failure Alliance

2019 "People's Good Doctor of the Year".

2019 Heart Failure Center "Model Specialist".

Recommended candidates for the 2020 National Hundred Million Talents Project in Fujian Province

Fujian Provincial Hospital, Department of Cardiology III, M.D. Chief Physician Postgraduate Advisor. He has been engaged in the clinical work of cardiology for more than 20 years. His main specialties are: cardiovascular disease treatment, coronary intervention, percutaneous catheter aortic valve placement (TAVI), percutaneous catheter mitral valve clamping (TEER), atrial fibrillation left auricular occlusion (LAAC), congenital heart disease intervention, etc.

Heart valve specialist clinic hours [contact number 13328671679 (can add WeChat)
Guo Yansong	Chief Physician	Thursday morning, Tuesday morning (Jinshan)
Wu Zhiyong	Chief Physician	Tuesday and Thursday morning
Chen Xinjing	Chief Physician	Tuesday all day
Fang Mingcheng	Attending Physician	Thursday morning
Hong Jing Xuan	Attending Physician	Thursday afternoon
Yang Qingyong	Physicians	Tuesday afternoon