I thought I needed to replace a heart part, but after the thoracotomy I received an unexpected gift | Guokr Patient

During the college entrance examination physical examination 14 years ago, the internal medicine doctor heard a heart murmur in my heart. I went to the cardiology department and found out that I had congenital aortic valve insufficiency.

At that time, the degree of valvular regurgitation was moderate, and the doctor asked me to have a cardiac ultrasound check every year, and told me that it was only a matter of time before I would need a heart valve replacement, but I could wait until I was in my 50s or 60s. I was still hoping that I could hold on until then.

Immediate hospitalization and surgery are recommended

I graduated, got a job, got married and had a daughter. However, a few years ago, the aortic valve regurgitation gradually progressed to moderate to severe. When I rechecked my heart with color Doppler ultrasound at the end of 2019, there was an extra sentence on the report - dilatation of the ascending aorta. I decided to see a doctor in the cardiac surgery department of a tertiary hospital that I had been paying attention to for a long time. During the waiting period, I still hoped that I could wait 20 years before having surgery. After all, I had been observed for 14 years and had no symptoms.

Cardiac ultrasound results | Photo provided by the author

However, my fantasy was shattered too quickly. After understanding the situation, Director Liu of the Department of Cardiac Surgery suggested that I be hospitalized for surgery immediately. Thinking that it was the end of the year, I asked the director: "Do you recommend that I be hospitalized within two weeks or three months?" The director replied: "I suggest that you be hospitalized today."

Since I still had some unfinished work, I made an appointment to be hospitalized two days later. I went to the company to take over the work, explained to the elderly how to take care of the children, and went home to prepare the items I needed for the hospitalization. I remembered that my colleague said he would come to the hospital to see me when I asked for leave, so I brought my eyebrow powder and lipstick.

Logically speaking, this director was a great man who had performed nearly 500 cardiac surgeries in the previous year, more than the number of times I cooked in a year, so there was nothing to worry about. However, I still couldn't sleep the night before I was admitted to the hospital. Maybe he was afraid that the food in the pot would be cooked badly.

Do a check-up before surgery and do lung function training

On the first day of hospitalization, the nurse came to the bedside and assigned homework: 10 lung function exercises in the morning and afternoon, and accurately record the amount of water and urine output each day. I started taking medicine and receiving intravenous drips, which were some medicines to nourish the myocardium and replenish electrolytes.

Breathing trainer and intake and output record sheet | Photo provided by the author

The doctor ordered a preoperative examination, and there were various blood draws waiting for me the next morning. About ten tubes of blood were drawn.

The results showed that I was a strong middle-aged man, and other indicators were normal except for my heart condition. On the third day of hospitalization, Dr. Zhang, who was in charge of me, confirmed the date of surgery, which was scheduled for Tuesday of the following week.

The doctor confirmed with me and my family which valve to replace. Between biological and mechanical valves, we chose biological valves because they do not require long-term medication and dietary restrictions. The disadvantage of biological valves is that they cannot last long and will require a second surgery in 20 or 30 years. My family and I are full of confidence in the development of medical technology and believe that the next time we replace the valve, we will no longer need open-heart surgery.

Mechanical valves and biological valves丨wikimedia

My mood went up and down as the surgery lasted.

On Monday afternoon, the nurse suddenly informed me that my surgery was rescheduled to Wednesday. I felt relieved and decided to go to the convenience store to buy a pair of Christmas stockings to hang on the bedside, wishing myself a smooth operation.

After I came out of the convenience store, I received a call from the nurse, asking me to go back quickly. At this time, I was eating toasted gluten and had a piece of tiramisu cake in my hand. When I returned to the ward, I learned that another patient could not have surgery for some reason, so my surgery was still scheduled for Tuesday, but the time was postponed.

The nurse recorded my weight, gave me two enemas and a tablet of Diazepam, and asked me to take it at 8 o'clock in the evening.

Lying in bed that night, I was a little worried from time to time, wondering whether I should tell the doctor that I had registered with the Organ Donation Management Center, and not to waste my good parts in case of an accident. But before nine o'clock, I fell into a deep sleep. Usually, I am very sensitive to noise in the ward. I can hear the nurses coming in for rounds or the snoring of the patients' family members. But I slept very well that night, and woke up naturally at five o'clock.

The style of the Moments notification is as above | Photo provided by the author

I'm not nervous about the surgery, can the stitches look better?

When I woke up in the morning, I didn't have the nervousness of the upcoming surgery, nor the anxiety of waiting. I guess this was the effect of the pill I took last night. At 9:40, the flat bed came to pick me up.

The bed was pushed into the operating room hall. On my left and right were flat beds with patients lying on them. Like an assembly line, the operating room nurses assigned us to the corresponding operating rooms.

After entering the operating room, the nurses and doctors began to insert needles all over my body, including an arterial puncture in my left wrist, a large-sized indwelling needle in my right wrist, and a deep vein catheter in my neck. It was very painful at first, but then it didn't hurt that much. After the needles were inserted, my hands were fixed in the pockets beside the operating table.

I looked at the ceiling with boredom. There were two shadowless lamps on it. Each had three groups of bulbs arranged in a circle, and each group had ten bulbs...

I found the surgeon standing next to me, so I asked, "Director Liu, can I get cosmetic stitches?" "We don't have any needles that are not cosmetic needles here, don't worry, we can make your stitch look better." A strong doctor next to Director Liu answered.

"The sewing looks better, that's great, thank you." The memory ended abruptly.

I heard from fellow patients that some patients were awake from the beginning to the end of the general anesthesia surgery. The heart stopped beating, the extracorporeal circulation was used, but the patient was awake. It was very exciting to think about it. Fortunately, I knew nothing.

Received a huge Christmas gift in the ICU

When I woke up again, it was already dark. I was lying in the intensive care unit, connected to a ventilator and unable to speak. My sternum and shoulders hurt, and the pain worsened with every breath.

The nurse asked me a few simple personal information questions and asked me to nod or shake my head to answer her, probably to confirm whether I had regained consciousness. She asked me to breathe deeply and try to unplug the ventilator as soon as possible. Another doctor came over, put his hand in mine, and asked me to squeeze his hand.

After that, the nurse patted me every once in a while and told me to breathe well. I don’t remember how many times I was reminded three or five times before the ventilator was finally removed. The moment it was removed, the tube was inserted and the sputum was suctioned. It was not a pleasant feeling, but it was much better than the feeling of being hospitalized for bronchoscopy due to pneumonia.

The ventilator was unplugged and replaced with an oxygen mask. After a while, the mask was removed and replaced with a nasal cannula for oxygen. Although my body was in pain, I soon fell into a deep sleep. That night was Christmas Eve.

The next morning, when I woke up and saw the nurse, I said Merry Christmas to her. She smiled and said thank you, then brought me a bowl of millet porridge. But I didn't eat much because I didn't want to do anything except sleep.

Later, Dr. Zhang came to see me and told me that the aortic valve was not replaced, but Director Liu repaired it. In this way, I don't need to take medicine or undergo a second surgery decades later. I am almost like a normal person. After the repair, not only the quality of life has improved, but the cost of the surgery has also been reduced by half. This technology was learned by Director Liu half a year ago when he went abroad, and it is still rare in China.

This was simply a huge Christmas gift, and I suddenly felt like a person blessed by God. Joy diluted the pain, and the snow-white ICU seemed to be illuminated by the twinkling light of the colorful lights on the Christmas tree.

There are doctors to take care of your body and nurses to take care of your emotions.

I fell asleep again until I don't know when my lover came to see me and said a few simple words. "Do you know there is a song called "Breathing Pain"? This is how I feel now." I fell asleep again before he left.

Afterwards, a doctor came and put a board behind my back and took an X-ray beside the bed. After I was discharged from the hospital, I saw the X-ray. The sternum that was split during the operation was fixed together with steel wires and it did not need to be taken out afterwards. The steel wires were twisted in the most ordinary way, without the bow I expected, and without the strange shape that looked mysterious and impressive.

Steel wire on the sternum | Photo provided by the author

On the first day after surgery, the doctor in the ICU asked me to sit up and cough up phlegm, and the nurse patted my back to help. But I was so sleepy, I had no strength, and it hurt. I told the nurse to let me sleep for a while, and I would cough hard when I woke up.

As a result, the next morning, the doctor shouted at the nurse, saying that my blood gas index was not good, and asked if I didn't cough well last night. The nurse did not defend herself. I was so ashamed that my laziness caused trouble for the nurse. Then the doctor shouted at me again, and the nurse next to him suddenly said, "Why are you shouting at the patient!"

I am very happy to have doctors who care about my health and nurses who take care of my emotions. I am grateful to them.

After that, I tried to get up and cough, and practiced breathing with a breathing trainer. After the indicators were qualified, the doctor announced that I could leave the intensive care unit and enter the general ward. It was 46 hours after the operation, and I was indeed a strong middle-aged man.

Remove the various tubes one by one

When I was transferred to the ward, I found that in addition to the monitoring equipment and the needle for the IV drip, I also had a drainage tube inserted in my stomach. This made me unable to get out of bed even though I had the strength, which made me feel very frustrated.

On the third day after the operation, when I was removing the drainage tube and changing the dressing, I realized that the incision on my chest was 20 centimeters long. To repair a 2-centimeter thing, 20 centimeters of skin and flesh were cut open and the sternum was sawed open. Only the heart should be treated like this.

In the first few days after leaving the ICU, I was still connected to the monitoring equipment 24 hours a day, monitoring my heart rate and blood oxygen, and automatically measuring my blood pressure every hour. I was given more IV drips every day than before the operation, with antibiotics, dopamine injected by a micropump, and red blood cells.

After another two or three days, I was finally able to remove the monitoring and the tube implanted in my neck, and all the restraints. I washed my hair immediately, and when I looked at myself in the mirror after not seeing myself for a long time, I suddenly felt that I had become more beautiful.

A deep vein catheter that needs to be sutured on the neck, when inserted and after removal | Photo provided by the author

The day after the restraints were removed, Dr. Zhang wrote me a bunch of checkups. My fellow patients told me that if the results of this checkup were up to standard, I could be discharged. After a few days of injections, medication, blood draws, tests, and walks in the ward corridor, I was discharged.

Before I was discharged from the hospital, Dr. Zhang came to check my wounds and told me to sleep on my back instead of on my side, saying that my lungs were not fully inflated because I had not coughed hard before and I would have to cough hard when I got home. I said I would change my ways and work hard, and the serious Dr. Zhang was amused by me. It was the first time I saw him laugh.

Half a month later, I was discharged from the hospital

It took 6 days from admission to surgery, and 8 days from surgery to discharge. It took half a month to complete an open-heart surgery.

During the hospitalization, I met many patients, some of whom had aortic dissection and needed to stay in bed, and some of whom had aortic dissection and were sent to the ambulance with a narrow escape. Therefore, regular physical examinations and timely surgery are undoubtedly the best options. In addition, some patients' cardiovascular diseases are caused by "three highs", so healthy living habits are also very important.

On the day I was discharged from the hospital, I guessed what happened during the hours of surgery based on the items on the bill. It was only two weeks later when I got the medical records that I learned the truth. I looked up all the words I didn't understand, and even at my age I couldn't suppress my strong curiosity.

Treatment list and discharge medical record | Photo provided by the author

When you first return home, you still need to rest quietly. When the weather is good, you can go out for a walk. You can do some handicrafts and listen to books at home. You can do some light housework one week after being discharged from the hospital.

During this major life event, I felt the kindness of strangers. The medical staff not only completed their duties professionally, but also put themselves in my shoes and treated me tenderly. I tried to think seriously about the value of life during the time I returned home, but to no avail. Anyway, let's be a good person first. I plan to get well soon and then go to the hospital to donate blood components.

One month after the operation, I walked three kilometers every day at a pace of ten minutes per kilometer, and I felt that I could go back to work. Due to the impact of the epidemic, I actually started working one and a half months after the operation. On the first day of work, I had to clean and disinfect. I walked more than 10,000 steps a day and didn't feel any discomfort.

By the way, forty days after the operation, I went to the hospital for a follow-up checkup with proper protection. The result was good, and my Santa Claus was very happy! Santa Claus is the surgeon who gave me a Christmas present.

Results of cardiac ultrasound examination one month after discharge | Photo provided by the author

Doctor's comments

Song Bangrong | Attending physician of the Department of Cardiothoracic Surgery, Beijing Anzhen Hospital, Capital Medical University

The cause of this patient's aortic regurgitation is a developmental abnormality of the aortic valve. During embryonic development, the large artery from the heart splits from one arterial trunk into two blood vessels, the aorta and the pulmonary artery. During the blood vessel division process, the valve leaflets that act as a one-way valve are formed, and the number or structure of the valve leaflets may be abnormal.

Abnormal development of the aortic valve most often causes valvular stenosis, followed by valvular insufficiency (causing aortic regurgitation in this patient) and infective endocarditis. In the early stages, the aortic valve function is similar to that of a normal aortic valve and does not cause obvious symptoms. With age, the valve is damaged by the impact of blood flow for a long time, leading to valvular stenosis; on the other hand, valvular insufficiency may also occur due to mismatched development of the valve leaflets and the valve ring to which they are attached, irregular valves, and deformation of the valve ring. This is also the reason why the degree of regurgitation in this patient gradually worsens with age.

Comparison of normal and abnormal aortic valve丨care4heart

Aortic valve malformation is often accompanied by dilatation of the ascending aorta and the formation of an ascending aortic aneurysm. Dilatation of the ascending aorta may occur when the valve is functioning normally.

This disease is difficult to diagnose accurately through questioning and auscultation. Echocardiography is the most direct and reliable examination method.

In terms of the timing of surgery, if there are no symptoms, you should have regular checkups and follow the doctor's judgment on the condition. If you have obvious symptoms such as chest tightness and shortness of breath, decreased heart function, enlarged heart, or significantly widened ascending aorta, surgery is usually required.

Currently, surgical treatment focuses on the treatment of diseased valves and ascending aorta. Surgical methods include shaping and replacement of the aortic valve and ascending aorta. Transcatheter aortic valve replacement (TAVI) has recently emerged, but this surgery is only suitable for some patients.

Doctors will choose different surgical procedures based on the patient's specific situation. Patients with aortic valve regurgitation without stenosis and children have better results with aortic valvuloplasty, which is the case with the author of this article.

Regarding the choice of valve type, since biological valves have a limited service life but do not require long-term anticoagulant medication, young women who want to get pregnant, elderly people over 65 years old, or patients with particularly high quality of life requirements can choose biological valves. Mechanical valves are generally recommended for other patients, and biological valves can also be used if a second surgery is performed more than ten years later.

Author: Xiao Xie, who lives opposite the intersection of Hope

Editor: Dai Tianyi

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