A Miracle in the History of Cardiac Surgery

Text by Liu Xun, Wang Jiliang, Nie Wenwen & Liu Kunwei

Edited by He Sai & Yi Wanru

Photos by Wang Yongsheng

“I never expected that I could have the chance to come back,” said Lingling(pseudonym), a girl from Weihai, Shangdong Province,who was lying in an ICU of the Union Hospital affiliated to Tongji Medical College of HUST(Huazhong University of Science and Technology), in Wuhan.Recalling her thrilling experience on her way back from Japan, she felt sheer luck and some lingering fear.

Two years ago, Lingling started her internship at an electronics manufacturing enterprise in Aichi-ken, Japan. There the medicine she took to treat her acne caused a severe drug allergy that damaged her renal and myocardial function. Last May,her illness worsened rapidly,causing her blood circulation system to lose function. As a result, her life was in great danger. Lingling was then transferred to Fujita Health University Hospital in Nagoya for treatment. The experts from the hospital confirmed that Lingling was suffering from giant cell myocarditis, which meant that she was nearly undergoing cardiac failure, and cardiac arrest could occur at any time.

Last September, Professor Yoshiyuki Takami performed the surgery for Lingling, installing two extracorporeal artificial hearts to help pump blood.Seeing Lingling’s heart connected with so many pipes, her mother was extremely sad. Worse still,Lingling’s cardiac function remained unimproved even after the operation, and her cardiac muscle was still undergoing extensive fibrosis. Owing to the relevant policies and regulations in Japan, Lingling had to receive a heart transplant back in China.

After waiting for nearly ten months, Lingling finally has her heart transplant on June,25, the Dragon Boat Festival端午節(jié)（6月25日），玲玲完成等待了近10個(gè)月的心臟移植手術(shù)

“我沒(méi)想到自己還有機(jī)會(huì)回來(lái)?！蹦贻p的山東威海女孩玲玲（化名）躺在武漢華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬協(xié)和醫(yī)院的ICU病房里，回想自己一路驚心動(dòng)魄的搶救經(jīng)歷，感到萬(wàn)分幸運(yùn)，又有些心有余悸。

兩年前玲玲以實(shí)習(xí)生身份，前往日本愛(ài)知縣一家電子設(shè)備制造企業(yè)工作。因服用了治療粉刺的藥導(dǎo)致嚴(yán)重藥物過(guò)敏，引發(fā)腎功能、心肌功能損傷。去年5月，病情一度急轉(zhuǎn)直下：血液循環(huán)系統(tǒng)功能接近喪失，生命告危。玲玲被轉(zhuǎn)入名古屋藤田醫(yī)科大學(xué)醫(yī)院治療。醫(yī)院組建專家組，確診玲玲是“巨細(xì)胞性心肌炎”，這意味著她心臟幾近衰竭，隨時(shí)會(huì)驟停。

去年9月，該院心臟血管外科教授高味良行主刀，為玲玲加裝了2臺(tái)體外“人工心臟”，協(xié)助心臟泵血。看著女兒的心臟連接了這么多管子，身邊的母親非常難過(guò)，更難過(guò)的是，都裝了兩臺(tái)人工心臟了，玲玲的心臟功能還是沒(méi)有任何恢復(fù)的跡象，且心肌廣泛纖維化。而受限于日方相關(guān)政策條件，玲玲只能回國(guó)接受心臟移植手術(shù)。

Seeing Lingling in such severe condition, her parents were on pins and needles. After learning that the Department of Cardiac Surgery of Wuhan Union Hospital was among the top ones in the field, her father turned to Professor Dong Nianguo for help this January. Professor Dong,head of the Department of Cardiac Great Vascular Surgery of the hospital, immediately started conversations with the Japanese experts and decided that Lingling should be taken back home in late January. However, the plan was stopped unexpectedly by the COVID-19 epidemic. Lingling had to cancel her flight and stay in Japan to receive her maintenance treatment.

Lingling sitting in the first row on the flight 玲玲坐在航班第一排

Infection, bleeding, and cerebral infarction occurred in succession afterwards— Lingling’s life was in great risk. Artificial hearts have a limited service life,“We really cannot afford to delay the heart transplant any longer,”Professor Dong intensified his communication with the Japanese counterparts. Meanwhile, the relevant departments of the two countries were also making efforts jointly. This would be a transnational relay and most importantly, the artificial hearts would have to have a continuous power supply during the journey back to China. What’s more, the two artificial hearts were of such a big size, how could they be taken on board the plane together with the patient? With the small passenger cabin, how should they transport the equipment and the patient together? Furthermore, in case of emergency, how could they carry out salvage work? All these problems had to be taken into account carefully in advance and an alternative plan would have to be made. The two hospitals were facing an unprecedented challenge.

The final solution was that Lingling would sit in the first row with the two artificial hearts on the seats next to her. To make more space for salvage, the seatbacks of the first three rows would be put down so that the stretcher could be fixed in place.To eliminate any unexpected circumstances, the Union Hospital had prepared two more artificial hearts and two sets of batteries for fear of possible incompatibility with the Japanese apparatus and batteries during electric power conversion. To ensure the supply of oxygen, the airline approved especially of a sufficient quantity of oxygen to be taken aboard. What’s more,the flight also decided on 5 provisional landing sites on the route in case of emergency during the transit.

Approved by the CAAC (Civil Aviation Administration of China), the flight set off from Wuhan Tianhe Airport at 9 am on June 12 and arrived at Nagoya Airport in Japan at noon. After Lingling was put on board, she waved goodbye to the Japanese doctors. 45 minutes later,learning that everything was normal, the Japanese medical workers returned to their hospital. At 6:27 pm, the plane arrived at Tianhe Airport, and Lingling got to the Union Hospital at 8 pm.

Doctors checking Lingling’s physical condition on the flight 醫(yī)生在飛機(jī)上監(jiān)測(cè)玲玲的身體指標(biāo)

女兒命懸一線，父母心急如焚。聽(tīng)說(shuō)武漢協(xié)和醫(yī)院心臟外科很優(yōu)秀，今年1月，玲玲的父親找到該院，向心臟大血管外科主任董念國(guó)教授求助。董教授馬上與日方專家反復(fù)溝通，商定1月下旬接玲玲回國(guó)手術(shù)。沒(méi)想到突如其來(lái)的新冠疫情打亂了計(jì)劃，原訂的航班取消,玲玲只能在日本維持治療。

感染、出血、腦梗等問(wèn)題接連出現(xiàn)，玲玲危機(jī)重重。人工心臟都有使用期限，“再拖下去可能就沒(méi)希望了”。董念國(guó)加強(qiáng)與日方溝通，同時(shí)中日兩國(guó)相關(guān)部門也在共同努力。跨國(guó)接力，人工心臟不能斷電，兩臺(tái)人工心臟“塊頭大”，如何連人帶機(jī)器上飛機(jī)？機(jī)艙狹小，如何擺放人和機(jī)器以及發(fā)生意外怎么搶救？一系列問(wèn)題都要提前考慮并設(shè)立預(yù)案。雙方醫(yī)院都面臨前所未有的難題。

最終定下的方案是：玲玲坐在第一排，兩臺(tái)人工心臟并排放在隔壁座位上。為了騰出搶救空間，乘務(wù)員放倒三排座椅靠背，方便擔(dān)架固定。為了確保萬(wàn)無(wú)一失，協(xié)和醫(yī)院又備了兩臺(tái)人工心臟和兩套電池，以免電功率轉(zhuǎn)換時(shí)日方機(jī)器不匹配；為保證供氧，航空公司特批足量氧氣上機(jī)；擔(dān)心轉(zhuǎn)運(yùn)途中隨時(shí)有突發(fā)意外的可能，航班還在沿線暫定了5個(gè)備降點(diǎn)。

經(jīng)民航總局批準(zhǔn)，航班于北京時(shí)間6月12日9時(shí)從武漢天河機(jī)場(chǎng)出發(fā)，于當(dāng)日中午到達(dá)日本名古屋機(jī)場(chǎng)。中日雙方工作人員將玲玲安置好后，玲玲與日方工作人員揮手告別。飛行45分鐘后，日方醫(yī)務(wù)人員得知玲玲安好才返回醫(yī)院。18時(shí)27分，飛機(jī)平穩(wěn)降落天河機(jī)場(chǎng)，20時(shí)順利抵達(dá)協(xié)和醫(yī)院。

“It’s a miracle in medical history that the two artificial hearts have been working overload for ten months,” said Professor Dong. Actually, the Japanese experts’ meticulous treatment created favorable conditions for her subsequent heart transplant.

However, the heart transplant was not so easy. There had been two opportunities between June 16 and 19, but Lingling missed them once because of the health problem of the donor heart, and the second time her own physical conditions. Thus they could do nothing but wait patiently for the right heart donor, while the cardiac surgery team treated Lingling carefully.

On June 25, Lingling got a “big present” during the Dragon Boat Festival: the heart of a male donor in Guangzhou matched hers. A“heart-protection delivery” team from the Union Hospital departed for Guangzhou at once, to retrieve the heart within 8 hours.

Every step, from removing the heart from the donor’s body to protecting the heart, to trimming the heart, and finally putting it into Lingling’s chest, was of crucial importance. At 3 pm of that day, the donor heart arrived at the operation room of the Union Hospital. A team of over 20 experts headed by Professor Dong Nianguo and Professor Xia Jiahong got into the operation room at once. At 4 pm, Professor Wu Qingping led his team to proceed with anesthesia for Lingling. According to Professor Wu, it was really challenging.Professor Dong also exclaimed that “the difficulty of the surgery was by far greater than they had expected,” because the pipelines of the artificial hearts were so complicated that it made the thoracic tissues fragile with severe adhesions.

Chinese and Japanese doctors discussing Lingling’s treatment plans online中日專家通過(guò)視頻討論玲玲的病情

Surgery under such difficult conditions was unprecedented.After removing the sick heart,Professor Dong trimmed the donor heart and finally managed to put it into Lingling’s chest and then proceeded with vascular anastomosis. After 7 hours of intense surgery, the healthy heart started to beat again in Lingling’s body—the surgery was a complete success. The long-lost smiles appeared on the faces of Lingling’s anxious parents waiting outside the operation room.

On the day of the operation,the Japanese experts viewed the whole process of the surgery through video. Seeing the success of the operation, Professor Yoshiyuki Takami felt relieved.He said he was pleased to see the relay across the two countries produce good result and he also admired the expertise and professional dedication of the Chinese doctors.

The next day after the operation, Lingling began to take breathing exercises; on the third day, the trachea cannula was removed; on the fifth day,Lingling was able to eat by herself;by July 2, everything was normal with Lingling’s circulation system and breathing, and she was able to eat normally and exercise at the bedside on her own. According to Professor Dong, Lingling still needed to face challenges such as infection and rejection before a full recovery.

After leaving the cabin, Lingling and her artificial hearts are carried to the ambulance together出機(jī)艙后，玲玲和人工心臟一起被抬上救護(hù)車

“從一臺(tái)到兩臺(tái)人工心臟，超負(fù)荷運(yùn)轉(zhuǎn)10個(gè)月，這在醫(yī)學(xué)史上已經(jīng)是奇跡?！倍顕?guó)教授說(shuō)，日本專家前期的精心救治，為玲玲后續(xù)的心臟移植創(chuàng)造了條件。

然而，供心的事又一波三折，16日至19日有兩次供心機(jī)會(huì)，先后因?yàn)樾脑幢旧砗土崃岬淖陨砩眢w狀況遺憾錯(cuò)失。等待心臟供體期間，心外科團(tuán)隊(duì)精心守護(hù)玲玲，靜待供心再次出現(xiàn)。

6月25日，玲玲收到了她的端午“大禮”：一顆位于廣州的男性供心。心外科“護(hù)心跑男”團(tuán)隊(duì)立即出發(fā)去廣州取供心。他們必須在8小時(shí)之內(nèi)把供心取回來(lái)。

從取心到護(hù)心，再到心臟修剪，最后放入胸腔，每一步都至關(guān)重要。當(dāng)天15時(shí)，心源抵達(dá)協(xié)和醫(yī)院手術(shù)室，董念國(guó)教授、夏家紅教授帶領(lǐng)20余名專家團(tuán)隊(duì)進(jìn)入手術(shù)狀態(tài)。16時(shí)，武慶平教授帶隊(duì)實(shí)施麻醉。他說(shuō)，這次挑戰(zhàn)前所未有。董念國(guó)也感慨“難度遠(yuǎn)超預(yù)期”：人工心臟管道在體內(nèi)走向錯(cuò)綜復(fù)雜，導(dǎo)致胸腔組織脆弱、粘連嚴(yán)重。

在這種條件下進(jìn)行心臟移植手術(shù)，世界罕見(jiàn)，難度極高。在切除病變心臟后，董教授修剪心臟，最終成功置入并小心進(jìn)行血管吻合。經(jīng)過(guò)7個(gè)小時(shí)的緊張手術(shù)后，一顆強(qiáng)勁而有力的心臟在玲玲體內(nèi)重新跳動(dòng)，手術(shù)圓滿成功。手術(shù)室外焦急等待的玲玲父母，終于露出了久違的笑容。

手術(shù)當(dāng)天，日方專家通過(guò)視頻觀摩了這場(chǎng)高難度手術(shù)。高味良行教授看到手術(shù)成功后，松了一口氣。他說(shuō)，很高興看到中日攜手的生命接力結(jié)出碩果，敬佩中方醫(yī)生的專業(yè)技術(shù)與敬業(yè)精神。

術(shù)后第二天，玲玲開(kāi)始鍛煉呼吸；第三天，成功拔出氣管插管；第五天，恢復(fù)自主進(jìn)食；至7月2日，玲玲循環(huán)、呼吸穩(wěn)定，能夠正常進(jìn)食，并在床邊自行活動(dòng)。董念國(guó)說(shuō)，后續(xù)她還有抗感染、抗排斥等關(guān)卡要闖。

“這個(gè)女孩有著頑強(qiáng)的生命力，無(wú)論多難，臉上都掛著溫暖的微笑，令人感動(dòng)?！眳⑴c救治玲玲的協(xié)和醫(yī)院醫(yī)生李平說(shuō)。女兒重生，玲玲父母百感交集。

“生命所托，即使再難，醫(yī)生不能輕易說(shuō)放棄?！倍顕?guó)教授感慨，此次跨越國(guó)界生命接力的成功，是中日兩國(guó)民眾患難與共、用愛(ài)守護(hù)生命的又一生動(dòng)寫(xiě)照。

“What moves us most is the girl’s strong vitality. However hard it was for her, she always smiled,” said Li Ping, a doctor assisting the surgery. Lingling’s parents also hold mixed feelings witnessing the rebirth of their daughter.

Lingling recovers well after the operation 玲玲接受手術(shù)后恢復(fù)良好

To Professor Dong, it is “the entrustment of the patient’s life on them, no matter how hard it is”—as doctors, “they would never give up saving a life.” The success of the transnational relay is another reflection of the Chinese and Japanese people sharing weal and woe together and saving life with love.