Chapter 2123: 2050 Save the Adult or Save the Child, an Ancient Proposition

2050 Save the Adult or Save the Child, an Ancient Proposition

The Di Du Women and Children's Hospital is one of the few obstetrics and pediatrics hospitals in Di Du and even the whole country.

Each year, the number of newborns delivered is around fifteen thousand.

It is bustling year-round, with crowds as busy as a market. Even during the New Year, when other large tertiary hospitals quiet down, this place remains lively.

Unlike other large general tertiary hospitals, the vast majority of people here are full of joy, not downcast.

After all, adding a new family member is a good thing, a great thing.

The obstetrics wards of the Women and Children's Hospital number over ten, and in each ward's doctors' office, banners of appreciation are piled up, more than can be hung.

When people encounter happy events, they feel refreshed; with mother and child safe, giving congratulatory money and banners is only natural.

But today, the atmosphere in the first obstetrics ward is somewhat off.

The doors of the doctors' office are tightly shut; those not performing surgery sit inside the office, with external expert professors and the hospital's leadership sitting in the office.

The air feels stagnant, as if a major medical accident had just occurred, and no one dares to speak.

The incident happened a little over two months ago.

During a check-up, a 39-year-old elderly pregnant woman discovered that the fetus in her womb possibly had congenital aortic valve stenosis.

At that time the fetus was only 24 weeks gestation, and being able to detect congenital aortic valve stenosis shows that the level of the Women and Children's Hospital is quite high.

Upon seeing this test result, the doctor at the time explained the condition clearly to the patient and her family.

Because of congenital abnormal development of the aortic valve, it leads to obstructive heart disease of the left ventricular outflow tract, accounting for about 3%–6% of congenital heart diseases.

If the fetus develops aortic valve stenosis in early or mid-pregnancy, as gestation progresses, the left ventricle's filling volume will be affected and continue to decrease.

In the end, this may lead to progressive developmental impairment and heart failure, forming hypoplastic left heart syndrome.

From birth to treatment, even while still in the mother's uterus, the child faces a new danger every day.

Every step is a pitfall; a misstep means the gates of hell.

The likelihood of the fetus dying in the womb is high; even if born alive, it will face countless troubles.

The doctor recommended induction of labor, which is the option best suited to the current situation.

But the pregnant woman herself is nearly forty; to have a child and fulfill her dream of motherhood, she has given a lot. Even though she already has gestational hypertension, she continues to persist.

For her, giving up this option simply does not exist.

After hearing the doctor's tactful explanation, the pregnant woman herself firmly refused induction, weeping while hoping for a miracle.

Perhaps as the pregnancy progresses, the child's condition will not worsen but instead improve. This scenario is not impossible, but its probability is extremely low—so low as to be not worth considering.

After choosing to preserve the pregnancy, the pregnant woman traveled throughout Di Du; whenever she went to a high-level hospital, the final conclusion was always the same.

This time, it is because in yesterday's prenatal check-up they discovered the fetus's condition was deteriorating.

The aortic valve pressure gradient rose gradually from 22 mmHg to 85 mmHg. The ratio between the left and right ventricles became progressively unbalanced, and during observation, fetal pericardial effusion, mitral regurgitation, and similar conditions appeared one after another.

All signs indicate that the patient's congenital aortic valve stenosis is progressing toward extreme severity, and manifestations such as heart failure are appearing.

But the gestation is only 32 weeks……

The pregnant woman still refuses induction; she objected at 24 weeks, and eight weeks later her stance is even more resolute.

Although she knows that after a cesarean birth the child may have to endure repeated major surgeries and could even die, she still does not give up.

After discussion by internal and external expert panels, three treatment options were summarized.

First, close observation, conservative treatment.

Actually, this is a no‑option option; the patient's current condition cannot possibly last until natural delivery at 38–40 weeks.

Second, prepare for a cesarean section; after the patient is delivered, go directly to another operating table to perform an open‑chest operation and surgically treat his congenital aortic valve stenosis.

This treatment approach carries enormous risk.

The patient's own condition while growing in the mother's body is not good; at only 32 weeks, he already shows signs of pericardial effusion and heart failure.

The surgery itself is doable…… though extremely difficult, compared to the patient's postoperative recovery, it becomes a relatively simple and easy procedure.

This step is also the one chosen by almost all doctors in a vote.

For the surgery, the hospital also invited the nationally renowned Dr. Liu Cixi to be the chief surgeon.

For this type of surgery, Dr. Liu Cixi has performed the most cases domestically and has the highest number of successes; nevertheless, even so, the success rate of the surgery is below 30%.

Frankly speaking, choosing to retain the patient likely means the family will face an outcome of losing both person and wealth.

The surgery is ultra‑high difficulty, ultra‑low success rate, and daily massive expenses—these are all problems.

Besides that, there is a third treatment method—the development of neonatal cardiac surgery and catheter‑based interventional technology, which enables intrauterine interventional treatment.

At first listen, this sounds like an impossible treatment.

The principle is simple: interventional surgery treats congenital aortic valve stenosis. Open the narrowed area as early as possible, and improve aortic blood flow as early as possible.

The benefits are enormous; it can promote fetal left ventricular development and create an opportunity for biventricular circulation after birth.

Moreover, if the surgery is perfect, the fetus can continue to grow in the mother's body all the way to natural delivery at 38–40 weeks.

The next one and a half to two months are crucial for the fetus!

But,

Just,

It sounds beautiful.

Intrauterine interventional treatment has not been around for long.

In 1991, the world's first case of such treatment was first reported by MaxwellD et al. The literature was published in a case report in the 《New England Journal》 magazine, attracting the attention of many interventional‑department doctors at the time.

To date, internationally over 200 clinical cases have been reported consecutively, concentrated in Western countries. Aortic valve balloon valvuloplasty accounts for the majority, and the technical success rate exceeds 50%.

Well, over 50%; in other words, the mortality rate exceeds 40%, approaching 50%.

Compared to cardiothoracic surgery after cesarean section, this mortality rate is barely acceptable.

But!

Intracardiac Intervention Surgery has extremely high risk.

Besides the fetus, the pregnant woman also faces risk.

The second plan, the pregnant woman is definitely fine. However, if choosing Intracardiac Intervention Surgery, the pregnant woman bears half of the fetus's life risk.

At this point, a Disagreement arose between the patient and the patient's family.

The pregnant woman herself firmly demands the third type of intracardiac intervention treatment, while the family demands the second type of Shou Bing.

To save the adult or save the child, this is a Gu old proposition.

When medical standards were not developed, difficult labor was life-threatening. At that time there was no cesarean section, so such a proposition would arise.

And now, with medical Technique level advancing rapidly, the question of saving the adult or the child has become a false proposition.

But when this Gu old choice is placed on the table, all doctors helplessly discover that it actually still exists.