Chapter 928: 909 Mealtime Consultation

Yes. Zhao Yunlong said.

He immediately picked up his phone and sent a WeChat message to the on-duty doctor, asking that side to send over the ultrasound heart images and report.

A few minutes later, the phone rang; he glanced at it and handed the phone to Zheng Ren.

In the CDFI report, the patient's tricuspid regurgitant jet area was already greater than 8 square centimeters, indicating severe tricuspid regurgitation.

Meanwhile, the pulmonary artery pressure and other indicators were abnormal, but not consistent with the tricuspid regurgitation.

This is indeed somewhat strange.

Generally speaking, heart valves are like the door hinges of an old house; once opened, they are pulled back to prevent blood from flowing backward.

This situation most commonly occurs in elderly people whose muscles have weakened and atrophied, causing the door hinges to age and the valves to not close tightly.

In young people, it is commonly seen in congenital heart disease, infection, intravenous drug use, etc.

Zheng Ren again asked about the patient's medical history; there was no relevant history as mentioned. This is also a point of puzzlement for Zhao Yunlong, so he prepared to discuss it internally in the department tomorrow.

A disease that cannot be understood should not be taken directly to the operating table.

Once on the operating table, if an undiscovered disease exists, the surgeon will face more trouble. As an experienced surgeon, Zhao Yunlong certainly understands this.

It is better not to go on the table than to proceed without clarifying everything.

Therefore, he acted very cautiously.

Su Yun also took a look; countless questions swirled in his mind—this patient is truly abnormal.

Unwilling to let Zhao Yunlong refuse another drink, if he were to go on rounds or attend the department consultation tomorrow hungover, speaking sloppily, he would surely be scolded to death by the chief.

"Have the other lab results come out?" Zheng Ren, chin in hand, pondered and then asked.

"I have asked that side to send over all the images," Zhao Yunlong said.

This time Zhao Yunlong directly created a group, asking the on-duty doctors to send the images into the group.

Looking at the lab reports, Zheng Ren and Su Yun finally became honest.

Especially Su Yun, the black hair on his forehead swayed faintly without wind, as if his brain were operating at high speed, causing a subtle change in the airflow.

Zheng Ren examined the reports one by one and immediately discovered the problem.

The patient not only had changes due to cardiac fatty degeneration, but also severe fatty liver; on B‑ultrasound, the liver was larger than that of a normal person.

This is strange.

The patient is only in his thirties; even with alcoholism and heavy consumption of fatty meats, it is difficult to develop severe fatty liver that also enlarges the liver.

This, like the tricuspid regurgitation, is not an ailment that young people of this age should have.

Zheng Ren pondered deeply, comparing the data; after about ten minutes, he slowly said: "Tomorrow we will check a blood acylcarnitine profile."

"Huh?" Zhao Yunlong stared for a moment.

"Based on the patient's test results and the clinical symptoms you described, I suspect primary carnitine deficiency." Zheng Ren said: "Cardiomyopathy, lipid‑deposition myopathy, fatty liver, plus the patient's blood glucose of only 3 mmol/L, allows a rough judgment."

Zhao Yunlong was a bit confused; he had heard of this disease but had never seen it clinically.

Su Yun, lost in thought, after a few seconds asked: "Can the hospital test for the SLC22A5 allele?"

"Yes, but it takes time."

"Does anyone else in the patient's family have a similar condition?"

"When taking the history, the patient's account was vague; I have already asked the patient's father and mother to come over, and I will interview them in person tomorrow." Zhao Yunlong's clinical work is meticulous; everything Su Yun could think of, he also thought of, and had already arranged.

"Boss is right; considering it is primary carnitine deficiency, we should not operate, give intravenous L‑carnitine for a period, then continue oral administration." Su Yun asked, "Right, boss?"

"Hmm." Zheng Ren nodded.

This is a fatal disease, but if detected early and managed with diet and L‑carnitine supplementation, quality of life will not be affected.

"Free carnitine is markedly reduced; if it is below 10 mmol/L together with multiple acylcarnitines reduced, we can basically diagnose." Zheng Ren said: "Once the genetic test results return, we will start L‑carnitine supplementation and the symptoms will ease."

Listening to Zheng Ren and Su Yun exchange words, Zhao Yunlong's doubts were resolved; Fang Lin felt somewhat moved.

The rising star of the Cardiothoracic Surgery department in the capital—this title is not undeserved. Su Yun can make the diagnosis, which is no surprise to me. However, this diagnosis was first proposed by Chief Zheng; Su Yun then reasoned backward and found several supporting points.

Chief Zheng is indeed very strong.

Regardless of right or wrong, being able to propose the next needed test and proceed step‑by‑step by trial and error is already enough. Many people, including myself looking at these lab reports, are just clueless.

"Old Zhao, are you still drinking later at the bar?" Su Yun asked.

"I have something tomorrow." Zhao Yunlong insisted.

"Tsk, what a buzzkill."

"Who knows we'd admit such a patient today." Zhao Yunlong completely ignored Su Yun's contempt; he seemed accustomed to it. He was pondering the patient's condition, and the more he thought about it, the more he felt Zheng Ren was right.

The likelihood of primary carnitine deficiency is high; after using L‑carnitine, the patient's symptoms of tricuspid valve insufficiency will also improve, making surgery unnecessary.

Even if he does not die, the chances of cure with later treatment are not high.

This disease is similar to diabetes, requiring long‑term medication. However, compared with complications, long‑term use of L‑carnitine seems hardly a burden.

After eating a while, following this "meeting‑room consultation," everyone's enthusiasm waned. Especially Zhao Yunlong's refusal to go to the bar for drinks made Su Yun feel bored; they chatted lightly and then dispersed.

After eating a while longer, after going through a "mid-meal consultation," everyone's interest also waned. Especially Zhao Yunlong unwilling to go to a tavern to drink, Su Yun found it even more boring; after a light chat, they dispersed.

Night fell, lights dimmed; Zheng Ren sat in the car, took out his phone, and reported to Xiao Yi Ren that he was preparing to go home.

On that side, Xie Yiren and Chang Yue were already lying down, chatting in the water group.

Chu Yanran was on duty tonight; the Hai Cheng side had received a traffic‑accident injury and was undergoing emergency surgery. She had no time for the water group, as Chu Yan zhi informed everyone.

"Boss, how many people do you think will come tomorrow to watch you perform the TIPS procedure?" Su Yun suddenly asked.

"Who knows." Zheng Ren was indifferent.

"I estimate that tomorrow someone will invite you to give a lecture; are you prepared?"

"It's completely unnecessary; if needed, just go. You, over there, having the agreement ready is what really matters."

"The agreement is fine; what do you think about the lecture fee and the cost of the flying knife?"

Agreement is no problem, what do you think about the lesson fee and the money for the Flying Knife?

Uh... speaking of money, Zheng Ren truly isn't prepared to want it. But he knows that free things are generally not cherished.

Wanting to quickly promote the learning of TIPS Surgery, I still have several nodes that haven't been cleared on my end. Furthermore, we must definitely work out detailed methods to increase the enthusiasm of doctors at other hospitals, so that they can quickly apply TIPS Surgery clinically.