I, Aki Tomoya, will not be a simp.

"Right atrium and ventricle enlargement, perimembranous defect of ventricular septum, an anterior leaflet near the valve appears to have a valve-like structure connecting to the septal side of the left ventricular outflow tract... there are also small chordae tendineae pulling on the valve..."

After reviewing the complete examination report, Aki Tomoya confirmed that the child transferred from another hospital to their hospital had a somewhat complicated condition.

A large mitral valve anterior leaflet has a large mitral valve anterior leaflet cleavage, suspected to be mitral valve. Color Doppler shows a moderate left-to-right shunt signal at the ventricular septal defect site.

"Mitral valve accessory leaflet with anterior mitral leaflet cleft and ventricular septal defect!"

It's not just a simple ventricular septal defect; it's also accompanied by AMV and anterior mitral valve leaflet cleft.

"Dr. Sagara, do the child's parents know?"

"We'll need to explain the patient's condition later. You can see it clearly; the problem is quite serious. You'll have to explain it to us later."

"Shall I come?"

“Use what you just said, polish it a bit more, and explain it to them properly.”

Dr. Sagara patted him on the shoulder, as if entrusting him with an important task.

It's just a medical description, but it's being made to seem like he's the one who's going to perform the surgery.

Sagara is the supervising doctor, so whatever he says goes.

They can see what's happening inside a child's body, but parents aren't doctors, so they need to explain things clearly.

Chapter 441 Mitral valve appendages, anterior mitral leaflet dehiscence, and ventricular septal defect

The patient is a one-year-old girl who was previously examined at a nearby hospital for jaundice. A heart murmur was heard during auscultation, and an echocardiogram revealed congenital heart disease, specifically a ventricular septal defect. A follow-up examination was recommended.

So they went to this better hospital for treatment and underwent more detailed examinations.

Dr. Sagara had already noticed the problem, and then used it to test Aki Tomoya, whose answer was the same as his own judgment.

Immediately afterwards, he planned to have Aki Tomoya explain his condition.

Symmetry, Aki Tomoya had no reason to refuse. Doctors don't just look at the examination and then treat the patient and that's it. They also need to let the patient and the patient's family know the details of the condition and give their informed consent before they can carry out subsequent treatment.

Dr. Sagara took Aki Tomo to see the girl's parents, and he noticed that the couple looked very nervous and worried about their child.

"Doctor, how's it going?"

"Please don't worry, calm down, we will explain later."

Dr. Sagara comforted the girl's mother, then gestured with his eyes for Aki Tomoya to hurry up.

After receiving his instructions, Aki Rin also placed the examination report on the table and pulled up the echocardiogram, saying directly, "The child has a mitral valve valvular flap with anterior mitral leaflet cleft and ventricular septal defect."

It's obvious they don't understand if you put it that way.

But it is precisely because they cannot understand it and it is so long that it easily aggravates their worries.

"The child's development was incomplete during the embryonic period, resulting in a ventricular septal defect, which creates an abnormal communication and causes a left-to-right shunt at the ventricular level. This is a congenital condition that may seriously affect cardiopulmonary function."

Aki Tomoya first pointed out the damaged part, and then continued talking.

"Here, the anterior leaflet of the mitral valve has a large cleft, and the leaflet cannot close completely. Near the edge of the anterior leaflet, there is a valve-like structure that connects to the septal side of the left ventricular outflow tract, and there are small chordae tendineae pulling on it."

"A normal mitral valve anterior leaflet is formed by the fusion of the left and posterior nodules of the anterior endocardial cushion. If the closure is not good, the anterior leaflet of the mitral valve is prone to have a gap. Such gaps and residual tissue form the mitral valve accessory leaflet tissue."

"In other words, due to congenital malformation, the anterior leaflet of the mitral valve is split, and then an accessory leaflet is formed, leading to regurgitation and causing obstruction of the left ventricular outflow tract. In severe cases, heart failure symptoms may appear in infancy, along with other symptoms such as tetralogy of Fallot and transposition of the great vessels."

After listening to Aki Tomoya's words, even though they still only had a vague understanding, it was enough to make them start to worry about their child's future.

They instinctively turned their pleading eyes to Dr. Sagara and Tomoya Aki.

"Fortunately, although there is mild to moderate regurgitation, the mitral valve accessory valve has not yet caused left ventricular outflow tract obstruction. In this respect, the two children are very lucky."

At this time, Aki Tomoya also shared some good news.

The examination showed a mild regurgitation response, but no left ventricular outflow tract obstruction.

In this respect, the child is very lucky.

However, even this good news couldn't immediately make the couple optimistic.

"So surgery is really necessary. The child is so young and the condition is so serious. Is surgery really the right course of action?"

The girl's father asked anxiously, his eyes already showing signs of panic.

It's not just a ventricular septal defect; it's accompanied by two other concurrent symptoms.

This was undoubtedly terrible news for them.

The only saving grace is that the situation hasn't gotten any worse, such as the left ventricular outflow tract obstruction that Aki Tomoya just mentioned.

Generally speaking, once the AMV tissue, also known as the mitral valve accessory valve, forms, it can easily cause left ventricular outflow tract obstruction. It is rare that the mitral valve accessory valve did not cause left ventricular outflow tract obstruction in this case.

"Surgery is necessary. We will carefully study the specific surgical plan. After that, the child will be observed in the hospital for a period of time, and we will come up with a plan as soon as possible."

This time it was Dr. Sagara's turn to speak.

This is a case where surgery is absolutely necessary, and the girl is only one year old.

The specific surgical procedure must be thoroughly discussed and consulted with experienced doctors in the department before a final decision can be made.

"Please, doctors, you must save our daughter!"

……

After explaining the illness to the child's parents, Sagara took Aki Tomoya back to the ward.

"Now I've got things to do."

"There's no left ventricular outflow tract obstruction yet, the child's growth and development are not significantly delayed, and there are no obvious shortness of breath or cyanosis, so that's good news, right?"

The situation is not very good, but it's not too bad either, and there are some things to be thankful for.

"But it's not much better; I need to have surgery as soon as possible."

Dr. Sagara shook his head slightly, seemingly finding the situation somewhat troublesome.

"If you were Dr. Sagara, what would you do in the surgery?"

At this moment, Aki Tomoya asked again.

He was eager to know what Dr. Sagara's thought process was as the attending physician for this child with a complex condition.

What do you think?

At that moment, Dr. Sagara asked Aki Tomoya a question, as if he wanted to hear his thoughts as well.

Aki Tomoya paused for a moment, then thought for a few minutes before speaking very seriously: "Ventricular septal defect repair, mitral valve paravalvular resection, and mitral and tricuspid valve repair, all three surgeries will be performed at once."

"...Indeed, if we can complete all three surgeries at once for a one-year-old child, we can minimize her burden. However, we must carefully manage the difficulty of the surgeries and the postoperative care."

Performing three different surgeries in one go was indeed a suitable approach for this patient.

However, the difficulty of the surgery also increases accordingly, depending on who performs the surgery, and postoperative care cannot be taken lightly.

This is a large undertaking and a difficult problem.

"Dr. Sagara will be the lead surgeon, right? Can I be your assistant?"

"You want to go into the operating room before we've even decided whether this is the right thing to do? And if this is the case, is it definitely me who will be the surgeon? Maybe I'll be the assistant; that's quite possible."

Dr. Sagara looked at Tomoya Aki with a hint of helplessness, but at the same time, there was also a sense of surprise in his eyes.

"But you really don't miss any opportunity. Unfortunately, I can't decide this matter. Even if I help you, it might not work out."

Dr. Sagara sighed.

However, Aki Tomoya was not disappointed. Instead, he sensed that Dr. Sagara seemed to be trying to get him a chance.

Even if I can't be the main surgeon now, I can still be a supportive assistant!

Chapter 442 Risk Reduction

"Mitral valve accessory leaflet with anterior mitral leaflet cleft and ventricular septal defect... Showing this to me, do you want me to be the surgeon? My schedule is completely full..."

Sasaki looked at the medical record Sagara had given him, his expression somewhat troubled.

His surgery schedule is already full, so it won't be easy for Sagara to have him perform the surgeries.

"Dr. Sasaki, I haven't even opened my mouth yet, can you let me finish?"

"You speak."

"I just wanted to ask you, if you were Dr. Sasaki, how would you consider the surgical plan?"

"Tell me your thoughts first."

Instead of answering Sagara's question immediately, Sasaki asked for his thoughts.

"Ventricular septal defect repair, mitral valve flap resection, and mitral and tricuspid valve repair—all three surgeries were performed in one procedure!"

Sagara directly quoted Aki Tomoya's original words.

After overhearing the conversation between Dr. Sagara and his party not far away, Aki Tomo also looked over in that direction.

Aki Tomoya now understands why Dr. Sagara said earlier that he wouldn't be the surgeon. It seems that Dr. Sagara intends to have someone more confident in performing the surgery.

"Three surgeries completed in one go, that's quite an impressive case, isn't it, Dr. Sasaki?"

Dr. Sagara looked intently into Sasaki Ichiru's eyes.