After being separated from my family, I became a darling of the military region thanks to my medical

Stephen paused for a second.

"Four months."

Ye Zhen continued speaking.

"weight."

"Six points per kilogram."

"Where are you now?"

"Building 9 of this hospital, Neonatal Intensive Care Unit."

Ye Zhen took the blank film but didn't rush to write the name of the surgery.

She first drew two loop paths.

The right ventricle is responsible for systemic circulation.

Pulmonary artery pressure is high.

The distal aortic arch is supplied with blood by the ductus arteriosus, which is not yet closed.

She placed a mark at the catheter location.

"Prostaglandin E1 cannot be stopped."

"First, maintain the patency of the ductus arteriosus, correct acidosis, and reduce pulmonary vascular resistance."

"Simultaneously review room traffic."

"If the pressure difference in the room continues to rise, perform a balloon septal prosthesis first."

Stephen's prepared follow-up questions got stuck in his throat.

This is not a maintenance treatment before giving up.

This is preoperative preparation.

Ye Zhen wrote the first line on the film.

"Phase 1: Improved BT shunt, with added pulmonary artery constriction."

The front seats were making a scraping sound.

A director from Boston Children's Hospital stood up.

"Wait a moment."

His voice, though not transmitted through a microphone, still reached the podium.

"Improved BT shunt requires the creation of an artificial channel between the subclavian artery and the pulmonary artery."

"This child is only four months old, and the branch pulmonary artery is less than two millimeters in diameter."

"Using existing instruments to perform end-to-side anastomosis makes the anastomosis site extremely prone to thrombosis."

Ye Zhen added a stroke at the location of the pulmonary artery branch.

"Therefore, the regular stitch length cannot be used."

"The posterior wall of the anastomosis was continuously everted, while the anterior wall was replaced with interrupted suturing."

"Artificial blood vessels cannot be selected based on age; they must be calculated based on weight, pulmonary artery pressure, and postoperative target blood oxygen levels."

She wrote two curves next to it.

"If the shunt is too large, the pulmonary circulation will become out of control, and the systemic circulation perfusion will further decrease."

"If the shunt is too small, blood oxygenation cannot be maintained."

"Pulmonary artery constriction must be completed simultaneously with shunt. Pressure is measured directly during the procedure, and the band is adjusted according to the pressure difference between the right ventricle and the pulmonary artery."

The director stood still.

"What if the blood vessel wall tears?"

"Remove the edges of the lesion and expand the area of ​​anastomosis."

What if there's insufficient blood supply to the distal end?

"Preoperative angiography to identify the branches of the subclavian artery, preserve collateral branches, and change the shunt side if necessary."

What about the risk of postoperative blood clots?

"Heparin transition, followed by low-dose antiplatelet therapy, with hourly reviews of shunt murmurs, blood oxygenation, and lactate levels."

After Ye Zhen finished speaking, she picked up her pen.

"This is only the first phase."

The discussion in the lecture hall immediately fell silent.

She left a space below the first line and wrote the second item.

"Second phase, bidirectional Glenn procedure."

"The timeframe is four to six months after the first surgery."

Harrison stood up.

He moved too fast and his knee hit the back of the seat in front of him.

People around him reached out to help him, but he simply pushed them away.

"You need to connect the superior vena cava to the pulmonary artery."

Ye Zhen nodded.

"The purpose of the first phase is not to repair the left ventricle."

"Its only responsibility is to keep the child alive and give the pulmonary vascular bed time to develop."

"Once the pulmonary vascular resistance drops to an acceptable level, blood from the superior vena cava can be directly introduced into the pulmonary circulation to reduce the volume overload of the right ventricle."

Harrison took two steps toward the podium.

"The venous return from the lower body will still enter the right ventricle."

"To be held for now."

"Forcibly completing the full vena cava-pulmonary artery connection at this stage would be too much for the child to handle."

Ye Zhen wrote the third line.

"Phase 3: Improved Fontan Cycle Reconstruction."

Seven or eight people stood up at the same time.

Someone knocked over a water glass.

People were pushing their way forward through the aisle.

The closed-circuit broadcast from the second lecture hall also revealed the sound of chairs being moved.

Ye Zhen continued to draw the third pathway on the film.

"Introducing blood from the inferior vena cava into the pulmonary artery."

"Venous blood no longer passes through the right ventricle; the right ventricle alone is responsible for systemic circulation."

"This is not a radical cure through autopsy."

"It's a phased reconstruction cycle."

Cohen looked down and opened his notebook.

He first wrote down the improved BT splitting, and then listed three numbers.

The child's weight.

Expected diameter of the pulmonary artery.

Current blood oxygen levels.

His pen moved faster and faster.

The young attending physician from Cleveland leaned over.

"Professor, the current equipment can't reach such a small anastomosis opening."

Old Cohen did not look up.

"The equipment is not the biggest problem."

"Once the alignment is complete, any error of even half a millimeter can change the flow rate."

He stopped writing and looked back at the projection.

"The real danger is the first 24 hours after the first surgery."

Harrison had moved to the far side of the front row.

"Dr. Ye, each of the three phases of the treatment plan could fail."

"I agree."

Ye Zhen put down her pen.

"In the first stage, death may occur due to shunt thrombosis, low cardiac output, and excessive pulmonary blood flow."

"In the second stage, we may encounter excessively high pulmonary vascular resistance and elevated superior vena cava pressure."

"The third stage will also include arrhythmia, protein-losing enteropathy, and venous hypertension."

A reporter quickly looked up.

He had assumed Ye Zhen would avoid the risks.

Ye Zhen listed the complications one by one on the right side of the screen.

After finishing the last item, she turned to Stephen.

"I didn't say this was a surgery."

"This is staged treatment that will last at least several years."

"No one can guarantee that all three phases will be successful."

Stephen finally spoke.

"I believe the risk of death in the first stage is already unacceptably high."

"How long will the child live without treatment?" Ye Zhen asked rhetorically.

Stephen's Adam's apple bobbed.

No one answered for him.

The data in the medical records already provides the answer.

The child's blood oxygen levels have been hovering between 78 and 82 for a long time.

Lactic acid levels rose daily.

The dosage of prostaglandins is constantly increasing.

Once the ductus arteriosus closes, death is measured in hours.

Ye Zhen pointed to the seven consultation conclusions.

"Stopping treatment is not about avoiding risk."

"That is accepting death."

Someone in the back row clapped their hands.

The applause quickly stopped.

This is not the time for applause.

Stephen stared at the three-phase pathway on the screen.

"How long do you think he can live?"

"Complete the examination first, then discuss individual prognosis."

"Judging solely based on this plan."

Ye Zhen offered him no comfort.

"If the first phase is successful, the pulmonary vascular development reaches the standard for the second phase, and the right ventricular function is maintained well, he will have the opportunity to complete the Fontan circulation."

"With proper long-term post-operative management, he has a chance of living to adulthood, or even longer."

Stephen gripped the edge of the podium with his fingers.

adult.

After that word was uttered, none of the experts in the first row moved.

All previous consultations and discussions focused on how many more days the patient could survive.

Nobody discussed what would happen a year from now.

No one mentioned adulthood.

The timer has run out in ten minutes.

Ye Zhen has completed the diagnosis, stabilization plan, and three-stage surgical planning.

She put away the marker and stacked the three sheets of film in order.

"The available data can only determine the direction."

"The specific shunt diameter, band pressure, and timing of surgery need to be recalculated based on bedside ultrasound, angiography, and pulmonary vascular resistance."

Stephen stood in front of her, hesitating to reach for the documents.

Ye Zhen picked up the stack of medical records.

"I want to see this child."