有幾點值得大家思考下
從內文資料分析,小baby有先天性有VSD(ventricular septal defect),餵奶時面色變紫其實可能有cyanotic heart disease如tetralogy of fallot (TOF)
TOF包括4個元素:VSD、Right ventricular outflow tract obstruction、overriding aorta和right ventricular hypertrophy
在嚴重VSD時情況下,右心室會逐漸變厚,不單止令到肺部血管壓力增加,同時當出現right to left shunt時,便會令小baby的血含氧量變低,因為右心室部分的血液不能經過肺部血管去oxygenate,而是直接shunt去左心室再經大動脈運到身體各處,這叫Eisenmenger syndrome,不過在發達國家如香港,這並不常見。
因為VSD令到更多血液流經肺部和心室,當小baby經過長期的volume overloading便可能會出現心臟衰竭。短期內可以試用藥物控制,但長遠還是要手術修補。
* 小baby可能會同時有右心室厚大(right ventricular hypertrophy)、cyanotic heart disease、肺高血壓(pulmonary hypertension)等問題
當baby出現體重過輕(failure to thrive)、面色變紫(cyanosis)、水腫或呼吸急速困難時,便代表小baby情況其實需要盡快以手術修補VSD或心臟結構異常以改善情況。
以往在初生兒先天性心臟發育不全的患者,有時候會先進行palliative staged surgery,先透過pulmonary artery banding(PAB)減少初期的left to right shunt和過多血液流向肺部(pulmonary over circulation)。不過近年研究發現早期直接primary definitive corrective surgery有更好的效果,但視乎個別情況,如臨床考慮和家屬的想法等,仍有不少病人需要先進行PAB再進行修補手術。
初生兒或兒童外科是非常複雜而且極為專門的專科,本身會去train pediatric surgery的醫生就極少,選擇去做這科的醫生一定都是有熱誠和深愛兒科才會去做,這比成人外科training所需要的成本、心血和時間多很多。
那我們回歸這個併發症:complete heart block
心臟是一個博大精深的器官,一些小小的disruption已經可以影響心臟自動發電心跳的功能。Complete heart block是VSD/TOF repair其中一個罕見的併發症,亦是有文獻documented的。
當然,沒有人會想有併發症,但梅菲定律告訴我們,anything that can happen will happen
不幸地,小baby似乎有complete heart block導致的心跳過低(Bradycardia)的併發症。很多家屬都反射性的想找原因,深信一定有人犯錯才會這樣,其他VSD/TOF repair的baby術後咩事都無,卻只有我的心肝寶貝出事。這種反應是可以理解的,但這是不是代表一定是醫療失誤?還是inadvertent的不幸?這是值得深思的一點
大家都不在手術現場,其實很難評論到底醫生有沒有犯錯、有沒有醫療失誤。目前仍然為口同鼻拗,但如我之前所講,當傳媒大肆報導醫生手術失誤害病人要安裝心臟起博器時,便已經嚴重傷害了醫生的reputation,就算到最後還他清白都好,damage has been done
更加重要的是,如小baby出現complete heart block,是需要治療和安裝永久性心臟起博器以確保心跳速度正常,過久的心跳過慢有導致心臟和器官衰竭的風險。但無奈的是,當家屬不信任醫療團隊時,再正路的醫療意見都不會被接納。
*先天性心臟病非常複雜,同樣是心漏病可以有非常不同的臨床狀況和治療方案。以上為general的分析,並不套用任何病人身上。
vsd surgery 在 MayJune 陈美君 Facebook 的最佳貼文
可以的話,幫幫忙。 🙏
【初生女婴先天性心脏病,术后情况不稳定,目前施予叶克膜(ECMO)治疗,急需10万令吉进行后续治疗保住小生命(Part 1:发动筹款)】
长盼了许久的千金终于出世,惟女婴甫出娘胎就连接到两张病危通知书,直让父母崩溃急找医药费挽救初生女生的小生命。
本会One Hope Charity於接到一宗特紧急的求助个案,案中主角是才出生17天的宝宝黄婕恩 ,来自吉隆坡,患有先天性心脏病,目前在国家心脏中心抢救中。
女婴於7月11日出世时脸色已经发蓝,体内氧气也显示不足,细查后确诊女婴患上先天性心脏病,心脏大动脉转位及心脏有孔,必须进行手术治疗。
当时接到这项消息时,父母已经难以接受,因为从怀胎直到生产,一切都很顺利。
女婴於隔日(12日)转入国家心脏中心 IJN,在加护病房接受深切观察及治疗。
7月24日进行近9个小时的手术,原以为顺利完成的手术会一切安好,惟医生却告知女婴术后心律不整,命在旦夕,让父母再一次无以承受这个事实。
女婴目前在接受叶克膜(ECMO,体外膜肺氧合)治疗观察,已让她度过生命的危险期,不过这个治疗的费用相当庞大,预计后续治疗需要10万令吉。
叶克膜正式称为体外膜氧合(Extracorporeal membrane oxygenation,ECMO),取代心肺功能,让女婴度过生命的危险期,直到心肺功能恢复。
父母的友人曾在脸书进行筹款,筹获了一笔约3万5000令吉左右,而这笔款项已经缴付给医院。目前个人脸书筹款已经停止,全权交给本基金会One Hope Charity负责募款及代收来自四面八方的善款。
父亲黄敬喆(33岁)是名房地经纪,月薪约2000令吉,母亲纪雯鏸(31岁)是名活动策划人员,月薪2500令吉。女婴尚有两名哥哥,6岁及4岁。
任何疑问可联络该会热线016-4192 192或04-505 9800,抑或游览脸书专页One Hope Charity & Welfare Berhad - 大山脚瑶池金母慈善基金会。
以下户头是专用来筹集女婴黄婕恩(WONG JAY EN)的医费,有意捐款援助者,可把善款汇入以下户口,万分感激。
户头 : One Hope Charity & Welfare Berhad
银行 : Public Bank Berhad
户头号码 : 3201428817
Swift Code : PBBEMYKL
(汇款后,请把姓名、联络号码、地址及汇款收据副本,电邮至info@onehopecharity.com.my,以便本会开出收据)
**声明:不得窜改本官方专页所发布的内容,违规者本会将依法追究责任。**
【Newborn baby suffers from congenital heart disease. Her condition is unstable after surgery and currently she is on ECMO treatment. She is in need of RM100,000 for continuous treatment to stay alive (Part 1: Fundraising initiates)】
Long awaited baby girl was born but after birth, her parents received 2 notice of serious disease suffered by her. Her parents were desperate and searching for funds to save their daughters life.
One Hope Charity received an urgent fundraising case. The patient is a 17 days old baby girl named Wong Jay En who is from Kuala Lumpur. She suffers from congenital heart disease and she is currently fighting for her life in IJN.
The baby girl was born on 11 July and when she was born, her face is bluish. Her SPO2 is low and after checkup, she was diagnosed with congenital heart disease (Arterial Switch and VSD Closure). She requires surgery to treat her condition.
When her parents received this news, they were very depressed as from pregnancy till birth, everything was fine.
The baby girl was then transferred to IJN on 12th and was kept under constant monitoring in NICU.
She undergone heart surgery on 24th and the surgery took 9 hours. While the surgery was expected to be successful, doctors informed that the baby girl has irregular heartbeat.
The baby girl is now under ECMO treatment and this treatment requires a huge sum of medical fee. The fee was estimated to sum up to RM100,000.
Extracorporeal Membrane Oxygenation, ECMO is a treatment where machines is use to substitute the function of lungs will the baby girl’s heart has recovered.
The friends of her parents had tried to fundraising on Facebook and successfully raised an amount of RM35,000. This amount has been paid to the hospital. Their fundraising was now removed from Facebook and it is official taken over by One Hope Charity.
Her father, Wong King Sing, 33, is a property agent who draws a monthly salary of RM2,000 while her mother, Kee Wen Huey, 31, is an event planner who draws a monthly salary of RM2,500. The baby girl has 2 elder brother who is 6 years old and 4 years old respectively.
For inquiries, please contact our hotline at 016-4192192 or 04-5059800.
The account below is use for the fundraising of Wong Jay En’s medical fee. For those who are interested to donate, please bank in to the account below. Thank You.
Acc Name: One Hope Charity & Welfare Berhad
Bank Name: Public Bank Berhad
Acc No: 3201428817
Swift code: PBBEMYKL
(Please attach you name, contact number and address together with the banking slip and email to info@onehopecharity.com.my. Receipts will be provided accordingly)
Disclaimer: Any alteration of this post is strictly prohibited. Stern actions will be taken against the offenders
vsd surgery 在 MizzNina Facebook 的最佳解答
#Repost @hasan_alakraa
・・・
LIFE SAVING CORRECTIVE HEART SURGERY FOR REFUGEE CHILDREN
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The Tiny Gold Hearts Project is a social non-profit initiative by a group of individuals aiming to help raise funds for refugee children with congenital heart disease.
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The current two cases involve a 4 year old Rohingyan boy and a two year old Somali boy.
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💛 Nor Khan is a lively 4 year old Rohingyan boy diagnosed with Congenital Heart Defect (VSD) causing Pulmonary Hypertension. Born to a young Rohingyan couple, the parents had high hopes and aspiration for him until he was suspected to be unwell. His parents started to notice a change in his physical health. At age 3, Nor Khan had lost a significant amount of weight and experienced loss of appetite. Devastated by the diagnosis of VSD, the parents never lost hope and they were looking for all avenues to help their son. When asked about his hopes for his son, the father replied "at this point, seeing him healthy and eat well again will be the biggest miracle I pray for everyday".
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💛 The second case is the harrowing story of Ahmed Hassan's family; an innocent two year old boy of Somali descent. When we first met him, he was resting on his mother's lap. Unlike other children his age, Ahmed has to limit his activity as he gets lethargic easily. Being a single mother with a sad history in Somalia, she moved to Malaysia to ensure her remaining children have a chance of a brighter future. When Ahmed was diagnosed with Congenital Heart Defect (Large VSD with Mitral Valve Defect), the mother was devastated. She simply could not afford the cost of the operation. However, her spirit prevails and it shines through when she told us "When he gets better, he will give back. I hope he will be a doctor to help others, just like how others have helped him".
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Each child need estimated RM50K. Any amount of donation is one step closer to saving their lives.
Deadline: 10th April 2019
To donate, please find the details below:
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MAYBANK
Acc Number: 563082120908
Acc Holder: Michael Savard
Reference: TGHP
Please send the receipt of transactions via email or Whatsapp to the following:
Email: tinygoldhearts@gmail.com
Whatsapp: 011-27441303 Ha
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