A Miracle in the History of Cardiac Surgery

Text by Liu Xun, Wang Jiliang, Nie Wenwen & Liu Kunwei

Edited by He Sai & Yi Wanru

Photos by Wang Yongsheng

“I never expected that I could have the chance to come back,” said Lingling(pseudonym), a girl from Weihai, Shangdong Province,who was lying in an ICU of the Union Hospital affiliated to Tongji Medical College of HUST(Huazhong University of Science and Technology), in Wuhan.Recalling her thrilling experience on her way back from Japan, she felt sheer luck and some lingering fear.

Two years ago, Lingling started her internship at an electronics manufacturing enterprise in Aichi-ken, Japan. There the medicine she took to treat her acne caused a severe drug allergy that damaged her renal and myocardial function. Last May,her illness worsened rapidly,causing her blood circulation system to lose function. As a result, her life was in great danger. Lingling was then transferred to Fujita Health University Hospital in Nagoya for treatment. The experts from the hospital confirmed that Lingling was suffering from giant cell myocarditis, which meant that she was nearly undergoing cardiac failure, and cardiac arrest could occur at any time.

Last September, Professor Yoshiyuki Takami performed the surgery for Lingling, installing two extracorporeal artificial hearts to help pump blood.Seeing Lingling’s heart connected with so many pipes, her mother was extremely sad. Worse still,Lingling’s cardiac function remained unimproved even after the operation, and her cardiac muscle was still undergoing extensive fibrosis. Owing to the relevant policies and regulations in Japan, Lingling had to receive a heart transplant back in China.

After waiting for nearly ten months, Lingling finally has her heart transplant on June,25, the Dragon Boat Festival端午節（6月25日），玲玲完成等待了近10個月的心臟移植手術

“我沒想到自己還有機會回來。”年輕的山東威海女孩玲玲（化名）躺在武漢華中科技大學同濟醫學院附屬協和醫院的ICU病房里，回想自己一路驚心動魄的搶救經歷，感到萬分幸運，又有些心有余悸。

兩年前玲玲以實習生身份，前往日本愛知縣一家電子設備制造企業工作。因服用了治療粉刺的藥導致嚴重藥物過敏，引發腎功能、心肌功能損傷。去年5月，病情一度急轉直下：血液循環系統功能接近喪失，生命告危。玲玲被轉入名古屋藤田醫科大學醫院治療。醫院組建專家組，確診玲玲是“巨細胞性心肌炎”，這意味著她心臟幾近衰竭，隨時會驟停。

去年9月，該院心臟血管外科教授高味良行主刀，為玲玲加裝了2臺體外“人工心臟”，協助心臟泵血。看著女兒的心臟連接了這么多管子，身邊的母親非常難過，更難過的是，都裝了兩臺人工心臟了，玲玲的心臟功能還是沒有任何恢復的跡象，且心肌廣泛纖維化。而受限于日方相關政策條件，玲玲只能回國接受心臟移植手術。

Seeing Lingling in such severe condition, her parents were on pins and needles. After learning that the Department of Cardiac Surgery of Wuhan Union Hospital was among the top ones in the field, her father turned to Professor Dong Nianguo for help this January. Professor Dong,head of the Department of Cardiac Great Vascular Surgery of the hospital, immediately started conversations with the Japanese experts and decided that Lingling should be taken back home in late January. However, the plan was stopped unexpectedly by the COVID-19 epidemic. Lingling had to cancel her flight and stay in Japan to receive her maintenance treatment.

Lingling sitting in the first row on the flight 玲玲坐在航班第一排

Infection, bleeding, and cerebral infarction occurred in succession afterwards— Lingling’s life was in great risk. Artificial hearts have a limited service life,“We really cannot afford to delay the heart transplant any longer,”Professor Dong intensified his communication with the Japanese counterparts. Meanwhile, the relevant departments of the two countries were also making efforts jointly. This would be a transnational relay and most importantly, the artificial hearts would have to have a continuous power supply during the journey back to China. What’s more, the two artificial hearts were of such a big size, how could they be taken on board the plane together with the patient? With the small passenger cabin, how should they transport the equipment and the patient together? Furthermore, in case of emergency, how could they carry out salvage work? All these problems had to be taken into account carefully in advance and an alternative plan would have to be made. The two hospitals were facing an unprecedented challenge.

The final solution was that Lingling would sit in the first row with the two artificial hearts on the seats next to her. To make more space for salvage, the seatbacks of the first three rows would be put down so that the stretcher could be fixed in place.To eliminate any unexpected circumstances, the Union Hospital had prepared two more artificial hearts and two sets of batteries for fear of possible incompatibility with the Japanese apparatus and batteries during electric power conversion. To ensure the supply of oxygen, the airline approved especially of a sufficient quantity of oxygen to be taken aboard. What’s more,the flight also decided on 5 provisional landing sites on the route in case of emergency during the transit.

Approved by the CAAC (Civil Aviation Administration of China), the flight set off from Wuhan Tianhe Airport at 9 am on June 12 and arrived at Nagoya Airport in Japan at noon. After Lingling was put on board, she waved goodbye to the Japanese doctors. 45 minutes later,learning that everything was normal, the Japanese medical workers returned to their hospital. At 6:27 pm, the plane arrived at Tianhe Airport, and Lingling got to the Union Hospital at 8 pm.

Doctors checking Lingling’s physical condition on the flight 醫生在飛機上監測玲玲的身體指標

女兒命懸一線，父母心急如焚。聽說武漢協和醫院心臟外科很優秀，今年1月，玲玲的父親找到該院，向心臟大血管外科主任董念國教授求助。董教授馬上與日方專家反復溝通，商定1月下旬接玲玲回國手術。沒想到突如其來的新冠疫情打亂了計劃，原訂的航班取消,玲玲只能在日本維持治療。

感染、出血、腦梗等問題接連出現，玲玲危機重重。人工心臟都有使用期限，“再拖下去可能就沒希望了”。董念國加強與日方溝通，同時中日兩國相關部門也在共同努力。跨國接力，人工心臟不能斷電，兩臺人工心臟“塊頭大”，如何連人帶機器上飛機？機艙狹小，如何擺放人和機器以及發生意外怎么搶救？一系列問題都要提前考慮并設立預案。雙方醫院都面臨前所未有的難題。

最終定下的方案是：玲玲坐在第一排，兩臺人工心臟并排放在隔壁座位上。為了騰出搶救空間，乘務員放倒三排座椅靠背，方便擔架固定。為了確保萬無一失，協和醫院又備了兩臺人工心臟和兩套電池，以免電功率轉換時日方機器不匹配；為保證供氧，航空公司特批足量氧氣上機；擔心轉運途中隨時有突發意外的可能，航班還在沿線暫定了5個備降點。

經民航總局批準，航班于北京時間6月12日9時從武漢天河機場出發，于當日中午到達日本名古屋機場。中日雙方工作人員將玲玲安置好后，玲玲與日方工作人員揮手告別。飛行45分鐘后，日方醫務人員得知玲玲安好才返回醫院。18時27分，飛機平穩降落天河機場，20時順利抵達協和醫院。

“It’s a miracle in medical history that the two artificial hearts have been working overload for ten months,” said Professor Dong. Actually, the Japanese experts’ meticulous treatment created favorable conditions for her subsequent heart transplant.

However, the heart transplant was not so easy. There had been two opportunities between June 16 and 19, but Lingling missed them once because of the health problem of the donor heart, and the second time her own physical conditions. Thus they could do nothing but wait patiently for the right heart donor, while the cardiac surgery team treated Lingling carefully.

On June 25, Lingling got a “big present” during the Dragon Boat Festival: the heart of a male donor in Guangzhou matched hers. A“heart-protection delivery” team from the Union Hospital departed for Guangzhou at once, to retrieve the heart within 8 hours.

Every step, from removing the heart from the donor’s body to protecting the heart, to trimming the heart, and finally putting it into Lingling’s chest, was of crucial importance. At 3 pm of that day, the donor heart arrived at the operation room of the Union Hospital. A team of over 20 experts headed by Professor Dong Nianguo and Professor Xia Jiahong got into the operation room at once. At 4 pm, Professor Wu Qingping led his team to proceed with anesthesia for Lingling. According to Professor Wu, it was really challenging.Professor Dong also exclaimed that “the difficulty of the surgery was by far greater than they had expected,” because the pipelines of the artificial hearts were so complicated that it made the thoracic tissues fragile with severe adhesions.

Chinese and Japanese doctors discussing Lingling’s treatment plans online中日專家通過視頻討論玲玲的病情

Surgery under such difficult conditions was unprecedented.After removing the sick heart,Professor Dong trimmed the donor heart and finally managed to put it into Lingling’s chest and then proceeded with vascular anastomosis. After 7 hours of intense surgery, the healthy heart started to beat again in Lingling’s body—the surgery was a complete success. The long-lost smiles appeared on the faces of Lingling’s anxious parents waiting outside the operation room.

On the day of the operation,the Japanese experts viewed the whole process of the surgery through video. Seeing the success of the operation, Professor Yoshiyuki Takami felt relieved.He said he was pleased to see the relay across the two countries produce good result and he also admired the expertise and professional dedication of the Chinese doctors.

The next day after the operation, Lingling began to take breathing exercises; on the third day, the trachea cannula was removed; on the fifth day,Lingling was able to eat by herself;by July 2, everything was normal with Lingling’s circulation system and breathing, and she was able to eat normally and exercise at the bedside on her own. According to Professor Dong, Lingling still needed to face challenges such as infection and rejection before a full recovery.

After leaving the cabin, Lingling and her artificial hearts are carried to the ambulance together出機艙后，玲玲和人工心臟一起被抬上救護車

“從一臺到兩臺人工心臟，超負荷運轉10個月，這在醫學史上已經是奇跡。”董念國教授說，日本專家前期的精心救治，為玲玲后續的心臟移植創造了條件。

然而，供心的事又一波三折，16日至19日有兩次供心機會，先后因為心源本身和玲玲的自身身體狀況遺憾錯失。等待心臟供體期間，心外科團隊精心守護玲玲，靜待供心再次出現。

6月25日，玲玲收到了她的端午“大禮”：一顆位于廣州的男性供心。心外科“護心跑男”團隊立即出發去廣州取供心。他們必須在8小時之內把供心取回來。

從取心到護心，再到心臟修剪，最后放入胸腔，每一步都至關重要。當天15時，心源抵達協和醫院手術室，董念國教授、夏家紅教授帶領20余名專家團隊進入手術狀態。16時，武慶平教授帶隊實施麻醉。他說，這次挑戰前所未有。董念國也感慨“難度遠超預期”：人工心臟管道在體內走向錯綜復雜，導致胸腔組織脆弱、粘連嚴重。

在這種條件下進行心臟移植手術，世界罕見，難度極高。在切除病變心臟后，董教授修剪心臟，最終成功置入并小心進行血管吻合。經過7個小時的緊張手術后，一顆強勁而有力的心臟在玲玲體內重新跳動，手術圓滿成功。手術室外焦急等待的玲玲父母，終于露出了久違的笑容。

手術當天，日方專家通過視頻觀摩了這場高難度手術。高味良行教授看到手術成功后，松了一口氣。他說，很高興看到中日攜手的生命接力結出碩果，敬佩中方醫生的專業技術與敬業精神。

術后第二天，玲玲開始鍛煉呼吸；第三天，成功拔出氣管插管；第五天，恢復自主進食；至7月2日，玲玲循環、呼吸穩定，能夠正常進食，并在床邊自行活動。董念國說，后續她還有抗感染、抗排斥等關卡要闖。

“這個女孩有著頑強的生命力，無論多難，臉上都掛著溫暖的微笑，令人感動。”參與救治玲玲的協和醫院醫生李平說。女兒重生，玲玲父母百感交集。

“生命所托，即使再難，醫生不能輕易說放棄。”董念國教授感慨，此次跨越國界生命接力的成功，是中日兩國民眾患難與共、用愛守護生命的又一生動寫照。

“What moves us most is the girl’s strong vitality. However hard it was for her, she always smiled,” said Li Ping, a doctor assisting the surgery. Lingling’s parents also hold mixed feelings witnessing the rebirth of their daughter.

Lingling recovers well after the operation 玲玲接受手術后恢復良好

To Professor Dong, it is “the entrustment of the patient’s life on them, no matter how hard it is”—as doctors, “they would never give up saving a life.” The success of the transnational relay is another reflection of the Chinese and Japanese people sharing weal and woe together and saving life with love.