Chapter 908
"Yes." Zhao Yunlong said.
He immediately picked up his mobile phone and sent a WeChat message to the doctor on duty, asking him to send the echocardiogram and report.
A few minutes later, the phone rang. He glanced at it and handed it to Zheng Ren.
In the CDFI report, the patient's tricuspid regurgitation jet area has been greater than 8 square centimeters, which belongs to severe tricuspid regurgitation.
The pulmonary artery pressure and other indicators are abnormal, but not consistent with tricuspid regurgitation.
This is indeed a bit strange.
Generally speaking, the heart valve is like the door bow of the old house door in the past. After opening, it will be pulled back to prevent blood from flowing back.
This kind of situation is most commonly seen in the elderly due to muscle atrophy and weakness, and aging of the door bow, resulting in lax valve closure.
If you are young, it is common in congenital heart disease, infection, intravenous drug use and so on.
Zheng Ren asked about the patient's medical history again, but there was no medical history related to the above. This is also Zhao Yunlong's strange point, so I plan to discuss it in the department tomorrow.
If you don't understand the disease, you can't go directly to the stage.
Once on the operating table, if there is an undiscovered disease, the surgeon will face more troubles. As an old surgeon, Zhao Yunlong will not fail to understand this.
I would rather not go on stage, but also find out all the situations.
Therefore, he was very cautious.
Su Yun also took a look, and countless questions swirled in his mind. This patient is really abnormal.
I don't want Zhao Yunlong to drink too much. If Zhao Yunlong is hungover and speaks in a rough manner during the ward rounds and internal consultations in the department tomorrow, it will be no wonder that the chief director scolds him to death.
"Did the other laboratory tests come out?" Zheng Ren asked suddenly, resting his chin in thought.
"I asked that side to send all the pictures." Zhao Yunlong said.
This time Zhao Yunlong directly created a group and asked the doctor on duty to post the pictures to the group.
Looking at the laboratory report, Zheng Ren and Su Yun were finally honest.
Especially for Su Yun, the black hair in front of his forehead was faintly moving without wind, as if his brain was running at high speed, causing slight changes in the air flow.
Zheng Ren looked at the reports one by one, and immediately discovered the problem.
The patient not only has cardiac steatosis changes, but also has severe fatty liver, and the liver is larger than that of normal people on B-ultrasound.
This is strange.
The patient is only in his thirties. Even if he drinks too much alcohol and eats a lot of fatty meat, it is difficult for him to develop severe fatty liver, and the liver becomes enlarged.
This, like tricuspid regurgitation, is not a problem that young people of this age should have.
Zheng Ren thought hard, compared various data, and after ten minutes, he said slowly: "Check a blood acylcarnitine spectrum test tomorrow."
"Huh?" Zhao Yunlong was taken aback.
"According to the patient's test value and the clinical symptoms you mentioned, I suspect it is primary carnitine deficiency." Zheng Ren said: "Cardiomyopathy, lipid storage myopathy, fatty liver, plus the patient's blood sugar is only 3mmol/ L, can approximate judgment."
Zhao Yunlong was a little confused. He knew about this disease, but he had never seen it clinically.
Su Yun was thoughtful, and after thinking for a few seconds, he asked, "Can the test of the SLC22A5 allele be done in the hospital?"
"Yes, but it will take time."
"Is there anyone else in the patient's family who has a similar situation?"
"When I was asking about the medical history, the patient's description was not clear. I have asked the patient's father and mother to come over, and I will inquire about it in person tomorrow." It was arranged.
"The boss is right. It is considered to be primary carnitine deficiency. Surgery is not recommended. It is enough to give levocarpine intravenously for a period of time and then take it orally. Right, boss." Su Yun asked.
"Yes." Zheng Ren nodded.
This is a fatal disease, but as long as it is detected in time and supplemented with diet and L-carnitine, the quality of life will not be affected.
"Free carnitine is significantly reduced. If it is less than 10 μmol/L, plus the reduction of various acylcarnitines, it can basically be judged." Zheng Ren said: "When the genetic test returns, start to supplement L-carnitine, and the symptoms will be relieved. "
Listening to Zheng Ren and Su Yun answering Zhao Yunlong's questions one by one, Fang Lin felt a little emotional.
Tomorrow's star in the cardiothoracic surgery department of the imperial capital is not called for nothing. Su Yun was able to make a diagnosis, so he was not surprised. But this diagnosis was given by Mr. Zheng first, and then Su Yun deduced it and found several evidences.
Mr. Zheng is really strong.
Whether it is right or wrong, it is enough to be able to propose the next step that needs to be checked, and to try and make mistakes step by step. Many people, including myself, looked at these test sheets with dewy faces.
"Old Zhao, will you go to Yizang later, do you still drink?" Su Yun asked.
"I have something to do tomorrow." Zhao Yunlong insisted.
"Cut, spoil the fun."
"Who knew that such a patient would be admitted today." Zhao Yunlong didn't respond to Su Yun's contempt, and he seemed to be used to it. He was thinking about the patient's condition, and the more he thought about it, the more correct Zheng Ren said.
It is very likely that it is primary carnitine deficiency. After using L-carnitine, the symptoms of tricuspid regurgitation of the patient will also be relieved, and there is no need for surgery to treat it.
This is discovered early. If it is a few years or ten years later, or the patient has an acute outbreak, metabolic acidosis and hyperammonemia, the person may die immediately.
Even if it is not gone, the possibility of cure is not high if you do treatment in the future.
This disease is similar to diabetes and requires long-term medication. However, compared with the complications, long-term use of L-carnitine seems to be nothing.
After eating for a while, after a "inter-meeting consultation", everyone's interest also dropped. Especially Zhao Yunlong refused to go to Yizang to drink, Su Yun felt even more boring, chatted for a while, and then left.
Each called a car to go home.
The night was shrouded and the lights were dim. Zheng Ren sat in the car and took out his mobile phone, and reported to Xiao Yiren that he was going back.
Xie Yiren and Chang Yue had already lay down and were in the water.
Chu Yanran was on duty tonight, and Haicheng was injured in a car accident and was undergoing emergency surgery. She didn't have time to swim, it was Chu Yanzhi who told everyone.
"Boss, guess how many people will come to see you for TIPS surgery tomorrow?" Su Yun asked suddenly.
"Who knows." Zheng Ren didn't care.
"I guess someone will invite you to give a lecture tomorrow, are you ready?"
"I don't need it at all, just go if you need it. On your side, it's true to prepare the agreement."
"There is no problem with the agreement, what do you think about the lecture fee and the money for throwing knives?"
"Uh..." Speaking of money, Zheng Ren really wasn't going to ask for it. But he knows that free things are generally not cherished.
In order to promote the study of TIPS surgery as soon as possible, there are still a few nodes that have not been opened up on my side. Then there must be a detailed approach to increase the enthusiasm of doctors in other hospitals, so that they can apply TIPS surgery to clinical practice as soon as possible.