A Chinese girl named Lingling, who work in Japan and suffered from giant cell myocarditis (GCM) had been living with an artificial heart for nearly 10 months (295 days). She would be at death's door if she didn’t receive surgery timely. On June 12, an international transfer was finally completed right before a storm set in after long-drawn-out preparations for half a year. On the Dragon Boat Festival, more than 20 experts from Cardiovascular Surgery Dept., Anaesthesiology Dept., Operating Theatre and the ECMO team of Union Hospital made concerted efforts, challenged their limits and finally performed the heart transplant after ten months' waiting. The team was led by Prof. DONG Nianguo, Director of Cardiovascular Surgery Dept. at Union Hospital, and Prof. XIA Jiahong. World's longest in-vitro Bi-VAD is healing well. With stable circulation and breath, Lingling can eat normally and move around the bed on her own.
The 24-year-old girl, Lingling, is from Shandong Province. Two years ago, she began to work as an intern for an electronic equipment manufacturer in Aichi County, Japan. She took some medicine to treat acne on her face, which caused serious allergic reactions and renal and myocardial dysfunction.
In May 2019, Lingling was admitted into Fujita Health University Hospital. Fujita Health University Hospital took the case seriously and formed a taskforce headed by Prof. Takami Yoshiyuki from Cardiovascular Surgery Dept.. And Lingling was diagnosed with giant cell myocarditis (GCM). In September 2019, Prof. Takami installed an artificial heart in vitro for Lingling successfully. She was able to get off the bed and walk. The Artificial heart partially or completely take over the blood pumping function of the heart by mechanical means, and maintain blood circulation in patients. It is an effective treatment for heart failure patients at the final stage or for critical cases, as well as an effective temporary replacement for heart transplantation.
Lingling could not get rid of this life support method, as there was still no sign of recovery of her cardiac function, pervasive myocardial fibrosis was observed and whole-heart function was extremely weak, after the centrifugal pump had been providing assistance for nearly 10 months. Meanwhile, during a long period of heart assistance, thrombus and embolism of important organs could ensue and the patient was threatened by general infection. The incidence of any complication might endanger the patient's life. A heart transplant was needed as early as possible. Subject to the policies and conditions in Japan, however, Lingling could not receive the surgery there. Hence, Fujita Health University Hospital got in touch with Prof. Dong's team and they agreed to send her back to China to receive a heart transplant.
Prof. DONG Nianguo's team and Japanese experts in a video meeting about the patient's conditions before the transfer
In March 2020, the Japan-China (Wuhan) international transfer plan was restarted. Thanks to joint efforts of relevant parties in Japan and China, a green channel was opening up to Lingling.
All possible difficulties must be anticipated and properly addressed. Plan A and Plan B were made for every anticipated difficulty. The medical teams in China and Japan had video meetings every day in the week ahead of the transfer, to discuss the conditions of Lingling andany detail of the transfer.
Union Hospital appoints a cross-disciplinary team to a consultancy of Lingling before the transfer
Monitoring on the plane
They had made meticulous arrangements and preparations for the transfer in advance.
At eight on June 12, Lingling arrived at Union Hospital safely. Then Prof. DONG Nianguo completed a physical evaluation and examination of Lingling and made sure that her vital condition was stable. The medical team came up with an ICU treatment plan. By then, the international transfer that tugged at the heartstrings of numerous people at home and abroad ended in success.
The ambulance carrying Lingling speeds to the hospital
The heart transplant surgery is done on June 25 (Dragon Boat Festival) after ten months' waiting
The artificial heart in vitro had been running at an overload for 10 months for Lingling, a special patient living with Bi-vad. And a heart transplant must be done as early as possible.
Four artificial rubber tubes in the thoracic cavity of Lingling were extremely intricate. As the artificial tubes had been interwoven with the thoracic tissues for long, the thoracic tissues were very fragile and serious adhesion was present. Re-thoracotomy might lead to hemorrhea, cerebral embolism, infection and other hazards. "Performing a heart transplant under such conditions is seldom seen and very challenging," said Prof. DONG Nianguo.
A group of experts led by Prof. Dong Nianguo and Prof. Xia Jiahong in the middle of the transplant surgery
On the Day of Dragon Boat Festival, more than 20 experts from Cardiovascular Surgery Dept., in vitro circulation team, Anaesthesiology Dept. and Operating Theatre, led by Prof. DONG Nianguo and Prof. XIA Jiahong completed a seven-hour surgery, and then a strong heart started beating in Lingling. The surgery was very successful. The twin artificial centrifugal pumps that had been working for 10 months continuously were finally retired.
Before the transplant, Cardiovascular Surgery Dept. practiced central catheterization into dual artificial hearts and made sure she did walk exercise twice a day. It was the first hospital in China to do this. All of these provide strong support to quick rehabilitation after the heart transplant.
Prof. Takami Yoshiyuki wrote a piece of calligraphy "Share the same concern and care for patients" as a send-off gift to the medical crew of Union Hospital. The successful cross-border life-saving relay was the result of careful preparations and high expertise of the medical staff in both countries, as well as the united efforts of the society.
Lingling in postoperative recovery
Seeing Lingling recovering day by day, Prof. DONG Nianguo said, "the power of our country, international cooperation and significant improvement in healthcare conditions together provide a solid foundation for 'people first' and 'life first', and empower all medical practioners to save lives!"
