In June 2018, Wu Meng, a 42-year-old lying-in woman, gave birth to a son despite the doctor’s dissuasion, arousing social concern.
In the same month, cardiac atrial septal defect repair and lung transplantation were performed, becoming the world’s first lung transplantation for elderly parturient with pulmonary hypertension.
Now, ten months later, this famous [surgical miracle] has not had a happy ending.
Wu Meng was admitted to hospital on December 17 due to pulmonary fungi complicated with Acinetobacter baumannii infection.
Her surgeon, Chen Jingyu, known as [China’s First Lung Transplant Person], revealed the cause of her death in her heartfelt words on Weibo @ Chen Jingyu.
Immunosuppression after lung transplantation is easy to induce infection, so the recipient must follow the doctor’s advice and strengthen follow-up. However, Wu Meng did not trust the doctor’s anti-infection drugs, felt that the postoperative cost was too high, and refused the necessary medication treatment, resulting in repeated infection of both lungs and inducing chronic rejection.
She did not even follow the doctor’s advice, did not take rejection drugs, asked a psychiatrist for consultation and had a split personality. In the letter she wrote to me when I decided to have a second transplant, she also felt that only God could save her, not the doctor. In the end, I was also very helpless. I felt that my whole heart could only save her body’s disease, but not her heart.
On April 1, Wu Meng died on his way home from the hospital at the age of 43.
Wu Meng’s departure is painful and makes people think about the essence and significance of childbirth.
At the end of the movie “Find You”, Yao Chen said a word: “Having children is the most selfish thing in the world. Use other people’s lives to complete yourself. It is said that maternal love is great, but in fact, a mother’s love for her children is just to bear the consequences for her choice.”
Wu Meng took the consequences for her maternal love at the cost of her own life.
Perhaps you will say that children are the ties of a family, and we cannot make false remarks about a woman’s simple wish to be a mother.
But have you ever thought that Wu Meng not only lost her life, but also her children lost their mother, her husband lost his wife, and her parents lost their daughter … This price is too heavy.
Today, I hereby attach the report of Clove Garden on this matter at that time to express Dr. Clove’s attitude:
Pregnancy for patients with pulmonary hypertension is not recommended. Family ties are not giving birth to children, but love.
The following is the original report:
In 2013, Wu Meng was diagnosed with Esen-menger syndrome (a severe congenital heart disease, including atrial septal defect and aortic transposition), accompanied by severe pulmonary hypertension.
Since then, Wu Meng has bought four oxygen inhalers and put them in the four places where she usually moves. She can hardly leave oxygen for a moment because her lips are blue due to long-term lack of oxygen. At that time, doctors predicted that Wu Meng’s life span might be less than 4 years.
However, five years later, Wu Meng gave birth to a child by cesarean section assisted by general anesthesia ECMO (Extracorporeal Membrane Oxygenation). After the operation, she underwent interventional closure of atrial septal defect and lung transplantation at the same time because she could not get off the machine for a long time. Both mother and child survived.
In the eyes of many people, this is the only medical miracle in the world. Chen Jingyu, her chief surgeon, felt extremely heavy.
Clove Garden visited Wu Meng and her attending doctor team, only to find that this is not a simple [Guinness Book of Medicine]. It is Wu Meng’s desire for life, his desire to get married and have children, and his courage to pass through the jaws of death together.
In this story, everyone struggles for the last strength of life, biting the last hope tightly and struggling to a place beyond the reach of death.
Meet [paranoia]
At the beginning of 2018, Wu Meng came to the obstetrics clinic of Wuxi People’s Hospital. She calmly handed the examination form to Ma Jinqi, director of obstetrics.
After Ma Jinqi took it, he took a breath of air conditioning:
A total of two ultrasound images, one showing early intrauterine pregnancy, the other showing congenital heart disease, atrial septal defect and severe pulmonary hypertension (Wu Meng’s pulmonary artery pressure is 112mmHg, while normal is not more than 30mmHg).
Does this mean what? That is to say, this girl, who looks petite and exquisite and smiles like a flower, may die at any time, not to mention getting pregnant and giving birth.
[Pulmonary hypertension means that the heart has no strength to pump blood to the lung. If it is not treated in time, people will die of systemic hypoxia, and pregnancy will undoubtedly aggravate all this.] Tian Jishun, a colleague of Clove Garden, Zhihu Big V and an obstetrician and gynecologist, explained this way.
Pregnancy complicated with pulmonary hypertension is one of the most dangerous diseases. According to statistical results, the incidence rate of pregnancy complicated with pulmonary hypertension is about 11 parts per million, but the perinatal mortality rate is as high as 30% ~ 50%.
Therefore, both international and domestic guidelines for pulmonary hypertension explicitly suggest that women with pulmonary hypertension should avoid pregnancy. Ma Jinqi’s first reaction was to suggest Wu Meng to terminate the pregnancy.
However, Wu Meng firmly replied:
I accept all possible risks. Even if I pay the price of my life, I will persist in pregnancy until I give birth.
As she said this, she handed over a prepared disclaimer.
Mr. Wu Meng also said: [rain or shine.]
[I want to have a home]
I feel that this child is a gift to me from heaven.
2013 was especially heavy for Wu Meng. At the beginning of the year, she just divorced her husband. At the end of the year, she was diagnosed with congenital heart disease and pulmonary hypertension, and her life fell into icehouse.
After the blow of his first marriage failure, 42-year-old Wu Meng was lucky to get love again.
At the scene of the proposal, the man said: “I know you are a patient with pulmonary hypertension, you need oxygen at any time, and you also have four oxygen machines in different places where you move, but I think you need a person who drives the oxygen machine for you more, so let me drive the oxygen machine for you in this life.”
Wu Meng felt that it was fate that made her meet him, and heaven also gave her a gift-unlike the first IVF pregnancy, this time Wu Meng conceived naturally. She immediately decided to give birth to the baby no matter what.
Love, old age and almost impossible natural conception are intertwined, giving Wu Meng the strength to grind his teeth and be stubborn.
Wu Meng said frankly: At the beginning of pregnancy, she felt relatively good about herself, which also made her full of confidence to continue her pregnancy.
However, with the continuous advancement of gestational weeks, the changes in the systemic circulation brought about by pregnancy made her feel more and more heavy burden: by the 20th week of pregnancy, Wu Meng’s cough obviously worsened, and then nosebleeds began to appear, with a maximum of more than 100 milliliters a day.
Difficult negotiations
In early May 2018, Wu Meng was admitted to the lung transplant department of Wuxi Municipal People’s Hospital. The first difficult problem faced by doctors is when and how to take out the child in what.
After repeated discussions by experts from many departments, the doctor finally decided to terminate the pregnancy when the fetus grew between 26 and 28 weeks and give birth to the child by cesarean section.
However, cesarean section is not everything, because it is also difficult during and after the operation:
[When the child is taken out, the extra blood will quickly flow back to the heart, causing the heart to overload. 24 ~ 48 hours after delivery is the key period to observe whether the heart can return to normal operation. Only after passing these two hurdles can the critical period be smoothly passed.] Tian Jishun explained.
Obviously, Wu Meng’s heart cannot withstand such challenges, so doctors suggest that before caesarean section, extracorporeal membrane oxygenation (ECMO, artificial lung + artificial heart) should be used under general anesthesia to replace Wu Meng’s heart and lung to save her life.
There is another two-way plan: during cesarean section, ligate the superior branch of uterine artery, and if there is massive hemorrhage after operation, perform interventional surgery or surgery to remove the uterus; If there is massive hemorrhage at the time of cesarean section, the uterus will be removed immediately.
The doctor took this plan to talk to Wu Meng before operation. Unexpectedly, Wu Meng accepted hysterectomy if he had massive hemorrhage, but he definitely did not accept ECMO, let alone general anesthesia.
[I’m afraid I won’t wake up again and I won’t see the baby.] Wu Meng explained. At this time, she already felt vaguely that she would probably never wake up again when she was on the operating table. If she couldn’t even see the baby before she died, she couldn’t accept it.
If you don’t accept life-saving weapons and let your mother risk less than 1% of the hope to break through the barrier, even if your child survives and loses his mother, is it not a painful life for your child?
Experts from Wuxi Municipal People’s Hospital finally persuaded Wu Meng to accept the plan.
A narrow escape from death
On June 16, 2018, Ma Jinqi’s team performed cesarean section for Wu Meng under the assistance of ECMO under general anesthesia. The operation went smoothly.
Wu Meng, who had just finished her caesarean section, was lying in a hospital bed and made a gesture of victory to her family on the other side of the glass. In fact, she meant that her son weighed 2.3 kg.
Wu Meng, who is lying in a hospital bed, has been unable to remove ECMO because persistent heart failure cannot be corrected. Whether she can survive is still unknown.
In fact, the only effective way for patients like Wu Meng is to do heart-lung transplantation, or to do heart malformation repair and double lung transplantation at the same time. During the consultation, Chen Jingyu proposed to perform this operation for Wu Meng, and all doctors expressed strong opposition.
To put it bluntly, if Wu Meng is operated on and the operating table cannot be operated on, it will be another maternal death.
[What are the chances of successful surgery? ]
[If you don’t do it, you will almost die. If you do it, the success rate will be about 50%.] Chen Jingyu said.
Everyone was silent.
[If Wu Meng were your daughter, would you perform this operation on her? Chen Jingyu asked.
In the end, the Chen Jingyu team decided to perform heart repair and double lung transplantation for Wu Meng.
However, where can I find the source of lung? Can Wu Meng wait until the day of transplantation?
Fortunately, Wu Meng waited for a suitable lung donor on the 11th day after delivery.
[Heart repair and lung replacement], Chen Jingyu described the operation in this way, [whether it is atrial septal defect repair or lung transplantation, it is a major operation. What is more difficult is that the two operators should cooperate with each other in a tacit understanding and there should be no difference between them.]
In order to ensure the smooth operation of Wu Meng, Chen Jingyu contacted Chen Xinlai, vice president of Nanjing First Hospital and a famous cardiac surgery expert, to perform atrial septal defect repair.
After completing the heart operation, Chen Jingyu let the heart beat again. Chen Jingyu relay and completed the lung transplant operation in one go. The operation lasted eight or nine hours, and only 5000 ml of blood was used for transfusion.
This operation finally pulled Wu Meng’s foot back from the jaws of death. On the 5th day after the operation, Wu Meng successfully removed ECMO and his heart function was greatly improved. Apart from cough fatigue and tracheotomy one week after the operation, everything recovered smoothly.
When we visited Wu Meng, her tracheotomy wound was still there. She had just removed the gastric tube and her face was still covered with blood scabs. Her whole face was thin and bloodless.
I dreamed that the baby was dead and I didn’t want to live either!
Wu Meng’s son has grown from more than 2 kg to more than 4 kg. When he is in good condition, Wu Meng will video with the child with the help of a pediatrician, but she will wake up from time to time in her sleep and shout out the above words.
Write at the end
More than 1.2 million, one child, half a life.
Wu Meng, who walked out of ICU smoothly, wanted to see his son most. The little fellow slept peacefully in the incubator and did not know that his mother had endured what for his arrival.
[No matter how fate treats us, we can never lose: the confidence on our faces, the kindness in our hearts, the backbone in our blood, and the strength carved into our lives.] As a well-known online writer, Wu Meng once wrote this in his serial documentary novel < < Alive > > in 2015.
In this book, Wu Meng records the story of pulmonary hypertension, a rare disease group, based on her own experience. Wu Meng once said in an interview that she hopes to let more people know about the disease through her book so as to avoid more tragedies.
However, she did not expect that today, a few years later, she would reappear in public with doctors in such a decisive way as the world’s first maternal lung transplant.
After obtaining Wu Meng’s consent, Chen Jingyu, who performed cardiopulmonary surgery for her, posted the story on Weibo, arousing netizens’ discussion.
Some people say that Wu Meng: [Pregnancy is also irresponsible to the child under such circumstances. Its essence is selfishness. It is still selfish to gamble with one’s own life. One should be moved by oneself and orgasm by oneself. One should still sigh with emotion with the benevolence of a doctor.]
Some people also think that Wu Meng is wasting medical resources and question why she can wait for the lung source so quickly.
Chen Jingyu’s heart is also very tangled. On the one hand, he wants to tell everyone the story of Wu Meng and alert all patients with pulmonary hypertension not to easily risk themselves. On the other hand, he is worried that more patients will be misled by Wu Meng’s success and try more recklessly after seeing this story.
He understood that Wu Meng was born as a human being and had the right to desire to live, to marry and have children. He also lamented the greatness and hardship of maternal love and the miracle and tenacity of life. However, Wu Meng’s stubbornness also made all the doctors involved in the rescue feel scared. He opposed this kind of risk that almost cost his life.
Director Xu Hongyang of ICU of Lung Transplantation Center said: [It is really the first time to manage the extremely high-risk and severe parturient with pulmonary hypertension after cesarean section under ECMO, and it is also the first time to successfully manage double lung transplantation and heart repair after pulmonary hypertension. I often lament that this woman’s vitality is so tenacious that I don’t know whether to admire modern medicine or whether it is already doomed to hit everything].
From a medical point of view, Wu Meng’s approach is to challenge science and life. This is a risky move. It is not only his own life and children in his womb, but also the pressure borne by medical personnel and the happiness of several families.
Wu Meng said that she supports Chen Jingyu to put her story on social networks.
Editor: Zuowa
Authors: Liu Yinghui and Ren Youyou