Chapter 909: Session Consultation
“Yes,” Zhao Yunlong said.
He then picked up his phone and sent a WeChat message to the doctor on duty, asking him to send over the ultrasound picture and report.
A few minutes later, his phone rang. He took a look and handed the phone to Zheng Ren.
In the CDFI report, the patient’s tricuspid regurgitation had an area of more than 8 square centimeters, which was considered a severe tricuspid regurgitation.
The pulmonary artery pressure and other indicators were abnormal, but they were not quite consistent with the tricuspid regurgitation.
This was indeed a little strange.
Generally speaking, the heart valve was like the bow of the door of an old house. After opening, it would be pulled back to avoid blood regurgitation.
This kind of situation was most common in the elderly because of muscle atrophy and the aging of the bow, which led to the valve not being tightly closed.
For young people, it was commonly seen in congenital heart diseases, infections, intravenous drug injections, and so on.
Zheng Ren asked about the patient’s medical history again, but there was no related medical history. This was also what Zhao Yunlong found strange, so he prepared to discuss it internally in the department tomorrow.
Diseases that could not be understood could not be directly performed on the operating table.
Once they were on the operating table, if there were diseases that were not discovered, the surgeon would face even more trouble. As an old surgeon, Zhao Yunlong understood this point.
He would rather not be at the operating table so that he could get a clear picture of the situation.
Therefore, he acted very cautiously.
Su Yun also took a few glances at the patient. Countless questions lingered in his mind. This patient was really abnormal.
He did not want Zhao Yunlong to refuse to drink more. If Zhao Yunlong had a hangover the next day during the ward rounds and the internal consultation of the department, he would definitely be scolded to death by the chief.
“Have the other test results come out?” Zheng Ren held his chin in thought and suddenly asked.
“I’ll ask them to send all the pictures over,” Zhao Yunlong said.
This time, Zhao Yunlong directly created a group and asked the doctor on duty to send the pictures to the group.
Looking at the test results, Zheng Ren and Su Yun finally became obedient.
Su Yun especially. The black lock of hair on his forehead faintly fluttered without any wind, as if his brain was operating at a high speed, causing a faint change in the air flow.
Zheng Ren read the reports one by one and immediately discovered the problem.
Not only did the patient have changes in heart fat degeneration, but he also had a severe fatty liver. Moreover, his liver was bigger than a normal person’s liver on the ultrasound.
This was strange.
The patient was only in his thirties. Even if he drank too much and ate a lot of fat and other foods, it was very difficult for him to have a severe fatty liver. It also caused his liver to become bigger.
This was the same as tricuspid regurgitation. It was not a problem that a young person at this age should have.
Zheng Ren racked his brains and compared all kinds of data. After about ten minutes, he slowly said, “Tomorrow, we will do a blood acyl carnitine test.”
“Huh?” Zhao Yunlong was stunned.
“According to the test results of the patient and the clinical symptoms you mentioned, I suspect that it is a primary carnitine deficiency,” Zheng Ren said. “Cardiomyopathy, lipid storage myopathy, fatty liver, and the patient’s blood sugar is only three millimoles per liter. We can make an approximate judgment then.”
Zhao Yunlong was a little confused. He knew about this disease, but he had never seen it in the clinic.
Su Yun was deep in thought. After thinking for a few seconds, he asked, “Can the hospital do the test for the SLC22A5 allele?”
“Yes, but it will take time.”
“Is there anyone else in the patient’s family who has a similar situation?”
“When we asked about the patient’s medical history, the patient’s description was not detailed. I have already asked the patient’s father and mother to come over. I will ask them in person tomorrow.” Zhao Yunlong was very meticulous in his clinical work. He could think of anything that Su Yun could think of. Moreover, it had already been arranged.
“The boss is right. Considering that it is a primary carnitine deficiency, surgery is not recommended. The vein will be given a left-handed carnitine for a period of time, and then it will be enough to be taken orally. Right, Boss?” Su Yun asked.
“Yes.” Zheng Ren nodded.
This was a fatal disease, but as long as it was discovered in time and supplemented with diet and carnitine, the quality of life would not be affected.
“Free carnitine is significantly reduced. If it is less than 10 micromoles per liter, coupled with the reduction of many kinds of acyl carnitine, we can basically judge it,” Zheng Ren said. “When the genetic test returns, we will start to replenish the levocarnitine. The symptoms will be alleviated.”
Hearing Zheng Ren and Su Yun solve Zhao Yunlong’s doubts one by one, Fang Lin felt a little emotional.
The rising star of the Department of Cardiosurgery in the Imperial Capital was not called that for nothing. He was not surprised that Su Yun was able to diagnose him. However, this diagnosis was given by Chief Zheng first. Then, Su Yun reversed the deduction and found a some evidence.
Chief Zheng was indeed strong.
Regardless of whether it was right or wrong, it was enough for him to suggest that the next step needed to be examined and to try and make mistakes step by step. Many people, including himself, looked at these test results.
“Old Zhao, we’ll go to Yizang later. Are you going to drink?” Su Yun asked.
“I have something to do tomorrow,” Zhao Yunlong insisted.
“Tsk, what a killjoy.”
“Who knew we would have such a patient today?” Zhao Yunlong ignored Su Yun’s disdain. It seemed that he had gotten used to it. He was thinking about the patient’s condition. The more he thought about it, the more Zheng Ren was right.
There was a high possibility that the patient was suffering from primary carnitine deficiency. After the use of levocarnitine, the patient’s tricuspid valve insufficiency symptoms would also be alleviated. There was no need for surgery to treat it.
This was discovered early. If it was discovered a few years or ten years later, or if the patient had an acute outbreak and developed metabolic acidosis plus hyperammonemia, there was a possibility that the patient would have died.
Even if it was not, it was unlikely that it would be cured if it was treated in the future.
This disease was similar to diabetes and required long-term medication. However, compared to the complications, long-term use of levocarnitine did not seem to be a big deal.
After eating for a while, after a ‘consultation during dinner’, everyone’s interest also dropped. Since Zhao Yunlong refused to go to Yizang for a drink, Su Yun felt even more bored. After a brief chat, they dispersed.
They each called a car to go home.
The night was shrouded in darkness, and the lights were dim. Zheng Ren sat in the car and took out his phone, reporting to Little Yiren that he was ready to go back.
On the other side, Xie Yiren and Chang Yue had already laid down and were in the group chat.
Chu Yanran was on duty tonight. Sea City had a car accident and was undergoing emergency surgery. She did not have time to chat. It was Chu Yanzhi who told everyone.
“Boss, guess how many people will come to see you for TIPS surgery tomorrow?” Su Yun suddenly asked.
“Who knows.” Zheng Ren did not care.
“I guess someone will invite you to give a lecture tomorrow. Are you ready?”
“There’s no need at all. If you need to go, then go. On your side, it’s only good if you prepare the agreement.”
“There’s no problem with the agreement. What do you think about the fees for the lecture and freelance surgery?”
“Uh…” Speaking of money, Zheng Ren really did not intend to take it. However, he knew that things that were free were usually not cherished.
In order to promote the learning of TIPS surgery as soon as possible, there were still a few things that he had yet to get through. Furthermore, he had to find detailed ways to increase the enthusiasm of the doctors in other hospitals so that they could bring TIPS surgery to the clinic as soon as possible.