Moderator: We understand that you are very accomplished in the treatment of tricuspid valve subluxation malformation, and the efficacy of tricuspid valve subluxation malformation surgery in China is leading the world. What is the current success rate of the surgery? Professor: Tricuspid valve subluxation is a congenital heart disease, also known as Ebstein malformation. Wu Qingyu, Department of Cardiac Surgery, The First Affiliated Hospital of Tsinghua University There are three valve leaflets in the right ventricle of a normal person, and the leaflets themselves are connected to the subvalvular papillary muscle with tendons, and there is a device that connects the leaflets, the annulus, and the papillary muscle, just like a door, which is a component of the three constituent valves, like a parachute, and the parachute is intact. The size and position of the tricuspid valve leaflets in patients with Ebstein’s malformation are not different from those in normal subjects. First of all, the three leaflets of the tricuspid valve are not normal, they grow bigger than they should, and some of them do not grow, or they grow very small. This is the first one, the size difference. In patients with Ebstein malformation, the tricuspid valve grows in a different position than in normal people. Normal people grow to the level of the base of the annulus, but in these people it may grow at a different level, at least in most people, like the posterior septal leaflet is shifted down, which is the most common. The distance of the downward shift varies from one centimeter to two or three centimeters, or even to the apical part of the heart, which is not well developed, and the position of the downward shift and the enlargement of the annulus leads to a failure of the right ventricular valve to close, and the blood will regurgitate. Tricuspid inferior valve malformation itself can be combined with many conditions, such as preexcitation syndrome, ventricular hypoplasia, patent ductus arteriosus, and possibly transposition of the great vessels. If left untreated, a subtricuspid valve deformity may become more and more severe, but in some patients it may not be visible after birth and may only be detected when the patient is very large. The first step in surgery for a subtricuspid valve deformity is to address the valve, which may change if it does not grow properly. In the past, the main treatment for tricuspid inferior valve deformity was a plastic surgery approach. This disease has been done the most number of the earliest number of the overall or the United States of America, Minnesota, a hundred kilometers south of the city of Medical City, where they did the earliest. According to the traditional approach, it is not a subluxation of the valve lobe? Give it a lift. The other way is to replace the valve, but what are the problems with replacing the valve? The first problem: we have to replace the valves that are commonly used now, one is a mechanical valve, we have to give these patients a lifetime of anticoagulants so that the blood can not clot, once clotted, the valve leaflet is stuck. Once stuck in the lungs will soon be dangerous. The anticoagulant can not be stopped, the child is so small, at any time bump, may be a bleeding is not easy to stop, daily medication for life, almost often laboratory tests, can not leave the hospital, there may be a variety of bleeding or thrombosis risk. Another problem is that the mechanical valve leaflet may have to be replaced again when something around it grows in. Can there be a valve that doesn’t require anticoagulants? There is what we call a tissue valve, which is usually made of pericardium or other materials, and is commonly used today. But for children, these valves break down more quickly, usually in about ten years the valve must have failed, and very rarely for longer. Consider that even if you start replacing them at age three or five, once every ten years or once every twenty years, and with the difficulty of each heart surgery, heart surgery will be more difficult than ever. The third problem is that these children may be born very small, and some valves may not be the right size, and even if they can be put in, it will affect the function of the heart in terms of contraction, which is not normal. The French also use a similar method to do this, but it is better than the American method. So far, no doctor in the world has treated more patients with better results than I have in this procedure. How are we going to solve this problem? We do a lot of basic research, including animal experiments, and clinical improvements. For example, this valve place originally did not grow at all, you said there is no way we can make him have a valve leaflet? But if there is, can he grow on it? And so on many questions, we have done a lot of systematic and rigorous research in the past. For example, the autologous pericardium, which was used in many heart surgeries in the past, was found to be able to grow on, and we made the autologous pericardium into a leaflet and sewed it on the septum, which probably no one in the world has done experimental studies and found. The normal one has three leaflets, which should grow big enough and good enough to work, but now they are growing in the wrong position and growing in a mess, can these abnormalities be put together into a near normal leaflet, no one has such experience. The defective leaflets can be replaced with other materials, and there are also leaflets that grow abnormally on their own. So we found out in the end during the clinical process that these problems should be achievable. This is the solution to the leaflet problem, what about these problems with the tendon papillae? What about these problems below? We were able to find ways to, for example, this muscle is very abnormal, it’s growing there itself as a redundant, abnormal bundle of muscle that needs to be removed, affecting blood flow. By standing it up and joining it to that leaflet, that solves the problem of the papillary muscle. Then the annulus is abnormally enlarged, we turn the annulus into a normal size, these problems are solved, what about the atrium and the valve, the atrial part of the ventricle? Whether in the United States or in France, their approach is to fold it, both horizontally and vertically, but the folding approach may often be due to the extent of some very large, the future does not grow well or will also leak blood. The method we use now is to cut off a large part of it and restore the normal shape of the entire ventricle. Why do other experts not dare to do this? Because the blood vessels are very important and the coronary artery is passing through there, they dare not solve it. The way we think of it keeps these vessels in place and allows these heart muscles to overlap again and increase the contractile force of the heart. It is easy to understand that we are making a complete change from the ventricle itself, the annulus, the leaflets, and the tendons to the patient’s original material and foundation. Even if we cannot restore all patients to normal, a large proportion of them can become normal. The biggest meeting of our specialty is the annual meeting in the United States, once a year, there may be more than 5,000 experts attending the meeting, of course there are not so many experts in congenital heart disease, but in this meeting, I gave a presentation in the congress in ’07, about the treatment of congenital heart disease. No one before me had given that lecture on the Chinese experience on how to treat congenital heart disease. All this work, on the one hand, we help these patients, and on the other hand, we let our colleagues all over the world know that we Chinese are not inferior to them in many aspects of treatment, especially in surgery for precocious heart disease. Moderator: This aspect should be among the absolute world leaders. Professor: Some aspects can be said, but not all, there are many aspects. The most important thing is to know what our shortcomings are, and we will try to solve them one by one.