Still waiting... but some news

Nurse came back about 30 minutes ago to say she is now on the heart/lung machine, which is to say she is ready for the actual procedures.

bloggin in the waiting room

As Megan mentioned in an earlier post there are two major parts to today's surgery.  The first part, which by now is well underway, is to create an alternate path for mixed (pink) blood to reach the body via the Aorta.  The only path up until today has been via the existing Ventricular Septal Defect (VSD), which would normally be a problem that requires sewing up or patching.  In fact another parent staying at RMH is here for that very reason - her 2 year old son has a VSD that was just closed (by patch) late last week.  In Muriel's case, because her displaced tricuspid valve was closed off in her first surgery, the VSD is actually required to complete the circuit to the body.  Unfortunately her VSD is getting smaller.  Partly because it is starting to close on its own, and partly because she is growing and it is not.

The solution to this problem is the Damus kaye stansel procedure.  It goes hand-in-hand with her Glen procedure (the second part which I will go into in a minute),as the Glenn includes clamping off where the Pulmonary Artery was banded in her first surgery.  Instead of it being a dead-end (the heart-side), it will be connected directly to the ascending Aorta.  They won't close off the VSD - it will remain open as a secondary path.  I asked why they didn't just widen the VSD, but apparently there is a lot of structure involved that they can't just start cutting.  Good enough for me!

The second half of today's surgery will be the BiDirectional Glenn Operation, which if you have been following the blog I have linked to a number of times already.  The basic idea is to take all of the blood returning from the upper half of the body (via the Superior Vena Cava (SVC)) and send it to the Pulmonary Artery (i.e. the returning blood will go directly to the lungs instead of into the heart).

Here is where a potential complication has come up.  Part of the Glenn procedure is to close off any "collateral vessels" that may have developed between the IVC and SVC.  If you want a difficult read, try this: Where There Is Blood, There Is a Way: Unusual Collateral Vessels in Superior and Inferior Vena Cava Obstruction  .  But there is some evidence that her IVC is occluded (blocked), and if that is true, the collateral vessel (whose name was told to me but I didn't write it down!) may be the only way for the lower half of her body to drain, so they can't close it off!  So at the time I started writing this one of her doctors (the head of the heart unit in fact) was poring over literally thousands of images from her dozens of echo cardiograms since birth, looking for confirmation so they would know what to do.  He just came by, and couldn't find anything conclusive.  I'm not sure what that means for her surgery, but I am sure they will let us know soon.  One potential effect if it is true is that the Glenn procedure will redirect not only the blood from the upper half of the body, but almost ALL of the body's blood (organs will still have to be redirected later in the Fontan procedure - surgery number 3 - when she is between 18 and 24 months).  This could mean higher oxygen saturation which I can only imagine being an advantage.

I guess this was a fairly technical post!  Sorry about that - I am trying hard to understand exactly what is going on, and writing it out helps that process for me.  To sum it up, she is in surgery now, there is a potential complication that they may have to work around, but so far all is well.