thursday 8/15/2013 heart surgery day

Today Ava has the complete repair of her tetrology of fallot. We spent the morning singing Christmas songs and trying to forget about hunger. Ava is a slightly more challenging case because she is on the small side, has a colostomy (infection risk), has recently been sick, is weaker from being in the NICU her whole life, and is a near impossible IV stick. On the upside I understand that the incisions of babies with less fat, like Ava, heel better/faster and another "plus" is at she is on room air AND is bigger compared to some who have to have surgery.  Dr. Phillip Burch is the surgeon today and Dr. Evans is the anesthesiologist. The first thing they will do is sedate her and give her some fluid so the anesthesiologist can try to find placement points for her arterial line and a good central line for getting blood and fluid boluses. She will probably get blood either during or after surgery and the IV has to be bigger than the one she currently has. He may have to do a "cut down" to place new lines. They just called and told me they didn't have to do a cut down to get any lines in-yay. 

Dr. Burch started about 12:10. She will be on bypass within the next 2 hours. This is where the aorta is clamped so the heart is stopped. The blood is cooled and sent to a machine which oxygenates the blood and then sends it to back to the body, "bypassing" the lungs. She will probably be on bypass for 70-90 minutes total. 

Pray for:

steady hands and appropriate judgement calls by physicians and staff

short bypass period so as to affect the lungs the least

that the tricuspid valve will not have to be touched

that the pulmonary valve will not have to be cut

that the heart easily restarts after bypass

ability to go to recovery with a closed chest rather than an open one

no bleeding or swelling

free from infection post surgery

sinus rhythm beating after surgery and into recovery

that Ava will be easily extubated and require little oxygen supplementation

that Ava will be comfortable with little to no pain

peace and, ultimately, God's will

1:50pm Ava is on complete bypass now, and they are beginning to repair the heart.

4:00pm Ava is off bypass now. They said they should be done in about 2 hours.

5:45pm Just spoke with Dr. Burch. Ava is headed out. He had to dissect quite a lot of extra muscle from around the pulmonary artery that was making it so tight/closed off. Her large vsd hole was repaired with a dacron patch. There is a small leak accross the repair, but should seal off as scar tissue forms around the patch. He couldn't access the hole from the right atrium well so he had to go right through the right ventricle- he repaired that incision with a little bit of the pericardium. The pericardium is the sac that surrounds the heart. He also closed up the hole that was in the right atrium. He could not see the small vsd below the large one in the ventricle, though, so that one we'll expect to close up as she grows. Her pressures accross the pulmonary artery were about 14-15. Normal is 6-10. His goal was less than 30. HOORAY! -They didn't have to transect the pulmonary valve-so that is intact. He also said the tricuspid valve is fine too. They were able to restart the heart just fine and thus far the rhythms are fine. They were able to close the chest, so she didn't have to go to the floor with an open wound.                     One thing we didn't know about is that one of her pulmonary veins is in the wrong spot. Normally you have two pulmonary veins from each lobe of the lung returning oxygenated blood to the left side of the heart which then sends it to the rest of the body. But in Ava's case, one of her veins coming off the right lobe is connected to the right side of the heart..so it kind of gets double oxygenated. It will only be an issue if it negatively affects the pressures in the right side of the heart by sending too much blood in there along with blood coming from the rest of the body and causes the right side to get thicker. If this happens she could have another surgery around age 4-5.

All the updates today will be on this same posting. So keep rechecking this same post if you like.