Pre-op appointments and heart cath
Evan went back for his cath a little after 11. I went back with him to the room to help keep him calm until the sedation kicked in. Usually they give the kids Versed, but instead of making Evan sleepy it makes him energetic so they had to give him some sleepy gas. They pulled out a little mask for Monka and Evan cried a little when he got his mask, but the medicine works so quickly that he really didn’t have time to fight it.
They came and brought us to see him in recovery around 2:30 and he looked well except for being high as a kite. He has an IV in his left hand so that hand is pretty useless as they have it taped to a board. A bandage on his neck and groin – no big deal.
The doctor gave us a nice breakdown of what they saw. Here’s what we learned:
1. Before the procedure, we were told that his heart function (based on the echo) was more depressed than they thought. It looks like there is a region on his ventricle that isn’t squeezing as much as it should. We’ve heard this before and addressed it with meds (mostly upped some Dig). It’s still not the news that we want to hear. After the cath, the doc said that his squeeze is better than expected from the echo, so he has some mild loss of function and his heart works better than they thought. Fantastic news!
2. They were slightly concerned about Evan’s coronary arteries and thought maybe this was the reason his squeeze wasn’t so strong in certain parts of his heart. This wasn’t the case – Awesome news!
3. Before the procedure we were told his leg veins were both occluded due to having so many access lines in the past. This would make it impossible to do the cath through his leg vein, so they would need to find another pathway. You don’t get the exact same type of info going through another pathway, so this was a bit of a bummer to hear. Well, turns out his right leg vein is completely open, so they were able to put a line in his groin and get all the data they wanted. Great!
4. His pulmonary pressure (the pressure in his pulmonary arteries leading deoxygenated blood to the lungs) is 10 (I assume mmHg?). The doc said that Hemi-Fontan kids are usually 8-12, so being 10 is perfect. It is very important for the pressures and resistance to be low in the pulmonary artery. A normal heart actively pumps blood to our lungs (via the right ventricle). Evan’s blood will passively go to his lungs to get oxygen since he lacks a working right ventricle. So if the pressure/resistance is high, it means the blood will not flow well/easily and you will have poor oxygenation. That and a host of other issues. But we don’t have to worry about that because Evan is a perfect candidate!
5. Evan doesn’t appear to have any major collateral vessels, at least nothing they needed to take care of in the cath lab. There are a couple we can keep an eye on, but nothing major. Excellent! Your body is amazing and when you have a blockage or narrowing of a vessel, your body can make collateral vessels to go around the blockage. Sometimes these can be a problem and cause pressure or flow issues, and the docs need to get rid of them, like by putting coils into the collaterals to close them off. But that isn’t the case for Evan.
6. The one semi-bummer thing we learned is that his right pulmonary artery is about 10mm in diameter – which isn’t bummer news at all! That’s actually great. But his left pulmonary artery is only 6 mm in diameter. There is no narrowing – it’s just smaller. There is no pressure difference between the two sides, so that part is also great news. It just means he uses a lot of his right lung when breathing and only about half of his left lung. It will be something to watch out for. But again, he doesn’t have any narrowing (stenosis) and there is no pressure issue, so that part is actually really good news!!
Evan was admitted and we settled into our room at about 5:30. I will spend the night with him here at the hospital and tomorrow morning they will come by around 7:30AM to take him to the pre-op area and get him ready for surgery. It’s going to be a long day for all of us, we expect the surgery to take the better part of the day. We will try to keep everyone updated via Facebook and the website. Please keep Evan, the surgeons, and all of the staff in your thoughts and prayers.
Here are some photos from our stay so far and some additional photos of this sweet boy enjoying the last days of summer.
We did a more “formal” photo shoot of Evan. These were some of the best.
