Not everyone will want to read this. The first part won’t be too bad. I’ll just tell you a little about Cori Lou’s procedures to get ready for her surgery. But after that, I will write about what her parents were told the surgery would involve. It is not for the faint of heart.
Today, Cori Lou was poked and examined. Some of it she handled all right, but she really didn’t like having to be stuck in her arm for a blood sample. The ultra sound (yes, another one) was tolerated reasonably. It was discovered that she has an extra superior vena cava (major vessel bringing deoxygenated blood from the body to the heart before it gets pumped to the lungs and back to the heart again). It is on the left, as opposed to the normal superior vena cava on the right, but it is connected to the heart in a way that works fine. They are calling her “turbo charged.” (side note: it is not uncommon for people to have anatomical variations that they don’t know about and live fine with them). They also found another small opening between chambers of her heart that should be closing about now in normal infant development, so that will be taken care of during surgery, too.
The physician’s assistant who will be in the operating room took a look at her, as did the assistant to the anesthesiologist. This is a children’s hospital, so they do surgeries on children every day, and there was a sense of competency without treating her like a number. Cori did seem to eat pretty well throughout the day and her weight is up to 8 pounds 8 ounces by their scales. Not a lot for a 2 month old, but at least still trending up some. She will not be allowed to have her milk after 8 AM tomorrow morning (the day of the surgery), even though the surgery is not scheduled to begin until 2 PM. She may be given some pedialyte, especially if the surgery time gets pushed late. There is some chance that her “elective” surgery could get bumped if anything comes together for another child’s heart transplant. It’s just one of the risks where there is so much pediatric cardiac surgery going on.
The surgery was explained to her parents with some detail, to inform them of risk and help them understand the timeline. Of course, there are all the normal risks inherent in surgery, from infection to bleeding. There are also some associated particularly with this type of surgery which I will mention later. From beginning to end, it is expected to take 4 – 6 hours. These are the steps after Cori Lou is anesthetized:
- One last echo cardiogram.
- Break the breast bone. (see this link if you want more explanation of this)
- Hook up the heart-lung machine that will keep her blood oxygenated and circulating while her heart is incapacitated.
- Stop her heart using a cold potassium solution. The coldness also helps preserve the heart tissue during the operation.
- Cut open the pericardial sac, at the same time taking some of it to use as the patching material to fix the holes in the heart. This means that her body should accept the patch without the complication rejections that are a problem with foreign or donated material.
- Get into the heart to sew in the patches. The trick here is to sew the stitches just deep enough to securely hold the patches in place, but not so deep that they interfere with the electrical connections in the heart muscle. A combination of a few somewhat deeper stitches, filled in with other shallower stitches, is the pattern used to make this work. The sewing is expected to take about 45 minutes in and of itself.
- Close up just her heart (not her chest), and get her heart stimulated with the warmth and flow of her own blood in order to check things out before completely sewing her up. It takes about 15-20 minutes for a heart to respond to this. At this point they will be watching for proper electrical function (to make sure all the heart chambers are pumping synchronously) and that the patches stay in place (if it comes loose, it could get stuck in a valve, causing an urgent situation).
- If everything holds up under pumping pressure, they will do another echo cardiogram to see if there are any more holes that were not seen.
- Then, if all is well, they will sew her up.
As mentioned in the last post, Cori Lou may be in the hospital for 5-7 days for recovery. Scar tissue will form around the patches and the heart will grow normally around them, according to observations made on other children’s hearts when there has been reason to go back into the child’s heart for unassociated problems. So, it is only during the initial healing time that there is any concern about the patch coming loose.
Heidi and Rich are still needing to work out where they are going to be able to stay for the few days after the surgery. The Ronald McDonald House (RMH) is still full. The guest house/hotel associated with the hospital is not cheap. There are some donated dinners at the RMH that they are still welcome to partake of, but these are not every night. While Cori Lou is in surgery, they will be trying to stay busy, including figuring this out.
This evening, things were pretty normal. Cori Lou got a bath, giggled, and went to sleep. Sleep tight, Cori Lou.