Cardiac Cath Scheduled & Surgery Consult

Be prepared for a long post!  I broke it up into 2 parts, with the first about her cardiac catherization and the second part about the surgery consult.

Cardiac Cath:

On Tuesday I received a call from Cook’s that Evin’s surgeon had reviewed her file and would like to schedule a cardiac catherization prior to her surgery.  The first available appointment was on August 28^th, less than 1 week before her scheduled surgery.  We were originally told that Evin wouldn’t have to have this done prior to surgery, so it was a shock to receive this news.  I was pretty upset at first, because it is just one more procedure for my baby girl to have to undergo, but I have accepted now that it will be best for her in the long run.

The catherization (cath for short), will give the doctors a very in-depth look at Evin’s heart.  They will be able to evaluate the structure and function of her heart and major blood vessels connected to her heart.  They will insert a long, narrow tube into an artery and vein in the groin, and go through the blood vessels and into the heart.  Once in place, blood pressure and oxygen level measurements can be taken from within the heart’s chambers and blood vessels that are connected to the heart.  Dye will be injected so that pictures can be taken of particular areas.  She will have to be sedated and intubated for the procedure and will stay sedated for several hours after.  We expect that we will stay at the hospital for 1 night and then be released to come home.

She will have pre-op the day before, on August 27^th, which will consist of blood work, chest x-rays, potentially an echocardiogram, etc. 

Surgery Consult: 

On Wednesday, Mitch and I went to Cook Children’s to meet with the pediatric cardiac surgeon that will be doing Evin’s upcoming surgery.  It is the same surgeon that placed her shunt in March.  I had been nervous about the consult and had been praying and praying for a positive and productive conversation with the surgeon.  Prayers were answered and Mitch and I came out feeling encouraged about Evin’s heart and her upcoming surgery.

The surgeon started off by asking how Evin was doing at home and where her oxygen saturation normally sits.  We filled him in on her weight gain (good for a heart baby) and that she sats around 90 at home, but is usually about 93 at the cardiologist.  He then asked us if there was any rush in having the surgery.  What?!?!  Mitch and I were kind of shocked when he asked this and we told him there wasn’t any rush, and that we were told at the cardiologist that we needed to schedule her surgery and we were given a date.  He said that strictly speaking from a medical standpoint, Evin could wait for surgery.  Her oxygen saturation is high for a heart baby and she is gaining weight.  Besides taking a long time to eat and having to take meds daily, she does not have any struggles or discomforts in her day-to-day life.

He said that during Evin’s first surgery, he discovered that her pulmonary arteries were extremely small.  He said he wanted to schedule the cath prior to surgery to get a really good look to see if these arteries had grown.  At our last cardiologist appointment, the echo showed that the arteries had widened some, but we aren’t totally sure of how much.  The cath should give us that answer. 

We received lots of “ifs” at the consult, so get ready for several different scenarios.

Scenario 1-  If Evin’s pulmonary arteries have grown adequately, we will move forward with surgery on September 3^rd, as planned.

Scenario 2-  If her arteries have grown some, but not quite enough, surgery would most likely be postponed for a couple of months.  As mentioned before, her sats are pretty high which means that her shunt is working well and she is receiving a good amount of blood flow.  She could stand to wait to have surgery if need be.  This would give her some extra time to try and open up those arteries a little bit more.

Scenario 3-  If her arteries are still tiny and haven’t grown much at all, there is a possibility that she would have surgery (not immediately) to take out the shunt she has now, and place a larger shunt.  This would NOT be a repair surgery, it would be another surgery to buy more time for her arteries to widen.  Then she would have to have the repair surgery later (possibly even 1-2 years later).

We are praying for Scenario 1.  Scenario 2 is not ideal, but not horrible.  He did not act like Scenario 3 was extremely likely of happening, which is good because it would require 2 surgeries instead of just 1.

When we move forward with her repair surgery he will:

• Remove the shunt that was placed during her first surgery.

• Patch her VSD (hole between her ventricles).

• Connect the aortic valve to the left ventricle.  Right now it is straddling the VSD, so it is in the middle of the left and right ventricles.

• Enlarge the narrowed area of her pulmonary valve by adding a patch. *He did mention that he will make a decision during surgery if she needs to have the patch added or not.  Based off of her weight, her pulmonary valve is expected to be a certain width, say 7 mm.  If her valve were to be a decent size, say 5 mm, it should widen on its own with the other repairs she is having done.  If it is much too small, say 3 mm, she would need to have the patch added.  If she has the patch added, this permanently damages her valve and she will have to have a valve replacement every 10-15 years for the rest of her life.  Obviously we are fervently praying that her valve is big enough that it does not have to be repaired, but we have been thinking all along that she would undergo this repair so we are trying not to get our hopes up.*

The discussion of the different scenarios dominated most of the discussion, but I did come with a list of questions that I asked and I got answers to most of them.  Here are the highlights:

-The surgeon rated this surgery a 5 or a 6 on a scale of 1-10, with 1 being very basic and 10 being extremely complicated.  He said it is a fairly “routine” pediatric cardiac surgery.

-She will have a transesophogeal echocardiogram (pictures taken of her heart through a scope) immediately before and after the surgery.  This will show them exactly how things look before and after the repairs are made.

-She will have 2 hours of prep time before the surgery and the surgery itself will take about 4 hours.

-She will be on bypass for about 90-100 minutes.

-They will use the same incision as her last surgery.

-They expect her to remain intubated for the rest of surgery day and hopefully remove the tube the following day.

-Her chest will probably remain open after surgery due to swelling and will be closed after a day or two.

-Average in-hospital recovery time is 1-2 weeks, as long as there are no complications.

Like I said before, Mitch and I left feeling very encouraged.  We have great confidence in Evin’s surgeon and he gave us some “ifs” that we didn’t even know were possibilities.  I left the consult without having teared up, so I would say it was a positive conversation!

We go to her regular cardiology appointment this coming Tuesday, although I am not sure if they will do an echo or run any tests that day since she will have the cath done just 2 weeks later.  I will update on that appointment next week!

Thanks to all for the prayers.  There is no doubt in my mind that Evin is doing as well as she is because God made her a strong little girl and His hand is over her every step of the way.  Please continue with the thoughts and prayers for Evin.  Mitch and I appreciate them more than we could ever say!