Before you read this post it might be nice to refresh yourself on what we are dealing with from a previous post. Click here to read up on that. That is the post explaining the problems they found when I was about 22 weeks pregnant.
Savanna and I have learned a lot over the past 10 days being in the hospital for days at a time talking with the nurses and doctors. Fortunately, we've had so many great people take time out of their busy schedules to sit down and explain things so that we fully understand what's going on with Linc.
This morning, Dr. Eckhauser came by to fully explain the surgery he performed on Lincoln. He did explain a little bit of the surgery right after, but we just heard him say, "Linc did great." And then didn't quite comprehend too much after that. Anyway, I'll try to go through what he explained to us so we can all understand.
On July 24, 2013, about 7:45AM Lincoln was given an CHG bath (a wipe down with a heavy-duty antibacterial wipe) by the nurse in the CICU. He was also being connected to the mobile monitors so he could be taken to the OR. Once that happened, we all travelled out the CICU to meet the anesthesiologist. By that time little Linc was awake and wondering what was going on. The anesthesiologist explained what he was going to do and assured us he would be with Linc the whole time. We said our goodbyes and Linc was taken to the OR.
About 8:40AM the surgeon, Dr. Eckhauser, came in to the waiting room to see if we had any questions and said he would be scrubbing in to begin surgery around 9:00AM. We were given a pager so we could get updates.
Here is a simple diagram of the heart to refer to as you read.
The first update from the OR nurse told us Linc was completely under and was on bypass around 9:45AM. Dr. Eckhauser said for the bypass machine to work with such a small body that a blood transfusion would occur. IVs were placed in his superior and inferior vena cava's as well as one of the branches off the aorta. The bypass machine connects to the top and bottom of his heart. The blood continues to flow through Linc's body like normal except when it gets to the heart it is directed into the machine thus 'bypassing' his heart and lungs so doctors can work on Linc's heart. The miracle of modern medicine!
In order to perform open heart surgery, Dr. Eckhauser split the sternum down the middle from the top of Linc's chest (where the collar bones meet) to the bottom of his ribcage. From Dr. Eckhauser's perspective looking directly down on the heart, he sees the right side of the heart. He noticed there was some bruising and hematoma (tissue clotting) on the right ventricle wall. This was kind of a surprise, but since Linc had chest compressions for 12 or 13 minutes at birth, it made sense to the surgeon. The bruising didn't give the surgeon the best place to attach the patch, but the bruising will heal and be fine. Linc's ventricular septal defect (VSD) was located pretty far up the ventricular septum near the aortic valve and pulmonary valve. It was also very close to the tricuspid valve (the valve letting the pumped blood from the right atrium travel down to the right ventricle). Obviously, Linc's heart isn't huge, but his VSD was quite significant for Linc's size and was slightly more difficult for the surgeon to patch. His VSD was around the size of a quarter. Dr. Eckhauser used a material called dacron to patch Linc's VSD. In order to fix Linc's VSD, Dr. Eckhauser had to work through Linc's tricuspid valve (valve letting pumped blood from right atrium down to the right ventricle). The top of the patch was sewn to the tricuspid valve annulus to the edge of a chordae (rope-like tissue that makes sure the valve doesn't swing too far back) and the bottom part was sewn directly to the muscle.
After fully patching Linc's VSD, Dr. Eckhauser also shrunk an inherent atrial septum defect (ASD) to all babies. This ASD naturally closes as babies get older, and Dr. Eckhauser expects this ASD to heal itself.
Once the septal defects were fixed up, Dr. Eckhauser began to fix Linc's aorta. Linc's aorta (vessel sending oxygenated blood to the body) was very skinny throughout the curve and then got even more skinny as it finishes the curve (aortic hypoplasia and coarctation, respectively). How Dr. Eckhauser fixed Linc's aorta was by making an incision through the hypoplastic part and cutting out the coartation, then by sewing on a pulmonary artery cadaver piece he expanded the aorta. All fixed up!
Once surgery was completed at 1:00pm, a transesophageal echocardiogram (TEE; an echocardiogram with a camera down the throat) was taken to check the fixes. The VSD was fully closed and the aorta was completely fixed; however, Dr. Eckhauser noticed the tricuspid and mitral valves had some back-leaking (this is trivial). One thing he said to watch for was the Left Ventricle Outflow Tract (LOVT; the opening of the aorta from the left ventricle). It was skinny before surgery, and only slightly expanded after surgery, but it should still be larger and is expected to grow with the fixing of the VSD and as Linc gets stronger. There is no significant difference in pressure from the ventricle to the aorta, so it's not a big deal now.
Because of the traumatic surgery Linc went through and because of all the fluids they were pumping him with, he was pretty swollen after surgery. Because of the swelling, Dr. Eckhauser kept Linc's chest open for a day and a half. Using a specially treatment protective wrap, Dr. Eckhauser sealed Linc's chest and then added layers of antibacterially-treated gauze. Linc kept this chest cover on until Dr. Eckhauser came back to close Linc's chest, which he did today.
From what I understand, because Linc's sternum was split in half, it had to be tied back together. Using [surgical] stainless steel wire (probably similar material to Cutco knives), Dr. Eckhauser sewed Linc back together. The stainless steel wire will stay in Linc forever. His bone which is mostly cartilage now will grow around it like a tree around a wire.There were also a number of other layers of stitches to close Lincoln all up. Now Lincoln is officially on the road to recovery.
We will be meeting with Dr. Eckhauser in a couple weeks for a surgical check up and a few weeks after that we will meet with the cardiologists again. We will probably be meeting with cardiologists for most of Linc's childhood and adolescence. If Linc has a recoarctation, it will only require a catheter to balloon the aorta. No more surgeries!!
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