Thursday, May 20, 2010

Plan For Surgery


Two weeks ago, the day before Kimble's Cleft Lip surgery, Kimble underwent some CathLab procedures.  This was in anticipation of his next heart surgery in June. The doctors told us a bit about what happened during that time, and what the results told them at the time, and all of this questioned whether he would actually have the surgery in June as planned.  So we have waited...anxiously, to find out what their "roundtable discussion" decided for Kimble.

During the CathLab, Dr. Fagen took some measurements of bloodflow through all of Kimble's faulty valves and tiny ventricles, as well as through the normal ones.  He temporarily plugged up the hole between the two atriums (ASD, or Atrial Septal Defect) and measured how increased the pressure became in his right heart, which actually was quite minimal based on what they were anticipating.  They considered plugging up the shunt as well, to see if enough bloodflow went through his right chamber to sustain his life, but it was too risky to do in the CathLab, so they didn't do that.  However, with all of their measurements, they found that Kimble's right ventricle had indeed grown some, since he was born, and that there was a fair amount of capillaries extending their way through the ventricle and that the ventricle muscle had relaxed somewhat and was actually pumping blood, albeit a very small amount.

So, as I mentioned  before, the results made them question not whether he will have another surgery, but if waiting maybe six months, will be advantageous to let his right ventricle grow more.  In delaying the surgery, will it give things a chance to grow and function better, and thus possibly changing what type of surgery he will have?   As I've mentioned before, and as I'm reminded in every conversation we have with Kimble's doctors, this is not a simple case.  Kimble is complicated in his structure, his defects, and not a textbook case.  In my understanding, it's not that he's complicated so much, but that there are so many things going on with him, that it ends up being more of a "weighing the odds and risks" and what they hope will give him a better life with as much heart function as possible.

That being said, yesterday was the day I finally received the phone call that would tell us whether surgery was still planned for June.  The answer?  YES.  My heart sunk at the news.  Although I know he needs more surgery, there is a huge risk that he won't survive it, and as a mother, I tend to dwell on that aspect of it.

Originally, Kimble was scheduled to have the Glenn procedure at this next surgery.  This is where they reroute the bloodflow coming from the upper part of his body via the Superior Venacava, and instead of it going to the right side of his heart, it will go directly to his lungs to get oxygenated, which is normally what the right heart would be doing (pumping that blood to the lungs to get oxygenated).

However, Kimble's doctors have some other plans for that surgery.  Before they do the Glenn (which most likely, they will end up doing), they want to try out a few things.  First, they want to close the ASD.  Currently, this hole between the two atriums, is where most of Kimble's bloodflow goes, instead of going down to the right ventricle via the tricuspid valve, which as we have talked about, is about as faulty as they come.  The tricuspid simply isn't allowing enough blood into the right ventricle, so the blood chooses to go the easier route, and it slips across the hole and over to the left side of the heart.  This means that the left ventricle is now pumping blood that is NOT oxygenated, to the body.  Not the best scenario.

Now, the left ventricle, when it pumps blood to the body, begins it's journey via the aortic artery.  Along the aorta, Kimble has a BT shunt.  This shunt forms a Y, allowing that blood to either go to the body and begin it's circulation, or it can go to the pulmonary artery (coming from the right ventricle) where it travels to the lungs to get oxygenated.  Kimble's body has learned to regulate that in a happy balance, so that some blood can get oxygenated, and some goes to the body.  Thus, Kimble constantly gets mixed blood, meaning both red (oxygenated) blood and blue (non-oxygenated) blood circulating through his body, and therefore normally has oxygen saturation in the low 80s.

Ok, so now we come to the surgical plans.  Under the watchful eye of the surgeon, in the O.R., they will close the ASD, as well as block off the BT shunt.  Then they will watch and see what happens.  There are two probable scenarios.  First, with all this blood being forced to go where it should go in a normal heart, this could open up the tricuspid enough, allowing blood to fill up the right ventricle, and then it would go through the pulmonary valve and begin it's journey to the lungs to get oxygenated, as it should.  If this happens and all is good, this could possibly mean that Kimble's heart could essentially be fully functioning.  Would enough blood be getting pumped through that right ventricle to sustain his life?  That is the question.

The other alternative, would be that after closing off the ASD and the BT shunt, there would be a huge increase in pressure in the right heart because it is not able to meet the demands of the body. Thus, he would go into heart failure immediately...or possibly, all could be fine, or within minutes, or days, the heart would fail.  They should be able to see whether or not this is life sustaining.

If this fails, under these controlled circumstances, which it probably will, they are already in the O.R. (nice and safe) and they would then begin rerouting the bloodflow, and doing the Glenn procedure, as originally planned.

This surgery is scheduled for June 21st.  One month away.

16 comments:

Paula said...

Great explaination of a complex situation. We will be praying with you on the 21st. Glad you have a team of experts working with Kimble.

Trinette McCrary said...

“Faith exists when absolute confidence in that which we cannot see combines with action that is in absolute conformity to the will of our Heavenly Father.”
Joseph B. Wirthlin

My prayers are full of peace and comfort for your family and strength for Kimble! Love Ya!

Jed and Kera said...

Oh, I don't know what to say. I totally understand the hesitation and wanting to put off the surgery. Please know that we still pray for Kimble during our prayers. My husband has even gotten to know your blog, as he started to wonder who this Baby Kimble was that we prayed for. We want to put him and the rest of your family's names in the the Columbus, OH temple here. I don't know your last name though, so if you feel comfortable giving me your last name email me at kerabeth@hotmail.com

runningfan said...

What a lot of information. How are you?? You can count on my prayers.

Chalene said...

We love you and Kimble! We know the Lord has you in His hands, and we will keep praying for your whole family so you can keep feeling those prayers!

Shavonne said...

Of course, you know you have all of us praying for you!

Vix said...

21st June is a good day, it's the Summer Solstice, a time of new life. I hope Kimble's heart is given a new lease of life. I will be thinking of you all x

Alissa Maxwell said...

Praying for you guys. Shaina, you have an amazing way with words to explain something so complex in perfect clarify. If I were in your situation, I would want someone like you explaining this to me. I pray that Kimble surgical path will be just as clear to the doctors.

Jen said...

That sure is a mouthful of information. Thanks for sharing it all. We will be keeping little Kimble in our prayers for the next while. What a sweet boy.

Jeff and Lori said...

Oh Shaina. That's a lot to worry about and a lot to hope for. We will be praying for little Kimble!! Thanks for the details. I know that I like to know WHAT they are doing, step-by-step, and WHY, especially when it involves my child. It's comforting to me, mind and soul.

Colleen said...

So much interesting information! I am praying for that tricuspid valve to do its thing! And of course for Kimble's quick recovery and his worried mommy too.

Maynards said...

Maybe you should become a heart doctor. You sure know your stuff now.
As always, our thoughts and prayers are going your way especially on the 21st. We will still be around at that time, so let me know what you need.

courtney said...

Ditto to everything! We are always thinking of you!

Sara said...

1) You sound like a doctor. This whole thing with Kimble has basically granted you an MD.

2) This is horrifyingly scary. It just IS. I can't stand it.

3) Peace, Shaina. We have to have some peace here. It is going to be alright. Go to you your Father in Heaven and rely on Him - that's the only way to get through this ordeal as a mother and a wife. Get a blessing for yourself and for Kimble. As always you and your family are in our prayers. I think I need to make another blanket...

Sara said...

Adorable Mr. Kimble and the rest of you are in our minds, hearts and prayers every day!

Carol said...

So much for such a little guy, but you are one amazing family - will be thinking of you all!!