Friday, January 14, 2011
Teetering Toward Normalcy
At (almost) every cardiology visit, we have an echocardiogram done (detailed ultrasound of the heart). After his doctor analyzes everything, and compares it with the prior visit, he comes in the exam room and we talk about what he sees. Normally, his "cautiously optimistic" outlook, pertaining to Kimble, doesn't allow for high hopes. Rather, it is something like "Well, Kimble is so unique in his defects, that we really can't plan or estimate what his future holds. We just need to keep watching him and wait and see what his heart is going to do." However, yesterday's visit was a bit different, and changed the baseline "cautiously optimistic" to "surprisingly optimistic".
The ultrasound showed that Kimble's heart has grown! His right ventricle, which is the pumping chamber that pumps blood to the lungs, has made major improvements on the growth chart, and now qualifies in the range of NORMAL. This is astounding. Although he is still undoubtedly on the (very) small side of "normal", he is within range.
Half of Kimble's bloodflow is still flowing through that right ventricle (with the other half redirected to the lungs via his last heart surgery in June) and all of that bloodflow has helped the muscle grow and get stronger, without the pressure of pumping an entire body's worth of blood.
The other two defects that Kimble has, relate to that right ventricle. The valve going into it (tricuspid valve) is very small and defective, and the valve where the blood exits the right ventricle (pulmonary valve) was ballooned through when he was a week old, and although it isn't a "valve" by definition, is accomodating enough for the cycle of bloodflow.
More good news, is that the tricuspid valve is allowing enough bloodflow through to the right ventricle, to define it (meaning the bloodflow) as Normal. Amazing. All of this was shocking news, especially since two months ago, we were drowning in adjetives like "underdeveloped, small, dysfunctional, not-usable, defective, and restrictive".
There was another finding, however, which can be good, or bad. It was discovered that there is some narrowing where the superior vena cava (the main blood vessel which carries blood from the top half of the body, back to the heart to get oxygenated) was redirected and attached to the arteries going to the lungs. This means that less bloodflow is able to get through that area. A clot could develop, or more narrowing could occur, and this would need to be adjusted or repaired via surgery, or in the cath lab.
Just like when you have a bad cold, and your nasal passages get swollen, making it hard to breathe....the same thing is happening in that area where the bloodflow was redirected. Restricted bloodflow is not good.
Right now, it's small enough that we don't have to worry. We'll continue to watch it for signs of growth. Currently, because Kimble's heart has grown and is adapting, that means that plenty of bloodflow is actually going through his right ventricle, and because it is within normal limits, he is in no danger. He has, in essence, a "safety" that is his heart, even if the superior vena cava gets more restricted, because of the better-than-expected amount of bloodflow that is being pumped by his right ventricle. Hope that all makes sense.
Now, for the best and most unexpected news. I had said that the narrowing could be "good news". What I mean by that, is that if they find that they have to go back into surgery to have it repaired or adjusted, they would ask themselves "what is it that we are really trying to do here?" The goal, of any heart patient, is to have a fully functioning four chamber heart. If they find that Kimble's newly aquired status of "within normal limits" actually allows for his heart to be able to handle the workload that it should, then there is a chance that they could reverse The Glenn procedure (which was his last surgery) and actually re-route the bloodflow BACK to his heart, and then his heart would function the same way yours and mine does. Now, it would still have it's defects, but if it is still able to manage a healthy amount of bloodflow for his body's demands, then it would be alright.
Of course, this is just and idea to nibble on, all the while hoping that his heart continues to grow and is able to meet the demands of Kimble's more active lifestyle, as he progresses developmentally. Our next appointment is in three months. I'm excited to see what develops!