So last night, around 9pm, Kimble came back from Surgery/Cath Lab. They had taken him back to the O.R., and opened up his chest again. As soon as his chest was opened, his oxygen stats came right back up again. From a surgical standpoint, everything looked fine. Hence, they decided to send him to the Cath Lab, to do an angiogram to see from the inside, what was going on, since the outside looked normal.
As they were inserting the contrast (ink) through his artery, they discovered a part of the shunt near where it was connected to the artery, was either kinked, folded, or had some blockage of some sort. They looked at it from a few angles, then decided to balloon through it to clear everything out, in case it was a clot. If it didn't clear up, then it was a problem with the shunt and would need to replace it. However, the blockage cleared, with a good squirt of Heparin, which is an injectable anticoagulant. Thus, the shunt was fine, and the pathway was patent, meaning open again.
The Doctors aren't quite sure they can narrow down exactly one reason why this all started, but they think it may have been a combination of pressure from his closed chest, and the swelling from the surgery, as well as that slight blockage...and maybe other things, but the result was that the top end of his shunt got pinched off, or closed off, and blood was prevented from going to the lungs. Because the tiny amount of blood going to his lungs from his right ventricle and pulmonary artery isn't enough to support him, it was a dangerous time for Kimble. Just in case they needed to make a quick trip to the O.R. again, they left his chest opened, and covered it with sterile gore-tex dressing. This is pretty standard, and will be closed within a few days, after swelling goes down.
So, like I said at the beginning, around 9pm they brought him back to his room. All was stable for about 20 minutes.
Within seconds, his blood pressure dropped to something like 24 over 14. His carbon dioxide levels whacked out...his oxygen went crazy, and immediately, our world crashed.
Our nurse started doing chest compressions, which is just about the worst thing I can think of witnessing. It was absolutely horrible for me. I seriously thought that was the end. Heath and I prayed and prayed, as everyone was working on our sweet baby. The compressions continued for about 4 minutes, then things stabilized for a bit. I'd like to say that things got under control after that, but they just continued throughout the night. Our baby wasn't really in a safe zone until about 5am this morning. All night long he was critical, as a hundred things happened at once, around him and to him, as Heath and I watched. I was able to lie down for a little bit, as everything was going on. I did catch a little bit of sleep, as did Heath, but for the majority of the night, we were witnesses to the traumatic events that surrounded our baby.
Without recounting 9 hours worth of life and death moments, I'll give an overview. Essentially, the shunt that they put in allows some of the blood that is leaving the left ventricle, and going through the body, to get redirected and pumped into the lungs for oxygen. How much blood flow goes to the lungs, and how much goes to the body, takes some time to get regulated. Kimble's body needs to learn how to adapt to that. We were told that the first 12 to 18 hours after surgery are the most volatile, for babies, as we definitely found out.
Anyway, as Kimble's heart was directing this flow, and trying to balance it out, we think that too much blood was going to the lungs, and not enough was going through his body and back to his heart. Thus, his blood pressure dropped, which makes the heart not pump well, which causes less blood to get pumped back into the heart, which drops his blood pressure even more...you get the cycle. It plummets dangerously fast. That is what caused the first episode, where they had to do chest compressions. From there, the doctors have to administer different medicines, to try to balance out that blood flow. It's tricky, and because Kimble's body reacts so dramatically to even the slightest adjustment of medication, it made for a very long night of ups and downs.
First, he had too much blood to his lungs...then he didn't have enough, which cause oxygen to drop. Then he had too much, and they needed to administer nitrogen to counterbalance the high oxygen...then he didn't have enough..then blood pressure dropped again. It was a vicious cycle. He received lots of blood transfusions, lots of medications, and a bunch of crazy stuff that I don't even know about.
For now, since the last 4 hours or so, they have him stabilized. They found a balance that seems to be working for the moment. We are still warned that today could be a repeat of last night. It's touch and go for the moment.
We believe that the start of all this stemmed from that slight blockage in his shunt. If that hadn't had happened, which started the whole chain of events throughout the night, they think that he would have had a more stable night. With surgery twice in a few hours, as well as the Cath Lab procedures, it was pretty invasive for his little body. Fortunately, Kimble has been completely paralyzed and doped up with medication, so he hasn't been in any pain. They will continue to keep him this way, for a day or two.
Heath and I, besides being extremely exhausted and emotionally spent, are so very thankful for all the hands that worked their miracles on our baby last night. We are beyond impressed by the level of care and attention that was shown to Kimble, as well as the comfort that was extended to us, through this difficult time. Kimble very well could have died at least a dozen times throughout the night. We definitely had angels guiding everyone through the tough times.