Tuesday morning we woke up extra early (4:30am) so we could make a very early appointment in Denver for Kimble to undergo a Cardiac MRI and a 3D Echocardiogram. His doctors needed the information from these studies to make a more informed decision on the next stage of Kimble's heart surgeries.
Kimble had to be under anesthesia, as well as be intubated, for these procedures. Even though it wasn't surgery, it still made my heart go pitter patter. It is very hard. Every time I have a nurse take my baby from my arms, and tell me to say goodbye, it just...I don't know. It hurts. They see me crying. They tell me something like "Oh, he'll be fine! Don't you worry." But I do worry. I've watched him come out of anesthesia before. I've seen him struggle to live after his heart surgery. Even though this wasn't surgery, the same feelings were there. I absolutely hate handing my sweet baby over to someone else, and then have to turn around and walk down the hall, with my arms empty. It's just wrong.
After about three hours, Kimble was brought out of anesthesia, and he was HUNGRY! That is always a good sign. So after about half an hour of feeding him (his last meal was 3am, so he definitely needed to make up for lost time!) he was stable enough to be released from the Radiology department. After that, we made our way up to the 3rd floor Cardiology wing, so we could discuss with our Denver Cardiologist, Dr. Adel, about the MRI results.
While we were waiting for Dr. Adel to review the information, Kimble had his height and weight checked again (almost 15 lbs!), and everyone raved about how fat and healthy he looked. He also got some routine tests done, like an EKG...
...and some routine developmental checks...
And after some love from Daddy, we got to work discussing the next step for Kimble, in terms of his cleft lip surgery, as well as what his next heart surgery would entail.
Here's the thing with Mr. Kimble. His heart defects aren't "textbook". Because he has three serious heart defects, he doesn't fit into the quick fix category. Let me explain a little bit about the structure of the heart, to give you an understanding of his complications.
The heart is divided into four parts, essentially. There is a right side and a left side. Likewise, each side has a top and a bottom. The top chambers are called atriums, are are holding areas for the blood that is coming in, and at the bottom of each of these atriums, there is a valve that allows blood to go into the bottom chambers. These bottom chambers are called ventricles, and they are the pumping chambers. From these ventricles, blood gets pumped out, through another valve (on the right side, it's called the pulmonary valve) and then the blood leaves the heart. When it's pumped out of the right ventricle, it goes to the lungs to get oxygenated. From there, the blood goes back into the left side of the heart, where it then gets pumped throughout the body. Once it finishes it's course through the body, the blood comes back to the right side of the heart, to begin the cycle again.
Kimble has defects concerning the right side of his heart. The tricuspid valve is the valve that allows blood to enter the right ventricle, from the atrium. The pulminary valve is the valve that takes the blood that leaves the right ventricle, and directs it to the lungs. Kimble's tricuspid valve is tiny and weak and hardly lets any blood enter the right ventricle. Because of that, his right ventricle is tiny and muscleous, and isn't quite functioning very well. In addition, Kimble's pulmonary valve was missing, or unformed, when he was born. During his first 5 weeks of life, that pulmonary valve was ballooned through, and is now an opening, which allows for blood to leave the right ventricle.
So what the MRI showed, is that the right ventricle isn't getting enough blood to sustain Kimble's life. Currently the BT Shunt that was placed during Kimble's 1st heart surgery, is the only thing that is keeping Kimble alive. Needless to say, we are very thankful for that shunt!
The next stage of the 3 stage surgery that was originally planned for Kimble, is called the Glenn. After the blood has circulated through the top part of his body, it is directed back to the heart via the superior vena cava, where it is pumped back to the lungs to get oxygenated again. The Glenn procedure reroutes this blood directly to the lungs, connecting the superior vena cava to the pulmonary artery. This makes it possible for the lungs to oxygenate the blood, without the right ventricle needing to pump the blood to the lungs. This is a great thing, but puts a lot of pressure on the left side of the heart, which would be doing the work of two pumps.
Just for some quick information, the third stage of the heart surgeries is called the Fontan, and it essentially does the same thing as the Glenn, only it reroutes the blood coming from the bottom half of the body. Thus, the entire right side of the heart would be bypassed (not used, ignored, forgotten about, disregarded) This surgery, if it comes down to it, would happen between 3-5 years of life.
Because Kimble's right ventricle, although very small, is actually pumping blood (albeit a very small amount), his doctor's don't want to dismiss it entirely. They want to see if it can be made useful, because if they can get the right ventricle to pump enough, it will lead to a better quality of life for Kimble. Two pumps are better than one, afterall! So the problem isn't quite with the right ventricle, but with the tricuspid valve. If there is some way to tweak the valve, surgically, or do something to it to make it stretch open, be bigger, work better, then the doctor's think the right ventricle will respond positively, and such drastic rerouting of all his major arteries could be avoided.
However, in all likelihood, Kimble will need to have the Glenn, along with surgically tweaking the tricuspid valve, but we are trying to avoid needing to do the Fontan.
For the next little while, as the doctors discuss what is best for Kimble, we wait. This isn't a problem because Kimble is healthy and strong and THRIVING right now! While we are waiting on his heart decisions, Kimble will have his cleft lip surgery. That will most likely be next month. His next heart surgery will most likely be around June or July. So, we'll see.