We have been instructed to have Caden at the surgery check-in area of the main hospital of MUSC at 5:30am on Monday 9/22/08. The surgery will be performed on the 4th floor of the main building of MUSC and Caden will be transferred to the PCICU (pediatric cardiology intensive care unit) on the same floor. The PCICU is the only children’s ICU in the main (adult) hospital building at MUSC. Based on our conversations, the surgery should begin at 7:30am and take approximately 6 hours to complete. The best case and expected scenario is that Caden will spend 2-3 days recovering in the PCICU and then another 2-3 days on “the floor” (7C of the Children’s Hospital).
Caden spent most of today (Friday 9/18) in the pediatric cardiology same-day care at MUSC Children’s Hospital. Sherry and I joined Caden while my mom (Nana) spent the day with Riley and Josiah at home. The tests performed today included a standard physical, an EKG, echo cardiogram, chest x-ray, and blood work. We met with the cardiothorasic surgeon and many of the support staff that will be assisting with the surgery and follow on care.
Surgery Details
1. Removing the pacemaker
This procedure is pretty much summed up in the title. The surgeon will use the main incision (same as the one used during surgery at six days old) down the middle of the chest to access the pacemaker lead. He will have to make a separate incision to remove the pacemaker generator device which is located near Caden’s waist line. The major risk factor is the proximity of the lead to the phrenic nerve (controls the diaphragm).
2. Repairing narrowing of the aorta just above the coronary arteries
The description of this was a bit of a surprise to us today. We understood that the narrowing that has been discussed as being the cause of the hypertrophy (thickening of left heart muscle) was immediately above the aortic valve. As we have learned today, there is some narrowing just above the aortic valve, but the hypertrophy has primarily been caused by narrowing up above the coronary arteries. The extent of the repair of this will involve splitting the aorta vertically (lengthwise) in the area of the narrowing, and then placing a patch over the expanded incision so that the result is a larger diameter aorta in that area. The patch used for this is foreign tissue.
3. Repairing or Replacing the aortic valve
This could become the most complex portion of the surgical process and could lengthen the surgery time well beyond the estimated six hours listed above.
Aortic Valve Repair Option
The repair is what the surgeon will consider if the bicuspid aortic valve has some stickiness to the leaflets. There is a chance that the pressure gradient measured across the aortic valve could be caused by the little shutters being partially fused or grown together. In this case the surgeon would simply cut the tissue that is causing the valve leaflets to stick. This option would not significantly lengthen the surgery time.
Aortic Valve Replacement Option
The surgeon will determine whether or not this option will be done based on measuring the diameter of Caden’s aortic valve and comparing it to children of his size. If the diameter is smaller, he may go forward with the replacement of the valve. I have explained this procedure before. The Ross Procedure is the safest and most effective way to replace an aortic valve in a small child and is really the only option for Caden’s case. Back in May I explained it this way:
“…a Ross Procedure on Caden which is a bit more complicated than only replacing the aortic valve. I will try to explain the details, but just in case here is a link to a very good description with graphics. This procedure basically involves switching the pulmonary valve over into the place of the defective aortic valve (higher pressure) location and then adding a foreign valve in place of the lower pressure pulmonary valve location.”
The fact that the Ross is “a bit more complicated” of a procedure could lengthen the surgery time beyond the six hour estimate. This option also raises the risk level of the surgery over all because the aorta, pulmonary artery, and coronary arteries must be cut and the reattached. The surgeon must also determine how much of a factor the valve is playing in causing the hypertrophy (in combination with the other narrowing).
Updates will be provided when possible on this site. Our first update from the surgeon is expected to be at approximately 9:00am on Monday.
Prayer
Many people have responded to me with “I will be praying for Caden”. Thank you! Please do just that because that is the best thing you can do for Caden and our family. I want to give you some specifics to help you pray for Caden.
Praise and Thanks
- Rapid scheduling for this surgery
- No fever or infections
- Technology and skills that makes heart surgery possible
- Health insurance and Tefra Medicaid!
- Donated annual leave (over 100 hours donated by my coworkers)
- Nana’s recent retirement that allows her to stay with Riley and JJ
- A super strong support system at Seacoast and within the GrowingKids Community
Prayer Requests
- Whole body healing for Caden
- Continued protection from infections and illness
- Protection for Caden while under the care of MUSC staff. That the surgeon’s hands will be used as instruments for God’s healing.
- Continued discernment for the doctors and us.
- That we will be allowed as much access to Caden as possible to help with communication issues.
- Continued strength, rest, and peace for Sherry and me.
- Protection over all our boys’ emotions.
It is amazing to watch how God brings all things together for good! Thank you for your prayer and support for our family. Blessings to you and yours!