So the results of Jack’s cardiac cath is in and we’re finished with recovery. Now we wait for discharge.
Jack’s results were better than I was anticipating. When you had over your son to receive general anesthesia for the 15th time in 9 months, you tend to worry a little. But the procedure was only a little over 2 hours and we were beingn visited by the cardiologist for the results. Since there were a lot of numbers, he wrote them on a dry erase board from a photo. So I will do the same here.
The row labeled “BL” is Baseline and is Jack’s pressures at baseline without stress or medications. All the numbers are in the normal range. The row labeled “DOB” is his pressures while under stress to increase his cardiac output. There are high. The row labeled “DOB + NO” is the pressures under higher cardiac output with nitric oxide. These numbers are also in normal range. Interpretations: His pressures on a daily basis are normal and there is no need for concern. This could either mean that his pressures are normal on their own or the Sildenafil is bringing them into the normal range. Either way, there is no reason to change anything. If it ain’t broke, don’t fix it. The elevated pressures are what is to be expected for a CDH baby. His vessels aren’t dilating properly and are causing an increased pressure due to the increased blood flow. This didn’t surpride anyone. The last row didn’t surprise, but delighted. When his heart was given nitric oxide even under stress, the pressures returned to normal range. This means that the Sildenafil is working to decrease his pressures under dtress which will keep his pressures low (He is one regular doses of Sildenafil). Overtime, the Sildenafil could cause his vessels to react properly under pressure and dilate to allow for the increased flow. If this is the case (which they hypothesize) he could be off Sildenafil and with normal pressures in about a year. This has also been proven in CSH patients that have much more severe pressures than Jack. Also, since he’s at a normal range without pressure, they are going to discontinue Lasix. The lasix was used to draw fluid off the lungs that would put more pressure on the already underdeveloped and constricted vessels. Since this is no longer the case, he no longers needs to take this medication. One medication down!
After they brought his pressures and heart rate down, they took photos of this aortic arch. Because of the shift of organs during development, the aortic arch will sometimes form improperly. This is the case with Jack. The arch is supposed to be a candy cane shape but as you can see, his is a little lopsided and has a slight kink (The dark rings are the wires that are used to reclose his sternum after his slide tracheoplasty). This can be fixed in a couple years with a stent. Another quick and non-invasive surgery. I like the non-invasive ones. They will wait a couple years to allow him to grow a little more. The bigger he is, the easier the placement of the stent and the reduction in the chances of damage to his arteries.
So here he is getting ready for discharge. The nurse just came in with our paperwork so we are leaving. Just in time for dinner ….not in the cafeteria.