Well, Tuesday’s surgery was a success by everyone’s high standards and Tim is raring to get off the breathing equipment and pain meds so he can go back to the posh life of a NICU baby. But why, you wonder, was surgery required? Was it really open heart surgery? Was Meredith Grey actually on Tim’s surgical team? (Well, no, but don’t tell him that.) So to get an answer to your myriad questions, grab a hot, caffeinated beverage (preferably from Kirk Jeffery), and settle in as we talk about the heart.
You know the body is wonderfully complex (I’ve even heard it said that we are fearfully made). One of its features that I didn’t really get until now is that after birth it reshapes some significant organs and systems…kinda like a Transformer action figure. For instance, the lungs aren’t supposed to pump in utero, but obviously need to punch it into high gear once the big event kicks off. So before birth there’s a bypass duct that takes the blood flow away from the pulmonary artery that goes to the lungs and dumps it into the aorta where it can supplement the circulation to the rest of the body. This ductus arteriosis (oh yeah, medicine likes obscure Latin references almost as much as theology) usually closes up on its own within a day after being born. This lets blood flow to nourish the lungs, and the aorta is left all alone to do its job.
Usually the aorta is all, “I’m fine, I don’t need someone else in my life to validate me,” like that friend who just had a bad breakup but will be better for it in the long run. Sometimes, it’s left a little worse for wear. This is where our little issues begin.
As that duct closes up, in a very small percentage of the n00bs, it pulls on the aorta and causes it to narrow. A narrowed aorta means less blood flow to the lower organs and extremities while extra blood pools in the upper torso. Meanwhile, backpressure on the heart means it has to work harder than usual. This coarctation of the aorta thus is a real problem for newborns and especially for an early guy like Tim who has enough issues catching up and doesn’t need to work his heart like this. Ain’t nobody got time for that. The echocardiogram in the NICU at Schumpert revealed the narrowing and Texas Children’s is one of the places that does this surgery. Dr Fraser, chief of congenital heart surgery here, is one of the world’s leading surgeons who treats coarctation, and we’re beyond fortunate to have been able to have Tim worked on by him and his team—they’ve dealt with coarctations in much younger and smaller kids than him.
In some cases, if the duct isn’t closed off yet, it can be kept open or even widened again by medication at high doses. Before we even left Shreveport, Tim was on these drugs, and more was administered here in order to keep the blood flowing well through this cardiovascular self-sealing stem bolt. But it was a long shot at best that didn’t pay off in his case: surgery was the only option.
Now, in Timothy, the coarctation was isolated and located past the aortic arch, a series of arteries that branch off to the upper extremities and organs. This explains why his lower extremities were affected, but it also is a best-case scenario in terms of location. The surgeons could make an incision between his left ribs, go near the heart, and clamp the aorta down. This allows them to cut the coarctation out and suture the aorta back together. Sounded pretty scary to me, but in reality this was somewhat routine. I understand that if the coarctation was located where it couldn’t be sectioned easily (further up the arch), or there were several, or it was longer, then we would have been facing legit open-heart surgery instead of the kind of laparoscopic procedure that occurred.
The other concern aside from repairing the narrowing was that there might have been another cardiac problem connected to or causing the coarctation. Neither the tests nor the actual surgery indicated this to be the case. Now that we’re 48 hours post-op, we are breathing easier. Obviously, there’s still a long way to go—both in recovering from major surgery as well as preemie concerns. Some setbacks are inevitable, but the big picture is looking very good.
Now that we have some breathing room, let me add a word about what might have been. If Tim had been a bit older and/or bigger, and never did a stint in the NICU with extensive monitoring, tests, and scans, we likely have been at home when symptoms of the coarctation began. How long would it have taken us to call the pediatrician? To get initial tests run? To become aware of what was happening and get transported to TCH? And deteriorating the whole time. Tim had such a good prognosis because it hadn’t begun affecting his body much. But that could easily have gone differently. Standardized testing for these kinds of heart defects doesn’t happen in Texas (or many other states) right now. I’m still learning about it, but there’s currently a bill in the State Legislature that would add basic screening for critical congenital heart diseases to mandatory tests before newborns leave a hospital. You can be sure you’ll hear more about this from me in the days and weeks to come.
You can check out the Flickr link in the sidebar for more cute pics, (newer ones will be posted after he gets unwired/detubified some more). And don’t forget to follow @NewestHale on Twitter for more updates plus pint-sized commentary on hospital livin’. Thanks for all the prayers, messages, thoughts, and well wishes: you all mean a lot to us. If you have something you want to share with Tim or the family, leave a comment below!