Brandt came through his cath beautifully. They had warned us ahead of time that we may need to come back to keep him calm before he was out of recovery, because, while most people take a while to sleep off anesthesia, redheads burn through it. They were right. He was apparently waking up as they rolled him out of the OR. !!!! First thing he wanted, of course, was a bottle, that he downed in two minutes flat. He's a happy camper now, and is allowed to sit up as of a couple hours ago. (They like to keep them flat for four hours after a cath to make sure he's getting good circulation to his leg again.)
So, the actually prognosis. One of our guesses was partially correct. The stent that he has in his LPA did need ballooned, because he has grown but obviously hardware doesn't. The doctor couldn't fully open it without exerting force that made him nervous, however. (Too much force could potentially do extensive damage to the artery.) Widening the diameter of the stent also shortened it, which means not as much of the artery is stabilized now, but the pictures still look fine, so the plan is just to roll with it for now.
Next, he noted that the top third of Brandt's right lung (did you know that the lungs have different amounts of lobes? Found that out today...the right has three, left has two!) was partially collapsed and only oxygenating at 80%. There's a good chance that that's a side effect of the anesthesia and intubation. It's a semi-common complication of procedures like this. Tomorrow they'll do a chest X-ray to see if it's resolved itself. If not, they'll work with the pulmonary team to get something figured out. Even if that is the case, it's not enough to cause desaturations like the ones he's been having.
That brings us to his last find. Brandt has been developing what they call PAVM's. Pulmonary (on his lungs) Arteriovenous (spanning between arteries and veins) Malformations. They're similar to collaterals, which are blood vessels that form to try to get blood flow to places that aren't getting enough. Those are usually vein to vein, from what I understand, and PAVM's are from arteries to veins. So as the blue blood flows around the lungs through the arteries, it's siphoned away through the PAVM's to the veins that distribute it to the body without being oxygenated. Hence, the lower sats.
Brandt's are minor at this point, and it's something that they somewhat commonly see in Glenn physiology. For some reason, they develop most often when the lungs don't receive blood that's been through the liver. The lungs, post-Glenn, only get blood from the upper body. I don't know what exactly the lungs need liver-blood for, but it does seem to be an issue.
For now, our solution is just to take him home and keep an eye on it. As he gets older, if they keep developing, we may need to come back to Seattle for a "minor" surgery to direct part of the blood from his lower body to flow through the Glenn connection. From what I understand, that means going in almost through his armpit to connect a couple large-ish returns there. That "fix" should tide us over until the Fontan, which should patch things up itself. If, on the other hand, the AVM's keep progressing further, we'll probably have to go in for the Fontan earlier than predicted. Doctors generally agree that three years old is a good age to have it done, for a bevvy of reasons, but they'll also settle for a weight minimum of thirty pounds.
The good news there is that Brandt is only four pounds away from that threshold! (Eye roll) This kid certainly doesn't skip meals.
Anyway, we definitely won't be going in for the Fontan just for kicks. We're going to put it off as long as we can, which could still be a couple years, but now the possibility of doing it a little earlier is an option on the table.
So all in all, this trip was diagnostic, but we couldn't do a whole lot to fix him, so now we're in wait and see mode. Don't be surprised if we go trekking off west a few more times in the next year!
(As a matter of interest...to me, anyway...I've apparently delved so far into Brandt's diagnosis that I've begun to ask questions that the nurses can't answer. It's an odd feeling.)
So, the actually prognosis. One of our guesses was partially correct. The stent that he has in his LPA did need ballooned, because he has grown but obviously hardware doesn't. The doctor couldn't fully open it without exerting force that made him nervous, however. (Too much force could potentially do extensive damage to the artery.) Widening the diameter of the stent also shortened it, which means not as much of the artery is stabilized now, but the pictures still look fine, so the plan is just to roll with it for now.
Next, he noted that the top third of Brandt's right lung (did you know that the lungs have different amounts of lobes? Found that out today...the right has three, left has two!) was partially collapsed and only oxygenating at 80%. There's a good chance that that's a side effect of the anesthesia and intubation. It's a semi-common complication of procedures like this. Tomorrow they'll do a chest X-ray to see if it's resolved itself. If not, they'll work with the pulmonary team to get something figured out. Even if that is the case, it's not enough to cause desaturations like the ones he's been having.
That brings us to his last find. Brandt has been developing what they call PAVM's. Pulmonary (on his lungs) Arteriovenous (spanning between arteries and veins) Malformations. They're similar to collaterals, which are blood vessels that form to try to get blood flow to places that aren't getting enough. Those are usually vein to vein, from what I understand, and PAVM's are from arteries to veins. So as the blue blood flows around the lungs through the arteries, it's siphoned away through the PAVM's to the veins that distribute it to the body without being oxygenated. Hence, the lower sats.
Brandt's are minor at this point, and it's something that they somewhat commonly see in Glenn physiology. For some reason, they develop most often when the lungs don't receive blood that's been through the liver. The lungs, post-Glenn, only get blood from the upper body. I don't know what exactly the lungs need liver-blood for, but it does seem to be an issue.
For now, our solution is just to take him home and keep an eye on it. As he gets older, if they keep developing, we may need to come back to Seattle for a "minor" surgery to direct part of the blood from his lower body to flow through the Glenn connection. From what I understand, that means going in almost through his armpit to connect a couple large-ish returns there. That "fix" should tide us over until the Fontan, which should patch things up itself. If, on the other hand, the AVM's keep progressing further, we'll probably have to go in for the Fontan earlier than predicted. Doctors generally agree that three years old is a good age to have it done, for a bevvy of reasons, but they'll also settle for a weight minimum of thirty pounds.
The good news there is that Brandt is only four pounds away from that threshold! (Eye roll) This kid certainly doesn't skip meals.
Anyway, we definitely won't be going in for the Fontan just for kicks. We're going to put it off as long as we can, which could still be a couple years, but now the possibility of doing it a little earlier is an option on the table.
So all in all, this trip was diagnostic, but we couldn't do a whole lot to fix him, so now we're in wait and see mode. Don't be surprised if we go trekking off west a few more times in the next year!
(As a matter of interest...to me, anyway...I've apparently delved so far into Brandt's diagnosis that I've begun to ask questions that the nurses can't answer. It's an odd feeling.)
Thanks so much for all your sharing, Kara, about Brandt's latest trip to SEA. It's very interesting and yes, you know a LOT! Glad it all went & is going well after the adjustment.
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