Tuesday, November 11, 2014

Cath Complete

Abby did great during her heart catheterization today. Unfortunately, the cardiologist was unable to fix any of her problems in the process. They were able to measure the pressures in different areas of her heart and in her arteries, which was helpful in explaining which issues are the most problematic in Abby's unique case.

Here's where it gets complicated, and I will do my very best to explain everything...

What they found is that the blood flow across her ASD (a hole between the two upper chambers of her heart) is causing a pressure ratio of 1:2.5, when it should be 1:1 - this is a significant difference. This causes an overload of fluid in the capillaries around her lungs, which in turn, leak out, and they have to give her diuretics to expel the fluid. If her only problem were the ASD, they would simply diurese her and monitor her hydration levels. But, it's Abby, so nothing is that easy. The diuretics increase the outflow obstruction caused by her thickened heart walls (hypertrophic cardiomyopathy), so they have to give her more beta-blockers to keep her heart from overworking. This balance is nearly impossible to achieve, and ultimately means that she will have to have open heart surgery to close the ASD. What they are trying to determine now is when that will need to happen. The cardiologists are hoping that when pulmonary does their exam they will find something else that explains the increased pressure in the arteries around her lungs that can be fixed so that they can continue to put off heart surgery. If they don't, the pressure in her arteries could cause pulmonary hypertension - which is irreversible, and we'd probably be looking at heart surgery in the next couple of months. The bigger she is, the better she'll tolerate open heart surgery, so they really really want to put it off as long as possible.  

Though Abby did great during the cath, she had some trouble coming out of anesthesia, so we're spending the night in the CICU. She's just having some temperature fluctuations and increased work of breathing, and they felt more comfortable having her closely monitored overnight. Hopefully we'll get moved back to the step-down unit tomorrow. 

There was some question of whether or not she would be staying inpatient between the cath and her g-tube surgery next week, but now we know she will definitely be staying. Her white blood cell count has been elevated since admission, and it hasn't resolved itself, indicating that they still have some exploring to do to determine the cause.

Whew, that was a lot.  Here's our smiley girl shortly before heading back for the cath today: 

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