We finally talked the cardiologist into doing an echocardiogram on Hank. He hadn’t had an echo since he was in the NICU and we (Steve and I) have been really anxious to see how his heart function and structure was doing. We have been especially curious to see if there is any connection to his oxygenation problems with his heart (we have been told not in the past).
Hank had to have his Echo sedated so they could get really good, consistent pictures. He did great. The IV team came in and put in his IV line. Then, he went to the echo room, where the sedation team gave him a trio of medications. It seemed like a lot for a little guy (versed, nubain, and ketamine), but it did the trick. He was out.
The echo lasted about 45 minutes is all and Hank woke up right away. It took him a while to figure out what was going on. He got wheeled up to recovery where he had to be watched until he could hold down liquids. That took all of 20 minutes, seriously this kid is a rock star. Then we were on our way.
Earlier in the day, we had a pacer check and a clinic visit (in cardiology). Basically, Hank is doing awesome. His pacer generator (battery) is running out so he will have a generator change in the next 6 months or so. We will be back to clinic to have that checked in 3 months. That is a simple procedure that can be done in the cath lab.
But… we got Hank’s echo results later. Here is the diagram that Dr. Su drew for us.
Hank has had a hole in his heart since he was born. It is called an Atrial Septal Defect (or ASD). This is different from a PFO that many kids have. An ASD is a hole that has missing tissue, a PFO is a hole that doesn’t close the way it’s supposed to at birth, but it’s not missing heart tissue. The ASD should never be there in the first place. It’s a pretty common Congenital Heart Defect though. Normally, an ASD can be closed with a pretty simple procedure in the cath lab and if it doesn’t close on it’s own by the time a child is 3ish, generally kids get it closed with type of plug or balloon. We planned on doing this procedure, but guess what? Hank’s ASD is not the most common, easily fixed kind. Imagine that, Hank always making things hard! So Hank’s ASD has to be fixed (most likely) with an open heart surgery (OHS). Oh boy!
Here are Hank’s Echo results (with my interpretation):
- CHB, s/p pacer; ASD (Congenital heart block)
- Large ASD, 18mm x 13mm, with left to right shunt; deficient inferior and posterior rim (large being >8mm, so um… huge; blood flowing in the wrong direction through the wrong hole; bad spot for a plug)
- Trace TR, MR, PI (This stuff doesn’t matter)
- Normal left ventricular size and qualitatively normal systolic function.
- The ventricular septum motion is flattened during diastole. (I’m pretty sure this is the pacermakers fault, but we’ll forgive him)
- Dilated right ventricle with normal systolic function. (because the blood is going the wrong way, can lead to heart failure in later years if not fixed)
- Dilated right atrium
- Mild mitral valve regurgitation
But really, that sounds really bad, but it’s not. His heart is doing great. We just have to fix that hole, and we will. The new plan is to get the hole fixed with an OHS and we will do it the same time the generator battery is ready to be replaced.
We are ready.
Bring it!
