Cath #3 Results (9/21/16)

A cardiac catheterization is the best diagnostic tool available to assess cardiac function and the pressures and flows within the heart. An echocardiogram (an ultrasound of the heart) is of course less invasive but can't always give the best assessment. The "cath" is called such because it entails a thin piece of tubing (the catheter) inserted into an artery or vein (in the groin or neck or, apparently, liver). A cath can also be interventional, allowing the ballooning or stenting of a narrowed artery or vein.

Job recieved a LPA (left pulmonary artery) stent (which was described as a loop of fancy chicken wire). This will keep his LPA from further narrowing and it was placed where the green circle is. It's hard to see the narrowing in this particular picture but it was significantly inhibiting the LPA flow. The tissue around the stent will quickly grow around it, keeping it in place, and it won't grow with Job, so it will eventually need dilated (or replaced in a future open heart surgery, such as his Fontan).

Because Job is always one for fun extra surprises, he also had a clot where the purple circle is. It was dispersed with heparin and he will shortly begin a lovenox regimen (and we're old pros at lovenox injections!).

And because we're often asked, the orange circle highlights one of his sternotomy wires, keeping his cracked sternum closed.

Miraculously, Job's aortic arch repair did not need repaired as seemed likely. I think we're still in shock, actually. This is such wonderful news!

Job is not satting as high as we would like, even after this intervention, but it bought him a few days to get his sats up. His heart function likewise needs to improve, but again, he can have a few more days to accomplish that as well.

Surprisingly, Job was extubated in the OR and is on the BiPap at present. Reintubation is still a possibility but if he has a good night then that possibility diminishes. We want him to ween to CPAP then hi-flow then nasal cannula then no respiratory support but, because this is Job we're talking about, it will take some time.

Tomorrow Job will get another ultrasound to look at his diaphragm plication which is possibly coming undone. If this is the case he would get to have surgery tomorrow to fix it, but it is extremely rare for this to be necessary (but again, this is Job... He never takes the easy path).

Unfortunately his plication (which was necessary because of his nerve damage sustained in the Norwood) makes his ability to take deep, full and effective breathes more difficult at present. Around the age of two his thoracic/intercostal musculature will be strong enough that the plication will no longer be such a factor, but it very much inhibits him now. If his phrenic nerve was going to heal, it would have healed by now. So the left side of his diaphragm won't ever be able to move (even if it hasn't been plicated, or stapled down).

Job has yet to fully come out of his anesthesia and is pretty well sedated and will be through the night.

I'm not entirely sure what his goals will be for tomorrow. I think it will largely be a day of rest, to hold steady on the small forward steps he he has made and to assess his goals for the rest of the week.

We are so very relieved that Job has seemingly turned a corner. He was so very sick and had us all extremely worried through Monday. His progress has been tentative but to even use the word "progress" is thrilling. He certainly has a long road ahead of him, but we've done long hospital stays before and we can do one again.