Open Heart Surgery - Take 2

Surgery Day
The time finally came in March for Al to go in for his second surgery - the Glenn procedure. In this procedure, the Superior Vena Cava (the vein that brings back the unoxygenated blood from the head and top part of the body to the right side of the heart) gets cut off from the heart and grafted to the Pulmonary Artery (which brings blood to the lungs) This allows part of the blood flow to be diverted away from the right side of the heart and go directly to the lungs without being pumped. Al got up early to try his last bit of food allowed before surgery. Unfortunately he wasn't very interested at 3 am in drinking any milk or at 5 am in Pedialyte, which was his last chance to get anything in his tummy. He went to the hospital to get prepped to go in.

After Al went back, Mom, Dad, and both Gmas and Gpas went to the waiting area. Esther was bringing them their updates again. Luckily this surgery went much smoother than the other ones. Finally Mom and Dad were able to go back into the CICU to see Al.

He looked so much better than he had the first surgery. His chest was able to be closed in the OR instead of days later which sped up the recovery. He still had chest tubes and vent and lots of lines, which is pretty standard with any heart surgery.

On his forehead after surgery was a BIS monitor. Al decided to take part in a research study after this procedure. The BIS monitor is a tool used frequently during surgery to monitor level of sedation to determine adequate anesthesia levels.

The study involved trying to use this tool during recovery time in the ICU to better judge sedation and keep the patients more comfortable while recovering from heart surgery. Al was also much less swollen after the surgery than he was his first time around.

Feeding Time

This recovery went much more smoothly. The day after Al was already given an opportunity to try eating. He started with Pedialyte which he gulped down in no time. Next step he got to drink some breast milk from his bottle. He did great with his first bottle.

One risk of the procedure - Chylothorax. The thoracic duct, which is part of the Lymphatic system dumps right into the area where the surgery was done. What can happen sometimes is that that duct leaks fluid - mostly dietary fat which spills out into the pleural area (the space outside the lung). One of Al's chest tubes had been placed in his right pleural space. After feeding, we'd closely monitor changes in the fluid coming out of that one in particular. Well.. a few hours after Al's first feeding..

THIS is what happened.

You can see the fat floating at the top of the drain. All of the fat that he had just taken in from the milk started spilling out into the chest tube.

The usual treatment for this is a special diet for about 6 weeks where the infant drinks a special formula that only contains a special type of fat. Usually these babies drink a formula called Portagen that tastes a little bad. Since Al was allergic to milk protein though - he couldn't have this one and so the nutritionists and doctors had to work very hard to track down a formula concoction for Al to drink. A nutritionist finally found a formula without a name - just a number 3232 A. Its a specialized formula that is actually made for a different condition - for patients with carb restrictions. Its fat composition met Al's requirements - the fat is made the same way as the fat in portagen. But this formula was carb- free so it had to be mixed with Polycose to boost the carbohydrates.

Recovery

Al tried very hard to drink this stuff down, but he just couldn't drink much of it and who could blame him. So, he went back to the NG tube with the goal of trying to flavor it up and get him to drink more of it by mouth eventually. This was supposed to be a short term diet - about 6 weeks before he could switch back to a normal diet.

Well other than the chylothorax issue, Alan recovered very quickly. He moved upstairs to the CPCU within a couple days of surgery.

The drainage from his chest tube stopped and he got it removed. He was getting daily chest x-rays to look for accumulation of fluid that would go up and down each day. He was put on a significant dose of Lasix, a diuretic drug, which helped him to pee the fluid out and keep his chest dry.

Al was overall looking great. His oxygen saturations were amazing. Previously he was usually around 70%. Now he was well into the mid-high 80's%. His skin was much pinker than it had ever been before. Everything looked encouraging besides having to have the special formula for 6 weeks.

Eight days after surgery, his x-ray looked dry and clinically he was feeling great and so Al was discharged to go home!

That very day he had gotten a gift from his friends on the MM website - a fuzzy duck and a balloon. He loved it. That day Al was discharged early in the morning. He did have to go home on oxygen and would probably stay on it for a few months.

Al went home and crashed on his couch - glad to be out of the hospital!