First of all, Landen is doing great! Second of all, I'm sorry for not giving an update sooner for those who were concerned :)
Probably going to be a long post, so here are the big nuggets if you want to skip the rest. Landen was in the OR for about 5 hours with cross-clamp time (heart stopped) of 58 minutes while total bybass time was 73 minutes. He is sedated, and in the CICIU with Ashley and I by his side. All went well, and we are in for the long night of recovery....now for the details. Keep in mind that nothing about Landen is "normal" when it comes to the Norwood, Glenn or Fontan procedures. All documentation found on the internet is lacking in one way or another as his architecture is unique. Some of those changes help him, and some don't. This is the reason we keep the blog. It is the best way for Ashley and I to translate in one place, what we know about his specific system and what they are doing to help him.
The purpose of the procedure today was two-fold. First, it was to fully disconnect/close off the pulmonary artery from the heart (which was previously banded in the Glenn) and second to connect the Inferior Vena Cava to the Pulmonary artery (see image below...which represents PART of what they did today).
Probably going to be a long post, so here are the big nuggets if you want to skip the rest. Landen was in the OR for about 5 hours with cross-clamp time (heart stopped) of 58 minutes while total bybass time was 73 minutes. He is sedated, and in the CICIU with Ashley and I by his side. All went well, and we are in for the long night of recovery....now for the details. Keep in mind that nothing about Landen is "normal" when it comes to the Norwood, Glenn or Fontan procedures. All documentation found on the internet is lacking in one way or another as his architecture is unique. Some of those changes help him, and some don't. This is the reason we keep the blog. It is the best way for Ashley and I to translate in one place, what we know about his specific system and what they are doing to help him.
The purpose of the procedure today was two-fold. First, it was to fully disconnect/close off the pulmonary artery from the heart (which was previously banded in the Glenn) and second to connect the Inferior Vena Cava to the Pulmonary artery (see image below...which represents PART of what they did today).
The morning started early as we left the house around 5:40 headed for Boston. Apon arrival, we were checked in and ushered to pre-opp. With a little bit of play time, cuddle time and waiting...it was time for sedation to start. Unfortunately the medication they give him to help "ease" him into the sedation tastes horrible, so he didn't take the dose we needed him to take. To keep things moving the anesthesia team decided Ashley or I could help, so I suited up and we headed to the OR. Watching that little man be so strong while so confused about why we were holding him down, and why he felt so strange was hard to watch, but also helped me see what an amazing team we are working with. Not just because they were so professional in that OR, but because they see Ashley and I as a part of the team here. THAT is unique for sure...but common across every team here at Boston Children's Hospital. Even though I could never imagine doing this procedure, Dr. Kaza (AK) and the team are very familiar with it and have a ton of experience together. As you can see from the image, the connection actually happens external to the heart in this case. There are traditionally two ways to go about this surgery, and without sharing too many details, this is the less invasive, and better option given the conditions. Landen has grown enough to have this procedure rather than the more invasive procedure of building a cavity within the heart itself. The Gore-tex conduit (yes...same stuff in the jackets...but fancier) provides the blood flow from the lower half of his body to the pulmonary artery into the lungs. Along with that conduit, they make a small hole called a fenestration that allows blood flow between the right atrium and the conduit relieving pressure if needed from either.
After the procedure, Landen was transferred to the CICU where he was stabilized. Over the past several hours it has been a balance of fluids to help his BP (currently low volume is causing a bit lower than they want to see) and dex (medication to keep him sleepy). They have given him morphine every now and then as well, but want to keep as much of that out of his system as it will inhibit his breathing. Around 9pm the plan is to extubate him and let him start breathing on his own without assistance. At that point, he will likely be more awake but sedated to keep him comfortable.
We are in for a pretty long night, but Landen is with us and seems to be progressing as expected and as comfortable as he can be. He will keep the chest tubes for a while as well as the passing wires left to monitor and keep his heart above 110 BPM. Ashley will stay here in the room and I will stay alone in a room here in the hospital in the family center.
With that, I'll leave you all with one thought that I considered today. When Dr. Kaza (The surgeon who has done all of Landens surgeries, including this one) came to meet us this morning he said something interesting. He said after reviewing the cath procedure results as well as the echo's, he thought that Landen had "great architecture" and felt confident going into the surgery today. By choosing the word architecture it said something very important to Ashley and I. AK didn't see himself as someone who was there to solve a problem with a messed up kid. He was there as someone who was helping Landen work with the architecture he had. Because he realized that anatomy was not accidental, but the work of an Architect, with a plan. We don't claim to understand that plan, or know why Landen has to play this part in it...but we know its true because we have faith as well.
Thank you for your prayers!
Enjoying the journey,
George, Ashley, Landen, Madison & Lyla :)
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