20 March, 2008

DORV repair

Rowena is amazing... She kept all of the drawings Samuel's doctors gave us when they explained Samuel's heart condition to us shortly after his birth. They started with this "schematic" drawing to help us appreciate what a normally formed heart looked like and how the blood flow works (with color coding! - BTW, clicking on any image will give you a larger version): Those lines in the middle of the heart that the red and blue lines traverse represent valves (blue - tricuspid, red - mitral), as do the ones at the bottom going into the great vessels (blue - pulmonary, red - aortic).

Then, they drew for us Samuel's heart in a schematic representation. Key to understanding what happened to his heart during development in the womb is that the Aorta, in most hearts, migrates from the right ventricle over to the left ventricle. Then, almost immediately after birth, the hole between the ventricles (all hearts have this at birth) closes up and all is well.

In Samuel's case, this didn't happen. The aorta stayed put and the hole (VSD) did not close up. This diagram also shows the small mitral valve:
The indication of the blood flow shows then that of course, he was literally a bit "blue" in color. While if you looked at him you didn't jump up and go, "ewwww - he's blue", he was really just kinda dusky. This became more obvious after they did the repair and he "pinked up" to a nice, reasonably normal rosy color.

Here is a diagram of about what his heart looked like:
If you scroll down and back up, between the image immediately above and the very next one, looking at the vessels that remove blood from the ventricles, you can see how the aorta did not migrate (above).

To help put the above drawings into context of the human, as opposed to schematic, they added the arrows below indicating the blood flow first in a "normal" heart:

Then, the colored arrows are added to a diagram of Samuel's heart:

The doctors at Stanford / Lucille Salter-Packard Children's hospital determined that they could operate on his heart and make it schematically correct, by adding a baffle, using some cloth, in the hole (VSD), across to the space between the Aorta and Pulmonary arteries.

After the surgery, we talked to the surgeon. He told us things went well and more. When we were about done, I asked him, "do you have the material that you used for the patch?" He looked a bit stunned or puzzled, but said that yes, it was probably in the trash in the operating room, would I like him to get it? I said yes.

They use some special dacron, as I recall, for this purpose. Here is a scan of that material (the missing piece below - that's in Samuel's heart!) that we still have:
I asked Rowena to scan it w/the dime for scale reference. I still say wow when I see that... Over time, the heart tissue grows over the cloth and it is incorporated into the heart itself. Wow.

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