Day 1 of Post Glenn!

Catch up time! Luckily there isn't a whole lot of change from yesterdays surgery to today. First off though, surgery went well! Hooray for NO surprises! Alexander behaved himself!

Dr. Starnes (Alexander's cardiothoracic surgeon) completed the Glenn procedure in addition to a Pulmonary Artery Plasty, which is splitting the pulmonary artery and then patching it to make it larger. During the procedure, he also decided to remove the pulmonary vessel and the previously installed band as a means to prevent flow from the heart directly to the lungs. When Alexander returned from surgery, he looked quite dusky "blue", swollen, and was twitching from anesthesia - all of this was to be expected.  In addition, he had a very high heart rate (178) and high temperature (101) that the nurses kept a close eye on. Wes and I stayed with Alexander over night and luckily it was an uneventful night - thank goodness! By morning, his heart rate was at a good pace (120), his temperature was good (98), and his dusky color wasn't as strong. Today's goals are to work on weaning his nitrate, ventilator, sedatives (fentanyl and dexmedetomidine) heart medication (dopamine), and continue to flush out fluids in his chest tubes. In addition, we want to keep Alexander comfortable and resting, so that he can continue to recover.

So, to give you an idea of why the surgery happened, here is a little more information. Prior to the surgery, Alexander's heart looked something like this:

Due to his heart's configuration, he has blood leaving his heart from the same chamber, rather than from two separate chambers like a normal heart. Since the blood coming in is either oxygen enriched (from the lungs, via the pulmonary veins) or oxygen deprived (from the body, via the Superior Vena Cava from the upper body, or the Inferior Vena Cava from the lower body), the normal heart keeps them separated. With Alexander, the mixing of the two blood types resulted in blood that was a mix of the two going out to either the lungs or the body. The band placed on his pulmonary artery (during the first surgery) forced most of the blood to go out his aorta to the body, letting by only what was needed to go to the lungs and collect fresh oxygen. This means that the oxygen his body was getting was enough to sustain him, but was still of a lower oxygen concentration (or saturation, as Jessica has referred to it in past posts) than what he should be getting.

This structure is unsustainable, as the heart will wear itself out trying to maintain the two flows at the same time. The Glenn procedure is the first step into re-directing the flow. During the Glenn, the Superior Vena Cava is disconnected from the heart, and spliced onto the pulmonary arteries. The pulmonary artery is either disconnected from the heart altogether, or is restricted in such a way that only a little flow is allowed to pass (various reasons exist for either method, and it is a surgical decision on which way to go). In the illustration below, a normal heart is shown on the right, and a post-glen heart on the left. The illustration shows the remnant of the pulmonary artery that is still attached to the heart stitched onto the aorta; however we don't believe that was done to Alexander. The remnant was sutured closed, and the valve leaflets were removed to prevent blood from getting trapped and clotted.

So with his new configuration, Alexander's heart does not have to supply blood to the lungs, only to his body. Once the blood finishes circulating the upper body and is done supplying oxygen to the brain and upper body, it routs through the lungs to collect more oxygen, then flows to the heart to be pumped out again through the body.

Alexander's Inferior Vena Cava is still attached to his heart, so there is still some mixing of oxygenated and deoxygenated blood going on within the heart, however it was of more importance to relieve the stress on the heart. The final stage of Alexander's treatment, the Fontan procedure, will connect the Inferior Vena Cava to his Pulmonary arteries, creating one big flow loop with no mixing of the blood. This final treatment will be done when Alexander is somewhere between 18 months and 3 years old.

Thanks to Mark Aguilar (http://www.markaguilar.com/, http://injunmark.blogspot.com/) for the illustration of "Alexander: The Boy with the Super Heart." Without it, we probably would have had to use a silly stick figure or something for our diagrams. We hope and pray for Alexander to continue to have a comfortable and speedy recover with no hiccups along the way!