Wisdom Heart

I haven't posted a diagram in a while. Sophia's pre-op went good today. Now we just have to get through the weekend with no colds. We talked to the surgeon and I will do my best to recount what he said.

First, the diagram...

1. This is the homograft (human donor tissue). During Sophia's last surgery this conduit (darker blue) was placed from the right ventricle(RV) to the existing pulmonary arteries(PA). Prior to that surgery there was no direct connection from the heart to the pulmonary arteries.

2. This is the pseudoaneurysm (lighter blue) that has formed near the suture line of the conduit mentioned in 1. As you can see it is quite large. However, it should be noted, it has not grown any larger since fall. This is why the surgery was not considered to be emergent.

3. This is an area of stenosis (yellow) in the left pulmonary artery. Sophia's cardiologist will attempt to place a stent here during surgery in order to allow more blood to get to Sophia's lungs and also to relieve pressure on the heart and the new conduit.

4. This is the narrowing Sophia had corrected in the last heart cath (green). I had already posted on the success of this procedure (stretched from 2mm to 11mm). However, it should be noted, Sophia had oxygen saturations of 81 at the pre-op today. Prior to the last cath, you might remember, Sophia had saturations in the 60s.

a. This is the ventricular septal defect (VSD). This will not be repaired during this surgery. It was explained to us by the surgeon that it would create too much pressure in the heart and pulmonary arteries to close it at this time. He explained to us that the pressure in the left side of the heart is slightly higher than it is in the right. So once the left ventricle starts to force oxygenated (red) blood through the VSD into the right ventricle, Sophia's oxygen saturations will actually be too high. When this happens or if the pressures equalize to cause the blood not to mix across the VSD, they will be able to close it. The possibility of closing it when Sophia outgrows the conduit was mentioned.

So here is the plan.
Sophia will be put under using gas. She will get two I.V.s and an arterial line. She will be intubated.
She will be put on heart/lung bypass. They are going to do this via vessels in her neck this time, as they anticipate it will reduce complications caused by scar tissue just below the sternum.
Obviously, this will require the sternum be cut using the same incision line as her previous surgeries. This is called a median sternotomy.
After the scar tissue from previous surgery is resected.
The old RV-to-PA homograft along with the pseudoaneurysm will be removed. At this point, the stent will be placed in the left pulmonary artery. This will be like a cath. Only this time there will be direct access to the area to be stented.
After this, the new RV-to-PA homograft will be put in place.
After everything is put back together, Sophia will be taken off bypass and her heart will be started again.
Her chest will be closed (note:last time her chest wasn't closed until a few days after surgery). She will then go from the OR to the ICU.
I acknowledge there are some pretty big gaps in the continuity of this description. A large part of this whole process still remains magical and mysterious to me. But, I think this adequately explains the procedure in broad brush strokes. I am really not sure if I am able, emotionally, to visualize the surgery with any more detail than this. It is hard enough, as many of you know, to even imagine the incision when it comes to your child's body. Mostly though, knowledge and information helps me feel more comfortable with the whole process. I think that is why it is important for me to communicate so much of the details of all this in this forum. I hope the information is as beneficial for my audience as it is for me.
Now, we wait...