Fontan

Tyler presented to the OR at seven this morning.  They gave him some oral versed and then Heidi and I took a stroll through golden gate park.  The team had anticipated a 4-6 hour surgery.  At 3:00 Heidi and I started getting nervous.  They said they would call to update us on the surgery, but no.  finally, we saw Tyler's bed rolling down the hall.

Tony came to talk to us and began speaking to me in Spanish.  Then, he told us that the surgery went well and said, "He went under great.  Then there was a problem.  When I opened the sternum, his heart was fused to the bone.  So I started to dissect it and it started to bleed.  I put him on bypass and had to cannulate him through his neck....His valve regurgitation was on the lower end of mild, and I thought that was really good, considering that several months ago he had moderate... His heart function looked good.  The Fontan pressures were about eight when he first came off, now they're about thirteen (anything below 15 is good).  His rhythm was normal sinus for I'd say 95% of the time.  And then  he started waking up, he developed a junctional rhythm, I don't think that's terribly unusual, the fact that he had sinus rhythm is a good sign...The valve is better than it was several months ago...we put in a 20 mm gore tex tube...his pulmonary arteries look pretty good...short of the adherence of the heart to the back of the sternum,"

Heidi:  Is that common?

Tony:  You know, the number of times I've had to cannulate a neck, because the heart was stuck to the sternum (pause),

Danny:  You can count on one hand?

Tony:  Yeah, yeah.

Heidi:  So why did that happen?

Tony:  It's just the previous operations, and the conduit, and the scarring, it's just, the heart, it was fused to the bone.  And I didn't peel the heart off the bone, what I had to do is take a chunk of bone off the chest wall...One of the worries is when you're dissecting the heart off the sternum, and  you get into it, is that air can enter and...be ejected into the brain...but we controlled it, dissected everything, put him on bypass...supported his circulation, and everything was under perfect control, dissected everything out, fixed the hole, did the Fontan, took him off, close this, close that.  He's extubated.

Tony, Heidi and I went in to see Tyler and he was agitated.  I knew he was doing well when he started trying to rip off his nasal cannula.  The nurses were worried, though.  They kept wanting to give him drugs and I was like, "He wants a drink.  Give the man some water."  The nurses didn't want to, though.  Then Jeff came in and said, "Better the water than Versed and Fentanyl."

I agreed with that.  After one of the nurses left, Jeff said, "Let's lower his prn infusions."

That's all I feel like posting for now.  They aren't totally stoked about how stable he is, but I think he is stable because he's complaining, just like before.  He's like, "Mommy!  GET ME A DRINK RIGHT NOW!"  Eh, anyway.

Thanks for the texts and stuff.  I don't feel like entertaining any phone conversations right now, though.