As our visitors were leaving, Ruthann's pediatrician arrived and took her to the nursery for (yet another) examination. After a while, I started trying to track down my baby (again!). After all, I had seen her for a grand total of an hour. The pediatrician came in to tell me that while she was examining Ruthann, she heard a heart murmur and then the baby turned blue. The blue spell lasted less than a minute. (Apparently, because it was so unexpected, it totally freaked out the nurses and they had her on oxygen in a flash. I kept overhearing them talking about it at their desk for the rest of the shift.) Ruthann had been taken back to the NICU to have a full workup (chest x-ray, EKG, etc) done by the neonatologist. The pediatrician started telling me about the different possibilities which ranged all the way from "which she'll outgrow in time" to "requires transfer downtown for immediate heart surgery." After the neonatologist finished the tests on Ruthann, he sent all her test results to a pediatric cardiologist (to his home even) for evaluation. The cardiologist came in in the morning to see me with the diagnosis.
The Bottom Line
Ruthann has a heart condition called Tetralogy of Fallot. It fell in the middle of the possibilities raised by the pediatrician. There are no day-to-day symptoms or problems, but it requires open-heart surgery to repair. This surgery would happen sometime between four and eight months of age. If left untreated, Ruthann's blood oxygen levels would gradually decrease and by the time she was seven to ten years old, she'd be one sick little kid. Nowadays, they can operate on even very small children, so they no longer have to wait until the children start to have problems to operate.
Ruthann has a heart condition called Tetralogy of Fallot. It fell in the middle of the possibilities raised by the pediatrician. There are no day-to-day symptoms or problems, but it requires open-heart surgery to repair. This surgery would happen sometime between four and eight months of age. If left untreated, Ruthann's blood oxygen levels would gradually decrease and by the time she was seven to ten years old, she'd be one sick little kid. Nowadays, they can operate on even very small children, so they no longer have to wait until the children start to have problems to operate.
The repair surgery is now common and there are three hospitals in L.A. that are quite skilled at it. She is not on any medicines, oxygen, or active monitoring and she will grow at the same rate as any other baby. All she has is an extra set of appointments with a cardiologist who will check her blood oxygen levels every couple of weeks.
The doctors wanted to keep her under observation for a few additional days to rule out anything else like infection. We finally got to take her home from the NICU Friday afternoon. (I had been discharged Wednesday afternoon.)
Overall, if the cardiologist hadn't told me about her condition, I never would have guessed it from looking at her. She is pink and pretty, feeds well (better than Thomas at this age), and sleeps well for a newborn. It's kind of strange to say that a heart condition is no big deal, but this one really isn't. We don't have to treat her any differently from any other newborn baby and her condition will be repaired before she (or Thomas) ever has any memory of it.
The Technical Stuff
Tetralogy of Fallot has four components (pictures below). The most serious is called pulmonary stenosis (A), which means the valve going from the right ventricle to the lungs does not completely open. There may also be some muscle below the valve that also partially blocks it. This reduces the amount of blood going to the lungs, which causes her blood oxygen levels to decline as she gets larger. If the blood cannot flow to the lungs because of the stenosis, it passes through a Ventricular-Septal Defect (B) (a hole between the ventricles) and mixes with blood that is already oxygenated. The third component is an Overriding Aorta (C). The artery that carries oxygenated blood to the body is shifted over to service both ventricles.
The final component is a secondary feature. Because of the Ventricular-Septal Defect, both ventricles feel the same pressure (which is more than the right ventricle would usually feel). This causes the right ventricle to build up additional muscle. This is called Ventricular Hypertrophy (D). There is also a small hole between the atria (E). The surgery will patch both holes and repair (not replace) the pulmonary valve to restore normal blood flow. We'll learn more about the surgery as it gets closer.
Wikipedia also has a pretty good article.
1 comment:
Prayers and cheers for everyone. Hopefully next I'm through I'll be earlier and see both monkeys.
~D
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