Monday, January 18, 2021 - Sloan's Emergency Heart Surgery

On Monday morning, January 18, 2021, the Medical City Children's Congenital Intensive Care Unit team, which consisted of congenital heart surgeons, pediatric cardiac intensivists, pediatric heart nurse, pediatric perfusionists, pediatric anesthesiologists, and pediatric cardiologists, met to evaluate Sloan's case.  They discussed all the options and possible outcomes, and then decided the best option for Sloan based on his current situation.

After the CICU team met, Dr Brenes (congential heart surgeon), Casey (congenital heart surgery nurse practitioner), and Dr. Manzuri (pediatric cardiac intensivist) came to Sloan's room to give Mama and Pop the game plan...Sloan would have surgery in the afternoon to place a Blalock-Taussig (BT) shunt in his heart.  Sloan's condition was not improving even with all the medical interventions they gave him in the last couple days, and his heart needed this shunt to create a pathway for blood to circulate to his lungs.  

The surgery was not quite a shock to Mama and Pop because the pediatric cardiac intensivists have been preparing Mama and Pop that there would be a chance Sloan could have surgery.  They have been open and honest in their communications to us from the very beginning.  It was a blessing that Sloan did not have any infections or the surgery could have been delayed until the infection was resolved which could have been another week or two, and Sloan's condition required immediate surgery.  We were very fortunate that the CICU surgical team opened up their afternoon for his surgery.  

 

At around 2pm, Casey provided Mama and Pop information about Sloan's heart surgery.  This is what we learned:

Tetralogy of Fallot is a congenital heart defect that affects normal blood flow through the heart.  The spectrum for Tet is wide, but it is made up of 4 defects of the heart and its blood vessels:

1. Ventricular Septal Defect - a hole in the wall between the two lower ventricles
2. Pulmonary Stenosis - narrowing of pulmonary valve and main pulmonary artery
3. Enlarged Aortic Valve
4. Ventricular Hypertrophy - muscular wall of lower right chamber of the heart is thicker than normal

Normal Heart vs Tetralogy of Fallot

Sloan has severe pulmonary stenosis.  Because Sloan's pulmonary valve is too narrow, the heart's right ventricle must pump harder to force blood into the pulmonary artery.  This is why Sloan's oxygen saturation was plummeting and his heart rate was increasing in the ER.  The BT shunt that will be placed in Sloan's heart this afternoon is a small tube, 3.5 mm wide, that is used to create a pathway for blood to go from the arterial circulation to the lungs.  The BT shunt is not a long term solution since Sloan will eventually outgrow the shunt.  He will need a 2nd and 3rd surgery to increase his blood flow to the lungs to meet his body's oxygen needs.

Blalock-Taussig Shunt

Sloan is very fortunate that he had the best of the best surgical team.  Mama and Pop thank our lucky stars every minute for Medical City Children's CICU team.  The dedication and passion they put forth every day saved our little man's life.  

Below is Sloan's Congenital Heart Lead Surgical Team:

• Kristine J Guleserian, MD, (aka Dr G) Director of the Congenital Heart Surgery Program
• Javier Brenes, MD, Congenital Cardio Thoracic Surgeon
• Casey Cox, Congenital Heart Surgery Nurse Practitioner
• Dr John M. Kampine, Director of Pediatric Cardiac Anesthesia
• Lexie, Nurse Pediatric Cardiac Anesthesia
• Dr Poonam Thankavel, Cardiologist

Before sending Sloan off to surgery, Mama and Pop told him that he is a strong little warrior and we are so proud of him.  During surgery, Casey found Mama and Pop in the CICU waiting room and gave updates as each major step of the surgery either started or completed.  

After about 4 to 4.5 hours, Dr G and Casey came out of surgery to let Mama and Pop know that the surgery was successful and Sloan did very well.  They provided high quality pictures of the shunt that was placed in Sloan's heart and patiently answered all of Mama and Pop's questions.  They also informed us that due to the excess fluids, Sloan's chest would remain open until the swelling went down and his sats and vitals were stable.  Soon after Dr G and Casey's visit, Dr Kampine rolled Sloan out of the OR and into his CICU room.  Once the team set up his bed and hooked up his meds, Mama and Pop were able to see Sloan.  The nurses asked us if we wanted to cover up Sloan's chest because some parents get queasy at the sight of the open chest, but Mama and Pop did not want them to cover it up unless it was medically necessary.  Sloan is such a badass; we never want him to cover up what he's been through.  It's a badge of his badassry, and he should wear it proudly.  

This is me after my emergency heart surgery.  Mama and Pop say I'm a total badass.

Both Mama and Pop stayed with Sloan all night to make sure he got through the night with stable oxygen saturation and vitals.