- pulmonary vein repair. they have to remove the stent (a large piece of metal mesh) that is embedded in his heart and blocking the right pulmonary veins. (stop reading right now if you don't want to know how they will do this.) they will be cutting a chunk out of the inside wall of asher's atrium (upper chamber of his heart). pulmonary veins bring blood from the lungs to the heart. right now, blood is having a hard time getting out of his right lung.
- pulmonary artery repair. they're going to see if they can do something about the middle of his pulmonary arteries. this is the spot that is even narrower (which is just what he needs, a narrower spot in already tiny PAs). so they want to see if there's anything they can do about that. PAs are important, they take the blood to the lungs to be oxygenated (or, so it can be red again), so PA hypoplasia is a BIG problem. the narrower spot? that happened when they removed the main pulmonary artery (MPA, the vessel that - normally - takes the blood from the right ventricle to the PA branches. i think there's pictures in some of the links, check the SickKids links if you're interested.)
- they may have to cut open part of the stent in his aortic arch. the top of the stent, the "distal stent," on the far side of the arch, is open, which is good, it means it's growing with asher. but the bottom end or "proximal stent" is closed, meaning it's not expanding with him. the cardio's aren't sure if the surgeon cut it all the way down in june, so they're going to ask him. if he hasn't cut it, he'll have to do that either now or later, like when they do the third stage (Fontan). it's not a huge problem right now, which is why it could wait, but if they're in there now, why not deal with it before it's a problem? (novel idea!) anyway, if they need to do that, if they have to fiddle around in his arch, they will have to put him through "circulatory arrest" for a bit. that's when they stop his blood circulation. yup, you read that right. they lower his body temperature so that he is, essentially, frozen (or as i prefer to call it, "they put him on pause for a few minutes"; basically, it's medically-induced hypothermia), then when they're done doing what they have to do, they warm him back up, start up ECMO (heart-lung bypass) again, and get him circulating again. yes, it's just as risky as it sounds. feel free to vomit now. i want to, and i already know all this stuff. but he made it through this in june, when he was weaker. (oh, yeah, they've done this to asher before. he's getting to be a pro at all this open heart stuff. nice, in a horrifying, nauseating way. blech.)
so there you go. the nitty-gritty on asher's surgery next week. one week today. i think i'm gonna barf. it's just so close! i don't have much time to plan! yikes! i think i'm about to go a whole other kind of crazy! anyway, gotta go vomit, make blithe's lunch for school, vomit, breathe a bit, vomit, chant "serenity now, serenity now," vomit, then get on with my day. have a good one, and remember, at least it won't be as frenetically, panically (is that a word? ah, well, you know what i mean) busy as mine. talk to you later! :)
ps - a little heart friend of asher's, callum, just came home yesterday from toronto. he had surgery last week and did great! also, little ryley had a biopsy last week, and there is less rejection now than last time, which means she's recovering. she doesn't need anti-rejection meds right now, which is great news. she'll have another biopsy at the end of june. and dominic, a boy with hypoplastic right heart, is going in for his fontan next month. please pray for these little ones, and don't forget their parents! there's a big heart community out there, and we're blessed to be a part of it. please remember to pray for all these little ones, who are so much stronger than any of us, and go through more than you could ever imagine. thanks.