Christopher had his regular cardiology follow-up appointment yesterday. The news is a bit mixed: his heart function still looks great, and the spot where the GoreTex patch was occluding flow is continuing to improve. But there is new narrowing in his aorta at the site of his first surgery. This is called "re-coarctation" and I guess it's fairly common. We're not sure yet whether it's truly narrowed or if the scar tissue there has just stayed the same size while the rest of him grew quite impressively. (He was 17 lbs, 8 oz yesterday.) Either way, it is blocking some of the flow out of his heart.
The result is that the blood pressures in his two arms are different again: 110 in his right and 80 in his left. This reflects the fact that the narrowed part is between the points where the blood vessels branch off for the two arms, so his right arm is getting some backup of blood, while his left isn't getting as much as it should. The good news is that the narrowing is mild at the moment, and his heart isn't showing any sign of strain from pumping against it. The bad news is that it's unlikely to get better on its own and may well get worse.
So, at the moment, the plan is for another echo, to be done in the next week or two, this time under sedation. Christopher's aorta is really tricky to see on echo, and although I'm not entirely sure why, I think it's a mix of how he's built and what the surgery did to the architecture in his chest. Anyways, given that this echo will determine whether he requires intervention, they want the most accurate pictures possible, so he will be having it under sedation. We really don't enjoy the sedated tests: it's a long day, it's hard on him, and it's just exhausting all around. But if that's what it takes to get clear answers, that's what we'll do.
The cardiologist said that this can likely be managed by cardiac catheterization, where a tiny catheter is threaded up to that area (I think through an artery in his groin - at least that's how they do it in adults) and a balloon on the end of the catheter is inflated to stretch the area out. He said it sometimes needs to be done more than once, but that approach is much safer and less invasive than more surgery, so we are hoping that if he does need intervention, a catheter will do the job!
The cardiologist will be reviewing the situation with the entire cardiology/cardiac surgery team at CHEO this Friday. The information from that discussion, as well as the results of his sedated echo, will give us some answers about next steps.
Meanwhile, here's a photo of Christopher, his Great-Grandma, and me, taken this past weekend after his 'baptismal blessing.' He was baptized in the hospital before his first surgery, so our church did a beautiful anointing and blessing to celebrate his health and welcome him to the community. It was an incredibly moving day for all of us.
P.S. I wrote a blog post last week about his physio progress, but didn't get time to edit and post it. You'll find it just below.
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