Liam's Surgeries
Liam's Surgeries
I must preface this by saying that we interviewed three different surgeons at three different hospitals. It was very stressful, for each surgeon had a totally different approach on how to surgically repair Liam. We read everything we could get our hands on. My mom and brother went to the medical library for us and brought back all kinds of articles for us to read. We based our decision as to which surgeon on three criterions - experience, reputation and humanity. We felt that Dr. Hillel Laks at UCLA was our man. He is world renowned for pediatric and adult heart surgery and Liam's CHD is one of his specialties. He had come highly recommended by a friend of my stepdad's, Dr. George Reul, a renowned heart surgeon in Houston.
The plan for Liam was to repair his heart with a series of 3 surgeries. The first surgery was October 23, 1996. We took Liam to UCLA at 6 am, my step-dad was in town and met us there. He held little Liam for quite some time. At 7:30 they were ready for him. The image of my little guy being taken down the hallway by the nurse, his little arms playfully waving about, will be etched in my mind forever. It was heartbreaking. We felt as if we were giving them a healthy, happy baby who knew nothing that was in store for him. Liam was in heart failure but was very asymptomatic, which made it harder for us to come to terms with handing him over. We knew that he must have this surgery to save his life, but there was a part of us that wanted to run out that door with him.
The plan was to operate on both sides of Liam's heart, if he could tolerate it - a highly unusual procedure for one sitting. The left side was done first. Dr. Laks disconnected the stenotic collateral (ductus) to the LPA and put in a 4mm goretex Blalock-Taussig (BT) shunt which was brought back and connected to the ascending aorta. Let me tell you, the waiting is agony! They called us around 11:30 to say that this was completed and Liam was doing well so they were going ahead with the right side. The larger of the 2 collaterals was banded to reduce the blood flow to the right lung, the second smaller collateral was left alone.(See link to a diagram of Liam's heart and surgery below) A lung perfusion scan before surgery had shown that the right side was receiving 85% of the blood flow and the left 15%. The fear was that the high pressures and flow on the right would produce pulmonary hypertension, so the banding was to decrease the blood flow. A gortex membrane to the right chest wall was inserted to make it easier to access the area for Liam's next surgery - the unifocalization. Apparantly this helps to prevent scar tissue from adhering to the chest wall.
Liam's blood flow was now 60% to the right and 40% to the left. His oxygen saturations (sats) were still in the mid to high 80's, the goal had been to decrease them to the high 70's. It was felt that mid 80's was too high for mixed blood. The 2 procedures were bilateral thorocotomies, incisions that run from under the shoulder blades and continue to the sides under the arm pits. These are closed heart procedures.
There is no way to describe the sick feeling in my gut and heart when I saw my darling 5 1/2 month old baby in the CT ICU. He was hooked up to so many machines and had so many lines going in and out of him. I kept looking at him wondering how this tiny 11 lb baby had withstood so much. The worst part was he was not recovering from all of this. Three days later an attempt was made to extubate him, it was awful. I watched helplessly as my baby struggled and gasped. After 5 hours, he was reintubated. As the following week progressed, Liam continued to deteriorate. He still had too much blood flow to his lungs and it was decided that Liam would have to go back to surgery. Now, we are scared sick. They had also determined that Liam's left diaphragm had been paralyzed during the first surgery and it was pushing against his lung. So, they were going to have to surgically plicate (stitch down) his left diaphragm as well. Liam's heart rate would jump into the 220's, his blood pressure was in the 180's and he was running a high fever. On top of it, the night before they reoperated, we had a terrible nurse who I had to have removed from caring for my son. That's another nightmare of a story, that I won't go into here.
So, on October 31st Liam went back to surgery. I was petrified because of his weakened condition but I knew that he wasn't getting better. Again the waiting. When they finally called to tell us it had gone well, I lost it. I had cried so much the past 8 days that I wasn't sure many tears were left but there were plenty and sadly, many, many more to follow. As we went back up to the CT ICU to see Liam, 2 code blues were called on the unit. Our hearts sank, was it our baby? We weren't allowed into the unit but we finally caught a nurse running down the hall who told us it was not Liam. Thank God!
The second surgery consisted of narrowing the BT shunt with a snare to 3-3.5 mm, plication of the left diaphragm, banding the small collateral on the right and tightening the band on the large collateral. Also 150 cc of fluid was drained from Liam's pericardium (the sack around the heart) and left chest wall. Dr. Laks said that it is a rare occurrencce but some people have a reaction to the shunt that causes fluid to build in the pericardium which in turn spills over into the chest wall. This apparantly was the major culprit in the elevation of Liam's heart rate and blood pressure. The blood flow was now 52% on the left and 48% on the right. His saturations were now mid 70's.
To read about Liam's recovery from these surgeries, please click the link below!
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