Open Heart Surgery – Biventricular Repair

19 Oct

Kevan wrote up a post to describe Malachi’s surgery tomorrow. He understands the technical portions more than I do so I asked him to write it for those interested.

For those that may not read this whole post but want to pray. Please pray specifically for:

  • No bleeding episodes
  • Limited time on the bypass…just the right amount for what he needs
  • Healthy kidneys
  • No high fevers (sometimes after this procedure children spike very high fevers and he won’t be able to progress and get out of the icu until his temp is down)
  • His mood. He is always happy….that God would continue to give him special grace for being so happy
  • Full healing of his heart
  • No pacemaker (although it would be ok I would just hate it for him bc he would have to have maintenance in the future)

Post from Kev describing the surgery:

As we prepare for Malachi’s big surgery tomorrow, we want you guys to know what is being done.  Many of you know he had a previous “open heart” surgery in May of this year.  That was technically an “open-chest” surgery as there was no heart involvement.  Before he could have his heart repaired, he needed good blood flow to his lungs.  That is what was done in May.

The procedure tomorrow is a true “open-heart” surgery.  Currently, his lungs are fed from his aorta, because he has no pulmonary artery connection to his heart (single outlet).  If the surgery tomorrow goes as planned, he will have a dual outlet heart (aka a Biventricular repair, or Bi-vent).  He will have two outlets from his heart like normal.  One, the aorta, to send blood out to the body, and a separate pulmonary artery after to feed the lungs.

If that is all you want to know, you can stop reading now.  But, for those like me, that like all the details, here is more.

First some quick background information.  Malachi was born with a series of congenital heart defects.  He was born with a hole in the membrane between the upper heart chambers (the atrium) known by the acronym ASD (atrial septal defect).  He also has a rather large hole between the lower chambers of the heart, the ventricles, known as a VSD (ventricular septal defect).  Additionally, he had no pulmonary artery (pulmonary atresia).  His aorta is primarily fed from his right ventricle (TGA/DORV).  The aorta is the main artery that supplies blood to the body.  In his case it also feeds blood to the lungs.  This blood flow to the lungs was via collateral arteries, since there was no pulmonary artery.  These smaller collateral arteries severely limited the amount of blood flow to his lungs.

In March, Malachi had a procedure (cardiac cath) to place a stent in the largest of the arteries feeding  the right lung.  This widened this artery and made a huge initial difference in Malachi’s ability to get oxygen into his blood.  Later, in May he underwent an open-chest procedure called a unifocalization.  In this procedure, they took the best of the collateral arteries feeding the left bunch and brought them together to become a pulmonary artery.  However, since there is no pulmonary artery connection to the heart for Malachi, this new artery was joined to the aorta (the artery that feeds blood to the body).  This is called a shunt.  This bumped up his ability to oxygenate his blood even more.  But, there are limits to this.  His current normal blood oxygen saturation is only 80%, and 82% or so would be the best he could get from this arrangement.  As he grows, with no additional intervention, this would become less and less effective.

What he needs is a pulmonary artery connection to his heart.  A normal heart has two sides.  One pumps blood out to the body, the other out to the lungs.  The procedure tomorrow is to do the following:

  • Using the existing Aorta and the VSD the left side of the heart will be dedicated to pumping to the body.
  • The shunt will be removed and replaced with a new “conduit” to join the previously created pulmonary artery to the right ventricle.

In this arrangement, his heart will function similar to a normal heart with one side pumping out to the body and one side pumping to his lungs.  He should be able to achieve and maintain 100% oxygen blood saturation like a normal health person.

This will be a true “open heart” surgery.  They will hook him up to a system referred to as a “By-pass” that will act as his lungs and heart, and they, will for a time, stop his heart.  They will make at least two incisions in the heart.  One to fix the VSD and aorta connection (which are linked in his case).  The other incision is to join the the pulmonary artery to the heart via the conduit.  As a result of a surgery like this he will spend between 5 and 10 days in the cardiac ICU.  More if there are complications.  He will then require another 2 to 3 weeks in a regular room as he continues to heal.  We appreciate any and all prayers offered for Malachi, the doctors, the medical staff, Jayde, myself, Josiah, and Judy (aka Nana).

It has been an amazing road so far, since we began our process with adopting Malachi.  God has shown Himself faithful again and again, and we know He will do so many more times.  He is truly great, and though He often calls us to difficult paths, He walk with us through the struggles and gives us the necessary strength and encouragement.  He knits our hearts together to show us a glimpse of His great heart for us.  Though in many ways I do not look forward to the road ahead, I have great peace knowing He is with me.  And I know, looking back, I will see the amazing ways He showed us His grace and love.  It is my prayer that others will see Him working through us, and by that, gain strength and comfort and know that He loves them more than they will ever fully grasp this side of the grave.  Soli Deo Gloria

One Response to “Open Heart Surgery – Biventricular Repair”

  1. Cira Abreu October 19, 2018 at 3:11 am #

    Praying for Malachi and all of you.
    God bless you all.

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