Excellent heart report from Dr. G

More kissy lips while waiting for the doctor

Elijah's cardiology appointment went great today! He was very well behaved during the echo (these take quite a while to do, so I was hoping he would handle it well) until the very end when the tech accidentally scratched his chin with the wand and made him upset. Other than that, he was very comfortable and happy. The echo results showed that his new valve is working perfectly and the ventricular pressures in his heart are perfect as well. After a VSD (hole) has been surgically closed, it is not uncommon for pressures in one of the ventricles to be too high because of the new way the heart is pumping blood. That's not a concern for him right now and everything appears to be working as good as can be expected. On top of that good report, he has no feeding issues, no breathing issues, no sleeping issues, no color issues and no need for medicine. Elijah is a superstar, as Dr. G calls him.



We will bring Elijah back in to see Dr. G in 3-4 months, and he will need another heart cath sometime around October to see if his crazy MAPCAs collaterals are behaving. Since he has Tetralogy of Fallot with Pulmonary Atresia (as opposed to Pulmonary Stenosis), things are always going to be a little bit more complicated because his arteries just aren't "normal." Pulmonary Atresia means that his pulmonary valve was totally absent at birth (Pulmonary Stenosis means that the valve is just narrowed). With no valve to deliver blood, his body created a bunch of new pathways so blood could get where it needed to be. These pathways (called collaterals/MAPCAs) act as arteries, but they are not true arteries, so they can be twisty and narrowed and they are typically much more complicated and fragile than normal arteries. Sometimes they are duplicated and a couple different collaterals can be sending blood to the same place, which isn't good. During a heart cath(eterization) Dr. G can see all of those collaterals and figure out what parts of the body are receiving too much, or not enough, blood from them. He can do most collateral management in the cath lab, which is good because that is all done through a catheter inserted into a vein in the groin. Sorry if I bored you, but that was a long way of saying that Elijah will most likely need many heart caths in his young life. This next one will be #5. When he is 18 months old he'll have had two open heart surgeries and five heart caths, amongst a few other little surgeries unrelated to his heart.


See? He makes this face constantly! I love it.

I asked Dr. G to give us an estimated guess about when the next open heart surgery will need to happen. He said that on average, TOF babies need valve replacements 4-5 years after their final repairs (some kids need them after 1, some after 9), but since the Pulmonary Atresia/MAPCAs complicates things, his best guess for Elijah would be 2-3 years from now. Dr. G is ALWAYS very conservative in his guesses, so I'm hoping this means we'll have at least three years before we have to do another OHS. Really, all we can do is wait and see and just enjoy every day we have with this awesome little boy.


Finally! A picture with Dr. Gremmels. If only I would have noticed that Elijah's eyes were half open. Oh well, at least he's smiling!


The paper on the exam tables is the most fascinating thing in the world