I have followed other heart families through their child's Fontan and the difference before and after was drastic. Dr. Stefanelli does not feel like this would be true in Luke's case. With Luke's heart function so good and his sat's relatively high, he does not think Luke would be a totally different kid after the Fontan. He won't go so far as to say Luke will never have the Fontan done, but he is still not ready to put a timeline on this final surgery. He doesn't agree with the school of thinking that once you hit a certain weight you move forward without any other indication. And his perspective is that there is no other indication right now that Luke needs the Fontan. In a year from now could there be need? Of course, but I get the sense that we could still be putting this surgery off a year down the road.
Dr. S. explained the waiting to me in a new way yesterday: As soon as you do the Fontan (and that is to say that it is even successful in the first place and a take-down is not needed), the clock starts. The clock isn't ticking down to heart failure as much as it is to liver failure. As more and more of these single ventricle kids grow up, docs are realizing that the liver does not tolerate the Fontan circulation forever.
So we wait. The risk is too high for how well Luke's heart is working with the Glenn circulation. Although Luke doesn't have any semblance of a right ventricle pump, his heart almost fits into the category of a one and a half ventricle. His left is a big ol' strong pump and for that we are so very thankful.
One new development seen on the echo that we'll be keeping an eye on is a collateral vessel growing off his aorta. It had grown a bit since last May and may start causing Luke's sat's to go up. If it does, Dr. Stefanelli will coil it off in the cath lab at some point. But for now it's just a watch and see. Luke was satting yesterday between 84 and 86%. I really hate those sat machines. It took about three minutes to get an accurate read, and for those few minutes it was reading 65%. Do they know what that does to a mama's heart?!
The coarctation site was still wide open from the angioplasty a year and a half ago, which was great news, and his EKG and blood pressure (100/56) were fantastic.
The actual EKG is absolutely painless, but for most heart kids, taking the stickers off afterwards is the worst part of the appointment. We have never had a tearless EKG until yesterday. I watched Luke just shut his eyes and grit it out, telling the nurse, "Just do it! Just do it!" Stud.
|Loooong echo, but my big man did great, watching Peppa Pig and sucking suckers.|