What a weekend I am glad to have behind us. When we came for our Saturday afternoon visit Dr. Michael wanted to talk to us in the conference room in private. It’s never a good sign when the doctor wants to visit in private and this case proved to be no exception. That morning when Dr. Michael was doing his check up on Aiden he heard a murmur in his heart and ordered a echocardiogram to see what the cause was. The echocardiogram showed that Aiden had a PDA (patent ductus arteriosus) again and it was wide open. You might remember that Aiden and Evan both had PDAs and were treated with indomethacin (see 7/31 post). Because of Aiden’s age the doctors did not feel that indomethacin would work at closing the PDA this time and recommended surgery to place a clip on the open duct to pinch it close.
The news was somewhat of a shock to us (and the doctors) because Aiden has been doing so well and had not shown any signs of any of the problems that a PDA might cause. However, if left untreated it would be just a matter of time before the compromised blood flow caused problems so Dr. Michael wanted to do the surgery as soon as practical. So we agreed and the procedure was scheduled for Sunday morning at 9:30.
The actual operation is not too complicated and the impression we get from the doctors is that it is fairly common. The procedure is to make a small incision on the left side of the chest, go through the rib cage, push the lung out of the way a bit and place a small metal clip on the open duct to pinch it close. The whole thing takes about thirty minutes start to finish with most of the time spent identifying exactly where the clip needs to be placed. The biggest risk is that a nerve to the vocal cords runs down and through the same area as the duct and occasionally when this procedure is done that nerve is damaged. This happens in about one out of 4 to 5 times.
We arrived at the NICU Sunday morning at 8:00 and they were starting to prepare Aiden for surgery. They had moved him from his incubator onto a radiant warmer and were placing an arterial IV into his left arm. After twenty minutes we were asked to leave so they could switch Aiden’s nasal CPAP out for a ventilator. Fifteen minutes of waiting later we came back in and Aiden was intubated but having trouble getting stable. For an hour the respiratory therapist worked on Aiden’s settings and vent tube placement and finally was able to get it placed in such a way that Aiden was stable. The x-rays showed that Aiden’s lungs were probably starting to stiffen as a result of the PDA.
Meanwhile, Dr. Fox, the pediatric cardiac surgeon, arrived and went over in detail the procedure and associated risks with us. We signed the consent form for surgery and went back Aiden and Evan’s bed side to wait some more. We were told the operating room staff was tied up with other procedures and that our 9:30 procedure would be done at 10:30. At 11:00 the OR staff started to trickle in and began to prepare. At 11:15 we had to say good bye to Aiden and Evan and went out to wait in the NICU waiting room.
About thirty minutes later one of the nurses came out and told us that Dr. Fox had finished the procedure and that they were awaiting an x-ray to see if Aiden looked okay. Fifteen minutes after that Dr. Fox came out and told us everything had gone well. When he placed the clip on and closed the PDA, Aiden’s blood pressure changed right away indicating that the clip was blocking the blood flow as intended. We then got to go back into the NICU and see Aiden again. Aiden has an incision on his left side about a forth an arm length down from his armpit. The metal clip that Dr. Fox installed will be in Aiden for the rest of his life and should not cause any issues.
Since the operation Aiden has been sleeping off his anesthesia on the radiant warmer. We were warned that Aiden will likely have a rough couple of days following the surgery as his body recovers. This afternoon, X-rays showed that his lungs were not fully inflating so they have placed him back on the oscillating ventilator to try to expand them back out. He will probably be on a ventilator for a week. His feedings have been put on hold as well for a couple of days and he will be getting his nutrition through the IV. Hopefully, these set backs will be temporary and Aiden can get back on the growth track soon.
Evan is doing well still and continues to improve on his oxygen needs. He likes to be on his belly and has gotten down to 30% oxygen in this position. His steroid dosage is being stepped off and his last dose will be on Wednesday.
Here’s a couple of pictures from the last few days.