Night before Surgery
Logan is all done with the echo, they have decided to leave him intubated tonight and until surgery. They think it will be less stress on him this way. So he is in recovery for one more hour and then we will be meeting him in the ICU. We have heard so far that his IVC is uninteruppted (which is good) and that his PA pressures are low (which is really good). If his PA were high they would not be able to do the Bi Directional Glenn (the shunt that will give more blood to his lungs so he isn’t so ‘blue’) They are still trying to determine the position of the Pulmonary veins to see if they can get away with not moving them. If they could get away with not moving them that would take away the risk of them becoming obstructed from scar tissue, a small but bad scenerio. The surgeon is going to come and talk with us after 8pm tonight. I will post what he says then.
We just came back from seeing Logan in the ICU. Wow, that is very hard. He is on a paralytic and intubated and has a million cords and lines. He is on Morphine (just in case) they are regulating everything (temp., BP, Breath, Heart rate) he looked so sad laying there.

We met with the surgeon that will be doing the surgery and we already feel a lot better. He said that the valve looks fixable. He said that is mostly distended and there is a lot of tissue to work with. He also said (which is really good news) that since Logan has started on Lasix and has been sedated (so there is less workload on his ventricle) the regurgitation is now moderate. This is really good because they were hoping that just doing the BD Glenn shunt would help the regurgitation by lessening the workload on the ventricle so now they have evidence that this may occur. The bad news is that they did find an obstructed pulmonary vein coming from the left bottom to the upper right. They believe that it is only obstructed because the atrium is pushing on it but they can’t be sure until they are in there. If it is obstructed at the oriface then they may have to do some work on it. Logan is first case tomorrow and expected to go into surgery around 8-9AM Dr. Del Nido said that he probably wouldn’t be out until 4-5PM. I am not sure how I am going to get thru the day.
Morning of Surgery
Anestesia came to speak with us before they took Logan away to surgery. They said that most of the work was already done and that they just needed to get him fully under. I asked about ECMO and so far nobody thinks he will need to come up on it and Dr. Del Nido didn’t think he wouldn’t need to leave the chest open either. I asked how long they thought that he would need to be intubated and they said usually 24 after surgery but since his surgery was so complex it may be a couple of days. We followed him down to the OR and said our goodbye which was one of the worst things I have ever had to do in my life. There is a nurse that is going to call and update us about 1-2 hours. They don’t anticipate him being out of the OR until 4-5PM. This is going to be a looong day. My parents are flying in this morning to support us.
Update during surgery –
Everyone is very encouraged right now. Everything is going well, it looks like the pulmonary vein is not classically obstructed (narrowed) they think it is just obstructed because the atrium is pushing on it. This is a better scenerio. He is still on the heart/lung machine and Dr. Del Nido said there is a lot more work to do. They also said because this surgery is taking so long he will probably have to be intubated for a couple days while his body heals. We are staying positive and are very encouraged right now, but we know enough to know that things are always up and down.

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