Surgery Explanation 1

I found this picture on the internet. It is of a normal heart, then three below it with Pulmonary Atresia VSD, which is what Dr. Cleveland referred to is as (as opposed to Tetralogy of Fallot with Pulmonary Atresia).


In the first pic, a healthy heart, you can see the pulmonary artery (labeled PA), then in the pic labeled 1, you see hole between the RV & LV (right & left ventricle). This hole is called a Ventricular Septal Defect, or VSD. The PA shown in pic 1 is skinny but in Scarlett's heart it's absent. Pic 1 also shows MAPCAs (major-aorticopulmonary collateral arteries ), one of which was coiled off during Scarlett's heart cath last Wednesday.


During the "full repair", Dr. Cleveland will patch the hole (the VSD) and he will implant a homograft to replace the pulmonary artery. Picture 2 shows the hole (VSD) being patched, and Pic 3 shows the homograft.


What is tricky during this surgery is that Dr. Cleveland has to test her arteries, veins, vessels, valves for pressure resistance. He is going to go in and place the homograft. After the homograft (which Dr. C confirmed will be human tissue, not pig tissue) is placed, Dr. C has to do a series of pressure tests. Based on the results of these tests, [how her heart is going to behave/react to the homograft], he will continue with patching up the hole (VSD), and completing the surgery.
However, if during the pressure tests, her heart is working overtime, and the pressures are too high, he's going to take out the homograft, leave the hole open (unpatched), and just replace her shunt with a bigger shunt.


She's going into surgery on 10/1 at 7:30am. Dr. Cleveland said that hopefully around 1:00pm, he will be able to determine whether or not he can complete the the full repair or not. We will be in the PCTICU (in her room) waiting. Dr. C will call the PCTICU with status updates during her surgery (just like they did the first time).


This is just a small part of what her surgery will consist of. I will post more about her procedure in the days to come. But her surgery is going to be a lot more complicated than I described above. Because of her MAPCAs, it complicates things. Also, because her existing pulmonary arteries (the ones going left/right, not the one going up/down) are also underdeveloped, there may be other complications that arise. This might be a little too technical or confusing , but I thought I'd at least try to explain why her surgery is higher risk and more complicated than a 'regular' Tetralogy of Fallot full repair. Thanks for reading.