MAPCAs (Major Aorto-Pulmonary Collateral Arteries) labeled here with the letter "C" are the second reason why her Oct. 1st surgery is so complex, challenging, difficult and will take all day. Evidently, normal people like you and me do not have MAPCAs, but it is very common for patients with Tetralogy of Fallot/Pulmonary Atresia to have them.
I am no doctor, but from what I've read [internet education], when the heart doesn't have a pulmonary artery to send blood through, it compensates by creating tons and tons of tiny collateral arteries instead. MAPCAS are practically useless little veins connected to your heart.
For Scarlett, Dr. Cleveland will have to implant the homograft (conduit) and test pressure in her right ventricle/existing tiny pulmonary arteries. If the pressures are too high, he *might* cut off several of her MAPCAS, bundle them together, and relocate them to another area in her heart where they will be more useful (its called unifocalization). This is obviously tedious and time consuming, and Dr. C has to be careful, meticulous, and calculating. (God Speed to Dr. Cleveland).
Also from my internet research: "The management of infants and children with pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries (PA/VSD/MAPCA) has proven to be challenging. Therapeutic approaches have included staged unifocalization, shunting, coiling of collateral vessels, and heart/lung transplantation"
She already has a shunt, and they already coiled one of her collateral vessels. Dr. C talked about inserting stents later in her life (he's being optimistic about her chances for survival, at least..).
I have been up and down emotionally since Friday. I am doing fine, then someone asks me how the baby is...or when her surgery is, and I fall to pieces answering them. I cried 3 separate times at work yesterday and I'm tearing up as I write this. I really should at least TRY to be strong, but it scares the crud out of me that my daughter has to undergo this risky operation in 8 days. :(