Well, it's just about the best news we could have hoped for. Connie is in Atrial Flutter, which is causing his mitral leak to increase and the left ventricle to dilate giving him the issues with failure. Dr. Bromberg saw it right away when he checked the pacemaker. He tried to convert him to normal sinus rhythm using the interrogation device but it was unsuccessful several times. He tried getting the atrium to fire at 300 bmp and the lower chambers at only 80 but he couldn't get the top chamber fast enough. Either the degree of failure won't let it go that fast or his little heart just isn't capable. That means he needs a cardioversion, which is what you see on ER when they use the paddles to shock the heart. It is painful and he needs to be sedated for the procedure so they wanted to wait until he hadn't had anything to eat or drink for 6 hours before they could give him the anesthesia. Then Dr. Bromberg got to thinking about the risks of him having a clot in his heart and the shocking would loosen it. When you've been in a fib or a flutter for more than 48 hours, your risk of developing blood clots in your heart is higher. When you have a heart like Connie's with lots of scar tissue and a very messy atrium due to the baffles and such, it is even greater that they could hide and not show up on an echo. Therefore, the safest course of treatment at this time is to anticoagulate him for two weeks to make sure that any blood clots dissolve before shocking him. The current plan is to start him this afternoon on chewable coumadin (blood thinner--kind of a yucky thing, but temporary so we're not complaining), give him a dose or two of lasix to get the fluid off his lungs and help improve the failure, and lower his settings on his pacer to prevent his heart from beating over 105 bpm. He may even go down to 90 tomorrow. We stay in ICU tonight and might come home tomorrow! He will still be in A flutter, but his heart won't be suffering from it because of the decreased settings and the fluid loss. In two weeks well go back to ICU for the cardioversion shock with the paddles. It should be an outpatient thing.
Praise God. It looks like we're avoiding surgery and caths for now! This is a common complication for kids who have had a Senning procedure, or a Mustard for that matter, (the second part of Connie's switch operation) and it is likely that it will happen again. If it happens every few years it is something that we can kind of live with. If it would happen again in less than a year, we will need to put him on a strong drug called amiorodone (sp?). It has a lot of side effects potentially, but the other drugs that are typically used, like beta blockers, are very ineffective on kids like him.
Our prayers have been answered. We seriously thought we'd be moving to Children's by the afternoon and by mid next week be back in Michigan facing another open heart surgery. Dr. Bromberg doesn't see any difference in the conduit narrowing from last October's echo and frankly, that is a totally unrelated issue to what we're dealing with now.
Normally, a working AV node would have caught the fact that his heart was trying to beat 270 times per minute but his pacemaker kind of covered up that fact and was letting every other beat through. So on the monitor, it only looked like 135 was his HR. I asked him why it didn't show up on the pacer check we did last Thursday and he reviewed it again, saying Colleen pointed out an area on it to him but it only showed the rapid rate for 2-7 seconds so they thought it just wasn't capturing or something. He's going to talk to the CareLink Monitor rep about how to correct that so that this could be caught sooner next time.
We have been so happy with St. John's and especially Dr. Goel and Dr. Bromberg. Please say a prayer of thanksgiving for these two wonderful men.
p.s. Mary Kathleen asked grandma and grandpa if she could say a prayer for Connie and on her own asked Jesus to please keep she and Connie well so that no one has to worry anymore. She is such a believer and she justs trusts Jesus with her little squinting eyes and praying with all her might for him to take care of us all. She is such a blessing. I came home for a bit to let the dog out and brush my teeth! I'm updating from here because someone was on the computer in the RMH room at the hospital and our iPod is not liking their wi-fi too much. We've gotten some messages of support and thank you for those. They really help us feel not so alone! We love you all!