Care4Conway: Home from the Appt.

Tuesday, July 21, 2009

Home from the Appt.

Dr. Bromberg made a special trip in to the office to see his favorite patient today. We got there two minutes before the doctor and he came out himself to the waiting room to get us. Connie was interrogated where he was found to be in atrial flutter AGAIN (insert frustrated sigh). He tried to pace him out of it, but Connie didn't like that too much. A couple of attempts was all he could take. It was making his A rate 300ish and his V rate 150ish. So now we're all set up for cardioversion tomorrow morning at St. John's. He'll be admitted to the PICU at 7am and the procedure should be at 9am. Hopefully we'll be outpatient as long as Connie doesn't throw any curve balls in there. While they are starting the IV, they will draw a bunch of labs to check liver and thyroid function and get another INR level. If the labs show he's tolerating the current amiodarone dose, meaning it isn't hurting those other systems, then his dose will be increased 50% so he'll be taking close to 20 ml! I joked with him that I'd have to put it in a juice cup now instead of a syringe. The other frustrating thing about all this is that the mode switch was not switching again on the pacemaker. That is getting really irritating and tomorrow when we get more time to talk to him, I'm going to really press for some answers on that one. This is getting really old, making these monthly hospital trips. The good news is that while this is frustrating and a little scary, it's not nearly as scary as surgery or something really invasive. I'm so grateful we're not talking about that now.

1 comment:

Anonymous said...: I'll be offering tomorrow's mass for Connie, that all goes well. Love and many many prayers. Sr J; July 21, 2009 at 8:14 PM

Conway's Heart Story

Conway's Heart Story

Conway David Beckemeier was born on March 3, 2007. His heart defects went undetected during pregnancy and he was diagnosed at two days of age with L-TGA, a large VSD, sub pulmonic stenosis and Ebstein’s Anomaly. Just before turning six months of age, he underwent open heart surgery to reroute the bloodflow in his heart. Called the "double switch", this procedure is the most technically challenging for pediatric cardio-thoracic surgeons to perform. The version of the double switch that Conway received on 8/28/07 was called the Rastelli-Senning with VSD closure and sub pulmonic resection. He suffered a grand mal seizure following the surgery that lasted over an hour and had several other post-op setbacks including surgical heart block, which required another operation on 9/18/07 to insert a pacemaker. Following surgery and such a long hospital stay, Conway developed an oral aversion (he would not eat) and he was 100% NG tube fed for eight months. He also lost muscle tone and required both physical and occupational therapies. In April 2008, he had a cardiac cath and attempted balloon angioplasty on his pulmonary arteries that did not work. Although his recovery was very long, he had a solid year or so of being a "normal" kid . Then in May of 2009, it was discovered that Conway was having rhythm disturbances, specifically atrial flutter. His pacemaker allowed it to go undetected for several weeks until he showed signs of heart failure and was admitted to the ICU for a week to be placed on IV heart meds and undergo cardioversion on 5/6/09. He went home and his heart function started recovering when he had another episode of flutter (6/16/09). This time, he was again hospitalized and put on IV milrinone, but he converted back to normal sinus rhythm by himself. At that time he was placed on the anti-arrhythmia drug, amiodarone. On 7/22/09 he had to be cardioverted again for yet another episode of flutter. The following week, he got worse instead of better. His cardiologist did a full work up and it was determined that his aortic, mitral and tricuspid valves were all leaking worse and were felt to be the cause of his heart failure. On 8/24/09 he had a cardiac cath and attempted ablation. The electrophysiologist was unable to induce a single arrhythmia. Then, just two days later, he went into atrial flutter on his own. He was placed back in the cath lab where he underwent mapping and a total of 17 burns were made to try to knock out his arrhythmias for good. The next day, 8/27/09, he had his second open heart surgery to repair his mitral valve called ring annuloplasty. He also had a partial Maze procedure done. His surgeries are performed at C.S. Mott Children’s Hospital at the University of Michigan (Ann Arbor). This time he was discharged just six days later! His Left Ventricular function improved drastically. In December 2010 we noticed he began getting more winded during physical activity. A January 2011 cath showed that he is outgrowing his RV-PA gortex conduit, but he was not symptomatic enough to warrant intervention. In April 2012 Conway’s fatigue increased and an echo at the end of May revealed that the ratio between the right and left sided pressures has gotten too high and it is time to replace the homograft that was placed when he was five months old. He had a cardiac cath on 5/25/12 which confirmed the echo findings. He had surgery on 8/8/12 to replace his pulmonary valve and RV-PA conduit, add an additional pacing wire to his left ventricle, and change his generator to a bi-ventricular model which is shown to preserve function and help the heart muscle pump more efficiently/effectively.