Bit Rocky but Good News!

When we arrived at PICU at 6pm, there was an empty bay where Harrison should have been. He'd been delayed in theatre. It was 8pm before we finally got to see him. He had certainly been making his presence known to all the PICU staff. When he arrived in PICU he dramatically dropped his blood pressure and then started to flip in and out of heart rhythms. He had developed a problem with the top chambers of his heart. The electrical pathway wasn't triggering them to contract so he was losing 30% of his blood pressure as a result. There was a lot of tweaking of medication, two bags of platelets and three bags of plasma infused very quickly. He settled for a bit but then started to flip his rhythms quite regularly. They were also having to cool him internally so there were ice packs all around him. As he was quite unstable, they called the surgeon back in from home, his assistant, the paediatric electrophysiologist, consultant intensivist, cardiologist and several other doctors. Harrison was certainly keeping everybody busy! They were considering putting in atrial pacing wires but fortunately he finally settled on a particular drug. We left his side around 12:15am this morning as he seemed more settled. Since then, he has been much better and when his blood pressure dropped after that, he was able to recover it quite quickly himself. Since returning from theatre, they had paralysed him to keep him very deeply asleep. As he had improved overnight they stopped the paralysis at 6am so that when I arrived at 8am he was beginning to wake. Now it was my turn to be busy! Every time he woke a bit, Harrison went straight for his 3 chest drains and the ventilator. It was a bit like trying to catch an octopuses arms at times. Considering he was only semi-conscious he was doing a good job of out witting me! As he became more awake, the ventilator was distressing him more and more. He was doing so well at trying to breathe for himself that they extubated him at 9:30am. He now just has minimal support from oxygen through nasal cannulae. What a difference a few hours can make! To say we are relieved is an understatement. I am expecting him to still be quite tired today but hopefully now he will make steady improvements. They think that he's over the worst of the rhythm problems but they still need to keep a close eye. Because of last nights dramas, we had the opportunity to speak to Harrison's surgeon at length. He wasn't able to patch the pulmonary stenosis because when he looked at the narrowing inside the chest, it went right down into the lung, so just widening part of the artery wouldn't have sorted the problem. Harrison is left with the stenosis but the surgeon is going to ask the cardiologist whether he might be able to dilate the artery a bit more by cardiac catheter. As for the donated artery; he replaced the calcified one and everything looked great on the ECHO. Apparently before the operation, Harrison's ventricles were struggling to contract properly because the conduit / homograft was so stenosed. The new one immediately enabled the ventricles to contract properly but it showed that the valve inside the new artery was already leaking. The surgeon wasn't happy with this as it would have meant a valve replacement operation in about six months time, so he removed that conduit (basically repeated the whole operation) and put in another. This one is working perfectly with no regurgitation (back flow of blood). That was one of the reasons why the surgery took longer. The other was Harrison having his first rhythm problem. So all in all, Harrison is doing brilliantly now. I've been away from Harrison far too long so I'd better get back and check that he's behaving himself ;-) I'll update again later.