Januari 10, 2017
>> we left the hospitalafter he was born, after about threedays, normal time. and we had abouteight months at home, normal, which was wonderful,and then needed to have his surgery. >> eventually, we're going togo to the fontan operation. and in the fontan operation,what we do is we connect the blood flow coming backfrom the body directly to the lungs.
you can do it inone operation, but we've learned thatbabies do much better if we split it up and doit in two operations. >> when you have this singleventricle malformation, all the blood that goesto the lungs comes back to the heart, goes out tothe body, and a portion to the lungs again. and the amount that is goingto the lungs is an extra amount of blood thatthe heart has to pump.
so eventually, we want toget to a situation where we're separating thecirculations again. the second-stage operationtakes away that extra volume that the heart has to pump,and it does that by getting rid of the shunt, or gettingrid of the blood flow to the lungs directlyfrom the heart, and connecting the veinsfrom the upper part of the body directly to thearteries to the lungs. >> you have to wait untilthe lungs essentially mature
enough that you can providea different source of pulmonary blood flow. >> this is called either abi-directional glenn shunt or a hemi-fontan operation,half of the fontan operation. >> it's very, very importantthat the family feels comfortable with you,as an individual, taking their child fromthem and that the child recognizes that nothing badis going to happen to them, that they can do thiswithout being awake
for any painful experience. >> they'll go tothe operating room. the anesthesiologistwill put them to sleep. we'll then clean, prepareeverything in their chest and abdomen sterilely sothat we can do the operation without infection. it's performed throughan incision in the front, over the breast bone. and we put them on the heart-lung machine and cool them
down to take care of theirbrain and other organs while we do the repair. >> we're bypassing the heartand the lungs so that the operative field, thearea where we're working, is clean and we cansee what's going on. the heart'sgenerally not beating, although occasionallyit is, but at least it's decompressed. there isn't bloodflowing through it.
>> we'll then dothe operation, warm them up, bring themoff the heart-lung machine. we'll make sure that theheart is working ok, that the bloodpressure is ok, that there's enoughoxygen in the blood, that there's no bleeding. and then usually we leave acouple little tubes inside the heart to let us measurepressures in the heart and give drugs.
these come outthrough the skin. there's also usually twolittle blue pacing wires which let us changethe heart rhythm. we then leave adrainage tube. once everything is stable,the baby will come back up to the intensive care unit. >> once we get tothat second operation, the heart is in amuch better condition, and usually the risk of thatsurgery is extremely low.
and the risk after thatsurgery becomes quite low, also, of any sudden event. so i always breathe a sighof relief when we get to that second operation, orthat second-stage procedure, because it's a much betterphysiologic situation for the heart.
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