Wednesday, August 3, 2011

Heart Education--Transposition

Graysen has a cardiology/echocardiogram appointment tomorrow morning. So, I have had TGA-PA on the brain all morning.

I was inspired by other heart blogs to see if I could find educational videos on TGA-PA, specifically from Children's Hospital of Philadelphia (CHOP) which has videos on different types of Congenital Heart defects.

I found a six video series on TGA by CHOP. It is a great series and helps explain TGA in a simple way.

Part 1: I did not post because Gray does not have simple TGA.

Part 2: Good description of a "normal" heart and fetal circulation.

Fetal circulation allowed Graysen to be "safe" as long as he was in the womb. Doctors kept him alive for nine days after birth by using a drug called prostaglandin which forced the ductus arterious to stay open when it would have closed within 24-48 hours.


Part 3: Good description of TGA. Gray's "mixing" occurred at the ductus and VSD.


Part 4: Stabilization after delivery.

This video explains why babies are not rushed to the OR upon birth. Doctors take a few days to fully diagnose the defect and stabilize the baby.


Part 5: Arterial Switch surgery. This is the preferred method of "fixing" TGA. Unfortunately, Graysen was not a candidate for this surgery because he didn't have a pulmonary artery. You can't "flip-flop" something that is not there. Instead, he received a more complicated and rare surgery called the Rastelli Procedure.

The aorta is not moved in the Rastelli Procedure. It is left in the "wrong" spot. The VSD is closed in a manner (using pericardium) that cuts the right ventrical in two, adding part of it to the "left" ventricle while encompassing the un-moved aorta.

Thus, the "left" ventricle becomes roughly 1 1/2 sizes and the "right" ventricle roughly 1/2 size. Doctors use a Contegra bovine conduit (jugular vein from a dead cow) as a pulmonary artery and it is sewn onto the bottom of the "right" ventricle.

Graysen's heart is never "fixed." It does not look like a normal heart but functionally does the same thing.

Graysen's "Rastelli" surgery took over six hours and is not comparable to the Arterial Switch procedure. I shared this video because it discusses some of the complexities of heart surgery. There is very little information about the Rastelli procedure on the internet because it is rare.


Part 6: Life expectations.

A lot is unknown since these babies are just now getting to be adults. Graysen will need further intervention because his bovine conduit does not grow as he grows and will need to be cleaned out and replaced periodically.


Now you are all experts on Graysen's condition! You can also see why Graysen is exceeding all medical expectations.

Graysen is incredibly strong and I am expecting a good report tomorrow at the doctor's office.

2 comments:

Charles Meyer said...

Thank you for all the research you did to find these educational videos. About the best I could say to simply describe Graysen's surgery to my friends was "They re-engineered his heart". Now I can refer them to the blog if they would like more information.

Dee Meyer said...

That was very interesting and very
informative. It really gave me an
insight into what has been happening with Graysen. My friend, who is a nurse, tried to explain it to me when it was happening, but I didn't really understand it until now. Love you, Grandma