Info from Dr. Ross

When we met with Max's surgeon (Dr. Ross) today, we learned a few key things about Max's heart and the upcoming surgery. Warning... this is a lot of detailed information so please feel free to read or not read all of it. In addition to keeping you all informed, the blog is partially for our memory and reference so we are trying to be as detailed as possible.

First of all, Dr. Ross is the same surgeon that did Max's first surgery and although he seems to be a very humble and mild man, I can't help but think how amazing it must feel to be reunited with people that he has helped along the way and continues to help.

Dr. Ross reiterated that Max's entire left side of the heart is a bit "small", which we knew from the beginning. This is a result of reduced blood flow in the heart during development and prior to the first surgery in February 2013. He also mentioned the mitral valve being narrow which was the first time that we have heard this valve talked about in much detail. Basically, similar to the aortic valve, it is functioning fine at this time and it is just something to continue to monitor. Nothing may need to be done to either valve, however if valve work must take place, the older and bigger Max is, the better.

The subaortic membrane beneath the aortic valve is what will be operated on tomorrow. The membrane is basically thought of as a blockage, interrupting blood flow through the aortic valve and causing the heart to over work and swell. The membrane is basically a form of scar tissue that has formed as a result of turbulent blood flow through the valve. Without surgery, this will continue to grow and cause further problems to the function of the aortic valve. We were very much reassured that it is best to deal with it now as a strong aortic valve is what we want him to end up with and this is a major step in that direction.

However we also learned that it is a very precise procedure, as they will be operating within 1-2 mm of where the electrical system for the heart is located, although this is not something that can be observed visibly. So, precision is the key...

• Take too much of the membrane out and risk permanent damage to the electrical system, which could mean that a pacemaker would be required for some or all of Max's life. 
• Not take enough of the membrane out and require another operation to remove the rest at a later date. 

We trust Dr. Ross with finding the balance of how much membrane to remove. Either way, there is a 20-30% chance of requiring another surgery to remove more membrane because as Max grows, so will the membrane and the turbulent flow may come back. Once full grown, the membrane will not continue to grow. So just like all of Max's heart anomalies, this will be closely monitored by our cardiologist in Calgary. 

Other risks from this surgery include damage to the mitral or aortic valve from doing the surgery itself. Everything is very close together in the heart. This is not anticipated but is always a possibility. Also there is increased risk of bleeding due to the blood thinners that he will receive and there is always a risk of infection, stroke or brain damage but this is highly unlikely.

Another major difference from the first surgery is the incision type and location. Last time, Max had what is called a thoracotomy, which is an incision on the side of his body. This time, Max will have a sternotomy, which is an incision through the centre of the chest where the sternum bone is cut and separated to give access to the heart (hence "open heart"). Although it looks worse, the sternotomy is apparently much less painful for the patient as there is more bone and less muscle involved. 

After Max is asleep and access to the heart has been made, the use of a cardiopulmonary bypass or "heart-lung machine" will be used this time. The bypass machine allows the body and lungs to continue to receive oxygenated blood. It simulates what the heart does by using a mechanical pump. This allows them time to stop the heart (by cooling it and overloading it with potassium), drain it of blood and do the required operation. After the operation is complete, they will reconnect everything, fill the heart back up with blood which washes the potassium out of the heart and it restarts on its own. The surgery itself will take approximately 1.5 hours and the preparation for surgery will be 1-1.5 hours. They anticipate 3 hours total. 

One of the good things that we learned is that they will try to extubate Max (remove the breathing tube) soon after surgery and before we see him in the PICU. This is somewhat of a new thing, as last time he wasn't extubated until he had been in PICU for quite some time. Apparently the quicker they take out the breathing tube, the quicker the recovery tends to be. 

Because Max is so active and strong, they expect him to be quite resilient and to recover pretty quickly. There was even talk about him being able to play and walk around the unit within a few days of surgery which would be amazing! They won't keep him sedated just to keep him in bed which was one of our fears since we know how busy and active this boy is. 

Max is slated to be 1st in for surgery tomorrow so we will be there at 6:00 am and he will go in for surgery ay 7:20 am. This is such a blessing and answer to prayer because we could not imagine him fasting ALL DAY like we did last time. Max will begin fasting at midnight tonight and will also require 3 separate baths between now and tomorrow morning using a special chemical/soap that disinfects the body. 

Thanks again for all of your messages today. Technology sure is a great thing. Sorry if we have not responded to many of your texts, emails, comments, etc but please know that we are reading them and they are very encouraging. Keep them coming!

Cam

Max and Dad took a special father-son trip tonight
to Transcend Coffee Shop after a long day!