Jaxson's Heart Cath

The first thing you should know about Jaxson's heart cath on Friday is that this is a VERY rare case. Dr. Berman was very informative today at our appointment, and he said that if we knew a doctor who said that it wasn't rare, he wanted to meet him haha. Most mitral valves get ballooned after damage from rheumatic fever. Doing a balloon after a repair is rare, and having his mitral valve repaired at his age is also pretty rare. The goal of this procedure is to buy Jaxson time to get a little bigger before he has to have his mitral valve completely replaced.

That said, Dr. Berman and the other two cath doctors are taking a very conservative approach to this. Dr. Cheatham is the head of the cath lab, and he has developed new balloons for cath's that are now used all over the world. He is literally at the top of the field, and he hand-picked Dr. Berman and the other cath doctor whose name I can't remember. All three of them will be in on Jaxson's procedure, and Dr. McConnell is the surgeon on call if anything were to go wrong and immediate surgery is needed.

Jaxson's case isn't just rare, it's extremely complicated. They will run a cath through his femoral artery in his thigh and they will also have a transesophogeal echo camera in place while they do the cath as well. Before they attempt to balloon anything, they will run the cath through the arteries in his heart to measure the pressure inside his heart and lungs. This will establish a baseline for them to know if something isn't working well or is causing a problem during the procedure. They will use contrast dye to help clear up the pictures from the TEE scope, which will enable precise movement of the cath inside the heart. Once that is done, they will start with the smallest balloon available to see if they can open the valve. If that is successful, they will move to the next size and so on.

There are a few major risks that have to be considered during this procedure. One is that they are assuming Jaxson has at least moderate pulmonary hypertension, if not severe. That means the pressure in his lungs is really high, and if something causes additional pressure that the heart can't handle, it could cause problems. Stroke is one, and so is death. The risk of these two is minimal, but Jax is at a higher risk because of the pressure. They do not anticipate either of these presenting, but it is something we have to keep in mind. Another risk is that with part of the cath, they use a needle to poke through a certain wall in the heart to get access to the upper chambers, so when they do that it could cause a puncture of the heart or a major blood vessel that would require immediate surgery. Again, not something anticipated, but something to bear in mind. It could also be that he has a septal defect not seen on previous scans, in which case the needle used to go through that wall would slide through that hole instead of creating a new one. Septal defects (hole in the heart) are common with Kabuki, so it's a definite possibility even though we haven't seen it before.

Those are just the cath risks, the things that could happen based on a cath being inserted into the heart to gather information.

Once they are through with the first part, then they will attempt to balloon the valve. Again taking a conservative approach, starting with the smallest balloon and working up. When the balloon is attempted, even with the small one, it could cause leakage from the valve into the heart. Some amount of leakage is an acceptable trade-off that can be lived with until the valve is replaced. If it's a big leak, it's straight to the OR. There is risk of a tear or rupture of a heart vessel that could require surgery, risk of weakening of the vessel wall leading to aneurysm, and risk of damage to the leg artery or vein where the cath is inserted. There is a slight risk of the balloon breaking and not coming out through the cath properly, which would require surgical intervention but usually at the insertion site and not the heart.

There are so many things we have to be aware of and that the doctors are looking for and paying attention to in the lab. I think their approach is a good one, and I also believe that they will not take any chances on causing a leak. If they pull the balloon out and the mitral muscles do not stay open as they should, it's considered a complete fail. At that point we would be looking at replacing the valve as our next step, although I do not think it would result in emergency surgery.

The doctors have requested that we be admitted on Thursday night so that Jax can be on IV fluids while he's not allowed to eat. Keeping him hydrated plays a factor in the success of the cath, so we agreed and will be going in sometime Thursday evening. After the procedure, Jax will go to the PICU for recovery. Depending on the pressure in his lungs, the breathing tube may or may not be removed at that time. They could potentially want him to keep it in for a day and be monitored in ICU, or if he does well they will remove it and we'll go to a regular room for the night. A cath procedure is typically a one-night stay, but Dr. Berman did say that we should be prepared for a weekend stay. It's something we have already prepared ourselves for, but hopefully Jaxson proves the doctors wrong as he has done on so many occasions and we will have a "normal" experience.

There is nothing normal about this procedure, though. It's one of those things that no one knows what's going to happen until they get in there. And it would have been the same in Boston. Jaxson continues to live in the gray-area that doctor's can't pinpoint how successful the procedure will be. They will measure the pressure in his heart and lungs after each balloon, so they will know pretty quickly if it's going to work. We do not know how long it will take to complete this procedure because the doctors are going to take their time and do everything in their power to minimize the risks.

If this works, it will be a miracle in my opinion. I'm already mentally prepared for them to have to rush him to emergency surgery because it's not working like it's supposed to. I really, really hope I'm wrong, but I'd rather be prepared than not. We will get updates via the EASE app again, which is nice, and they will call if anything crazy happens. My personal best case scenario is that the cath works. Period. It doesn't matter to me how long it lasts, just give the kid some time before he has to be put through another surgery. The worst-case scenario is emergency valve replacement, at least in my head. Obviously we worry about the other risks of stroke and death, but I honestly feel so comfortable with the approach that I don't really consider those as options that could happen. And, it's just too hard to go there. Do we know it's a possibility? Of course, but it's such a rare thing to have happen in any case that I think they'll be able to prevent major risks by being cautious.

We have had an immensely busy couple of weeks and it doesn't look to slow down any time soon. We've successfully moved everything from the old house to the new one, although there is some major work to do unpacking. Jax has appointments all week, I have an appt on Thursday, I met with Jeffrey's school counselor this morning, Jax's cath is Friday and Jeffrey's birthday is Monday. Then there's Grandma Julie's birthday and Christmas and New Year's. And if we're lucky, we'll manage to stay out of the hospital for the holidays, although Jax does love to be there on holiday's. Any holiday!

Right now, there are only a few things you can do to support us. One is PRAY! That's the biggest. Pray for the doctors and Jaxson, pray for Jeffrey to have understanding and not throw crazy fits, pray for Jayson and I to make it through this with our sanity intact and pray for the best possible outcome of this. Another thing you can do is help us replace some of the things we were unable to bring to the new house. For example, our fridge had to be left because it was in too bad of shape to bring. After living with bugs for 18 months, it was too gross to even clean. We also need a toaster (had to be left) an oven (we didn't have one), a bed frame and mattress for Jeffrey (he's been sleeping on a futon mattress, poor kid) and there's birthday's and Christmas coming. We were able to pick up another couch and a desk thanks to a good friend of mine, but we have to rent a truck to go get it and there's a lot more house to fill than there was before. We'd like to replace our dishes, silverware, etc. and things that we brought here out of necessity but really need to go. Finances are always tight during the holidays and hospital stays, and we have both this month. We feel like we finally caught a break in that area and want to keep it that way!

Thank you to everyone for your continued support and prayers. I feel like I say that all the time, but there is no better way to say it. We could not do this without all of you! We firmly believe in the power of prayer, and a lot of our prayers have been answered recently. We feel very blessed and extremely lucky to have such an amazing support group! Thank you just never seems like enough. We love you all!