The cardiologist came to see us after they finished poking and echoing Wren. There was good and bad news.
Good news:
1) Left heart looks normal size. Right heart a bit enlarged as expected. Left heart makes apex and is doing what is needed now.
2) Sats are in the 90s.
3) Pulses good.
4) Have started him on Prostglandins successfully.
Bad news:
1) Coarctation confirmed.
2) Couldn't get good images "he imaged better in utero, getting a lot of lung shadowing"
3) Aortic arch seems hypoplastic. Not clear how much.
4) Unexpectedly, the aortic valve seems stenotic (measured 4mm). This is a shock as it appeared normal before.
5) The foramen ovale is smaller than normal and with the left side pressures higher from the pulmonary circulation there is some retrograde flow decreasing left side efficiency. This could lead to cardiac arrest so they are considering a "cath lab" procedure to open this hole and keep him stable longer.
The on-call cardiologist said that he will need a series of repairs: valve replacement, arch enlargement and removal of coarc. He mentioned the Ross procedure, Norwood, elongated end to end anastamosis and/or a aortic patch as possibilities. However, the timing is vague and what surgery best treats these conditions is also a matter of debate. We will wait for morning for consults with our cardiologist and later the surgical team at Children's.
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