12 month cardiology clinic

Wren had a Children's Hospital cardiology clinic this week. He had an EKG and upper and lower pressures, height and weight. The summary from Dr Lewin is that his heart condition is "stable".

The EKG and pressures were very easy since Wren was mesmerized by the bubbles Wendy was blowing and sat quietly. His EKG was normal which is supposed to show that his heart is putting out a usual degree of electrical impulse indicating it is not thickening due to the higher pressures in his left side. The pressures were good but still showed a mild gradient upper to lower. I think DR Lewin mentioned to his intern that if she listened at Wren's back she could hear turbulence in the aortic arch which "is that 6mm gradient". I am not sure exactly what that means. He said there was no sound from the valves which means they are not leaking. [leaking? I was thinking. Were you worried they might leak?]

Dr Lewin said that Wren does not need RSV shots and that they would probably not be approved this year because he is doing well.

His weight was 22 lbs and I want to say 8oz but it may have been more. His head was 47 and a half inches. I am a little concerned that Wren hasn't gained much weight since his 9 month appointment. He weighed 21 lbs 6oz then and was 75th %tile but based on the weight at clinic is is under 50th percentile this week. Dr Lewin said it might be because he is now so active (Walking a lot!) but it may also be due to the stomach flu he had for a few weeks.

The only frustrating part of the appointment is the ongoing uncertainty regarding Wren's prognosis. Dr Lewin was not at all clear about what we can expect. He would only say he is stable and doing well now and they want to see him in 6 months for a sedated echo. Actually, they will try a non-sedated echo but if he wriggles too much it will be sedated. They will be looking to see how the LVOT ridge is developing, whether it has increased or not.

It feels difficult to have no expectation about how Wren's heart is going to develop and what treatment, if any, he will require. Dr Lewin seemed to feel that there was some inevitable mysterious course that his heart would take and when I asked about low salt diet he said only that he didn't think any kids should eat much salt and processed food but that nothing we could do would "alter the course Wren's heart will take" or something like that. I tried not to insert ominous music at that point since everyone's demeanor was pleased and cheery. I guess this is the difference between Wren's CHD and a full repair.