Another downhill

Well we are back in the PICU again. Nana came up Thursday afternoon to help watch Henry while Paige went back to the Ronald McDonald House to take a nap. During the morning rounds on Thursday, the doctors had noticed Henry had not had an echo for awhile, so they sent orders to have one done, and said Henry would get the echo either Thursday or Friday based on the schedule.  The doctors said they didn't expect to find anything as Henry has looked great on the outside as well as his stats are looking great.

Well, as it is with all our timing, Henry had his echo while Paige was gone taking a nap. Shortly after he was finished, he had another one as a problem was seen.

It has been discovered that his tricuspid valve [separating the right atrium from the right ventricle] is regurgitating more than it was before (the regurgitation was first discovered while I was still pregnant with him). The doctors are also concerned with the rate of blood flow where the pulmonary artery was joined to the aorta. It is possible there is some narrowing there, which can happen as the sutures from his surgery heal and scar. Henry's aorta is only a couple millimeters in diameter, so even a little scarring in the wrong direction can narrow the opening significantly. There are some other markers in his labs that indicate his heart is being over-worked. These factors can all influence each other: if the opening to the aorta is narrowing, the heart will have to work harder to pump blood out, and more blood will remain in the ventricle, making it more likely to regurgitate through the valve, making the heart have to work harder...

So for the time being, we are back in the PICU and Henry is receiving milrinone to help improve his heart.  The milrinone may help these issues, and if it helps the heart function and the aorta is not too narrow, we will see it when Henry has another echo on Monday. If enough improvement is seen, Henry will be weaned off the milrinone and monitored to verify that worked.  If there is not improvement or it has gotten worse, we are penciled in to go to the cath lab on Tuesday. This will provide more detail than the echo does. If the opening is just  too narrow, they will be able to address it then with an angioplasty, using a balloon to widen the opening.

Henry is doing fine through all of this. He is continuing to eat and is getting better with his bottle each day. He is also starting to show some signs of consistent weight gain, as he is up to 3.5 kg (7lb 11oz). Whether or not we do go to the cath lab, we will probably be in the PICU for at least a week as they make sure the procedure or his medicine improves his heart function.