Cardiac Catheterization Soon?

They wanted to do another cardiac catheterization today but the cath lab is booked up so he'll probably have one tomorrow.  The fellow and nurse have kindly answered my numerous questions so I'll try to explain what they told me.  Josiah's saturation levels are too low.  This is either because the blood coming from the lungs is not saturated enough or the blood in the body is overly used up.  They've dealt with the question of the blood in the body as they gave Josiah more blood and optimized his haemoglobin, his cardiac output is good and he's not septic.  Thus, the issue is in the lungs.

The echocardiograms have shown that all of the connections are fine so that's not the problem.  He could have a collapsed lung, pneumonia, or fluid in the lungs but this is highly unlikely and not expected as there are no other signs of this and they are suctioning him when needed and the fluid looks fine.  They think that the pressures in the lungs are just too high so a cardiac catheterization will tell them what the pressures are.  As previously explained, the surgery Josiah had rerouted the blood from his upper body so that it goes directly to the lungs.  There are small veins that still go to the heart so one possibility is that one of these veins has become bigger and thus a portion of his blood is going to the heart and bypassing the lungs, thereby not getting oxygenated.  A cath would show this and if it were happening they could just cut the vein so that all of the blood goes to the lungs.

If the only problem they find is that the pressures are too high, then there is a decision to make.  They could either just wait until the pressures come down or they could do another surgery to create the BT Shunt that connects the aorta to the pulmonary artery and hence more blood would be oxygenated.  However, it would then be extremely difficult to keep him balanced as blood would be going to the lungs from two different shunts.

It was great to see my pastor and his wife this morning.  They each came and prayed for Josiah.  Josiah's saturation levels were either in the 50s or 60s when they saw him.  When I returned to the room after saying good-bye and then pumping, his saturation levels were in the 70s.  The nurse said that something in his blood work had not been good so they changed some of the ventilator settings and his sats increased.  I'm going to get more information from the respiratory therapist later.  When I left him to go and have my lunch, his sats were mid to high 70s.  It felt so great to see a good number after all these days.  Thank You Jesus!

A number of people have asked if the days seem long.  They don't.  Pumping 7-8 times a day really breaks things up as does eating and going back and forth to RMH and keeping you informed.      

I heard that Isaac slept well and is having fun with his cousins.  He made us laugh so much on the weekend.  He's living up to his name.  Thanks so much for all your prayers for our family.

Blessings,

Elizabeth