It is 11am and we just received word that Abby is not yet on the bypass machine, as it has been difficult to get through all the scar tissue from previous operations. She is doing great though and her chest is nearly open enough to get started.
Today Abby is having the Fontan. We have known that this surgery was needed since before she was born. Basically, the Fontan connects the blood flow from the liver to the lungs. If you want to read about Abby's specifics in more detail, James has typed it up below.
During this procedure, the blood flow from Abby's liver will be directed to her lungs. Currently the blood flows from her liver through her hepatic veins into her heart where it mixes with oxygen rich blood that has just come from her lungs and is then pumped through her body. This presents two problems: first, since this blood from her liver is very low in oxygen when it reaches her heart, it lowers her overall oxygen saturation when it mixes with the oxygen rich blood in her heart. Second, since her lungs are not receiving direct blood flow from her liver, they lack the unknown protein or enzyme that keeps them for forming collateral veins. So, as I write this Dr. Birch is doing his very best to correct this issue. Typically, the Fontan is performed by detaching the hepatic veins from the heart and patching the whole. Then theses hepatic veins are attached to a gortex tube and plumbed around the heart and into the pulmonary arteries. However, Abby's hepatic veins attach to the lower side of the heart more centrally, rather than to the side. This means that her heart would rest on and pump against the Fontan where it attaches to the hepatic veins, likely disrupting the flow. Also, her pulmonary veins come into her heart at different angles than typical which would make it extremely difficult to route the tube past them to her pulmonary arteries without disturbing them. Sooooo, the surgical board has elected to perform a Fontan with a bit of a twist. Today they will put Abby on the bypass machine (a neat gizmo that oxygenates and circulates her blood so that her heart and lungs can be out of service for a bit) and then they will open her heart and place this gortex tube THROUGH her heart. They hope to use at least a 20mm if not 22mm diameter tube and attach it to her heart where the hepatic veins come into it. It will travel through her heart, through her atrial chamber (since her heart is essentially two chambers instead of four((no left ventricle, and her atrium are basically one large chamber)), and out a hole they will make in the top, then connecting to her pulmonary arteries. A 3.5mm hole will be left in the tube in her heart so that if pulmonary pressure is too high it will act as a shunt, or a pop off valve of sorts, allowing some blood flow to route through her heart as it currently does.
Please pray for Dr. Birch and his team