Heart Catheterization and Balloon Angioplasty for Kids with Extreme CHD Case: Dario's Experience

CHD is a disease yet you can never find its cure, ever. Dealing with CHD is painstakingly painful, and it's like every time you're going to lose over an endless war.

Last week, Dario was admitted to Padova University Hospital to have his 4th balloon angioplasty to enlarge his hypoplastic arteries and collaterals. Angioplasty (balloon angioplasty) known also as a balloon dilatation is a minimally invasive interventional radiology procedure in which technologies are used to guide a catheter into an artery or vein to the point where it is narrowed or blocked. The vessel then enlarged with a balloon-tipped catheter. Angioplasty is a procedure that is widely used to expand a narrow blood vessel and improve blood flow. This procedure is usually done in a coronary case and nephrological.
Courtesy Aboutkidshealth.ca

Balloon angioplasty for Dario is not a new thing, as I said earlier that this was his 4th times, angioplasty becomes the-must-have procedure. It is a part of his Tetralogy of Fallot, pulmonary atresia, and mapcas care management. 

Dario was born with a complex and extreme heart condition in which most of his arteries and collaterals are hypoplastic. Incredibly small and grow so gradually. His team of cardiologists told me that this type of congenital heart disease need a long-life angioplasty procedure to make sure the heart functioning well. In addition, the conduit that has been placed in his native pulmonary artery (September 2015) started to be really stenotic and insufficient to carry the flow to both right pulmonary artery and left pulmonary artery.

Pulmonary stenosis, courtesy Children Heart Federation

First day in the hospital, got to get all exams done

The angioplasty is a part of the heart catheterization procedure that normally should be done in order to get the right picture of how one's heart work, including the flow and the pressure. In Dario's case, a heart catheterization is usually the preliminary procedure before heading to the surgical correction (Open Heart Surgery).

The Day of The Surgery
A day before the surgery, we had to do a check-in and got all the examinations done. Among them are a blood test, thorax x-ray, echocardiography and ECG (electrocardiogram). We had to do a small visit and a consultation, as well, to understand how this procedure would be done and what to expect from it.

I actually hoped the thing didn't go rough this time because the last angioplasty we did in 2017 was kinda nightmare. April 2017 Dario got a heart catheterization and angioplasty to enlarge some segments of his collaterals. Those collaterals are freaking smalls that during the second heart surgery, the surgeons let them as they were because recruiting or closing them seemed to be useless at the moment.

April 2017's angioplasty caused some bleeding in those hypoplastic collaterals and we had to stay another week in the hospital to let them heal proportionally.

Dario was the first case to be handled that day, 02 April 2019, I accompanied him till the operating theatre and he was quite calm except that he didn't want to lay around. They started to inject the anesthetic medicine and he was starting to fell asleep. I kissed him exaggeratingly and waited in sala attesa (waiting room). I was told that the surgery would be 3 hours long approximately and once they finished, I could see my baby.

I waited and kept waiting. Updates nil.

sala attesa (waiting room)
They finally called me and said everything ran well and he could wake up in some minutes.
I could see my baby there lying on the hospital bed with the oxygen supports and all the wires. I could see he was starting to move and kicking. I noticed his saturation was higher than before the surgery: 87-84 percent compared to 68-63 percent.

I was so happy and then I got the anesthesiologist and a pediatrician explain to me what happened during the surgery. Long story short, everything was fine and they did enlarge the conduit on his pulmonary artery.

Dario started to kick and cry at the same time then I noticed the bandage of the surgery got a lot of blood. I informed the nurse and they rushed him back to the operating room and tried to save the day. I panicked, I couldn't think straight and one doctor kept saying to me to stay calm, this was no danger.

Finally, Dario was moved to the emergency ward and they told me to not let him sit and bend the knees to avoid the same thing happen. I said yes and I watched Dario fell asleep again, I thought he was still unconscious.

Around noon, we could come back to the ward and Dario started to regain his consciousness little by little. He started to ask for his favorite milk, yet actually, he could only drink some water or tea at the moment. 

Dario finally 'wake up' and I fed him solid food. He looked so fresh and pink, decisively seemed happy. We were so glad. We thought the storm was over...

The Next Day...
We were scheduled to do another echocardiography to see how the heart was functioning post-angioplasty. 

Dr. Castaldi told us that this angioplasty got the effect that they wanted: increasing more flow of blood to the pulmonary branches. His saturation climbed to its maximum thanks to the balloon dilatation that enlarge the stenotic conduit. At first, they were thinking about putting a stent on the stenotic conduit but turned out that native pulmonary artery got spasms during the intervention. So, for now, angioplasty was deemed to be effective enough.

As for the plan ahead, he said that Dario should undergo the third surgical correction as soon as possible due to the abnormal pressure in his aorta. Some unnecessary collaterals appear as the compromise of his overriding aorta and through the open heart surgery, these collaterals would be patched somewhere near his pulmonary artery. The main reason, he asserted, that Dario should do another open heart surgery is the fact that his 6mm homograft patch isn't big enough to carry the blood to its pulmonary branches which have diameters of 9mm and 7mm for each of them, So it needs to be changed to the larger version (12mm or 16mm). The ventricular septal defect is to be left untouched though, he said, because it's still too risky to be closed at this stage.

His third open heart surgery will be in Summer...

What I feel
I know that Dario needs another open heart surgery due to his case complexity but I didn't see it coming this fast. The pain I saw in him from the last surgery is crystal clear, feels like it happened just yesterday. Maybe it was too painful for me to forget...

I've lost words of how heart-broken I am for this announcement, I just can't fathom the fear and pain he has to endure. Lord knows that I would like to replace him for that...

I wish I could gather the strength I need to get this through because I need to show him that I am strong enough so that he could be strong too. We've gone this far, we're gonna make it!

Love you so damn much!

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