THIS IS GOING TO BE A MESSY SURGERY

3/10/09 - 11:30PM

Today, Kristi was evaluated by her Cardiologists, Dr. Jutzy and Dr. Bansal. Both of them are the best there are. They have been treating her since she was a little girl (when her murmur was discovered) and care about her very deeply. Dr. Jutzy is the Chief of Cardiology here at LLUMC. She had a Echocardiogram (Ultrasound of the heart) and they discovered that she has a ruptured cuspid in her Aortic Valve. A cuspid is another term for the part of the heart valves that open and close. The Aortic valve is under tremendous pressure when the heart contracts, so a tight seal is key. At her last "Echo" which was 5 months ago, they noticed a small leak in the same place and they decided to re-evaluate her after she had the baby. This leaking is typical of a valve that is reaching the end of it's useful life. At the time, it was not an emergency and they would usually try to plan another surgery a year or so from finding something like that. So although we were counting on having another surgery within the next year, we never imagined that it would happen this way.

Compounding this problem is the possibility that she may also have an infection in her heat muscle that is also causing some other issues. She had multiple (8 in all) blood cultures done today that will test for various bacteria in her bloodstream. Unfortunately those results won't be back for 3 days, so we are here...waiting...watching her monitors.

Tomorrow she is going to have a Trans-Esophageal Echocardiogram. That is when they insert a ultrasound device in her throat and take a look at the back side of her heart. It is very uncomfortable, as you can imagine, but is necessary. Dr. Bansal wants to make sure that there is no abscess behind her valves or in a place that he can't see using the other machine. He explained that it is important to find out all there is to know before they open her up. They don't want any surprises that will complicate the surgery. Kristi is not looking forward to this...at all...and is telling everyone she sees here that this test is pretty much the worst thing ever. Although they sedate you, you are wide awake for the whole thing.

If it turns out that she does have an infection they will treat it with antibiotics until it clears up and then they will operate. If she does not, they will proceed with the surgery. If for some reason she does have an infection and there is no time to wait, they will give her massive doses of broad spectrum antibiotics and do the operation.

Either way, she is most likely going to have surgery before the week is out. They are definitely going to remove her damaged biologic Aortic valve and replace it with a mechanical one. This mechanical valve should last her for the rest of her life. She will need to be on blood thinners and now that we have 2 babies she is OK with that. The question is weather or not they will replace her Pulmonic valve at the same time. It is older, 13.5 years but seems to be holding up well. This valve does not have to deal with the same pressures that the Aortic valve has to deal with so it lasts longer. Kristi feels like if they are going to open her up, they might as well do both. But doing 2 replacements will be more traumatic on her system and the doctors are unsure if it is worth the risk to replace a valve that is working, just because the patient does not want to go through another surgery down the line. This surgery will be more "messy" as the last 3, says Dr. Bansal. Since she has scar tissue from past operations and since the heart is enlarged the surgery will require more time, more blood transfusions and possibly more complications.

In the meantime, she is resting, watching the one channel we get here (CBS) and thinking about her boys. Harrison and Louise (our pug) are resting at Phil and Kathy's house. Hudson is with Ron and Karen. They will get the chance to see their mommy for a short time tomorrow afternoon. They will not be able visit her much in the CCU because there are people here with some pretty bad infections and we wouldn't want them to get sick.

I am going to try to get some rest tonight...although it seems unlikely. My eyes are glued to the blood pressure, blood O2 sensor and pulse monitor. It beeps when the O2 level goes below 90...or when her BP is too low.

She is taking calls when she can, getting text messages and emails. I can also relay messages to her for you.