Fontan

We checked in at the surgery center this morning at 6am. We've been through this drill a few times before. Verification of insurance and due to Gabriel's condition Idaho medicaid. Issuance of identity bracelets and taking him back the OR prep area. We met the anesthesiology team, one of whom remembered Gabriel from an earlier procedure and she trained and practices in New Mexico but was doing a residency here three years ago and just came back to complete a fellowship. It's reassuring to see some familiar faces. The child life specialist helped Gabriel decorate his anesthesia mask with truck stickers and rubbed watermelon and strawberry scent on the inside of the mask. Gabriel wanted both, she called him a little scientist mixing the flavors together, big brother Powell would be proud. They gave Gabriel an oral sedative which they call "happy juice" and as it started kicking in we hugged and kissed him and said goodbye.

Waiting to go, watching Mommy's phone.

We checked into the OR waiting room and were greeted by the friendly smile of Maira, she had worked at the front admissions counter during our last procedures and remembered us! She has the biggest smile and was and is always cheerful and wanting to do whatever she can to improve things for the parents and the patients, just the perfect person for the position she is in, but it seems Stanford has many of these people.

Just after eleven Dr Hanley stopped by to see us and introduce himself. Gabriel's previous surgeon, Dr Reddy returned to UCSF and left us with a choice. Do we follow Gabriel's amazing surgeon to a new hospital or do we stay at an amazing hospital and go with another surgeon? Fortunately Dr Hanley is on par with Dr Reddy as one of the top surgeons in the world conducting surgeries on what many other surgeons consider inoperable cardiac kids. 

Dr Hanley told us Gabriel was prepped and they were almost ready for him (Dr Hanley) and assured us they would take good care of him. He would try not to use the heart and lung machine, but it was there if necessary and he preferred to act conservatively and use it if need be even though recovery time would be extended. I told him we knew Gabriel was in the best hands and Beth asked if she could give him a hug and they hugged.

So about five and a half hours after reporting in he was undergoing surgery. The Fontan procedure requires the surgeon to open the chest which evidently is more difficult this time as it has been done twice before and is full of scar tissue. Once the chest is open the surgeon removes the inferior vena cave from the atrium and connects it directly to the pulmonary artery (all of this was done three years ago during the Glenn procedure with the superior vena cava). At the end of the Fontan Gabriel's cardiopulmonary function is quite unique: his right ventricle pumps blood out to perfuse the body via a recombined aortic arch and the blood returns directly to the pulmonary artery, passively moves through the lungs and returns via the pulmonary vein into his atrium, dumps into the ventricle and repeats, on ventricle, one atrium. His oxygen concentration increases but pressures drop (which create other problems he will address in life but that's something else).

Two and a half hours later, about two pm, Dr Hanley met with us and told us everything had went smoothly and they did not need to go on bypass (heart and lung)! He said they would have him upstairs in the CVICU (cardiovascular intensive care unit) in less than an hour and after they had Gabriel settled in up there we would get to see him!

Long, long day.