5th times a charm?

Ford, post-op.

Ford's 5th time under the knife went well, even though there were a few surprises.

First off, the bronchoscopy revealed no blockages in the lower airways of his left lung. So the promise of simply sucking out some kind of 'plug' to free up the lung was a bust.

However Dr. Campbell did notice, to his surprise, that Ford's left lung was completely encased in old, sticky chyle, which must have failed to drain back in September when they first noticed he might be suffering from a chylothorax (a cut lymph duct that leaks fatty fluid into the chest cavity). It was this stuff that had compromised the ability of his lung to fully expand and, I gather, in the intervening months slowly force it to quit altogether. He was surprised because this is something that they would have expected to see on an x-ray or a CT-scan, yet it had somehow gone unnoticed.

So he removed as much of it as he could, but got nervous as he closed in on the lung. He had to leave some of it around Ford's lower left lobe for fear of damaging healthy tissue.

The next issue was removing the collateral veins which had grown into the lung, competing with the antegrade flow from Ford's left pulmonary artery. There were many, as they suspected, and they were all cauterized without a hitch. Dr. Campbell then tried to impress us with the 'spectacular quality' of Ford's pulmonary artery, which I guess they suspected would be in rough shape, and we were impressed.

Next up he put in the 'BT Shunt' to supply more direct blood flow from the heart to the left pulmonary artery (which was supposed to be receiving passive flow via the 'Glenn' but was being entirely neglected in favour of the right lung).

Apparently that seemed to do the trick and Ford's oxygen saturations acutely jumped from 70% to 90%. Dr. Campbell explained that even though this is what they needed to have happen, they were hoping to trigger it without putting in the shunt (sucking out goo or freeing up space around the lung). This new modification will put an increased load on Ford's single ventricle, which is a bad thing in the long-run. They are worried that his heart has already been working harder than expected and that there might be some issues with it's function that will be exacerbated by the shunt. It's a wait and see sort of thing, from what i gather. Something they can assist with drugs but might end up becoming a big problem down the line (re: all this transplant talk of late).

Even though Ford performed well in the OR he's had a rough go since coming back to the ICU. His saturations slowly dropped back the 70's. The oxygen they're supplying him to compensate kept getting bumped up. He is very swollen and grey. They had just started him on a transfusion when we left, and everyone seemed convinced that it would do the trick.

The plan is to leave him intubated "for a while" keeping the pressure support high so that they can keep the lung open until it gets its strength back.