Posts Tagged ‘Lung’


October 11, 2009

Update 1, 9:47 PM Eastern (0248 GMT): New Email: Florida Eliza is in the Operating Room. Surgeon has the Transplant Team assembled and are ready to go. If the donor heart and lung are not compatible, the transplant will not proceed… and we won’t know for about 3 hours. Until then, we wait.

While we are pulling for our Heroine, please keep the Donor family in your thoughts. They have just lost a loved one.

Update 2, 10:58 PM Eastern (0358 GMT): New Email just in: The transplant has been called off. There was a problem with the lung and the Transplant Team decided that it wasn’t worth the risk.

All is not lost; the heart is perfectly fine. Someone will receive it tonight and hopefully be able to resume their life soon. (Florida Eliza can’t accept the heart and get the lung later, she has to wait for a matched set.)

TGA Explained by a Doctor

August 25, 2009

Here’s a great article, one so good it makes me wish that I had written it. PalMD, who posts on the blog White Coat Underground, takes the time to describe Transposition of the Great Arteries (TGA). No matter if this is your defect or not, hustle over there and learn more. Because as PalMD says,

Heart-lung physiology is pretty cool stuff.

My Glenn Shunt is worth more on eBay!

October 13, 2008

Yeah, you read that right. My Glenn Shunt would bring a higher price on eBay! Yours? Not so much. I have a classic vintage model, so the price would be higher!

I’m kidding with you, obviously. If you happen to need a Glenn Shunt (or any other heart operation) then the true cost is out of your reach; it’s priceless.

The Glenn Shunt is one of the oldest heart operations around. It was first described in 1951, and Dr. William Glenn of Yale University first reported performing the procedure successfully in 1958. Since he was the first person to routinely have success, the operation bears his name. (If you or someone you know has a Glenn shunt, please click THIS LINK and download and read the PDF file. There is a lot of important information here that you need to know!)

When I tell people I have a Glenn Shunt, the ones who know what I’m talking about will nod their heads knowingly. Most of the time, though, they are still wrong. My Glenn was done in 1967, and I am a proud owner of a Classic Glenn Shunt. Most of the Glenns done today are the Bidirectional Glenn Shunt.

So what’s the difference? Before you describe the Glenn, it helps to have a diagram to help you visualize it. Click HERE for a useful diagram of the heart.

In the Classic Glenn, the Superior Vena Cava (The large vessel that leads into the Right Atrium) is closed near the Right Atrium (usually, it is not cut, but rather sewn closed.) The Pulmonary Artery (the “T” shaped blood vessel that runs under the “loop” formed by the Aorta) is also cut… the right branch of the Pulmonary Artery is disconnected. The hole left by cutting the right branch of the Artery is sewn closed, and then the right branch is connected to the side of the Superior Vena Cava.  By doing this, the Right Atrium is completely removed from the blood flow. Blood coming to the heart through the Superior Vena Cava now goes directly to the Right Lung, and flows back to the Left Atrium normally. Then it goes through the Left Ventricle and back out to the body.

The Bidirectional Glenn was invented, surprisingly, in 1966. While it was around when I had my Classic Glenn in 1967, my operation was the fifth Glenn Shunt (of any kind) that had been performed at Johns Hopkins; so it is a safe assumption that the surgeons weren’t prepared to try the new version just yet. In fact, the Bidirectional Glenn really came into its own in the 1980’s, when it became the second step in the three operation Norwood Procedure used to combat Hypoplastic Left Heart Syndrome (HLHS).  It’s also part of the Fontan Procedure, sometimes performed as a seperate operation as part of a Staged Fontan.  The biggest difference in the two operations is that in the Classic Glenn, the Superior Vena Cava is completely cut and sewn into the right branch of the Pulmonary Artery. In the Bidirectional Glenn the Pulmonary Artery is not cut, which allows blood flow to both lungs.

It’s important for someone with a Congenital Heart Defect (CHD) to know what “version” of an operation they have had. For years, I told doctors “I have a Glenn Shunt,” not knowing that the operation had been changed. After I had told a new doctor that I had a Glenn Shunt, he slapped my X-Ray on the lightboard, took a long pause, and finally said “I don’t know what the hell this is, but it ain’t no Glenn Shunt.” Only after the head of the Cardiology Department came in and said “I haven’t seen one of those in a while!” did I realize that simply saying “Glenn Shunt” wasn’t good enough. Thankfully that snafu occured during a routine office visit and not a crisis visit to an Emergency Department.


October 2, 2008

A recent appointment with my Adult Congenital Heart Defect Cardiologist in Atlanta was going wonderfully, right up to the moment I got the ECG. (ECG stands for Electrocardiogram; it used to be popular to refer to it as an EKG, but ECG seems to be the favored term now.) The doc came back into the examining room carrying the ECG sheet, stroking his chin and saying “Hmmm….”

I cringed. Long ago, I learned that “Hmmm…” is doctor-speak for “Ut-oh.” Finally after a few moments, he says, “Looks like you are the proud owner of an Atrial Flutter.”

Proud owner? Yeah, right! Normally, the Atriums (the two top chambers of the heart) contract a few milliseconds before the ventricles do. With a Flutter – you can have an Atrial Flutter if the problem is in the top chambers of the heart, or a Ventricular Flutter if it is confined to the lower chambers – the two cycles become unsynchronized. One is slightly faster than the other, and the two halves of the heart aren’t working in tandem anymore. When it is mild it is a Flutter, and when it is more pronounced, it is a Fibrillation. Flutters can turn into Fibrillation, and a Fibrillation can be deadly.

“Double your dose of Amiodarone and have another ECG in two weeks,” the doctor instructed. “Have them fax the results to me. If it’s good, we’ll set up an appointment in six months.”

And if it is not?

“Be prepared to come down within a week, and perhaps stay a few days.”

There’s no need to worry about an ECG because nothing you do can affect the test. So in two weeks, I get the test done and have the results faxed to the ACHD Doctor. Later that day, the telephone rings: Be in his office on Thursday, I’m scheduled to see the Electrophysiologist.

I have no idea what an Electrophysiologist does, so I look it up. According to the dictionary, he “studies the electrical system of the body, concentrating on the heart.” Ok, but there is no description of exactly how he conducts his studies. I’d like to know if he is going to plug an extension cord into a live power source and then hand me the bare wire ends. “Here, hold this,” he tells me as he watches all of my hair stand on end. Things like that you just need to know.

Thankfully it isn’t that bad. Electro-Doc (my nickname for him, since Electrophysiologist ties my tongue in knots) starts by giving me a 12 lead Electrocardiogram. It works just like a regular ECG does, but there are a few more little wires running to your body. He also listens to my heart for a while longer than the usual exam, and questions me pretty closely about my health. After about half an hour, he excuses himself to consult with my regular Adult Congenital Cardiologist. The Adult Cardiology Clinic normally sees patients on Mondays and Wednesdays, but Electro-Doc is only in area on Thursdays. And on Thursdays, my doc is in an entirely different hospital. Thanks to the cell phone, this fact really isn’t a problem.

The minutes later he is back, and admits that he’s in a bit of a quandary. With an Atrial Flutter I should feel dizzy and lightheaded when the Flutter kicks in. I don’t. And I should be able to feel a Flutter when my heartbeat changes. I can’t. So after putting their heads together, he and my Adult Congenital doc have decided (drum roll, please) not to do anything at this time.

That may sound like a cop-out, but I don’t see it that way. Electro-Doc is going to proceed by how I’m feeling, not what the ECG tells him. The evidence – the ECG, his training, and what he’s hearing through his stethoscope – tell him that I am having an Atrial Flutter. But I’m telling him that I don’t even feel it. so instead of paying attention to the machinery, he’s going to pay attention to me…what a novel idea!

“Since it doesn’t seem to be affecting your heart rate, stop taking the Amiodarone,” he says. “Get an ECG in two weeks, if it looks the same, we’ll just drop that drug altogether.”

With that statement, Electro-Doc has just become my new best friend! Amiodarone is a very effective anti-arrhythmia drug… but it has some nasty side effects. It can cause damage to your eyes, your liver, your lungs, and your thyroid.

Every year that you are on Amiodarone, you must get an eye exam to determine if it has started to damage your eyes. Take a friend with you; they will put those drops in your eyes that cause your pupils to expand. They only expand your pupils for a few hours but during that time you are very sensitive to light and your close-in vision is worthless. Good luck reading a book or a magazine – or a dashboard, for that matter.

You’re also due for a breathing test every year if you are taking Amiodarone. You sit in a small circular box- actually a tube – about the size of a phone booth. (Remember those?) There is a breathing tube mounted in front of you; usually adjusted to be about a half inch higher than your mouth, so you have to sit up nice and tall to place your mouth on it. The technician will tell you to do various breathing exercises. A favorite one is “Take a deep breath and hold it, and when I tell you blow it out as hard as you can. Ready? Deep breath… hold it, hold it… now BLOW! Keep blowing, empty your lungs!” You actually blow out so much air that you involuntarily begin to cough before you can draw a breath. You’ll also see the computer generate many cool-looking graphs and charts while you are doing your breathing exercises, but you won’t have a clue what they mean. Take a friend to this test, also; after an hour and a half of various breathing exercises you are usually exhausted. It’s not unusual to nap in the car while heading home.

Your liver and thyroid are checked by blood tests. That’s nothing new to a ACHD patient, so you just roll up your sleeve a few more times a year.

My two-week ECG reading was the same as it was before Electro-Doc told me to quit taking the Amiodarone, so I no longer take that drug. But that doesn’t mean it’s gone. It can take as much as 100 days (over 3 months!) from the time you stop taking it for it to be completly gone from your system. By my count I’ve got about two more weeks, and then that nasty stuff is gone… hopefully forever!