Jonathan's Heart

Jonathan was a trooper in his visit to Dr. F, pediatric cardiologist, on Friday at Children's Hospital. (Same doctor Elijah saw back in Feb.) He had an echo done right away, and did great laying there while the tech took 100+ "photos" of his heart. He just got antsy at the end. Then we met with the nurse and then the doctor.

So, we have GOOD news and news.  Not good news and bad news, just news. :-)


The News:
* J does still have a PFO and a PDA. (I'll explain those down below.)
* His PFO is larger than "normal" and possibly bordering on an ASD. Usually, PFOs close up on their own, but in kids with Ds, there is the potential for it to get bigger. He goes back in 6 months just for Dr F to listen to him and then in a year for another echo to make sure it hasn't grown.


The Good News:
* J does not need "urgent" open heart surgery now or ever!
* J does not need any type of heart surgery right now, and possibly never!
* The defects his heart still has are the "best kind of heart disease" a child w/ Ds could have. (Doctor's words :-))
* The PDA is pretty small and Dr. F could not hear it.
* The PFO is in a "good" place. If it needs to be closed up surgically in a couple of years (age 3), it is a cath procedure, not major surgery. The PFO can cause extra pressure in the lungs. This is of particular importance in a child w/ Ds as their muscle tone is lower, and this causes the tongue to sit back farther in their mouth, esp while they are sleeping (why they snore more and Jonathan definitely does). This also causes extra pressure in the lungs. So, the combination is worth keeping eye on.

Praise GOD!!! Great news overall!!!!!! Thanks for praying! And thank you Lord for answering prayers!

An interesting note: Jonathan was listed on RR as having a PDA and a PFO. I think it is pretty rare that the medical diagnosis a child is listed with is accurate when examined in the US. This is no fault of RR or even the facilitators that list the child. Medical services are just not the same over in Ukraine as they are here. It is just more difficult to get an accurate diagnosis. His profile did say he needed "URGENT" surgery, but after researching PDA/PFO before going over, rarely are these heart issues in need of urgent surgery. When my facilitator talked to the orphanage director in April, the director said J needed surgery, possibly several. When we got there in June, J had been to the cardiologist in May and did not need to come back for 6 months. Confused yet? :-)  Bottom line is he is doing well and is cleared for 6 months!

Ok, if you know what a PDA and PFO are, you can stop reading. If not, I'll try to explain it.

Both the PDA and PFO are natural openings that a baby needs in the womb. They normally close up w/in a few days of birth. http://www.chw.org/display/PPF/DocID/34305/router.asp explains it this way:

Fetal circulationThe normal circulation of a fetus while in the uterus follows a slightly different path than after a baby is born. While in the uterus the placenta acts as the lungs, therefore less blood passes into the actual fetal lungs. There are two structures within a fetal heart that allow this "bypass". One is the patent ductus arteriosus or PDA. The PDA allows mixing between the pulmonary artery and the aorta as it is a passageway between these two major vessels. The other is the patent foramen ovale (PFO). The PFO is a hole between the two atriums. It allows mixing of blood between the two right and left atrium. The PDA and PFO allow a right to left shunt, which directs blood away from the lungs and directs this more oxygenated blood to travel to the body.

The pressure in the lungs of a fetus is higher than that in the body. This increased pressure encourages the right to left shunt also. After a baby is born the pressure in the lungs decreases as the vessels in the lungs begin to relax. The pressure in the body increases after birth. This change in the pressures allows more blood to flow into the lungs. These factors, the changes in pressure, are what cause the PDA and PFO to eventually close. The final closure usually takes several days.

Clear as mud? Here are a few more links with more details but still in layman's terms.

HERE is a link about the PDA with a diagram. (If you decide to research this further, do yourself a favor and be sure to type PDA heart defect in your search engine. :-))

HERE is a link about an ASD (which by the way, that is what Elijah was listed with).

HERE is a link about the PFO.

HERE is a link about the catheter procedure to close the PFO. Fascinating!

Let me know if you have any questions. I put lots of info in this post, as it was posts like this one that I read on other adoption blogs that helped me, so maybe this will help someone too!