Tues 12/23/08 - - Surgery #2

Overnight, Ava had a brief period of PVCs or premature ventricular contractions. On the monitor it looked like arrhythmia, however, the PVCs did not become regular in occurrence or in rhythm. The belief was that the PVCs were a side effect of the infection which by morning rounds was classified as staphylococcal aureus.

The AM echo revealed that the vegetation on Ava's heart valve had increased in size from 5mm to 7mm. At that current size and growth, it was determined that the IV antibiotics alone could not take care of the infection in the body.

An ultrasound also revealed another clot or series of small clots in the vein where the central line was following the first surgery. It was unknown whether or not there was an initial clot that became infected or if the clots themselves were originally caused by the infection.

Ava's blood pressure began to negatively fluctuate and it was at this time that the surgeon sat down with Teresa, me, and the family and started to go over the likelihood of a surgerical removal of the vegetation.

Simply put, the mass was big and Ava was more at risk - - especially if the vegetation released itself from the heart and traveled elsewhere like her lungs.

After a difficult discussion and reflection, Teresa and I gave consent for the surgeon to perform the second open-heart surgery in one week. Though the risks for surgery were stacked against her, Ava's initial congestive heart failure was mostly resolved at this point from the first repair surgery. Her heart function, lungs, and renal stability convinced the surgeon that this was the right thing to do and that Ava could handle it (and that it was the right thing to do).

After about two hours and some change we received word that the surgery was a success on many levels. First, they were able to remove the vegetation from her heart (we actually got to see it in a biopsy container) and second, they discovered that the wound from the first surgery was infected underneath the skin's surface (which probably was the culprit for the septic shock in the first place).

Though the surgery was a success, the next 24 hours are absolutely critical. The PICU staff will continue to fine-tune the medicines to ensure that Ava does not work too hard to function (heart beat, respirations). It is most likely that she will remain in the PICU for a long period of time.

The outlook is that each day will bring its own set of challenges for Ava and us, but the hope is that after about six to eight weeks of antibiotic treatment the infection should be successfully defeated and we can start to enjoy watching a healthy Ava grow and possibly go home for the first time since 12/16.