Years of Waiting Come To An End: William's Surgery

William is seen by Dr. James and Dr. Chris.

William and his family traveled four hours on a rocky road from Manabi to Guayaquil's Bustamante Children's Hospital.  They drove to Bustamante because William had been diagnosed with a heart defect when he was three years old, but the local doctors offered few solutions.  The result of the heart defect was that he tired easily and had not been able to keep up with his friends at home.  Unlike most children, William has never played a full game of soccer or run down the street at full pace.  During the car trip, William's mother thought that this might be the only chance that her son could live like a normal boy.  

When MKI first saw William in the hospital's hallway, it was immediately clear that his blood was poorly oxygenated because of the blue tint in his fingers and toes.  The question for the medical team, was not if William had a heart defect (that was obvious), but rather if his heart defect was operable.

William hours after surgery

As it turned out, he had a Tetrology of Fallot a very serious condition.  If untreated, 30% of children will die within 6 months, 50% will die within 2 years, and less than 10% will reach the age of 21.  Luckily this is an operable condition.  The procedure would resolve four different heart defects; a stenosis (or hardening of the arterial wall), an interventricular communication (or a hole that allows for blood flow to go between the left and the right ventricles), deviation of the aorta from left to the right, and in the right ventricle, hypertrophy (hypertrophy is a thickening of the muscle wall due to overuse).

The surgery begins with the cutting the sternum, where the rib cage falls to the sides, and the surgical team exposes the beating heart.  The team then works in concert with the profusionist and the anesthesiologist to stabilize the body.  First the anesthesiologist monitors the heart and lungs before the patient is put onto the bypass machine.  The surgical team begins to connect the bypass machine to the vena cava (where blood normally enters the heart) and then the bypass machine is connected to the aorta (where blood leaves the heart).  At this point, the heart is bypassed and the profusionist is operating the bypass machine to keep William alive.  The aneshesiologist is still responsible for the analgesic (pain killer) and aneshetic (sedation) drug administration.

 Beth, ICHF Intern, with William after Surgery

Dr. Gilbert successfully led the three hour operation.  William came into the ICU Monday early afternoon and in the early evening was extubated, where the respiratory tubes and drainage tubes were removed.

William is now resting on the hospital's fifth floor, and with his heart properly functioning he has lost the blue tones in his skin.  Early next week, William will be traveling back to Manabi where he'll grow stronger and soon play a game of soccer.

-Zak Kidd