Wednesday, February 25, 2009

Additional MRI post

This is not Penny's heart but gives an idea what the MRI looked like.
I was really blown away by the detail that the MRI showed. I can go through some of the things that Dr. S was looking at in this scan, because she was awesome enough to take Scott and I into a little room after the scan and walk us through the pictures. It was just really incredible. Since the scan is captured in three dimensions, there would often be 2 images on the screen. The images would be the same on both sides and then with a couple of mouse clicks to rotate the axis on one side, the other picture would coincide by bringing up the picture of a different cross view. Just really crazy stuff.

I was told by Dr. S that she checked out the size of Penny's right ventricle. One of the components of ToF is right ventricular hypertrophy. This is basically an enlargement of the muscle on the right ventricle. The reason for the enlargement is that this pumping chamber has to work so hard to get the blood where it needs to go if the pulmonary valve is defective or nonexistent,. When you work out a muscle it gets bigger, right? When Penelope had her repair surgery in December of 2007, the surgeon actually cut away some of the muscle tissue because it was getting a little out of control! Excess muscle tissue puts a strain on everything. It was a relief to know that the RV (right ventricle) was in fine shape because it means that the donor valve and conduit (donor artery or homograph) are working as they should be. There were no signs that her body was laying down calcium on the tissues. Also, the scan was able to measure the flow of the blood through the valve. Just amazing! It showed that the flow out of her RV was 20 ml per second (I am guessing second was the measurement of time here) and her back flow was barely over a ml. Some back flow is going to happen, I have been told. You just can't perfectly recreate God's system here. But 1 to 2 ml is something that anyone can live with.

This MRI scan was initiated because Dr. S could not get a good read on the condition of her branch pulomary arteries from the cardio echocardiograms. We were able to see in the images the large "patch" put in by the surgeon to funnel the blood out of her RV and into the donor valve. In a normal heart, the valve is partially inside the heart, like an exit door. From the valve, we could see the nicely sized conduit that was then connected to her branch pulmonary arteries. The arteries both measured a wonderful 7.3 cm or so. This is an ideal size for her and is actually close to the mean for children of her size. (well, compared to the data that has been collected). This was just wonderful news to hear!!! We do not have to go back to see Dr. S until November as long as there is nothing that concerns her from the scan. Dr. S still needs to take the time to review all the data she got from the imaging this morning, but she did not anticipate any surprises.

When Penny and I first got into the MRI department at 6:30, my baby girl was still pretty happy and sociable. We did have to wait until close to 8 am before I was able to take her into the receiving room. As I said previously, I had to quickly get her into her johnnies and then I was asked to follow the anesthesiologist into the imaging room. I had to sit her down on the bed and hold her while he put the gas mask on her face. After about one minute or so of her struggling to get the mask off, she had breathed enough of the gas to make her seem out. I know my daughter and I knew that she was not out just yet so I held onto her as the dr. turned away with the mask. When she began to talk again, he turned right back around and said "oh, I guess she isn't there yet!" So he masked her again and after another minute she was finally O-U-T. But she was so funny, even out like that, she managed to hold her leg up and then bring her foot close to her face. The 4 of us in the room thought that was soo cute.

A little after 10 am we were finally told that she was done and we would be able to see her "in a few minutes." About another twenty minutes later, we were told that it wouldn't be much longer now (I love how hospital time is so much longer than real time. 5 hospital minutes = 1 real time hour) As we were heading back to see her, following the sound of her cries, the anesthesiologist muttered something along the lines that they don't need that IV anymore anyway. As Scott and I looked to her wrist we noticed a good amount of blood. The bad baby that she is had pulled out the IV as soon as she could. But oh was she mad. I hate those scratchy cries from the dried out throat. They also needed to take peripheral blood pressures on all 4 extremities. This was a pretty impossible task considering her thrashing around and how upset she was, but the nurse did her best.

Soon I will post the few pictures I took of our event today. I am just so glad that it is done with!


Melissa said...

WOW, that's just so amazing. WELL,SIGH, it's over & done with...poor thing! Now, let's just wait for those answers;)

Please give Pretty Penny big smooches from the both of us!
love U!

Lynne said...

That is truly amazing! you can see everything so clearly! I'm so glad that everything looks good but then again...I knew she'd come out sitting pretty...she just has too much energy to be having problems.
Love her (and you, too!)

Michelle said...

That's great to hear that you received good news from the MRI!