Bruce's ASD saga

I have scattered hyperlinks (the highlighted, underlined words) throughout this epic. If you click on them, they will take you to other sites that will further explain some of the details. Although you are, of course, under no obligation to use them, I highly recommend them to anyone who wants a better understanding of what's going on! Okay, I am finally going to write out the recap of our adventure. I will skip the background, assuming that most of you have already heard/read about it -- if not, look back in my May/June archives to get the full story! We went in for Bruce's ASD device closure Wednesday, July 18th. They got the heart cath in and went in with the balloon to measure the hole precisely, and found that it was even bigger than they had thought. They didn't have a big enough device to close it up, so they pulled out and put him into ICU overnight. Another Atlanta hospital had two bigger devices, so one of the doctors went and got them and then they did a second heart catheterization and successfully closed the defect on Thursday, July 19th. Here are the details on the device: It is called an Amplatzer device (click on that link to see the device, and then click here to see an animated video of the device being deployed -- check it out if you have the time, because it's fascinating). Bruce's device size (and accordingly, the size of his defect) was 36 mm -- as in, just shy of 1 1/2 inches. Isn't that incredible?! The highest off-the-shelf size is a 38, and for anything bigger than that, they typically switch to open-heart surgery. We're thankful that we made it under the wire at 36! Anyway, they have confirmed with chest x-ray and echocardiogram that the device is fitted nicely, with no complications. More excitement came the second night, when they took out the second catheter sheath. (As an aside, the cath-sheaths they use for device closures are bigger than the ones they use for other heart caths such as angioplasty, stents, etc., and Bruce's second cath-sheath was even bigger than his first one!) They put the cath into a vein in the groin, and then after the procedure, they have to wait until certain blood levels are in the proper range before they remove the cath sheath (which looks like a hard plastic drinking straw). The first day's sheath removal was very painful; the second day's sheath was even larger than the first day's, and the cath site was a fraction of an inch from the first one, so the area was already bruised and painful from the first day. As if this isn't enough pain for one person, when they pull the sheath out, they have to apply tremendous pressure at the cath site to help prevent bleeding (necessary but nasty!). In short, the excessive pain, combined with all of the other physical stress factors of the whole ordeal, caused a vagal reaction (aggravation of the vagus nerve causes heart rate and blood pressure to drop); that is, his blood pressure dropped (to 74/42!), he was fighting losing consciousness, etc. (we found out afterwards that patients are supposed to be given pain medication prior to the sheath removal...Bruce didn't get any either time...suffice it to say that the nursing staff in his ward left much to be desired!) It was a tense little while until he was stabilized again, and it left him wrapped in blankets and towels with his teeth chattering so hard that they were knocking together (which gave him a grand headache and sore jaw the next day!). After the chest x-ray and echo showed everything to be okay, we were able to come home on Friday, July 20th. Now they will follow him as they wait for the heart tissue to grow around the device -- this usually takes 6 months-1 year to happen. The doctor said it will probably take a couple of months before the right-ventricular enlargement starts to reduce; they are unsure whether there will be any reduction in the right atrial enlargement. ...which brings us to our next piece of excitement. Bruce has gone into atrial fibrillation (a-fib) three times since the surgery. As long as that right atrium is enlarged, he is at risk for a-fib -- we knew that prior to the device placement -- but he has never had this many episodes this close together. Thursday, the cardiologist put him on a beta-blocker to try to discourage the a-fib (there is no great medical option to prevent a-fib; the anti-arrhythmia medications have some nasty potential side effects)...but Bruce went into a-fib again last night. He is on medication to keep his heart rate down, as well as on Plavix and aspirin for clotting, but they may have to put him back on coumadin (warfarin) as well (the main risk when he goes into a-fib is formation of a clot that could result in a stroke, heart attack, or pulmonary embolism). We will have to wait and see how this all plays out -- either he will just have to live with the a-fib for the rest of his life, or perhaps the Lord will see fit to reduce that right-atrial enlargement! There was also a minor complication with the cath site continuing to bleed, but that has finally closed up and isn't causing any more issues. The bruising is starting to fade now and Bruce is starting to get a little more mobility every day (though he still walks like a wooden soldier!). So there you have it...a very dramatic way to do things, don't you think?! Bruce isn't usually dramatic, so I've been teasing him that I must be rubbing off on him. :-) Thanks to all of you for your encouragement, best wishes, prayers, etc. It has been so nice to see love expressed from so many people via blog comments, emails, notes, phone messages, visits, meals, offers to help, etc, throughout an ordeal like this. God is so good. He has met our every need and sustained us with a strength and faith far beyond our own. We are very grateful that He allowed us to become aware of Bruce's heart situation prior to a more life-threatening event, and that He kept Bruce safe throughout the many aspects of this device placement. We so clearly see His hand in our lives...