Friday, February 27, 2015

Mechanical Valve Issues

Please excuse the big ugly head IV. It may not look like it, but Evanna is looking/doing soo much better.

Evanna's transfer back to the Stollery Hospital here in Edmonton went very well. They just kept her very sedated, paralyzed, and bagged her the entire way.

Nick and I arrived around 9pm and they were rounding on Evanna when we walked in. They continued to keep her on a heparin infusion, and played around with the epinephrine, norepinephrine and milrinone levels (drugs that help the heart pump). Dr. Guerra stated that she had been paralyzed for the transfer, so he was surprised when I told him that Evanna had in fact been paralyzed for the past 48 hours. The goal was to keep Evanna as stable as possible during the night, but Dr. Rebeyka was aware that if things took a drastic change during the night, he would come in to do something about it. Nick and I left around 10:30pm and checked in at the Days Inn hotel. We're currently on the waiting list to get back into the Ronald McDonald House, but we're not sure how long that'll take.

This morning we found out that Evanna had a great night. They've restarted Evanna on dexmedetomidine and midazolam, as well as up her hydromorphine (these are all types of sedation medications). Though Evanna is on a LOT of sedative medications - she still wakes up, no longer has to be paralyzed and is much more content. She even smiled at Nick this morning, and it was just so good to get a glimpse of our baby girl.

They did initially book Evanna for another bronchoscopy, but a few things have come up, and those plans are now on hold. They took her to the cath lab for a fluoroscopy, and it revealed that BOTH leaflets of her mechanical valve are not moving/working. Originally we thought it was just one leaflet not working, but now we know it's both. They're stuck open, so blood is able to get through, but it's still a scary situation.
Dr. Rebeyka, the intentivists, and Kid Clot (hematology) decided that they would really like to avoid a THIRD open heart surgery. Instead there's a drug called TPA, and it's essentially a "clot buster", HOWEVER, there are also so major risks involved with this drug (brain bleeds, etc), so my nerves are at an all time high at the moment. They just began running it, and it will take about 6 hrs to run its course. Tomorrow they will take her back to the cath lab and do another fluoroscopy to see if the TPA worked. If it doesn't, then they may have to do another open heart surgery to replace the mechanical valve.

So why did the mechanical valve stop working? Well it appears that here heparin levels dropped significantly in Calgary and weren't within therapeutic range anymore. This caused a clot to form on the valve and the leaflets to stop moving. Thank goodness they stopped in a more open position, allowing blood to still go through the valve, but it's still been a scary few days.

Though it kind of sucks that Evanna had to be retransferred back up to Edmonton, Nick and I feel so much more comfortable here, and can relax a little knowing she's in good hands.
Thanks for continuing to follow along,

xo The Irvine Family


  1. How did they not know the heparin wasn't therapeutic? It's supposed to be checked at least daily when on a drip!

    1. Looking back I totally used the wrong wording here. She was on enoxaparin (so not on a drip, but the shots) and her INR level dropped.