Seattle Cardiac Catheterization

The results are in.

The doctor performed a diagnostic catheterization and wanted to see the affects of different medications on ethan's pulmonary arteries and pressures. They tested room air, oxygen, nitric oxide and milrinone because for some reason Ethan's echo looked better when he was on milrinone but they never understood why exactly. The cath allows them to get a better picture of how milrinone affects Ethan to see "why". Ethan was responsive to nitric oxide (which we already knew from a previous cath) but he did not do well with milrinone. He did not do well because his heart rate went up, his blood pressure decreased and his PA pressures increased significantly so it really shook Ethan up which is why we are now staying the night in the hospital. He's been on milrinone for a large portion of his life so the response was surprising to me but the difference is that the doctor gave Ethan a bolus of milrinone (per testing procedure) compared to a drip that he's usually been on. I am not sure why Ethan responded this way but it's new information for the doctors to discuss.

Another finding was that ethan's PA pressures compared to systemic were elevated (2/3 compared to a normal 1/4). There are multiple factors for the elevated pressures including: a bicuspid mitral valve, injured LV causing poor relaxation, imperfect aortic valve, and aortic arch narrowing around where it was repaired. You can see the narrowing of the aortic arch in this picture. To the right of the narrowing is where the homograft patch was added but the arch may have folded right where the graft was added. In any case, there are several points of obstruction to blood flow and the combination increases the pressures so drastically that treatment by medication may not be enough. The doctors are looking at possibly doing another intervention (surgery) to help. They want to present Ethan's case with this new cath data to the whole team on Tuesday to see what the cardiologists and surgeons think. So I guess more info to come later next week. For now, welcome back to the hospital Ethan!! You get to see all your nurse friends.