Well, that didn't last long. Sky is running around and I can't keep her still. She's also eating everything in sight! I feel like all I do is tell her to stop jumping and make her food. It's never ending. It just amazes me that she had surgery 9 days ago, a 7 hour surgery to boot.
I don't think I explained what happened during her surgery and why we have to be careful about moving her left arm. During the surgery the Doctor had trouble getting her lead into the proper position because Sky's veins are too small. It's difficult to explain without showing you a picture but the vein (coronary sinus) that runs along the hearts muscle was the problematic area. The lead had to go in a certain amount in order to sit properly, and if I understand correctly, exert a certain amount of pressure on a part of the lead that activates the coiled tip. The coiled tip is what keeps it in place. If the lead slips out of position even a little bit the part that keeps the coil, well, coiled, will fail and the lead will straighten and fall completely out of place. I probably didn't explain that very well, sorry. Anyway, the doctor is worried that since he couldn't get that lead in all the way that it will move and Sky will need yet another huge surgery.
I came up with this great idea while talking about the surgery with the doctor. I'm writing it here in hopes that someone will steal the idea and make it happen. The doctor was explaining the pros/cons of the transvenous approach as well as the thoracotomy epicardial approach. The transvenous is less invasive, faster, and easier but not always successful in kids with smaller veins. A small incision is made in the left chest and leads are run down into the heart and attached to the pacemaker, which is placed in the upper left chest wall. The epicardial approach is very invasive. A large transverse incision is made along the rib cage, the lung is deflated, and the leads are placed on the outside of the heart. This approach works best for kids.
Ok, so now that you kinda have an idea of the 2 different approaches...... I suggest a third approach, a hybrid method if you will. I suggest making an incision in the upper chest wall, dropping two leads down into the heart (right atrium and right ventricle). The ventricular lead is the issue. It cannot be placed into the heart (deadly). It must be placed either in the coronary sinus or on the myocardium itself. My hybrid method for the LV lead is a transvenous approach for epicardial pacing. Drop the lead down the vein just like the explained transvenous approach but once you get close to the heart "pop" the lead out of the vein and place the coiled tip directly onto the heart. This could be done (in my mind at least) by inserting a chest tube to deflating the left lung, gently go thru the heart covering and inserting a small instrument (laparoscopy) that could manipulate the lead into place. It is still invasive BUT it is no way as brutal as thoracotomy.... Especially if it's your 3rd thoracotomy! I asked sky's electrophysiologist why this approach isn't used. He paused and told me they don't have the instruments to do it. I told him to get on it and make it happen. So could someone out there make this happen please? You can take most of the credit, just let me be on the research team. Thank you :)
Side note: I'm not suggesting I am the first person to think of this. I have not been able to find any literature on the idea. If you are reading this and thought of it before me, yay for you... make it happen please.
