I thought it might be helpful to give some insight in to Finley's heart condition and what she is having surgically repaired on Tuesday.  Finley was born with a congenital heart defect called Tetralogy of Fallot.  It is actually one of the most common congenital heart defects and the prognosis after repair is usually quite good.

Well what is it?
Tetralogy of Fallot, a condition present at birth, is a combination of four ("tetra") heart defects.  I still remember the doctors sitting us down on the evening of August 9th after doing what seemed like an all day echocardiogram and telling us what the name of this condition was and that it was characterized by FOUR defects.  FOUR?  Isn't one enough?  Anyway, I digress.  The four defects cause several problems and usually cause the skin to turn blue due to poorly oxygenated blood.  This is actually why they called the transport team to pick up Finley and bring her to Childrens - she had a bluish-gray tone to her.  I will also never forget, when Mike and I walked into the NICU that day, I asked the cardiology fellow that was doing the echo what she was looking for - and she told me - very matter of factly - she was looking for a "blue baby disease" or in other words a defect that causes cyanosis - the condition of having that bluish pallor.

The four defects associated with Tetralogy of Fallot include:

1) A hole in the heart wall between the lower heart chambers (ventricles - called a ventricular septal defect or a VSD) that causes oxygen -rich blood and oxygen-poor blood to mix.  Finley has a large VSD that will need to be closed.  And, as a bonus, she also has an atrial septal defect - ASD - which is a hole between the upper chambers (atriums) of the heart).

2) A narrowed or blocked passageway between the lower-right heart chamber (right ventricle) and the main blood vessel leading to the lungs (pulmonary artery- infundibular stenosis) that causes reduced blood flow to the lungs and requires the heart to work harder.

3) A shift of the main blood vessel carrying blood to the body (aorta) to the right that causes oxygen-poor blood to mix with the oxygen-rich blood (overarching aorta)

4) Abnormal thickening of the muscle of the wall of the lower right heart chamber (right ventricular hypertrophy)

So how will they correct this?
The surgery is an 6-8 hour procedure that involves the closure of the ASD and the VSD with a patch (which is actually Gortex) so that the blood can flow normall from the left ventricle to the aorta.  The narrowing of the pulmonary valce and right ventricular outflow is then enlarged by a combination of cutting away obstructive tissue in the right ventricle and enlarging the outflow path with a patch.  The hope is that her pulmonary valve will be salvagable - meaning not too tight so it can be widened enough to allow proper blood flow but won't leak.  If the valve is too tight, they will attempt to cut the valve open and put a patch in to make it wider (as previously explained).  The third option would be to put in an artificial valve if its too tight to salvage.  Either of the last two options will mean that Finley will eventually need to have that valve replaced - fortunately this can be done through a catheterization process vs. another open heart surgery.

The interesting thing about the repair and Finley's condition is that they only actually repair two of the four defects.  The act of closing the VSD will correct the overarching aorta and the procedures in total will allow the parts of the heart to do their jobs equally and will, over time, correct the hypertrophy of the one side of her heart.

During the procedure, Finley will be put on the heart/lung bypass machine, her heart will be stopped and the machine will do the work of the heart.  The process of getting her up on the bypass machine and then back off is actually what takes a considerable amount of the time she is in surgery.

Finley's surgeons Dr. Backer and Dr. Russell are the same doctors who performed Finley's first open heart surgery and are two of the best doctors in the country.  We feel very fortunate to have access to such wonderful physicians and know that she will be in the best hands possible.  Finley should be the first case on Tuesday morning so I hope to have some updates by the afternoon or early evening. 

Please keep Finley in your prayers.