CAT Scan:The Results Show

Yesterday I described the ideal CT results. Today we got those results, and they were somewhat less than ideal. On the good side, all the major anatomical moves happened as expected....his left lung has collapsed, his heart has moved toward the midline, and his right lung has inflated well. However, his right bronchus is still being compressed by the pulmonary artery. We took a look at the scan results with a doctor, and the compression is quite obvious.

So.....our options are dwindling a bit. Some of the procedures that have been considered and discarded include inserting a stent (rigid tube) into the airway and/or physically lifting and moving the heart by attaching it to the chest wall. There are significant negatives to the stent approach, and Andrew's anatomy won't accommodate physical movement of the artery.

The current state of the bronchus isn't necessarily an awful thing. Obviously it's not as we had hoped, but his right lung is doing well recently, even with the compression. Moving forward, that bronchus could grow with his lungs and body, and provide enough airway to allow a normal breathing pattern. On the other hand, the pulmonary artery could grow even larger, compressing the bronchus entirely and cutting off air to his one good lung. People can live with compressed bronchi, but he has the unfortunate situation of not having a "good" lung to back it up.

Speaking of his "bad" lung, the purpose of the anticipated lobectomy was twofold. First, to relieve the compression on his right bronchus, and second, to allow his heart to shift and his right lung to inflate appropriately. Since the compression hasn't been solved by this pseudo-lobectomy (keeping him on his side for three weeks), they want to be especially careful before deciding to remove any portion of that left lung....the benefit is no longer quite as obvious. So, in order to confirm 1) that the left lung isn't doing anything to help, and 2) that it will always cause problems if given the opportunity, they have come up with a new short-term plan of action.

They are going to move Andrew off of his side and allow his left lung to slowly reinflate. They've decided that the best position in which to do this gently is with him on his stomach, so they've rolled him over on his belly. Over the next couple days-to-weeks, his lung should slowly recover from being compressed. During this portion, they'll keep him sedated and paralyzed for maximum breathing consistency. Once the lung is reinflated, then they'll allow him to start waking up again, because we also need to confirm that it can stay normal while he's awake. Assuming it does, then we would be back to where we were a month ago...on low ventilator settings and pushing toward another try at extubation. However, if the left lung hyperinflates at any point in the process...while sedated, while awake, or while trying to extubate...they'll have confirmation that the lung is continuing to cause problems, and they'll most likely remove the upper lobe.

At this point, Andrew has definitely run an uncommon course and has proven himself to have a unique anatomy and relatively rare combination of issues. When we first learned about CDH and the lung development issues that are associated with it, we certainly wouldn't have predicted we'd be discussing removing his stunted lung because it was too large. At this point, the doctors are running out of good options for obvious solutions. There are still a few clear paths toward possible recovery, including the new plan described above. Beyond that, the doctors and surgeons are brainstorming for additional ideas, but there aren't a whole lot of stones left unturned.

We'll see how the next couple of weeks go....we're certainly hoping he responds well to the new position so that they can remove the sedation and let him wake up again...we miss him.