2nd Fetal Heart Echocardiogram Results

Whew! What a LONG day! I'm going to do my best to translate what the doc said, but it was hard to follow him at times! We were glad when he noted right off the bat that Liam was in the best possible position for the echo, and he was asleep, so he was able to get really good pictures of the most important things. The first thing he said when he came back into the room after interpreting the echo results was that he was encouraged.

If you'll recall the last echo showed Liam had borderline HLHS with small measurements on the mitral valve, aortic valve, a possible narrowing of the aorta (which might lead to coarctation of the aorta), and a possible VSD (hole in his heart). Today we were looking to see if any of these problems had corrected themselves. The primary thing the cardiologist wanted to see was that the left side of Liam's heart had continued to grow and develop.

So, the first thing he noted was that the left side of the heart still has both chambers (so we still have a 4-chamber heart). This is good, because if it hadn't grown or if one or both chambers had closed, we would have a full-blown case of HLHS. We are still looking at borderline HLHS, but now we've been given only a 30% chance that Liam will have full-blown HLHS at birth. The left side of his heart is still smaller than the right side, but is functioning.

His mitral valve is currently measuring 7 mm, and at birth, they want it to be at least 8mm. His aortic valve is currently measuring 4 mm, and at birth, they want it to be at least 4.5-5.0 mm. He said it is entirely possible that they can achieve that kind of growth over the next 6 weeks. This places Liam at the 5th percentile for both valves. That isn't ideal, but if they continue to grow, they might be functional at birth. The leaflets on his aortic valve are opening and closing normally, which is a good sign. IF these valves are functioning and measuring within acceptable limits at birth, the cardiologist will check them periodically to ensure they are functioning as Liam gets older. If they fail, they will need to be replaced at some point.

On to the aorta: We are most likely looking at a coarctation of the aorta (70% chance), and this would have to be fixed surgically within the first week of life. The best case scenario would be that they would be able to go in from Liam's side to fix the aorta and not have to put him on a bypass machine. If it's a more severe coarctation, they will have to do open heart surgery. We won't know until he's born how bad the problem is, because you can't see part of the aorta that might be a problem on a fetal heart echo. You have to wait and do an echo a few hours after he's born to get good pictures of that area of his heart.

The VSD (hole in his heart) has disappeared. At the last echo, he couldn't tell if there was a VSD or not. Today, he couldn't see any. He did say this only rules out a large VSD--a small or medium VSD might not be visible in a fetal heart echo.

Liam's heart problems now resemble a condition known as Shone's Syndrome much more than HLHS. That's a term used when a baby's heart is showing multiple issues but doesn't fit criteria for HLHS or another congenital heart defect. We won't know the extent of what Liam will need until he is born, but we do know we are looking at some type of heart surgery in the first week of his life (unless God intercedes and performs a miracle in the next 6 weeks, of course!).

The plan at this point is that Lisa will get to spend a few minutes cuddling with Liam in the OR right after the C-section, and then he will go with Bill and Dr. Liske's cardiology team to the NICU at VUMC. As soon as he's stable, he will be moved to the Vanderbilt Children's Hospital NICU, where he will have various tests to determine his exact diagnosis. Lisa will continue to recover at VUMC. Lisa is NOT happy about learning this, but it can't be helped. This means that Lisa will not see Liam for probably 24 hours after he leaves the OR. Granted, the two hospitals are connected by a walkway, but we joked that a golf cart was really called for to get from Lisa's room to the NICU at VCH.

Although we realize that it was necessary to tour the NICU to prepare ourselves for what lies ahead, it was a very difficult tour to take for both Bill and Lisa. We were actually doing pretty good after the echo appointment until we toured the NICU and all the areas we would be moving to and from and between during the first couple of weeks this baby is alive. Frankly, that was just depressing and overwhelming.

We are doing ok at the moment. We will post more updates as we remember more information. It's a lot to absorb and then try to explain to others, but hopefully we've made it as clear to you as it is to us. Please keep the prayers coming--we know God is providing the strength we need to both of us as we deal with each "next step" in this process.

Bill and Lisa