Miz Hot Ta' Molly

Technical Update

....big thanks to Uncle Matt for the details...

Grandma Dianne asked me to submit a more technical medical description of things going on with Molly, so here goes.

On Tuesday, after learning that Molly was at Sutter Hospital, I was able to leave UC Davis Hospital to go see her. When I arrived the pediatric critical care doctor was in the midst of dealing with the crisis that was Molly Groh. He let me see the initial labs and gave me a brief update, his working diagnosis was septic shock. It was not easy keeping a poker face when I saw her initial blood gas analysis. She was in critical condition for sure, but by the grace of God or pure luck the doctors at Enloe sent her by air not by ground because she may not have made it to Sacramento. She was in severe shock, with a pH of 6.8 (normal is 7.4) anything below 7.1 is severe and at levels below 7.0 organs begin to fail and fatal cardiac arrhythmias can occur. However, she was responding to the aggressive resuscitation efforts and was hemodynamically stable ! on the ventilator a drug called dopamine.

The next morning heralded good news as I received an update on Molly’s lab values. Her acidosis, coagulopathy, electrolyte abnormalities were corrected. Thank you Dr. Dicarlo! She looked great on paper, but when I went to the hospital two hours later it was clear that something was wrong. When they tried to wean Molly off of the dopamine she became unstable again. This prompted the echocardiogram (ultrasound) of the heart. It then became clear that Molly had been in cardiogenic (heart) shock and not septic shock.

She was diagnosed with coarctation of the aorta (narrowing of the main blood vessel that carries oxygenated blood from the heart to the rest of the body) with a ventricular septal defect (VSD). Alprostadil was begun to reopen Molly’s ductus arteriosus (small vessel that helps oxygenated blood from the placenta bypass the lungs in utero) this “unloaded” the pressure on Molly’s heart and allowed her to be taken of the dopamine and ventilator.

Well, Molly needs a permanent fix !

So, now on to Stanford for her heart surgery. In terms of complexity of congenital heart repairs, Molly has a technically easy repair. However, it is still open heart surgery.

All medical institutions do things a little differently so I’m speculating a bit but in essence this is what will happen. Molly needs two repairs the VSD and the coarc. She will be given a general anesthetic, reintubated, and lines placed by the pediatric anesthesia team. The surgery will then begin most likely a sternotomy incision and she will be placed on cardiopulmonary bypass for the VSD repair. They will give her cardioplegia to stop her heart, open it up, and place a small artificial graft over the hole. They will then close up the heart and either repair the coarc with the bypass machine still going or do what is called circulatory arrest. This is where the induce hypothermia (cool her down with ice) and stop the bypass machine for a short time. The coarc repair should be a simple primary anastomos, meaning they will simply remove the narrowed portion of the aorta and sew the two ends back together. She will then be rewarmed, her heart will be restarted, and she’ll be taken off of the bypass machine. After surgery she will remain intubated (breathing tube in place) initially and in the intensive care unit for a few days.

She is so strong I would be surprised if she doesn’t bounce back from the surgery very fast. Remember that she survived the severe shock and that is with a heart that is still not working at 100%. After the surgery her heart will be repaired and theoretically she should have better function than before the surgery.

So there we go. Here is a link to the NIH article about coarctation, http://www.nlm.nih.gov/medlineplus/ency/article/000191.htm

I provided some technical terms for people to Google as the see fit.

We are all looking forward to continued good news in the days to come, and have enjoyed having the Groh boys stay with us. Our Grow boys have been having so much fun with their cousins and will miss them dearly.

Love to all and if anyone has questions call me at any time.

Molly’s Uncle Dr. Matt