The Other Other Shoe

As the parent of an extremely premature infant (or, I imagine, of any baby who's had a particularly rough start to life), you spend a lot of time waiting for the other shoe to drop. In my case, when I'm feeling particularly sorry for myself about the run of bad luck I've had in the childbearing department, I think of it as the "other other shoe". The other other shoe reared its ugly head on Friday, when Mark and I brought Peter to his follow-up appointment with his cardiologist, Dr. Ra Han, at St. Mike's. You see, dear reader, when Peter was in the NICU, he was identified as having a small patent ductus arteriosus (PDA). The ductus arteriosus is an artery involved in fetal blood circulation. Because a baby in the womb gets oxygenated blood from its mom, it doesn't need to oxygenate blood through its lungs (i.e., breathe). So, in fetal circulation, the ductus arteriosus diverts blood away from the lungs to the rest of the body. Once a baby is born, the ductus arteriosus begins to close. However, in some babies, and especially in premature babes, it remains open or partially open, called a "patent" ductus arteriosus, or PDA. Here is what a PDA looks like, compared to a normal heart (diagram is from the U.S. National Institutes of Health): The problem with a PDA is that some oxygenated blood gets mixed in with the deoxygenated blood in the pulmonary artery, where it is pumped to the lungs and, essentially, reoxygenated, rather than being pumped out to the rest of the body. In other words, to the extent of the diverted blood flow, the heart is doing double the work. This can put strain on the heart and lead to congestive heart failure. So, dear reader, as I was saying, when Peter was in the NICU, he was identified as having a small (about a mm) PDA. Since his PDA seemed to be asymptomatic (i.e., he had no signs of congestive heart failure), and since he did not respond to the use of drugs to help it close, Dr. Han decided that the best course of action was to do nothing and wait for it to close on its own (which it usually does). She scheduled a follow-up for three months from the time Peter was discharged from Sunnybrook to level 2 care, which then seemed a lifetime away. Until now, we had been hopeful that Peter's PDA had indeed closed on its own, and all of his doctors at St. Joe's had assured us that they thought it had. In fact, Dr. Han also assumed that was the case when she examined him on Friday, but performed an echocardiogram (which is an ultrasound picture of the heart) to be sure. As it turns out, the PDA is still there. This means that, for now, Peter still needs to be monitored. If he starts to show any signs of congestive heart failure (e.g., he has trouble eating or gaining weight), or if the duct doesn't close on its own in the next six months or so, then he will need to have a procedure to close it. The good news is that, now that Peter's a little bigger, that would not mean surgery. Rather, the PDA can be closed through a non-invasive procedure whereby a catheter is inserted up through the groin into the heart, as explained here, on the Sick Kids website. All of which is to say, dear reader, that it looks like this is not the other other shoe just yet. It's just that it stinks just a little bit to know that you have to watch your son for signs of something as scary-sounding as congestive heart failure. It also stinks to know that Peter's little heart is, to some extent, working twice as hard as it needs to. As if he didn't have enough to worry about.