Less than 24 hours we'll say bye, bye to SAM

No offense to anyone named Sam but we are looking forward to getting rid of SAM (sub-aortic membrane) tomorrow with surgery at Texas Children's scheduled for 12 pm.

The following article (Thanks Casey!) is the best description of the procedure that I've seen but beware it's from a medical journal so it's technical and it has graphic pictures of the heart.

http://mmcts.ctsnetjournals.org/cgi/content/full/2007/0723/mmcts.2006.002303

It also mentions that the most likely cause of the membrane (some cardiologists might debate this though) is a result of the angle between the aorta and left ventricle. The theory is that this membrane actually developed from the heart trying to heal itself as the membrane formed in order to protect tissue that is not supposed to be in the path of the high pressure blood flow entering the aortic valve. The article also mentions the removal (myectomy) of the muscle tissue around the membrane that Dr. Heinle says can reduce the likelihood of SAM growing back from 30% to 10%.

As long as things go well tomorrow after Jake stabilizes his mean arterial pressure ((SysBP-DiaBP/3)+DiaBP)) should decrease which corresponds to an increased velocity through the aortic valve. Hopefully, with this pressure decrease the regurgitation through the mitral (valve repaired last surgery which Dr. Heinle will also inspect) and aortic valve will decrease. How much aortic regurgitation remains after surgery is an early indicator of how likely future surgery/surgeries might be in order to repair the aortic valve so we're hoping for zero aortic reg.

We should also be able to immediately hear a difference in his heart. Right now instead of the "lub-dub" sound of a healthy heart Jake's "lub" sound (valves between atria and ventricle closing) is a bit muffled because of his mitral valve reg. and the "dub" (valves in the pulmonary & aortic artery closing) sound is a big "swoosh". It actually sounds like a stream of water from a garden hose being put through a nozzle.

However, it's not in knowing the details of what's going to be done tomorrow that is giving us peace but only because of the all the prayers and support from family (both sets of parents/grandparents will be here), friends, and even those we don't know. We literally have friends from New York to California (with a big concentration in Oklahoma) praying for Jake. There is also a group of ladies at my work (I call them my underground prayer network friends) who are meeting to pray for us today and tomorrow at 9 am, a couple of groups at the Pentagon and Department of Defense, and a group from the M/V Pacific Link Mercy Ship currently in New Zealand. There is also a big group of young families at my sister's church in Fort Worth praying. They made and are wearing blue "Pray for Jake" bracelets this week and sent this picture in last night.

We are thankful for all the prayers and have learned and relearned how much of an honor it is when someone says that they are praying for you. Please keep them going for the next few days. The surgery is expected to take 5-6 hours (3.5 or so on bypass) and then we'll have about 48 hours in the CVICU which is a critical time period especially after a second surgery. We'll try to keep the blog updated as time allows so please check back for info.

I also would like to say thanks to Amy for marrying me 7 years ago today. It always seems like the dates of these medical experiences is close to or on a birthday and now our anniversary. Jakes first surgery was on Amy's birthday and my heart cath. was done on my 21st birthday in preparation for surgery 3 days later back in 1996. I promise we'll have a better anniversary next year and hopefully it won't include being tied up at Texas Children's for pre-op stuff.