Sorry for the delay in update. We had a lot go on over the past few hours. The surgeons were able to implant the arterial line in his right wrist. They worked on that first. They had originally tried to put it in his left wrist but couldn’t find a vein large enough. That delayed things a little. The important part was they got it in.
They then moved on to work on closing up his sternum. That for the most part went well. They inspected the outer appearance of the heart and from everything they could tell it looked good. They were able to place the sternum back together and suture him back up. Normally they would have cleaned him up and the procedure would have been through. The head transplant surgeon decided to perform a chest echo just to take another look at the heart function and to make sure that things were progressing as they should. When they preformed the echo they found something. There was a clot in the right atrium of the heart close to where the superior vena cava artery enters the heart.
They came out at around 5:50 and want permission to perform a bronchial sonogram of the heart. The cardiologist uses a special sonogram probe to enter his esophagus and travel down his bronchial tube to get a very up close and clear view of the heart. The cardiologist discovered that the clot that they found was sitting right where some older arterial sensing lines enter the heart. There arterial sensing lines help take certain pressure of that particular atrium. The sensing line was installed with the transplant and was more than likely going to stay there until he was transferred out of the ICU to the recovery floor. It is not uncommon for blood to clot around a foreign object in the body. Typically blood doesn’t clot that fast (but who are we to call any of this typical).
The surgeons have really studied the area and have determined that the clot is not infected and that the clot is not posing an immediate danger to Keegan yet. The surgeon says they could take Keegan at a moments notice and remove the clot surgically. They have decided not to do that yet. There is still concern that another open heart surgery could effect or set back the gains that his kidneys have made. They are treating Keegan with a drug called Heparin. Heparin is the same anti-coagulation drug they used when he was on ECMO. This will keep the clot from growing in size. In the mean time they are going to put a new arterial sensing line through the femoral artery in his groin. They are performing that procedure as I type this now. That is all they will do for him this evening besides watching him as on call as they always do. In the morning they will remove the two arterial lines that are in his right atrium (the ones in question). They will also finally remove the umbilical arterial line too (the arterial line they were trying to replace by putting the new one is his wrist).
When the surgeon broke all this down to us she was clearly concerned. She wasn’t so worry that they felt like they didn’t have control of the situation. The clot is not life threatening enough that they feel like they should risk the ground gained by the kidneys over the past week.
New Update: (Maddie just called with another as I was writing this up… didn’t feel like changing stuff.)
The surgeons just came out from attempting to place the femoral artery sensing line. They attempted to place the sensing line in both legs and didn’t seem to have any luck. Rather than to force the issue they are opting to sit back and let Keegan rest for tonight and they are going to address the issue in the morning. They thing that the veins might have either turned a "funny" enough angle that made it tough to sheath it up the artery. Anther reason is the artery it self could have a small clot too (they feel that this is unlikely because there is no real swelling in his legs). Either way they figured the little guy has had a long enough day and they will let him rest up before they plan for something tomorrow.
Good news though… (About time right?) Keegan’s pre-chest closure numbers are starting to come back to normal now that his chest is closed. Keegan’s chest has now been made into a smaller space once they had closed it up. This meant that his heart was working in a tighter area, his lungs had less room to breath, and he had the stress of an operation. His heart rate has started to come back down to a normal level, his blood pressure has started to come back to where it is supposed to be, and his blood oxygen saturation levels are coming back up. All of this is good new and a pleasant surprise.
Well… thank you for your patience and support. Keegan really has been living off the prayers and well wishes. I will keep everyone updated on tomorrow’s events. In the meantime Maddie has the watch so Keegan is in good hands… you can all get some rest.