
These are good pictures to go with a cardiology update for James! We checked in with his cardiologist today for a run-of-the-mill echocardiogram and EKG. We hadn't done an echo for a year, so it was important to get good images. I was fully anticipating James to have a very hard time sitting for the echo. H doesn't like strangers, but he loves to say NO as emphatically as possible before crying and refusing to do anything, even things he would normally like. He can be very stubborn in this sense, and given that echos require an invasion of space, strangers, and touching, I did not expect any success....I expected to have to schedule an out-patient echo under sedation. You can imagine my shock, then, when James ONLY cried to get his weight checked. He sat perfectly still for his blood pressures-all four! He sat perfectly still during the EKG and even helped peel the stickers off! And yes, he sat perfectly stick for the entire echo-about 45 minutes, on my lap, eating the plethora of snacks I had packed, and watching Elmo (though he never watches TV). He just impressed me to all ends, even when I had to crane his neck way up towards the ceiling,-he didn't care, just kept commenting on all the lights that were either working or broken. So proud!

So the good news of the visit: no issues with his coarc, or with his ASD, or even with the potential issue with his mitral valve. Though the pressure through that valve is ever so slightly higher than it should be, it is not enough to even be on the table. All good news!

The not so great news: James' aortic valve is doing worse. His pressure gradient last time was around 25, which is fantastic-the lower the better. It was in the high 40's when he was released from the hospital after heart surgery. Today it was averaging between 55 and 60. Now, Dr. Garn was quick to mention that there were moments when James' heart was down at that 25-30 range, and he also said it is hard to get good images of James' heart with his bone structure. Regardless though, the fact of the matter is his valve is in fact worse, and its the first time it has been worse since surgery. :( We knew this day was coming, and to some degree, I still felt like I was being hit with a mack truck (or whatever the phrae is). Dr. Garn clarified for me that we were not in emergency mode, even with the worse numbers. But it does mean we need to change our plan of attack and begin to consider future options.

So the plan now is to forgo our normal 6 month appointments/yearly echo, and come back in 4 months to repeat the echo and EKG. If the numbers are the same, chances are likely we will ride it out another 4 months and repeat the echo again. If the numbers are worse, we will move forward with surgery, which could mean one of two things. We will either do a balloon via catheterization, which will give us a ton of information about his heart along with ballooning open the valve, thus buying time; or we will do the full valve replacement, which would require open heart surgery again. The balloon is temporary, but less invasive. The valve replacement is obviously very invasive, but would be permanant at least until James gets into his teenage years and needs the artificial valve replaced to match his growth. After chatting with Dr. Garn, it seems much more likely that they will balloon first, since that will give him much needed information regarding what James' heart actually needs. The only way we would move forward with valve replacement is if his heart gets significantly worse in the next 4 months.
So.....yeah. Its hard to wrap my mind around this, and yet I am grateful I have time to do so. Last time was so rushed and hurried-I couldn't think, much less consider options, second opinions, and preparing. This time around, I am already considering how I can prepare James mentally and emotionally for heart surgery, who we will get a second and probably third opinion from, and how we will balance family and work to accomodate a huge surgery/recovery. Even with these thoughts on my mind, I also realize there's no point to worrying or stressing until we see what the next echo shows in 4 months. I am on the watch right now for any red flags from James that might indicate he is struggling-mostly more frequent fatigue during play, a greater desire to nap at odd times, etc. Otherwise though-I know I need to stay level-headed while being practical about what we can do to be prepared. Part of me wants it over with; part of me wants more time; all of me wants none of this for James, but that's not what we were dealt, and for the most part, I'm okay with that.

This is a good image to end with. I love James' beads of courage. I have started to talk to James about it, about his "heart line", and about his little heart bead. This is such a good reminder to me that James is so very strong, and there is so much hope in family, our amazing medical team, and the Lord. It gives me and our family courage to press forward, even if its into the unknown. I'll just focus on keeping the faith and praying for continual strength.