hypoplastic left heart

[littlepeach]

So my best friend's baby has hypoplastic left heart syndrome. He survived his first surgery on Thanksgiving. He's doing fantastic. His mom is awesome. He is scheduled for his second surgery next month. Although I am a NICU nurse, I don't care for heart babies in my hospital. Anyone with any suggestions about how I can prepare her for his second hospital stay? She is well informed and calm. Is there anything different with the recovery from the second surgery she should know. Dr's can only tell her so much, so I am turning to the experts for advice!!:heartbeat

[SteveNNP, MSN, NP]

Hey,

I work at a center that does keep pre and postop cardiacs in the NICU. We don't ever have babies postoperatively from the Glenn procedure, which is the 2nd stage of the repair. (Norwood-Sano,> Glenn, > Fontan)

I would imagine it to be very similar to the Norwood. Although I've never seen a postop Glenn, so I don't know. This might be something that someone in the PICU forum could answer, as PICU/PCICU always handles these patients...

[TiffyRN, BSN, PhD]

I might suggest you browse the PICU forum a bit. The PICU staff is more likely to deal with children past their first surgery. I know there are some long-term PICU nurses that I'm pretty sure have extensive experience with the many stages of LHH repair.

We welcome when they visit with us and give advice on such things.

[NotReady4PrimeTime, RN]

I've looked after quite a few babies post-Glenn. The immediate post-op period is pretty similar to that of the first stage (Norwood-Sano), in that the baby will have a chest tube, pacing wires, central line, arterial line and may or may not be intubated. Very occasionally the baby will come out with an open sternum, but it isn't that common. They're often more stable post-Glenn than they are post either Norwood or Fontan although they will still saturate in the 80's. The Glenn shunt connects the SVC to the right PA and disconnects the SVC and right PA from the RA. This creates a passive circulation from the head to the PA and can cause significant congestion in the head with associated headache. The kids do better with early extubation because of this passive return and the pressure shift, because positive pressure ventilation decreases cardiac output by impeding preload. They are usually most comfortable semirecumbent and not supine; they're virtually all rather... irritable until the adapt to the changes. The last several Glenns we've had on our unit have been rapidly extubated and very stable, ready for the ward in only a few days. I hope your frined's baby is one of these.