Day 2 after the Operation

It’s been 55 hours since the operation. Zane is still on a respirator.
We were hoping he would come off the respirator today but he appeared to need another pipe put in him to drain fluid between his rib cage and his organs.

He is on a cocktail of about 7 different drugs ranging from adrenalin for his heart to dormicom for sedation and I think I saw some morphine on the list. I will post a photo of all the drugs being pumped into him on the Gallery website.

So right now there are 4 tubes coming out of his body getting rid of excess fluid. He has an IV on his right wrist feeding him nutrients. He has a rectal thermometer, he has a catheter, he has a thick cable going into his jugular feeding him the 7 drug cocktail.
He has sensors all over his body checking heart, respiration, breathing and heart chamber pressures.

They have a spirit level next to his bed in order to make sure his heart is at the same level as the pressure monitor in order to get an accurate pressure reading of each chamber of the heart.

I know the surgeon is one of the best in the country however he is the worst people person for parents who don’t know too much about this.
His answers to questions are usually one word, maybe 2 and then disappear to help another patient.

We do appreciate that he did such a good job on Zane but I would also appreciate a little compassion and explanation. I guess I will go to the Pediatric Cardiologist who dealt with us Dr Raymond dansky.

While we were watching Zane’s Heart rate went up to 177 bpm and the light on the monitor started to flash and alarm. I guess it makes you nervous when these things happen.

OK Philippa has just called for a quick bath with Trenton.

– out


I am just adding this video from day 2 to this post
A status of Day 2:

At 10:45 this morning while we were biting our nails in the waiting room a nurse just came in and gave us the all clear Zanes operation was a success they were just taking him off the bypass machine. We will probably be able to see him in about 1.5 hours. He will however be heavily sedated and non responsive at least the HUGE weight is off our shoulders of anything going wrong.

The emotional stress that one goes through for this is not very enjoyable.

I got to the hospital this morning at 7am, I got to see a groggy pre-med Zane (very cute in this phase) getting ready for the operation. We found out his blood type is B positive. I wonder what Trenton’s blood type is?

The tears were not something that I tried to pull back. They flowed, for both of us.

We have taken lots of photos before he went in and just as he was put under I managed to sneak in a video of how they were doing it.

They are very nervous about camera’s in the operating room because I guess if there is a malpractice issue you have proof.

I got some last minute photos and now we wait for the post op photos.
They may be a bit traumatic but I figured one day he would like to know what happened and why he has this scar on his chest. I guess this blog will serve as a record of events and why it all happened.

Anyhow, not long now and we can see him. Granny is bringing Trenton to come and visit shortly which will be nice, unfortunately they do not allow him to come into ICU. . . Understandable.

During the morning to keep our mind off any issues we took a walk around builders warehouse to try plan our new house. The distraction did not work too well as we kept wondering how things were going.

Ok enough banter I need to give some attention to Philippa now.


Morning of the op

Maybe I am posting too many times lately but I think it is necessary.

Got to sleep round midnight and up at 5am, at 5:30 I got a call from Philippa saying they are bathing Zane in betadine and he has been up for a while now.
Philippa’s phone has died so she called from a pay-phone.

Trenton never stirred at all the entire night, I have just given him a small bottle and popped some baby einstein on for him.

I am ready to go and will ask our Nanny Beuaty to come in a spot earlier so I can get my ass to the hospital.

I have camera laptop, ipod, some magazines, a spare battery for phils phone and a wirelsss modem so I can do some blogging and uploading of photos at the hospital.

Time to change Trent and get my ass into gear to try miss any form of rush hour.

– Bren

Booked in!

OK I have just returned from the hospital leaving my wife and son there for the night. Zane had some blood taken from his neck amidst all the screaming and wailing it had to be done in order to get the correct blood type for the operation tomorrow morning, they get 3 blood bags of his blood type to run through the machine while they do the bypass operation.
There is a bypass machine and a breathing machine that takes about an hour to get him hooked into it.

I have to wake up around 6 tomorrow get Trenton all fed and set up tomorrow morning, then the maid will help feed with granny while I head over to sunning hill hospital.
The preperation for the op starts at 7:30 and the operation will be over at 12:30.

Zane will be sedated for 24 – 48 hours after the operation while in ICU where he will stay for 74 hours.
After that he will be in the childrens ward.

When they say he is ready to come home which may be a few days after that.

Right now I am on Trenton duty. He just finished his night time bottle and went to sleep like a very good boy.

The baby monitor is set up and the milk bottles are almost ready if he decides to yell at night I can make him some milk, quickly.

I need to groom and shower tonight, get a laptop ready for all the waiting we will do at the hospital and try keep my mind off it and do some work.

off to nuke some woolies dinner!


Just a quick update
It is Tuesday the 5th today
Zane’s operation has been moved to tomorrow morning of the 6th of December.

In about 30 minutes I will be heading to Sunning hill hospital to check Zane in.

God only knows the next week is going to be very tough for us and Zane and not to mention Trenton who will miss his brother for that period of time.
Granny Lyn will be taking care of Trenton some of the time while we are in the Hospital.

Philippa and I will be alternating nights at the hospital looking after Zane and Trenton.

Hopefully there will not be a time when one of us are not by his side.

Lets hope Discovery pays the entire bill.

Feel free to shoot us an SMS/email to wish Zane well, if you are reading this you probably have one or the other.

I will try keep the blog up to date as time goes by. I will be sitting around waiting in the hospital so time will be available I guess.

On the right this pic of Zane was taken during his first swing on a swing at the multiple birth Christmas party on this past Sunday the 3rd of December.
As you can see by the smile he loved his swing. Looks like I will have to find a spot in the garden for a swing set for the boys.

OK time to head to the hospital Philippa just called to say she is on her way.


– Brennan

Heart op date change

After driving back from rather intoxicating Christmas lunch to pick up my sister I get a call from Dr Kingsley (Zane’s surgeon). Well from his secretary. God forbid that he should call himself.

He will be on leave until the 6th of December when Zane’s op is on the 5th. We quite obviously had a small dilemma here.

She gave us the option of having the operation next week.(29th Nov) or on the 7th of December. We opted to go with the 7th when he would be around after the operation should anything go wrong he would be there to look after our special package.

It’s quite tricky preparing your mind for an operation at a specific date then having the doc screw things around.

*deep breath* think happy thoughts*

We are prepared to do anything to make sure everything goes well.

Check out the links on the left to see some photos of the boys and to read up on the heart operation.

– Bren

Zane’s Heart operation


I am sorry to be landing everyone with a group mail but I have just had so many phone calls and e-mails that it would take me forever to respond individually.

Bren and I cant thank you all enough for all your concern over the past 10 months and kind wishes for Zane’s upcoming surgery.
We saw his Paediatric Cardiologist Dr Dansky on Tuesday and we have booked the surgery with Dr Kinsly – SA’s top Cardithorasic Surgeon – for Tuesday 5th December. He will be in Sunninghill hospital – The Walter Sisulu Paediatric Cardiac Centre of Africa – for approximately 7 days.

I have had quite a few request with regards to the actual condition and the process of the surgery involved. So for those of you that feel like a read I have listed below a description of what Tetralogy of Fallot is and the process involved in the repair.

Thanks again …. all our love hugs and kisses

Brennan, Philippa, Trenton & Zane

What is Tetralogy of Fallot?

Tetralogy of Fallot (TOF) is congenital heart defect causing cyanosis, a bluish discoloration of skin caused by oxygen-poor blood reaching the general circulation. An embryologic failure of the right ventricular outflow tract to form properly results in the four cardiac abnormalities characteristic of TOF:

· Ventricular septal defect (VSD): An abnormal opening between the two lower chambers of the heart

· Pulmonic stenosis (PS): A narrowed area within the main pulmonary artery, at, above or below the pulmonary valve

· Malpositioned aorta: The entrance to the aorta overrides the VSD

· Ventricular hypertrophy: An overly muscular right ventricle

In the normal heart, oxygen-poor blood returns to the right side of the heart where it is pumped to the lungs to be oxygenated. In TOF, the pulmonic stenosis increases the resistance to right ventricular outflow. This can cause elevation of right-sided heart pressures that may result in oxygen-poor blood being diverted across the VSD to the left ventricle and into the aorta (“right-to-left shunt”). When the aorta carries “mixed” blood to the general circulation, less oxygen is available to the tissues and cyanosis can result. Without surgical intervention, most patients with TOF will not survive past early adulthood.

Congenital heart surgery: Day of surgery

For patients who are hospitalized the night before surgery, an intravenous (IV) catheter may be used. This allows intravenous fluids to be given once the patient is designated as nothing by mouth (NPO).
All patients — whether they are admitted to the hospital or not — will be placed on NPO status after midnight the night before surgery and should not have anything to eat or drink after that time. Clear liquids may be allowed with the specific instructions of the anesthesiologist.

On the morning of surgery, the family will meet staff, and the patient will be given a private waiting room.

Approximately one hour prior to surgery, the patient is taken to the holding area, dressed in a hospital gown, and placed in a crib or bed. The anesthesiologist will order medication either by mouth or IV that reduces anxiety and will make the patient sleep.

During surgery

The following steps commonly are followed in all types of congenital heart surgery.


The anesthesiologist and operating room nurses escort the patient into the operating room. A heart monitor is connected to the patient that shows the OR team a continuous read-out of the heart rate and rhythm throughout the surgery. The patient is given a mask that disperses a gas that brings on a deep sleep.

Once the patient is asleep, the anesthesiologist puts a breathing tube (endo-tracheal tube or ET tube) into the patient’s windpipe. This tube is attached to a breathing machine (ventilator) that does the breathing for the patient during surgery. Next, the anesthesiologist places several intravenous (IV) catheters in the patient’s veins (usually in the large vein in the neck or the groin). Intravenous fluids and medication are given through them throughout the operation.

Another special catheter — an arterial line — is placed in an artery to monitor blood pressure during and after surgery. This special catheter is used to draw samples of blood to obtain various laboratory values and usually is placed in the wrist or the groin. A nasogastric (NG) tube is placed in the nose and gently guided down to the stomach after the arterial line is in place. An empty stomach will continue to produce juices, which can lead to nausea and vomiting. The NG tube empties the stomach and prevents vomiting. Finally, a Foley catheter is placed in the patient’s urinary opening and guided gently to the bladder. This catheter is attached to a device that drains and measures the urine produced during surgery. This process may take from 60 to 90 minutes.

Once all the lines and tubes are in place, a transesophageal echocardiogram (TEE) is performed. A cardiologist places a probe into the patient’s mouth and gently guides the probe down the esophagus. The TEE probe rests behind the heart and provides the surgeon with a continuous picture of the structures of the heart during the operation. When the TEE is completed, it is time for the surgeon to begin the operation.

Incision and operation

The type of surgical incision is based on the specific surgical repair.

· Median sternotomy incision: This type of incision is used for open-heart surgery (surgery that occurs inside the heart). This incision usually begins at or below the top of the breastbone (sternal notch) and goes straight down the sternum (breastbone). The breastbone then is separated to expose the heart.

The patient is placed on a heart-lung bypass machine, a device that provides blood flow to the body and bypasses the patient’s heart and lungs. Diverting the heart’s blood flow to the bypass pump allows the surgeon to open the heart and operate on the structures inside the heart. The heart-lung bypass machine provides continuous oxygenated blood to the other organ systems during the open-heart surgery. A certified perfusionist is dedicated to maintaining heart-lung bypass throughout the surgery.

Once the patient is on bypass, the surgical repair begins.

When surgery is complete, the patient is weaned off the heart-lung bypass machine until the newly repaired heart is managing all the blood flow. One to three chest tubes are positioned at the base of the incision to drain the surgical area. Temporary pacing wires are positioned on one or both sides of the incision that temporarily may be used to pace the heart rate and rhythm in the post-operative period.

Intracardiac monitoring lines may be placed depending on the type of surgical repair. These special catheters are placed in the chambers and vessels of the heart to provide the surgeon and the postoperative team with valuable information about the pressures within the heart and lungs. A postoperative TEE is performed that provides the surgeon with valuable information after the surgical repair. Once the TEE is completed, the surgeon closes the sternum. The sternal bone is brought together, and stainless steel wire secures the sternum. The type of skin closure the surgeon uses is dependent on age and weight:

· Clear, absorbable skin suture that runs the length of the incision on the inside of the chest. A clear knot is seen at the top and the bottom of the incision. To secure the outside of the incision, adhesive strips (steri-strips) are applied to the surface of the skin along the length of the incision.

· Surgical staples (occasionally used in larger patients)

· Thoracotomy incision: This is used for closed-heart surgery (surgery that occurs outside the heart). An incision is made on the side of the chest under the arm, extending up toward the shoulder blade. The ribs are separated to expose the heart or blood vessels. Because the procedure is performed on structures outside the heart, the heart-lung bypass machine usually is not be used, and blood continues to pump through the heart and lungs during surgery.

Once the incision is made, the ribs spread and the heart exposed, the surgeon performs a surgical procedure.

When the surgical procedure is complete, the ribs are brought back together, and a chest tube is placed to drain the surgical area. Temporary pacing wires and intracardiac lines are not used with thoracotomy procedures.

Generally, the type of surgical closure is an absorbable skin suture with the clear knot seen at both ends of the incision. To secure the outside of the incision, adhesive strips (steri-strips) are then applied to the surface of the skin along the full length of the incision.

Completion and transfer to recovery room

Regardless of incision type, after closure of the incision a dressing is placed that remains on the patient for the first 24 hours after surgery. The anesthesiologist and operating room nurses then secure all the patient’s tubes and lines, and transport the patient from the operating room to the cardiovascular intensive care unit (CVICU).