Diaphragm Update

After the ECMO removal last night, I had a chance to talk to the surgeon (who also did the hernia operation earlier). Apparently I was overestimating things when I said that Andrew had very little diaphragm around the edges.....in fact, he had NO diaphragm around the edges. The surgeon characterized it as 98% missing, and he had to suture the patch to his chest wall. He had to use a 15x10 centimeter Gore-Tex patch and did only minor trimming to fit, which means he 'replaced' 150 square centimeters of left-side diaphragm. Fortunately, the one place there was some diaphragm was in the middle of his chest, where the right side comes together with the left and some major tubes (vena cava, esophagus) come through into the abdominal cavity. He was able to attach the patch to the existing diaphragm at this point, and that portion of it will grow with him and do fine.

Realistically, what this means is that some day he'll have to have the patch replaced. It won't be now, it won't be in the next few years, but at some point it will almost certainly require replacement. They'll keep an eye on him through major growth spurts (puberty, etc), as that time would be the most likely for a new herniation. Whether they would go in and replace it proactively or wait until he has another problem (MUCH more minor and treatable at that point), I'm not sure. The surgeon made the patch he put in very dome-shaped, meaning that he has a lot of extra material that can flatten out and "grow" with his body. It should last many years because of that "extra" area, and it will also show up on a chest X-ray when it begins to flatten out and get tighter.

I'm very confident with the meticulous work of the surgeon (who also suggested his scars would be relatively minor (long, but minor), and I think this solution will be effective for a long time. Baby's bodies are very resilient, and his other muscles will compensate for the lack of a diaphragm when breathing. He also has a full diaphragm on the right side, to go with his full lung, which will hopefully prove itself to be strong and useful in the next few weeks.

The other good news is that his left lung looks better than they were expecting. Instead of a nubbin or no lung at all, his lung is almost half-size. It has also formed two developed lobes instead of being stunted early, so it's not bad, just small. It should be able to expand, grow, develop, and fill a good portion of his left side (perhaps 3/4 of the cavity). That bodes well for his future lung volume.