Notes from appointment with Dr. Mello (pediatric cardiac surgeon at CCMC)

We met with Dr. Dennis Mello and Scott Callahan (Physician Assistant)

Dr. Mello and Dr. Kopf are the only pediatric cardiac surgeons in Connecticut. So any child with a heart defect operated on in Connecticut is done by these two doctors. They operate TOGETHER on every patient. They operate on approximately 300 patients a year. There are NO residents who will be operating on Olivia. Normally they operate in Hartford on Monday and Tuesday and at Yale on Wednesday and Thursday. Friday is a “swing day”.

He has never lost a patient from the Glenn or Fontan procedure.

Currently, the version of the Fontan procedure he does is newer than the one done in Boston.

They will schedule the Glenn for “earlier” than “later”. The Glenn is redirecting the returning blood from above the diaphram and the Fontan is for the returning blood from below the diaphram

Dr Mello operates daily using the Heart / Lung machine.

I asked about abnormalities in the pulmonary veins – how serious this would be. He said that there is a 2/3 mortality rate with the vein defect in conjunction with single ventricle disease. But he felt it would be worth taking the chance in having surgery if she does have this defect as well.

For the first step: They need to balance the pulmonary blood flow. Done around one week of age.
There are three scenerios

A) Too much blood going to the lungs and not enough to the body.
B) Too little going to the lungs and too much going to the body.
C) Equal amounts going both places.To fix:

A) Bend the pulmonary artery
B) Perform a “BT Shunt” which is the gortex or plastic tubing to connect the aorta to the pulmonary artery.
C) Do nothing – no surgery.

Second Step: Done anywhere from 4-6 months to a year old. Based on oxygen levels. He likes to do this surgery earlier than later.
Bidrectional Glenn Surgery or Cavopulmonary Shunt. Takes the returning blood from the upper half of the body and sends it directly to the lungs. Oxygen levels after this surgery are 85%.

Third Step: Fontan procedure Done at 3 years and at least 30-35 lbs. Will wait to make sure at least 35 lbs so they can connect an adult sized conduit. Disconnects the lower blood flow and connect to the pulmonary arteries. The Conduit is made out of gortex. Boston and Philadelphia are still doing the old style Fontan.

Side effect of the Fontan can be Protein Losing Enteropathy. Very serious but rare.

Dr. Mello has been operating at CCMC for 5 years.

Survival rates for the BT Shunt is 90-95%. The other surgeries ar ethe same.

The surgeries only takes a couple hours each but to a parent, it will be a half day.

Blood donation is an option but most people use the blood bank as the donated blood is screened the same.

Not necessary to donate cord blood.

God Forbid, if Olivia needed a heart transplant – he would recommend Columbia NY because they do the most.

Length of stay per surgery: 7-10 days per each. Length will be shorter as they get older.

He prefers the kids stay in the NICU or PICU until discharge as they have 1-1 monitoring.

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