At our routine 2 week ultrasound with Maternal Fetal Assessment Unit (MFAU) yesterday we found out that Baby Jacob has developed another heart condition called Complete Heart Block. I've taken the description of CHB or Third Degree Heart Block from another site (http://www.cincinnatichildrens.org/service/f/fetal-care/conditions/heart-block/) to explain:
Complete heart block is a disorder of the heart’s electrical system, which controls the rate and rhythm of heartbeats. Heart block occurs when there is a disruption, preventing the electrical signal from the upper chambers of the heart (the atria) from reaching the lower chambers (the ventricles).
Normally, the electrical signal passes through specialized conducting tissue known as the atrioventricular (AV) node. After the signal passes through the AV node and reaches the ventricles, it causes the heart to contract and pump blood. When this signal does not transmit properly, there is heart block or AV block. This does not mean that the flow of blood in the heart or that the blood vessels of the heart are blocked. It does mean that the electrical signal that spreads across the heart with each heartbeat is slowed or in some cases completely interrupted. This can limit the ability of the heart to pump blood to the rest of the body.
There are three types of heart block, depending on the extent of disruption of the electrical impulses: first degree, second degree, and third degree. Also known as complete heart block, third degree is the most severe and represents complete interruption of electrical communication between the atria and ventricles.
While all forms of heart block, including complete heart block, more commonly occur after birth, some babies are born with heart block. This is known as congenital and can be detected before or after a baby is born.
So essentially what is happening is the top chambers of Jacob's heart are beating strong and normally, but no communication is reaching the bottom half to tell it when to beat. Because of this Jacob now has two heart rates - Higher Chamber and Lower Chamber. His lower chamber is currently in the 80 beats per minute range. If it goes down to 60 or lower than than the risk of heart failure and/or fluid build-up in his lungs or heart is very high. Right now the middle node of Jacob's heart is regulating the bottom chambers at it's own rhythm, and if this node fails than the time between failure and likelihood of fatality is short.
So overall, what this means right now is that I will be having 3 MFAU ultrasounds a week to closely monitor the heart rhythm and fluid build-up. If his lower chamber heart rate drops to 60 I will be sent immediately to TO in an air ambulance for his delivery, or potentially will deliver here if the doctor's don't think there is time to get us to TO safely. It also means that my pregnancy is now high risk, and it may be safer for Jacob to be delivered early than for him to stay inside. This creates further complication for the first surgery, as the smaller Jacob is the higher the risk is. The first surgery will now be two surgeries in one - the DILV surgery and placement of a pacemaker to regulate the lower chambers of the heart. I received the first of two steroid shots yesterday to help Jacob's lungs develop faster in case early delivery is needed. I had another ultrasound this morning to monitor his heart rhythm, which was 85bmp, and will go into the MFAU again this afternoon to receive the second steroid shot.
My family is feeling devastated all over again right now. We had finally reached a place of acceptance with the DILV diagnosis and treatment, and now to add this additional condition on top of the DILV may significantly reduce the likelihood of no complications during birth/the first surgery. Our pediatric Cardiologist has told us to be prepared for the worst case scenario, although it may never happen. If Jacob can continue along the 80bmp route until he is term that will make a huge difference. I know that we have been asking for a lot of prayer, but I'd like to ask for a renewed effort concentrating on Jacob's heart rhythm/fluid build-up, making it to full term (one month from Monday past), and for safety during the initial two surgeries. My faith has taken a hit over the past two days, but I still believe.
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