Day of the Fontan

Steele went back into surgery at 7a.  They will start his PIC (peripherally inserted catheter) line and IVs and arterial lines.  The plan is that surgeons will open him up around 8a.  They will cool him to a hypothermic state to lessen the oxygen demands of his tissues: brain, muscle, and heart have a high need for Oxygen, so when he is cooled to 23 Celcius they can essentially stop his circulation without repercussion while they begin the surgical repairs.

1- First up is the tricuspid valve, which will receive a few stitches to reduce regurgitation (backward flow of blood) and thus make Steele's right heart a more effective pump. 

Next up is the 2- aortic arch repair.  Steele had a stent placed in his aortic arch in late 2015 to keep it open.  He has outgrown the stent so the surgeons will need to fillet the stent open and patch cadaver tissue around it to reconstruct the arch into a larger diameter vessel. 

Finally, will be the 3-  Fontan surgery.  This is the typical 3rd surgery for HLHS kids where the inferior vena cava, the vessel draining "blue" blood from his abdomen and legs,  is rerouted to the pulmonary arteries with a long shunt.  This will make it so that ultimately, Steele's heart does not pump blood to the lungs anymore because the blue blood is rerouted passively to the lungs. All Steele's little half heart has to do is pump the oxygenated blood to the body after it has returned from the lungs.  I am calling Steele's heart "little" because it only has half the function chambers and valves of a normal heart, however, since his heart works so much harder than most, it will, of course,

hypertropy (enlarge) like muscles tend to do.

All in all, the surgeons expect Steele to be on heart-lung-bypass for about 2 hours and the entire surgery should last about 6 hours.