25 March 2008

Neonatal pre-op MRIs

One of the research studies I am involved in at the hospital includes performing an MRI immediately prior to the heart repair surgery of TGA and HLHS babies*. The baby we studied yesterday was oversized (due to mom's diabetes), but otherwise stable. The MRI revealed PVL,** which we have seen in 20% of patients prior to their surgery, and also a temporal lobe hemorrhage. We immediately called the surgeon to the MRI suite and a discussion ensued: what is the bigger danger - delaying the heart repair or potentially enlarging the bleed (the surgery would involved heparin, a blood thinner)?

We decided to delay the surgery and re-image the child in a few days to re-evaluate.

Sitting in on that discussion reminded me why I want to be a doctor. I've been losing the faith a bit with all the paperwork that is my job recently and this year long illogical waiting game of frustration that is applying. It was nice to have a reminder; hopefully I will get another one this Friday in clinic.

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*TGA = Transposition of the great arteries. The aorta is connected to the right ventricle and the pulmonary artery is connected to the left ventricle, creating two independent circulations.
HLHS = Hypoplastic left heart syndrome. The left ventricle fails to form and the aorta is small and insufficient. Once the ductus closes, there is no systemic circulation.
**PVL = Periventricular leukomalacia, a white matter injury that occurs in pre-mature babies and is thought to be associated with mild cognitive problems.

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