Dr. Kashif Yousuf's update on the technical aspects of Samaah's condition:


This is just a follow-up Samaah’s current medical condition. If you are reading the blog for the first time, it may be helpful to read the August 27 posting describing her congenital heart defect (Total Anomalous Pulmonary Venous Drainage [TAPVD]).

We previously described that a septostomy (making a hole in the septum; the septum is a wall which divides the left side of the heart from the right) was most likely completed on Samaah’s heart. However in patients with TAPVD, an Atrial Septal Defect (a hole in the septum of the atrium [upper chambers of the heart]) is found and that is the case with Samaah. So the septostomy was not necessary, since a hole, which connects the right side of the heart to left, already existed.

However, over the weekend, physicians did complete a procedure that keeps the hole in the septum patent, which ensures that the left side of Samaah’s heart continues to receive some oxygenated blood that can then be pumped to the rest of her body.

A complication, which about 50-60% of patients with TAPVD develop is pulmonary vein obstruction. Just to recap from the August 27 post, in Samaah’s heart, the pulmonary vein is the vein that carries oxygenated blood from the lungs to the right side of her heart via the vena cava. When pulmonary vein obstruction occurs, the heart is unable to get oxygenated blood into the right side of the heart, and thus the blood is not able to travel to the left side of the heart via the Atrial Septal Defect. This then causes the rest of Samaah’s body to be deprived of oxygenated blood.

To try and resolve this problem, physicians needs to break the “clot” or the “obstruction” which has occurred in the pulmonary vein. Following the breaking of the clot, the physicians insert a stent (a hollow tube) in the vein to ensure that the vein does not re-clot. Veins that clot once, have a propensity to clot again, and that is why this preventative measure is ensued.

Both of these procedures (keeping the atrial septal defect patent and unplugging the pulmonary vein) can be completed with cardiac catheterization. Cardiac catheterization is a non-invasive procedure that allows physicians to complete the above-mentioned tasks, without having to invasively make an incision (cut) into the patient’s chest.

In cardiac catheterization, physicians feed a small catheter (hollow tube) into a large vein in the patient’s thigh. This vein (remember vein is a vessel which ultimately ends up opening into the heart) allows the catheter to be fed all the way into the patient’s heart. Using this catheter, physicians inject a radioactive dye into the patient’s blood stream, which can then be imaged using a machine similar to the x-ray machine (the machine detects the radioactive dye and provides a picture of the vessels which have the dye present within them). Thus the physicians are able to see exactly where the catheter is within the heart, and are able to complete the procedures described above.

Some of you may wonder why Samaah has not received her surgery yet. Well, the pulmonary vein obstruction occurred in Samaah’s case which needed to be resolved, and Alhamdulillah has been resolved already. The physicians are just allowing Samaah to recover from this non-invasive procedure before they move onto the open-heart procedure with which they can permanently resolve Samaah’s congenital heart defect. Also, our dear Samaah developed another complication known as pulmonary edema (fluid in her lung space). This complication can be treated medically, and does not require any procedural intervention. Alhamdulillah, the fluid has settled down significantly, and we hope that by tomorrow Samaah will be in a better position to receive the final surgery.

Please continue to remember Samaah, Hassan, and Naila in your duas in this difficult time.