Bryce and River 4-17

Dear friends, 

We will return to Cincinnati this Monday for full growth exams on the boys, another extensive Echo Cardiagram and a consult with Dr. Lim (the man that performed the TTTS surgery) and a cardiology team member.  Because there has been no slowing in the tricuspid regurgitation following the laser surgery now two months ago, and because of the Echo observations by the Cincinnati Cardiologists in our last exam, we are almost certain that Bryce has a rare condition known as Epstein's Anomaly.  And though the leakage has remained severe, his heart has been holding up well considering.  It now accounts for 50% of his chest cavity, whereas River's heart is a normal 30%.  One danger is if the heart enlarges to 65% or above, the lungs are unlikely to develop adequately because they are more or less crowded out by the enlarged heart.  In his case, the right Atrium is the chamber most affected and most significantly enlarged.   We are greatful that he has held this strong this long. And though we are only at 28 weeks, we are considered late term by the Fetal Care Team because most TTTS twins do not make it past 32 weeks before delivery.  In the case of Bryce, if his heart was mending laser post-op, it would be ideal to keep him in there as long as possible, and while the womb is still the best and safest place for both boys to be right now, staying in the womb has not and is not reversing the damage caused by the congenital defect.  We will continue to have Echo's in Chattanooga twice a week after our return from Cincinnati provided we return, but we also have every reason to believe we are in the last four weeks of this pregnancy.

Finally, there will be some debate on how and when to surgically intervene with Bryce post-delivery.  At this point, it appears he will require surgical intervention sooner rather than later because of the severity of the problem, but the earliest any surgical intervention might occur would be at around 5.5 pounds and that is only to manipulate the flaps of the valve in hopes of improving their performance in closing.  Mechanical valves do not become an option until the teen years.  So far, his heart has not been growing rapidly.  That is a huge blessing but his arrhythmia has increased in frequency, which is disconcerting, but there is also no sign of congestive heart failure or fetal hydrops - which means that blood is not pooling or backing up.  The fact that he has been holding so strong with his condition is a HUGE answer to prayer, HUGE!  We are so grateful for your prayer and support and for the Lord's work. Please continue to hold up both of our boys, but especially Bryce, as well as Nicole as it seems we are turning into the final stretch of this phase in their lives.