What a day! But in the end, even though we have been admitted to the hospital for monitored care, we are feeling pretty upbeat! During the ultrasound, Dr. Habli could not find a membrane that separates the boys and it did appear from the fluid arrangement that their membrane had ruptured and they were now Mono-mono, or, one placenta, one sac. This is a most complicated twin arrangement aside from the TTTS hurdle we have already jumped over because the boys can become entangled, their cords entangled and they can even harm one another or one another's cord. The sac that holds the boys had also separated from the uterine wall - there was no attachment. This alone was enough to prevent us from traveling home, but with the potential entanglement we now require very frequent monitoring. So, that is the bad news. But there is good news!
Bryce's heart is functioning well. It is not so enlarged that he is in imminent danger or his lung may not develop. He is tolerating the severe tricuspid leakage well and really holding strong. That has been the trend. But the good news came when the team decided to call his abnormality Displastic Tricuspid valve rather than Epstein's Anomaly. Functionally there is not much difference and the two are related, but the outcomes with Epstein's tend to be more grim as is more likely to trigger other heart malfunctions. There is even a chance that Bryce may NOT require surgery. After birth, when some of the tremendous pressure in his right ventricle is relieved, the leak may slow, it may virtually halt. It may not. It may go into rabid decline but it may do that at any moment, but it has tolerated this condition pretty well for a few months now so we can take heart that it may continue to do so. If the leak does not lessen he will require surgery, but they may be able to put off the procedure to attempt a repair on the valve until he is hearier and more stable, as in, he may be able to come home before intervention is required. There is a real possibility that immediate intervention may be required or that they will have to open the heart and reconstruct the valve before he is ever discharged from the CICU. While it's still murky, the possible positive outcomes did look much brighter after this fetal Echo.
Finally, because Bryce is stable now and because Cincinnati has the capacity to intervene post-delivery at any time and they have dealt with cases similar, though, according to Dr. Lim, they have not had a case exactly like ours with all the complicating factors and this specific heart defect, and because it is much closer to home and because we know this team, they know us and our boys and this place is ranked #3 in the U.S., we will most likely deliver here. There is a chance we may delivery in Nashville to be closer to home, but Dr. Lim is going to have some long talks with Vandy about their experience (if they have any at all) in emergent reconstructive valve surgery before we look seriously at that option. If they can convince him that they are fully confident in handling our care, we will certainly consider a transfer so we might deliver closer to home. There is also a chance, though maybe slight that the sac could reattach to the uterine wall and they may find that the membrane is still there keeping them apart only they could not see it today. If that is the case, we will be able to return home for a week or so before we have to hunker down where we plan to delivery at around 31 weeks.
I will be traveling home tomorrow to gather some stuff, knock out some work, tie up some loose ends with the construction projects around the house and then bring the kids up for a visit on Thursday afternoon before returning them to Chattanooga Saturday in time to take my girls (sans Eden) to the Daddy Daughter Dance at CCS Saturday night. Nicole has had a really rough haul. She has also endured some very stressful and difficult events outside of pregnancy challenges, but her spirit remains sturdy and committed. She has demonstrated uncommon strength and endurance. In the end, I feel more confident than ever before that in the end, both of our boys are going to be okay. What a journey so far. So many trials, yet, so many blessings.
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