By Daniel Liesen (younger brother of Richard):

Within this document I am making an attempt to explain the anatomy and problems associated with Natalie Catherine Liesen. Most of these problems were repaired or stabilized by the procedures listed below.

7/16/97 Balloon Valvuplasty of the Pulmonary Valve Stynosis by Cardiac Catheter

7/18/97 Surgery to repair the Tracheal Esophageal Fistula with Atresia (TEF)

7/22/97 Surgery to ligate the Patent Ductus Arteriosus (PDA)

7/23/97 Emergency Surgery to put in the Central Shunt across the Aorta and Pulmonary Artery

8/18/97 Re-Intubation due to Trachea Bronchitis

8/22/97 Insertion of G-J Feeding Tube in Stomach and then Correction of a Mal-Rotated Bowel and beginnings of Necrotizing EnteroColitis (NEC)

8/29/97 GI Surgery Incision Infected; Had to Open Incision, Clean Out Infection, and Re-Suture the Lower Layers and leave skin open to contain the infection. Fortunately G-J Tube Site was not infected.

10/2/97 Nissen Fundo Plication; Anti-Reflux operation or stomach wrap. You take the top lobe of the stomach and wrap it around the lower part of the esophagus to help keep the stomach contents from aspirating into the lungs.

 

The more serious of her conditions, her circulation problems are addressed first. To begin I will provide a basic outline of normal adult circulation.

In the adult, blood flow normally takes two general paths. The first is the blood flow through the body also called the systemic (relating to or affecting the body as a whole rather than individual parts and organs.) circulation. The left side of the heart accomplishes the pumping action for this circulation. In the diagram above you can see the systemic circulation from the heart being carried out by the systemic veins and the systemic arteries.

The second general path of blood flow through the body is the pulmonary (related to, associated with, or affecting the lungs.) circulation. The right side of the heart accomplishes the pumping action for this circulation. This is demonstrated in the diagram above. The pulmonary arteries and the pulmonary veins accomplish this circulation. This path of circulation provides the necessary gas exchange for the body (Releasing Carbon Dioxide and taking in Oxygen.) The nutrient/food supply from the body is received by the intestinal circulation (See diagram to the left.) which is part of the systemic circulation.

From this you can see that the heart receives oxygen rich but nutrient poor blood from the pulmonary veins. From there our heart pumps this blood to the systemic arteries. This flow goes through the intestinal circulation and returns oxygen poor but nutrient rich blood to the right side of the heart through the systemic veins. The right side of the heart pumps this blood out through the pulmonary artery to the lungs where it is picked up by the pulmonary veins.

Below you will see this circulation system portrayed how it actually appears in the adult body. The aorta is the primary systemic artery and the Pulmonary Artery is the primary pulmonary artery. The superior and inferior vena cavas form the primary systemic veins. The pulmonary vein is not shown in the diagram below.

 

 

The fetal circulation is slightly different from the adult circulation. The reason for the differences is that the fetus does not have a great need to circulate much blood to the lungs because it receives no oxygen from the lungs. To accomplish the reduced circulation to the lungs it has two main peculiarities. These peculiarities are a direct communication between the two auricles through the Foramen Ovale and an extra duct called the Ductus Arteriosus. The diagram below shows these peculiarities.

The first peculiarity is the Foramen Ovale. The Foramen Ovale is a port/opening that connects the left auricle to the right auricle. It actually is just a small opening in the septum (the center meaty part of the heart separating the left side of the heart from the right side of the heart.) This opening allows blood in the right side of the heart from the systemic veins to flow directly to the left side of the heart. This aids in bypassing the pulmonary circulation. At birth this opening is covered by a flap of tissue which grows over the opening to plug it.

The second peculiarity is the Ductus Arteriosus. This is a small duct that directs blood from the pulmonary artery into the aorta. (See diagram below.) This allows blood that is destined for the lungs via the pulmonary artery to shunt to the Aorta where it will flow to the body instead. At birth this duct will waste away.

 

Now that we have a little understanding of the anatomy of the adult and fetal circulation, I will explain Natalie's conditions.

 1. Her major problem at this point is that her Ductus Arteriosus has not wasted away. Now it is having an opposite effect do to changes in circulation pressure at birth. This duct is causing a decreased blood flow to the body because blood destined to the body is leaking through this duct into the pulmonary artery of the lungs. This decreased blood flow to the body is causing a number of effects. First, due to a decrease in the removal of carbon dioxide from the blood by the lack of systemic circulation the PH of her blood is dropping. They are administering Bicarbonate to alleviate this problem. Secondly, they are administering lasic to increase urination to help her eliminate waste from her blood. This was not being accomplished adequately due to the reduced renal flow. Thirdly, they are administering Dopamine to control her heartbeat.

2. Beside the Foramen Ovale there is another small opening in the septum. This opening does not have a flap to seal it off and is causing oxygenated blood on the left side of the heart to mix with deoxygenated blood on the right side of the heart

3. The third major problem is defective pulmonary valve. This valve was not allowing proper blood flow to the pulmonary artery from the heart. This caused a lot of extra stress on the heart. This problem was temporary corrected with a catheter operation on 7/15/97.

Now that we have addressed her circulation problem, I will move on to her digestive problem. Natalie's condition with her digestive tract is known as a TrachealEsophageal Fistula (TEF). This is a development al problem where the child has a discontinuous esophagus. The digestive tract with the esophagus is shown in the diagram below.

 

In a TEF the portion of the esophagus extending from the stomach has attached to the trachea instead.. The trachea is often referred to as the windpipe and a diagram of the respiratory system is shown below.

The other end of the esophagus, the end extending from the throat ends in a blind pouch. Below is a picture of the trachea and esophagus in relation to each other. The two ends of the esophagus were connected in a surgery on 7/18/97.