Diagnosis hitting hard

I found an article regarding Sawyer's congenital heart defect - Tetralogy of Fallot with Pulmonary Atresia and VSD.

Here is a link - http://emedicine.medscape.com/article/899368-overview

I guess I'm mostly posting this for other CHD moms out there to see how severe Sawyer's heart defect was and that his chances of survival were very grim.

Some things that stood out to me, made me cry - brought so many more questions to a head that's already swirling with a million of them.

Pulmonary atresia (PA) with VSD is considered the extreme end of the anatomic spectrum of tetralogy of Fallot. Tetralogy of Fallot with pulmonary atresia is worthy of separate consideration. Because of the wide variability of pulmonary blood supply, diagnosis and surgical management of tetralogy of Fallot with pulmonary atresia is more difficult than that of classic tetralogy of Fallot.

The Baltimore Washington Infant study reported an incidence of 0.07 cases per 1000 live births. This condition accounts for 1.5% of all forms of congenital heart disease and 20% of all forms of tetralogy of Fallot.

Patients with tetralogy of Fallot and nonconfluent pulmonary arteries are subject to increased morbidity and mortality related to the frequent need for multiple cardiac surgeries.

Many patients with tetralogy of Fallot with pulmonary atresia have associated syndromes and extracardiac malformations.

Sawyer had NONE of these - NONE!! And I had none of the maternal associations either

◦Conotruncal cardiac malformations associated with a chromosome arm 22q11 deletion have been incorporated under an acronym of CATCH22 (cardiac defect, abnormal face, thymic hypoplasia, cleft palate, hypocalcemia, microdeletion of band 22q11). Patients with tetralogy of Fallot with pulmonary atresia have a higher incidence of this syndrome than patients with classic tetralogy of Fallot. The prevalence of deletion 22q11 is 16% in tetralogy of Fallot with pulmonary atresia with confluent pulmonary arteries and 41% in patients with tetralogy of Fallot with pulmonary atresia and multiple aortopulmonary collateral arteries.6 Surgical mortality has been reported to be is greater among patients with tetralogy of Fallot with pulmonary atresia with a 22q11 deletion compared with patients with normal chromosomes, perhaps due to depressed immunologic status or other factors.7 ◦Other syndromic associations include the vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, and renal and radial anomalies (VATER) syndrome; the coloboma, heart disease, atresia choanae, retarded growth and retarded development and/or CNS anomalies, genital hypoplasia, and ear anomalies and/or deafness (CHARGE) syndrome; Alagille syndrome; cat's eye syndrome; Cornelia de Lange syndrome; Klippel-Feil syndromes; and trisomy 21.8 ◦Maternal diabetes mellitus; maternal phenylketonuria; and maternal ingestion of retinoic acid, trimethadione, or sex hormones increase the risk of conotruncal abnormalities. Infants of mothers with diabetes mellitus have a 20-fold higher risk than infants of mothers without diabetes mellitus