Medical blog, Apr 17, 2011

Having the ICU and Or thoroughly and expertly prepped by the advance teams, surgeons Drs. Worrall and Siwek started the HHNW 2011 season with 2 successful valve surgeries. The first was a 24 yo with rheumatic aortic stenosis; he came through surgery was was extubated via "fast track" in a few hours, all with no complication. The second, a combined aortic and mitral replacement was performed on a 27 yo male. It too proceeded without a hitch, with ICU/ post of care provided by Dr Jim Elmer.

Meanwhile, Drs. Hal Goldberg and Sam Joseph saw those patients scheduled for surgery over the next few days, along with other add-ons as per Chief Rwandan Cardiologist, Dr. Joseph Mucumbitsi. Included were three 12 yo patients, 2 with severe rheumatic aortic insufficiency and mitral valve stenosis, and one with a widely patent ASD (atrial septal defect). In addition, a 45 yo female with mitral valve stenosis was evaluated and felt not to be ill enough to merit surgery at this time.

Conversely, a 33 yo female, whose mitral valve was replaced last year for rheumatic mitral stenosis, returned with extreme fatigue and ascites, her ECHO showed severe tricuspid regurgitation. She was felt to represent possible portopulmonary hypertension, vs idiopathic PAH, vs Chronic Thromboembolic Pulmonary Hypertension, vs schistosomiasis / POPH. Plan is for right heart cath w/ hepatic vein pressure determination and pulmonary vasoreactivity testing w/adenosine. Treatment options may be limited by cost and availability.
Another confounding patient was a 22 yo female with minimal dyspnea and known mitral stenosis who surprisingly has an estimated PA pressure by ECHO of over 80 mmHg. She will be further evaluated, perhaps w/ right heart cath.
Overall, it was a wonderful beginning, reflecting a remarkable amount of work by a truly wonderful team.