News from the cardiology front

Marilyn, our incrdibly skilled echocardiographic technologist, and I, as the cardiologist on the trip, had the privilege of inaugurating the Team Heart Mission this yr, by arriving one week earlier than the rest of the team and screening many patients, trying to find those most in need of surgery, but who would also be able to survive the rigors of surgery and have long-term benefit. I see more critical disease here in 2 days than I see in one year at home. Our patients are generally teenagers or young adults who have likely had many bouts of rheumatic fever which have scarred at least one and, in many cases, 2 or 3 of their heart valves. The scarrring causes severe leakinss or narrowing of valves, producing symptoms of heart failure. Many of our patients have had to stop their work due to symptoms. Unlike in the United States, their disease is very advanced when they first come to medical attention. Heart valve infections, congenital heart disease, and primary disorders of the heart muscle are also causes of heart failure in this population. It is so wonderful when we can offer a patient an operation which may allow them to walk up hills (Rwanda is known as the land of a 1000 hills and feet are generally the only form of transportation for our pt) again and resume work and caring for their families. It is heartbreaking, however, to not be able to offer surgery to at least 40-50% of the patients we see-usually a result of chronic valve leakiness so weakening the right heart and/or the left heart pumping chambers that surgical risk would be too high. In addition, such pts, even if they survived surgery, would not generally have symptomatic benefit since advanced heart muscle function is not helped by valvular surgery. We have to catch those patients and operate prior to the advent of irreversible heart muscle deterioration. In many of these non-operable patients, however, we can often change their medical therapy (e.g. controlling heart rates if they are much too high) to significantly improve their symptoms. The patients are incredibly grateful for any help we can give them. The Rwandan population has suffered so much, from losing family and friends in the Genocide, from poverty, from lack of medical attention, etc.--to give them a chance for a better life is why we are all here. As was the case on prior missions, however, we get much more than we could ever give. This experience is truly a life-changing experience for all of us.
Our first patient had a mitral valve replacement yesterday. She is doing beautifully and will go from the intensive care unit to the step-down unit today. Our 2nd patient, who will receive 2 valves, is in the OR now. We have a busy schedule for the next week.

Pat come