Africa Outreach: Update on our Cardiac Surgery Patients
Friday, March 7, 2014
Members of our Cardiology team spent two weeks in Uganda providing treatment to children with heart disease, as well as training and education for Ugandan healthcare workers. The teams, led by Cardiologist Craig Sable, MD, have been helping children abroad for 15 years. This post is from Dr. Sable as he wraps up the team’s experiences during their last week in Uganda.
In Uganda, the Children’s National team most frequently encountered patients with Tetralogy of Fallot (TOF). This is the most common congenital heart condition that causes cyanosis or lack of oxygen in the blood; the combination of a big hole between the bottom chambers of the heart and the blockage of blood flow to the lungs results in blood without oxygen going through the body. In the developed world, children born with this condition have it repaired within the first 3 to 6 months of life with excellent outcomes. Without surgery, many of these children die before their tenth birthday, getting progressively bluer and weaker.
Tetralogy of Fallot Patient Updates
Only recently has repair and postoperative management of TOF been possible in Uganda. This year, we selected four very sick 4-year-olds to undergo surgery: Allan, Victoria, Lordrick, and Noel. All of them had oxygen saturations under 65 percent and could barely walk. Allan and Victoria were scheduled for surgery on Wednesday, February 19. When we arrived at the hospital early that day, the power in the operating room was out and we learned that the generator was present but not connected. That’s when Ozzie Rivera, a Children’s National biomedical engineer who has been the heart and soul of more than 50 international heart missions, went to work. Ozzie worked with a local contractor and the Ugandan biomedical engineer all day and into the evening to successfully connect the generator.
On Thursday, Feb. 20 with power restored and the generator backup ready to go, we took Allan back to the operating room at 7 am, followed by Victoria at 1 pm, and Lordrick at 6 pm. All three children did well, the first time three open-heart surgeries had ever been done in one day in Uganda! Noel got his turn the next morning with good results as well. Pranava Sinha, a Children’s National surgeon, worked closely with Ugandan surgeons, Tom Mwambu and Michael Oketcho, to fix these children’s hearts and provide skill transfer that will allow for the Ugandan team to do these cases by themselves in the near future. Other Children’s National team members involved in the care of these children in the operating room included anesthesiologist Jamie Schwartz, and scrub nurse Chona Lopez.
Allan, Victoria, Lordrick, and Noel are all slowly recovering with normal oxygen levels. I had a chance to visit with all four patients on Thursday, Feb. 27 prior to departing for Washington, DC. It is expected that they will have dramatically improved exercise tolerance and normal life expectancy.
These four children represent the most ambitious surgeries we have done to date in Uganda and offer hope for the hundreds of similar children with Tetralogy of Fallot who are in need of surgical repair in the region.
About the Expert
Craig Sable, MD, is director of echocardiography and pediatric cardiology fellowship training and medical director of telemedicine at Children’s National Health System in Washington, DC. He is a Professor of Pediatrics at the George Washington University School of Medicine.