Fall mission 2013- Day #3 (Sunday)

The day began with our early morning ICU rounds.
Both boys from yesterday are doing great. They are both drinking and starting to eat today, and likely will move out of the ICU tomorrow.
Waleed

Taha

The first case for this morning is Sondos Saleh Mohammad Al Khateeb, a 10 month old girl from Amman. She has Tetralogy of Fallot-but is consider “pink” in that she has only a mild amount of narrowing below her pulmonary valve, but the valve itself can be spared because it is of near normal
Size. She has her VSD closed, the muscle bundles and narrowing below the pulmonary valve resected, and the TEE after the case shows no residual VSD. She is extubated shortly after returning to the ICU and looks very good. Her mother is a distant relative of Dr. Kal–he comes from a long lineage-so Sometimes we will run into a 2nd or 3rd cousin related to him!
Sondos

Dr. Kal and Sondos’ parents

After the first case, we spent much of
The lunch hour evaluating cases for this mission and potentially future missions. We did a sedated TEE on Mariam from Iraq and found that her VSD has mostly
closed and is very small, so she will not
require any surgery to close the defect. Her brother, David, who has a large VSD but has pulmonary hypertension will go to the cath lab tomorrow for evaluation of his PA pressures-to determine if he is operable or not.
Mariam

But the best part of the afternoon we return visits from previous patients. First , Adian Firas Ali, 3 yr old from Bagdad we first operated on 1 1/2 yrs ago with a central shunt for discontinuous pulmonary arteries . Then Mark did a RVOT patch across her pulmonary valve spring 2013 mission trip. Her family has been living in Jordan since the surgeries–awaiting determination of when her next surgery will be. Her pulmonary arteries have been growing well-so she will
Likely be ready for VSD closure on our next mission trip.
Aidan didn’t want anything to do with us for pictures:

But her twin sister was very outgoing and receptive: (may be because she hasn’t had a heart operation before!)

She started warming up with her twin sister:

One more attempt with the team:

Next , one of our team favorite patients from Syria, who we have also
Operated on twice before, Nour Olabi came back to clinic for reevaluation. She is now 9rs old, a third grader, and she and her family have left Syria and are also living in Jordan. She looks so grown up now (also has new glasses!)

She also has a shunt, and then RVoT patch, very similar to Aidan. She had a cath on one of our last mission trips, has had multiple of her collaterals (vessels that have rerouted blood flow to her lungs) coiled in the past, and her right pulmonary artery still remains small. We may do another cath at some point in the future, and then contemplate closing her VSD as well-possibly on next mission. Her saturations are 87-88% and clinically she looks fantastic! It feels like we have been able to watch her grow up-since we first operated on her in 2009.
Nour and the team:

Nour and her brother and sister:

The afternoon, second case for the day is on a brand new baby, born 4 days ago named Laith Maher Mithqal Zaidan, from Jordan. Laith was diagnosed prenatally by echo with complex heart disease. He has interrupted aortic arch, mitral atresia, transposed great arteries, and single ventricle. The baby was transferred from the hospital it was born at to Al-Khalidi Hospital yesterday and we did a CT/angio scan to evaluate the arch. The baby has a type A interruption , which means all the branches of the aorta come off the aorta before the interruption, and then the rest of aorta is supplied and connected by the PDA. The baby is dependent right now on prostaglandins , a medication to keep the PDA open. This will likely require multiple operations down the road, but the most pressing issue is to connect the aorta and try and augment (enlarge) it as best as possible. We decided to approach the aorta through the side of the baby’s chest (called a thoracotomy) and reconnect the ends together.
Mark was successful in doing so with no significant BP gradient from above and below where the arch was reconnected. He also was able to do a PA banding to limit blood flow to the lungs. Next the baby will have to had the atrial septum opened up so the blood flow from the pulmonary veins can mix return better to the pumping chamber size the mitral valve is not
Allowing blood flow to return to left ventricle. Eventually the baby will need a HemiFontan and Fontan operations when older.
Baby Laith:

The children from today are all stable in the ICU when we make our evening rounds.
Tomorrow’s first case is Mahmoud Amer Al Daabseh, a 1 1/2 yr old with complex DORV (double outlet right entirely, VSD), remote side by side grey arteries, who will need a long tunnel patch to close the VSD to the aorta, which comes off the right ventricle.
Mahmoud:

Depending on how the day progresses tomorrow , we will either do a 10 yr old boy from the Palastinian refugee camp with a VSD or a 8 yr old patient we had previously operated on with PAPVR and a sinus venous ASD, who has now developed a subaortic membrane.

We also had a visit from our good friend Mustafa Nesaridden, a Rotarian and one of the first GOLA members we were privileged to work with. He and his wife Ghada, have been huge advocates of our missions, as well as GOLA and the Rotary club of Jordan. Mustafa informed us tonight that next year he has been elected as the district governor of the Middle East region-what an amazing honor.

Moustafa and our team:

Moustafa and Dr. Kal:

After leaving hospital somewhat late this evening, we stopped off at one of favorite restaurants for a quick bite-best hummus and pita in town, followed by outstanding falafel.