Archive for March 2024
Amman Jordan Riley Heart Mission #37 – Day 6
Our final day in Amman. There are no scheduled cases today. All of our patients have had a stable night. We rounded on the 6 patients in the PICU and 4 on the floor. Mohannad was discharged yesterday.
We head back to our hotel this afternoon to pack. Dinner tonight hosted by Rami, and then off to fly home tomorrow. We have had a great mission week, but leave with our usual fatigue. We have enjoyed amazing hospitality, food and friendship. And thankfully our patients have recovered well.
Dr. Turrentine mentioned that not only is this the 37th Jordan mission, but also his 50th mission including all the different countries we have gone to.
We have many generous supporters and friends to thank for the opportunity to help so many children around the world. Including:
Gift Of Life Amman
Rotary Club of Greenfield Indiana
Chain of Hope
Josh Lindblom Foundation
Al Khalidi Hospital
Grand Hyatt Amman Jordan
Ornina Shneker (relative of Dr. Riad Lutfi)
Gift of Life International
Amman Jordan Riley Heart Mission #37 – Day 5
We knew yesterday that Aya would be fragile after her PA band. And she was. Therefore, Riad decided to stay in the hospital overnight. Overall everyone behaved but Riad was busy. Omar had fevers and the viral panel came back positive for Covid. He was moved to an isolation room. So far the other kids are progressing well.
Case 1 today is Adam Al Mahdawi. He is Jordanian/Palestinian with Down Syndrome and large VSD. He also has a small ASD (atrial septal defect).
Adam did well once we got an arterial line. The VSD and ASD are closed and everything looks good.
Dr. Mark had a special visitor whose family drove 2 hours for a quick hello and present a gift. Muyassar has had several surgeries for her complex heart condition and is thriving now.
Our next case is Malak Tartouzeh. A beautiful 10 year old Jordanian/Palestinian girl. She has a significant VSD that is causing too much blood to go to the lungs and signs that her lung blood pressure is becoming elevated. Her name means “angel” and it fits her personality. She is the youngest of 4 children in her family and the only girl.
Malak’s VSD was closed successfully and she will be extubated soon after her arrival to the PICU.
Amman Jordan Riley Heart Mission #37 – Day 4
Before Omar made it up to the PICU yesterday, he began having bleeding from suture lines in the OR. It required a significant amount of transfusions of blood and clotting factor products and additional suturing to stop it. Finally around 9:30 pm we made it to the unit with Omar in stable condition. A little later we went directly to the home of one of our GOLA/Rotary friends for a quick and amazing meal and fellowship.
This morning we returned to find all of our patients doing well and ready for more progress today.
Today we are doing a re-operation Rawia Abdo. She is a 2 year old girl from a tiny island off the northeast coast of Syria – Arwad. She had tetralogy of Fallot repair when she was just under a year old. Since then she developed a narrowing below the pulmonary valve that needs to be repaired. Every time Maha has visited her here in the hospital, she has been playing with and talking about animals.
Dr. Mark and Dr. Maha resected a significant amount of scar and muscle below the pulmonary valve and put in a new monocusp valve. Everything looked good at the end of the case.
Our second case today is a 5 month old Syrian girl who is one of a set of twins – Aya Al Salamat. She has a large Ventricular Septal Defect (VSD) and severe failure to thrive. She weighs about 3kg (about 6 lbs 10oz). Our plan today is to place a band around her main pulmonary artery to limit the amount of blood flow to her lungs which will help breathe more easily and gain weight better.
Aya’s PA band operation went well. Her post op echo showed a maximum Doppler gradient across the band of 46 mmHg. This is about half of her body’s systolic pressure. A good result. Riad plans to keep a close eye on her tonight.
For some of our team it was possible to go back the hotel early. A few stayed back to discuss more patients with Khal. Although we definitely enjoy the great dinners and companionship of our Amman hosts and friends, tonight we have off. Which will give us all a chance to get to bed early and refresh for tomorrow.
Amman Jordan Riley Heart Mission #37 – Day 3
Rouh had some trouble yesterday evening after developing a pneumothorax (free air in the chest) that required chest tubes to be placed. Wateen had a fast heart rate, and Mohannad was struggling to be comfortable enough to rest. But eventually they all responded to the team’s efforts and interventions and the rest of the night was uneventful.
Our GOLA friends celebrated Maha’s birthday at a lovely Italian restaurant after we were able to leave the hospital.
Our first case this morning is Basmah Al Muhammad. She is a 15 year old from Syria and is the eldest child in her family of five. She has a very large atrial septal defect. Although we can sometimes close this type of defect in the Cath lab with a device, her defect is potentially too large and there is not enough rim on some of the edges for this method.
The ASD closure went well. And we will move on to the next of 3 cases today. Abdul Al Reqeb is a Jordanian/Palestinian 6 yr old boy with a recently diagnosed severe coarctation of the aorta.
In the operating room the narrowing of the aorta was even more severe than what the echo showed. in addition there were several large “collateral” vessels that helped blood bypass the narrowing but added complexity to the repair. Afterwards the maximum pressure differential from above the repair to below the narrowing was about 10 mmHg which reflects a good result.
The last patient today is Omar Abdullah. He is a 2 year old from Syria with a severe aortic valve stenosis. The valve was very thick and abnormal. There was a dilated aorta above the valve. He also had an atrial septal defect and a slight membrane in the left atrium. All of these things were addressed by Dr. Mark. Before surgery the mean pressure gradient across the valve was ~50 mmHg. Afterwords the mean pressure gradient was 12 mmHg.
Amman Jordan Riley Heart Mission #37 – Day 2
Despite some rain and wind this morning, things were bright at the hospital where we rounded on our post-op patients. Both Rouh and Muhannad did well overnight and looked great this morning.
Our first case today is Ahmed Al Hussein. He is a 10 month old Palestinian/Jordanian with Double Outlet Right Ventricle. His VSD is below the aortic valve. There may be some narrowing of the valve to the lungs but it is mostly reflecting more volume from the VSD.
Ahmed’s operation went well. His Double Outlet Right Ventricle VSD is closed as well as a small PDA and PFO. On his post bypass transesophageal echocardiogram he had good cardiac function and was in a normal heart rhythm.
Our second patient today is Wateen Al Ajrab. She is a 6 month old from Syria with a significant VSD causing congestive heart failure. Despite being on 3 medicines she has had difficulty gaining weight. She is the youngest member of a family of 5 children. When she arrived, she had a cough which worried us as a sign of a possible pneumonia. But her labs were reassuring and with 2 days of IV lasix, she has less cough and a better chest x-ray.
The VSD was closed and the operation was well tolerated. We will hope for an uneventful night of recovery.
Dr. Khalid also did 2 diagnostic catheterizations today that will help us plan for this and future missions.
We have to finalize the schedule for the rest of the week and then head back to our hotel.
Our Gift of Life Amman (GOLA) hosts and friends have been taking great care of us and tonight have plans for dinner at an Italian restaurant.
Amman Jordan Riley Heart Mission #37 – day 1
Our first patient today is Rouh Tanbakji, who I mentioned yesterday is a five month old from Syria. She has a very complex congenital heart defect, including mitral valve atresia with hypoplastic left ventricle, a small atrial septal defect, D – transposed great arteries, and pulmonary atresia. For the first month of her life she was supported with prostaglandin infusion, which is quite expensive. This was eventually turned off and the family was told that she would likely die. But she has surprisingly done reasonably well. She has been eating and gaining weight, although she is very blue. Her oxygen saturation level ranges from the mid 50% to mid 60%. Her name means “soul” and her parents just filled out her birth certificate last month when they learned that we would put her on the surgical schedule.
The IV that was started yesterday by Riad did not last and so we did not get a CT angiogram. Today in the OR our transesophageal echo showed a right pulmonary artery measuring 4 mm in diameter which is mildly hypoplastic, but a normal size superior vena cava. Her directly measured pulmonary pressure was 14 mmHg. Therefore Dr. Turrentine decided to proceed with an atrial septecomy and a Glenn operation. Basically this means that the hole between her upper chambers will be made larger and her superior vena cava will be directly connected to her right pulmonary artery to provide improved pulmonary blood flow. If all goes well, this would set her up for a future Fontan completion.
The surgery went well and we will do our best to help her recover over the next few days.
Our second case today is Muhannad Al Kelani. He is a nearly 3 yr old male from Jordan with a discrete subaortic membrane that is moderately narrowed and a dilated ascending aorta. We also discovered a bicuspid aortic valve with slight valve leak. He has had several non-cardiac surgeries in the past and recently was evaluated by a pediatrician who noted a murmur that led to his diagnosis.
He underwent a subaortic membrane resection, partial bicuspid aortic valve commisurotomy and ascending aorta slight reduction. Everything went well and he will be extubated once he is settled.
Amman Jordan Riley Heart Mission #37 – Arrived
We had an uneventful trip here from Indianapolis and arrived in Amman yesterday afternoon around 4 PM. Traffic was busy and took us quite a while to get to the hospital to drop off our trunks and then head to the hotel.
After getting to our hotel, we learned that one of our patients, Rouh Tanbakji (5 month old from Syria) scheduled for Saturday, was in town with her parents. The plan for her is somewhat uncertain until we know more about her atrial septum and pulmonary artery sizes. We decided to go back to the hospital and get some echo images to see if this could clarify these details. However due to fussiness, we ended up thinking that a CT angiogram would be more beneficial. We planned on doing that the next morning. But that would require an IV which up to this point has been quite challenging.
Friday morning, Riad, Tim, and Mark were all scheduled to give presentations at the 18th Annual Pediatric Review Conference that is hosted and run by Dr. Khal. In between his talks, Riad went to the hospital to get an IV started for our Saturday patient to get the CT angiogram. The meeting was very well attended, and the audience very warm and appreciative.
Tomorrow we start our first regular day of surgeries and are looking forward to getting well rested before starting in this busy week.
The Riley team for this 37th mission to Amman, consist of:
Mark Turrentine
Tim Cordes
Riad Lutfi
Maha Al Khuziem
Sheila Rocchio
Rebecca Baute
Joining us from Chain Of Hope will be our good friend, Oroyo Eubanks.
And of course our Amman, Jordan good friends and huge support from Rami Sha’ban (GOL Amman), and Dr. Khalid Al-Salaymeh.
Riley International Heart Missions 