Amman Jordan Riley Heart Mission #37 – day 1

Traditional first day team picture

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.

Rouh before surgery. Note the blueness of her hand against Riad’s fingers.

The surgery went well and we will do our best to help her recover over the next few days.

Dr. Maha and Dr. Mark with Rouh

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.

Muhannad before surgery

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.

Riad and Becca with Muhannad prior to extubation.

Sheila keeping Rouh calm. A big task since her extubation.