Update by Lavonna Redman

As I write this, I am on an airplane 25,000 above the Caribbean Sea. I have just finished a two-day screening of children in Playa Del Carmen, Mexico. I saw forty-eight patients. Sixteen have significant heart disease and need either surgery, cardiac catheterization, or medication. The other patients did not have any heart disease and they and their parents were very relieved to know that their hearts were fine. It is interesting to consider that even though Playa del Carmen is tropical paradise on the outside, behind the turquoise waters and white sand there are many people who are hurting and carry heavy burdens about the medical needs of their children.

Of the sixteen, five need heart surgery of varying degrees of complexity. Five need a cardiac catheterization to determine if they are surgical candidates. Three need closure of a hole or ballooning of a narrow vessel in the catheterization laboratory. Three do not need any intervention and can be managed medically for the time being. They may need surgery or cardiac catheterization in the future.

At risk of overwhelming you with medical technology, I thought you might be interested in the case notes I took. I did include a glossary of the medical terms at the end. Even if you don’t want to wade through the jargon, please join me in praying for these children.

12 y/o girl whose mother attempted to abort her taking unknown medications. She has been taken care of by her grandmother since birth. She is deaf, probably related to the medications taken by her mother. She has a coarctation of the aorta, patent ductus arteriosus (PDA), and sub-aortic stenosis. She needs surgical correction of these three defects.

11 month old girl with tricuspid valve atresia, ventricular septal defect (VSD), and atrial septal defect (ASD) status/post Rashkind. Needs a bi-directional Glenn. Peripheral oxygen saturation is 51% (normal is greater than 95%).

3 month old who has a small ASD. She was told by the private hospital that she will need surgery at 9 months of age. She does not need surgery now. If the defect remains until she is 5 years old, then she can have the defect closed by a device, avoiding surgery altogether.

4 y/o female with double outlet right ventricle (DORV), Taussig Bing variant, who had a pulmonary artery (PA) band procedure. Has been told that she is not a surgical candidate. She needs a catheterization to determine if she can undergo surgery. Peripheral oxygen saturation is 62%.

1 year old with Down’s syndrome with ASD and VSD. Peripheral oxygen saturation is 88%. He needs surgical closure of the ASD and VSD.

5 y/o boy with mild pulmonary valve stenosis and moderate tricuspid valve regurgitation. No intervention needed at this time. He needs spontaneous bacterial endocarditis (SBE) prophylaxis (antibiotics at certain times to prevent infection of the heart).

13 y/o with decreasing exercise tolerance. She has a possible coronary artery to pulmonary artery fistula. Needs re-evaluation.

9 y/o old with bicuspid aortic valve with mild stenosis. Needs SBE prophylaxis.

9 y/o boy with DORV with pulmonary valve stenosis and large aorta to pulmonary artery collaterals. Peripheral oxygen saturation is 67%. Needs catheterization to identify surgical options, if any. Would benefit from phlebotomy to keep hematocrit (red blood cell count) under 60%.

3 y/o with a small to moderate VSD with tricuspid valve tissue partially closing the defect. Needs cardiac surgical repair due to clinical symptoms of poor weight gain.

6 y/o female who has mitral valve atresia and pulmonary valve atresia with collaterals with aorta to pulmonary artery collaterals. Maine said they would do surgery at 9-12 years of age. Needs catheterization and then surgical repair, staged for single ventricle.

2 y/o with a restrictive PDA. Needs cardiac coil occlusion in San Antonio.

4 month old with mild coarctation of the aorta and a PDA with left to right flow. Needs cardiac catheterization intervention to balloon coarctation and coil PDA.

2 ½ y/o male with Down syndrome with VSD and pulmonary hypertension. Needs catheterization to establish if he is a surgical candidate. It may be too late.

20 y/o who has a PDA. Consider catheterization in San Antonio versus surgical ligation in Mexico.

6 y/o with a large PDA and tortuous aorta who needs surgical ligation of the PDA, preferably in Mexico.

Glossary

Atresia: Failure of a valve or a chamber to form.

Atrial septal defect (ASD): A hole between the two collecting chambers of the heart.

Bicuspid: Two-cusped valve, instead of normal three-cusped aortic valve.

Bidirectional Glenn: A surgical connection between the main vessel carrying blue blood back from the head and arms to the right pulmonary artery. Used for children who only have one pumping chamber in order to deliver blood to the lungs.

Coarctation of the aorta: Narrowing of the major blood vessel leaving the heart, resulting in damaging pressure overload on the heart.

Double outlet right ventricle (DORV): Ideally the aorta should arise from the left pumping chamber and the pulmonary artery from the right pumping chamber. Sometimes both vessels arise from the right pumping chamber.

Fistula: Abnormal connection.

Patent ductus arteriosus (PDA): The ductus arteriosus is a vessel used in the fetal circulation that should close shortly after birth, rather than remain patent. When it remains patent, it results in damaging overcirculation of blood to the lungs.

Pulmonary hypertension: High blood pressure in the pulmonary circulation.

Rashkind: A procedure used to make a hole between the two collecting chambers of the heart in certain emergency circumstances when there needs to be mixing of oxygenated and deoxygenated blood.

Regurgitation or insufficiency: Leaking valve.

Stenosis: Narrowed vessel or valve.

Ventricular septal defect (VSD): A hole between the two pumping chambers of the heart.

Please pray that God would open doors for us to make available treatment for these children, whether it be in the US or Mexico. Please also pray that we may be able to open a pediatric cardiac center in Playa del Carmen to treat the poor.