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Cutting-Edge Heart Surgery Arrives in Cambodia

Dr. Chen stands with 16-year-old Chun Leap on the fourth day after his surgery. Chun Leap had an atrial septal defect repair, or repair of a hole in the wall (septum) between the right and left atria of his heart. They are standing near the building where the families of the children were housed.

In February 2005, a group of American heart surgeons traveled to Phnom Penh, Cambodia, to perform pediatric cardiac surgery. This mission, the first of its kind from the U.S., was sponsored by Surgeons of Hope Foundation, Inc. and its partner Gift of Life International. Jonathan M. Chen, MD, Assistant Professor of Surgery at Columbia University College of Physicians & Surgeons and Site Chief of Pediatric Cardiac Surgery at New York Weill Cornell Medical Center led the team of doctors and nurses from NewYork-Presbyterian Hospital.

After a grueling 30-hour trip, the team arrived at the Phnom Penh Heart Center (PPHC), a four-year-old, cardiac hospital founded by the French foundation La Chaine de l'Espoir (the French organization that started Surgeons of Hope). In addition to Dr. Chen, the team included William E. Hellenbrand, MD, a pediatric cardiac catheterization specialist, and Charles S. Kleinman, MD, a pediatric echocardiography specialist. The group took on 23 cases in five days, with Dr. Chen operating on nine children in all. The procedures were performed in The Children's Pavilion, the two-year-old pediatric unit of PPHC, which serves more than 240 Cambodian children a year at no cost to their families.

Surgeons of Hope estimates that 100,000 children in Cambodia suffer from heart disease, and one-tenth of those are in urgent need of critical cardiac surgery. Faced with this overwhelming demand and working on a very tight schedule, Dr. Chen and his colleagues immediately set about prioritizing cases. First, they identified those children who would benefit most from a single procedure. Next, they prioritized the cases they believed might become inoperable within several months—before a team of European physicians would arrive. Finally, they determined which operations were low-risk enough that proper follow-up care could be administered, and straight-forward enough that they could be replicated by the Center's own surgeons. "All of this is so PPHC can become a self-sustaining hospital that can really help these kids," Dr. Chen said, underscoring Surgeon of Hope's mission to establish hospitals in less-developed countries and train local medical staff to provide the highest quality care.

Dr. Chen checks-up on four-year-old Cham Nan on the first day after her surgery. Cham Nan had surgery to repair a ventricular septal defect, a hole between the right and left ventricles of the heart.

One of the operations Dr. Chen performed was a complete repair of a congenital heart condition called Tetralogy of Fallot. Babies with this condition are born with a hole between the left and right side of the heart and an obstruction of blood flow to the lungs, impairing the ability of the heart to deliver oxygenated blood to the body. Open-heart surgery is required to seal the hole. Dr. Chen also operated upon a child with a subaortic membrane, or area of fibrous tissue below the aortic valve that obstructs the flow of blood through the valve. The surgical repair for this condition requires stopping the heart, opening the aorta and removing the obstructing tissue.

In addition to heart surgery, the team performed several cardiac catheterization procedures. A less-invasive approach, catheterization involves inserting a small, plastic tube through a peripheral vein or artery (such as in the groin) and threading it into the heart for diagnostic or treatment purposes. Dr. Hellenbrand used this technique to take pulmonary artery pressures to determine operability. He also repaired several cases of patent ductus arteriosus, an opening between the aorta and pulmonary artery that normally closes after birth. Using a catheter, Dr. Hellenbrand placed a small metal clip or closure device over the opening, thereby preventing the abnormal outflow of blood. According to Dr. Chen, "The local medical staff had never seen pediatric cardiac catheterization. It's a whole new era. Today we can do a lot with catheterization that spares kids from open-heart surgery."

The pediatric patients ranged in age from one to 16. They came from all over Cambodia; some were referred from smaller satellite clinics of PPHC where earlier diagnoses had been made. The Center allows them to stay with a family member at no cost and even attend school there thanks to funding from paying adult patients and donors. Dr. Chen reports that the working conditions were quite good, and the 50-bed facility was well-designed, well-equipped, and very clean. The team plans to return to Phnom Penh next year for another week of patient care and physician training.

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