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Children's Heart Project

Log for March 2001 Mission

By Jeremy R. Torstveit, M.D.

Thursday, March 15, 2001

Daya met us at the airport after an uneventful flight. After a brief trip to the hotel, we went to the hospital, made rounds and met our old friends. Dr. Iresh had gone to Cardiff, U.K. for training, finally! Dr. Gremini Ranasinghe (Dr. Lahie's) was now senior registar. The two new junior registars met during the last visit. Dr. Mahendra Munasinghe (Dr. Amarasena) and Dr. Prashanth Avigaratnana (Dr. Rajapaksa) presented the patients reviewed during our last visit and we set the schedule for Friday and Saturday. Shawn met Dr. Hemanthe and other staff including Dr. Rabel.

The staph infection has not recurred and they have had only one mortality so far this year (from a missed diagnosis primarily). After finishing our scheduling we retired for the day, to try to beat the jet lag.

Friday, March 16, 2001

I introduced Shawn to Dr. Hector Weerasinghe, the Director, and then Dr. Rabel took her to the floors. I operated with Dr. Pieris on an 8 year old with tricuspid atresia. We did a cavopulmonary shunt and ligation of the pulmonary artery. She had an initial stormy course but came around with a change in ventilation, and some post operative care coaching.

Dr. Amarasena and I collaborated on a second patient, a 7 month old 4 Kg child with tricuspid atresia and did a cavopulmonary shunt and oversew the pulmonary valve - this child did very well. No boxes yet so no conduits but they assure us everything will be here Monday.

Went to dinner with Neville R. to discuss guest list for next week's party and other C.H.P. matters.

Saturday, March 17, 2001

I helped Dr. Ranasinghe with his first VSD - a 10 year old with severe pulmonary hypertension. It was a struggle but I think he has good potential. The child did very well with a big drop in pulmonary pressures. Then Dr. Amarasena and I collaborated again on a 10 year old with univentricular heart of the DORV type. Again a cavopulmonary shunt and banding of the pulmonary artery was successful. This child had a clotted Blalock Shunt. I'm surprised at the reversibility of pulmonary pressures on some of these older kids.

In the afternoon we drove to Kandy to Father's retreat and went to mass. We had a very nice stay - saw Father again.

Sunday, March 18, 2001

Returned from Kandy and then checked with ICU, where all the patients were doing well.

Monday, March 19, 2001

The day started early with Shawn addressing invitations to Wednesday night's party. I passed them out in the morning, made quick ICU rounds and found the patients all to be doing well. Dr. Amarasena had an 11 month 5 kg child advertised as a TAPVR to the SVC with severe pulmonary hypertension. After the dissection only an enormous PDA was identified along with a moderate ASD. This echo was done on the old echo machine at Jawardenapura. The child did well post bypass. Meanwhile I was involved primarily with Dr. Pieris who operated on a 10 year old with severe AI and subpulmonic VSD. The boxes arrived and none were more well received than the 20 or so boxes of toys and stuffed animals that Shawn sorted and delivered to all children's wards throughout the day. The entire shipment arrived intact and unmolested, as usual. I spent the late afternoon seeing many more patients and setting the schedule up for the rest of this visit and for the upcoming visit. I finished arrangements with Hemanthe for the employee tea, Shawn and I went to Galle Face for dinner and to meet with Dr. Rabel and then back to the hotel and a welcomed sleep.

Tuesday, March 20, 2001

I made rounds and Shawn set aside toys for Father Tom's clinic and Dr. Rabel's orphanage. These toys were a fantastic success. I turned down a presentation of equipment to the Health Minister because of the time constraints, made rounds in the ICU and then to surgery for the first two complex cases. I helped Dr. Pieris with a 17 year old tetralogy with single RCA - LAD origin. We placed a 20mm conduit and the patient did well. Dr. Amarasena and I consulted intra-operatively on a tricuspid atresia with severe pulmonary hypertension. We ended up with a cavopulmonary anastamosis - tightly banded PA and PA pressures of 18. A nice job by Chandima. Shawn delivered the medicine boxes to St. Mary's because I was still needed in the O.R. I saw patients in the clinic. We had dinner in one of the professor's houses with a large group of people interested in a medical and scientific education. It was a great meeting and we got back late to the hotel. This is an excellent group we can support heartily.

Wednesday, March 21, 2001

I helped Chandima Amarasena with a 7kg 1.4 year old Tetralogy and now the S-ICU was full. Shawn spent most of the mornings up on the wards and was making a lot of friends. The children really loved her and she was mobbed when giving out the animals. She visited all the children's wards and did post op follow up on the transfers. We made final arrangements for the staff tea - I saw more clinic patients and then it was time to get ready for a great evening at Beach Wadiya. It was a great success!

Thursday, March 22, 2001

It was our longest and busiest day yet. Shawn was all over the hospital. I helped Dr. Lahie with an Epstein's repair and Dr. Amarasena did yet another cavopulmonary anastamosis which went well (I never made it to his room.) Then I helped Dr. Ranasinghe with a Common Atrium, Endocardial Cushion and TAPVR. All the cases went well. All the children with the exception of the AVR-VSD Closure were doing well. The new senior registar had made a good accounting of himself. The ICU was functioning very well. Dr. Amarasena exhibited extremely good judgment and technique as did Dr. Lahie. Dr. Hemanthe is doing an excellent job. Between cases Shawn and I served tea and sandwiches to about 150 minor staff and nurses. Dr. Amarasena and I went over last year's stats and results, and discussed expansion plans for the Heart Unit.

I also made arrangements for the distribution of 10 more boxes that Kathy had just sent for C.H.P. from the US. I got the request lists for instruments and equipment including requests for loupes for Dr. Pieris and Dr. Ranasinghe. We will be inviting new surgical consultants now that we have grant money. Dr. Iresh will be back in 2 years and hopefully will be capable of doing small complex children. We are closer to our goal but there's always much to be done. As usual there is a sadness in saying goodbye to my adopted country, but the CHP is thriving and ready with outside help to step up to the next level.

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