By Dr. David Moore, MD, Cardiothoracic Surgeon
Rheumatic heart disease continues to be a major health issue in the developing world. This is particularly true on the small island known as Kiritimati (Christmas Island), one of the islands in the Republic of Kiribati.
In this remote region of the Central Pacific, strep throat infections are unrecognized and untreated, leading to an immune response and clinical condition known as Acute Rheumatic Fever. This immune reaction results in damage to the mitral and aortic valves of the heart over time. It is thought that repeated and untreated Strep infections increase the risk of damage to the heart valve and lead to Rheumatic Heart Disease.
This condition ultimately will cause heart failure and death in later life. Open-heart surgery is required to replace these damaged valves and restore the patient to a better quality of life as well as improved life expectancy.
The purpose of our recent mission to Kiritimati was to identify patients with severe Rheumatic Heart Disease and make arrangements through Pacific Islands Medical Aid, Inc., to bring them to Baylor Heart Hospital in Plano, Texas for surgery.
We also wanted to make an effort to identify children with early echo findings of Rheumatic Heart Disease, which would allow us to treat them with prophylactic penicillin, thus preventing the recurrent infections, which are known to cause the progression of the valve damage.
In the course of the week that we were on Kiritimati, we saw more than 300 patients, did 298 echos with our portable echo equipment, and identified six patients in need of surgery now, as well as another five that will require an operation at some point in the future.
Nine children were found to have early evidence of Rheumatic Heart Disease and will be started on prophylactic penicillin. We also established an electronic database, which will enable us to follow these patients closely in the future.
In an effort to expand our initiative, we are planning to make another trip to Kiribati later in the year to the more populous island of Tarawa. The Kiribati Ministry of Health is enthusiastic and supportive, as there is a great need in that region.
Our team found the people of Kiritimati to be warm and most appreciative of our efforts on the island. Many thanks to Pacific Islands Medical Aid president Mr. Carlton Smith for organizing and supporting our trip, and of course my appreciation to our cardiac sonographer Michael Rampoldi, his son Jourdan, my wife Amy and daughter Sarah for their hard work and kind spirit which made the week a real success.