Heart Team Examines 300+; Six Need Surgery Now, 5 Later

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.

Heart Examinations Underway - Kiribati Director of Hospital Services, Dr. Burentau Teriboriki (left) observes heart patient examination as PIMA volunteer cardiothoracic surgeon Dr. David Moore of Baylor Heart Hospital in Plano, Texas (right) diagnoses patient's heart valve functions. Cardiac Sonographer Michael Rampoldi (center) completed more than 300 echo readings during the heart team's visit to Kiritimati in March, with many islanders needing intervention.

Heart Examinations Underway – Kiribati Director of Hospital Services, Dr. Burentau Teriboriki (left) observes heart patient examination as PIMA volunteer cardiothoracic surgeon Dr. David Moore of Baylor Heart Hospital in Plano, Texas (right) diagnoses patient’s heart valve functions. Cardiac Sonographer Michael Rampoldi (center) completed more than 300 echo readings during the heart team’s visit to Kiritimati in March, with many islanders needing intervention.

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.

Still Thriving - These four beautiful island ladies from Kiritimati are doing well, enjoying their children and grandchildren, thanks to the life-saving open-heart surgery they underwent at Baylor Heart Hospital in Plano, Texas five years ago. After a check-up on the island last month by PIMA volunteer cardiothoracic surgeon Dr. David Moore from Baylor Heart Hospital, each was pronounced healthy and fit. Your donations paid for airfare, housing, meals and local transportation in Plano for these and others from the island. Five more will be coming in June. Please help.

Still Thriving – These four beautiful island ladies from Kiritimati are doing well, enjoying their children and grandchildren, thanks to the life-saving open-heart surgery they underwent at Baylor Heart Hospital in Plano, Texas five years ago. After a check-up on the island last month by PIMA volunteer cardiothoracic surgeon Dr. David Moore from Baylor Heart Hospital, each was pronounced healthy and fit. Your donations paid for airfare, housing, meals and local transportation in Plano for these and others from the island. Five more will be coming in June. Please help.

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.

A greater need than we imagined

By Michael Rampoldi, Cardiac Sonographer

Our visit to Kiritimati is one I will remember for the rest of my life. This was my first experience with mission work, so I was very proud and honored to be invited. It’s something I always wanted to do, but never had the opportunity.

Our field of ultrasound is very specific and most of the time physicians are the only ones asked to volunteer, so this was especially important for me. Not only could I provide a selfless service to the people in need, I could represent my field and hospital with the dignity and respect that we so deeply cherish.

I believe our team provided a level of service and care that will set the standard for the future missions to come.

There is a greater need that what we imagined, so our mission doesn’t stop here… in fact, we are looking forward to the next assignment.

The people of Kiribati were very kind and thankful during our entire stay.. providing dinners and banquets for us at every opportunity. The gracious and exuberant way they accepted our help was very touching to me, and the physicians who currently manage the hospital (on Christmas Island) stood at our side offering assistance whenever needed.

It was truly a team effort, led by the local physicians, Mr. Carlton Smith of Pacific Islands Medical Aid, Inc., and cardiothoracic surgeon Dr. David Moore of Baylor Heart Hospital in Plano, Texas.

We seemed to have the right team from the start, as Amy Moore developed a database for record keeping and necessary follow-up documentation, which will also set the standard for teams in the future.

Sarah Moore continuously provided updates and managed the flow of patients entering the hospital doors, which included taking photos and interacting closely with the staff and patients in need. Jourdan Rampoldi was extremely helpful in organizing the echocardiography paperwork and keeping me on task to work more efficiently during exams.

Reducing the rate of Rheumatic Heart Disease and improving the lives of the I-Kiribati people will continue to be the primary goal of the ‘Heart Team’ from Dallas, Texas.