July 1 - happy Birthday Canada!

It took a considerable amount of effort to explain what Canada Day was
and why we were painting our faces with maple leaves today, but we
went out and mixed a little bit of alcohol with a little bit of
malarone and had a good night in Canada's honour. We were also
celebrating Meredith's 22nd birthday, so plenty of reason to
celebrate! Failing a Canadiana bar in Tanzania, we settled for the
next best thing: O'Willie's Irish Pub. Ha. Good times had by all.

Earlier in the day at Muhimbili, I finally got to see the large
mitral valve surgery that had to be pushed back. The patient was a 22
year old man, who, when I looked in the theatre, I swore was no more
than 12. This was another case of 'failure to thrive' and at 22, he
had not yet even gone through puberty because his heart was having to
work so hard to keep him alive. The problem is that the mitral and
tricuspid valves in his heart, which normally keep the blood flowing
in one direction were, in this patient, crippled and almost useless
due to a bacterial infection that triggered Rheumatic heart disease in
his childhood. Rheumatic heart disease is almost unheard of in Canada
because we can treat the bacterial infection so easily, but big heart
repairs like this one are common here, Really common: 90% of cardiac
surgeries are for mitral valve repair secondary to rheumatic heart
disease. In Canada, the majority of a cardiovascular surgeon's time is
spent repairing coronary arteries or grafting on new ones when our own
become clogged with cholesterol. I guess as the saying goes: Out of
the frying-pan and into the fire, or; out of the deep-fat frier and
into the rheumatic fever, burning away the youth of this country.

As a result of the rheumatic fever, all that blood moving in
the wrong directions has numerous consequences, the most striking of
which was to increase the size of his heart: on x-ray, it took up 75%
of the diameter of his chest (normal is 50%). It was massive. His
whole chest pulsated with every erratic beat and sound of blood
rushing the wrong way through one-way valves was clear as day.

The surgery itself was incredible to watch and amazingly
complicated, including cardiovascular bypass (a machine pumps all the
blood around the patient's body for them), a full mitral valve
replacement with a prosthetic metal valve and a tricuspid valve
repair. It was about 7 hours from start to finish and thankfully there
were no major complications, although the bypass was hard to set up
and the patient's blood pressure dropped to 7 / 5 for a couple minutes
while they sorted out the hole in the aorta. There were a few tense
moments where we packed ice around the patient's head to try to
protect his neurons from being damaged.