PALESTINE CHILDREN'S RELIEF FUND

Dr. Ziad Saba mission to Ramallah Catherization Lab, February, 2001
In February, 2001, the PCRF sent Dr. Ziad Saba, a pediatric cardiologist at Oakland Children's Hospital in California, to Ramallah Hospital in the West Bank to provide screening and treatment for sick babies with congenital heart disease. For one week, Dr. Saba treated several children and provided expert diagnosis for many more, enabling the PCRF to place them for surgery abroad. He also brought with him thousands of dollars worth of donated medical supplies to use in Ramallah.

Cases Screened and Sent Abroad for Surgery

Name
Age
Treatment

Nagham Qfashah
3 yrs.
Sent to Saudi Arabia

Wia'am Farhat
12 mo.
Sent to Wolfson Hospital

Marwa Kattam
2 yrs.
Sent to Saudi Arabia

Susan Atout
4 yrs.
Sent to Belgium

Rawan Abo Sarhan
14 mo.
Sent to Wolfson

Tasneen Al-Kidan
15 mo.
Sent to Wolfson

Mohammed Al-Hammami
14 mo.
Sent to US

Nahaya Shatat
13 mo.
Sent to US

Ibrahim Khamir
2 yrs.
Pending

Mohammed Al-Louh
3 yrs.
Sent to US

Aseel Kittani
3 yrs.
Pending

Ahmed Al-Kam
7 yrs.
Pending

Hatithem Al-Amoudi
10 yrs.
Sent to Switzerland

Mohammed Aouni
5 yrs.
Pending

Jihad Yacoub
14 yrs.
Sent to Switzerland

Cases Treated in Ramallah Hospital

Name
Age
Surgery

Mohammed Abo Hamad
5 yrs.
Dialitation

Sabir Zaanoon
12 yrs.
Balloon Dialitation

Shirook Abo Warde
6 yrs.
Coil Closure

Iman Edah
7 yrs.
Balloon Dialitation

Mohammed Abo Ramilah
7 yrs.
Balloon Dialitation

Cases Needing Surgery At An Outside Institution (Less Urgent)

Nahaya Shatat (DOB 25/5/99)
18 month followed for VSD/PS. Has mild cyanosis with O2 sat 85%. P.E. G III/VI SEM at the LUSB. Echo shows TOF with probably good size pulmonary arteries, left aortic arch and bidirectional flow across the VSD. Needs repeat ECHO before surgery to look at the LPA and the coronaries.

Ibrahim Khamir (DOB 15/9/99)
18 month old with large RV and RA. Tires easily. Echo shows a large sinus venosus ASD with probable PAPVR of the right pulmonary veins. Has large coronary sinus consistent with L-SVC to coronary sinus. Needs repeat ECHO prior to surgery as ECHO was not optimal.

Mohammed Al-Louh (DOB 7/4/1998)
Three y.o followed for AS. By ECHO peak gradient is 80 mmHg. Mild AI. We performed Cath in Ramallah, gradient appears to be in the supraortic area and did not respond to balloon dilation. Patient may have features of William syndrome. Suggest surgery to repair supraortic stenosis.

Aseel Kittani DOB 5/3/1998
Two and a half y.o with a moderate to large perimembranous VSD. Growing well but tires easily. P.E. G IV/VI holosystolic murmur at the LLSB. ECHO 5-6 mm perimembranous VSD, 5 mm with moderate to large shunt restrictive by at least 50 mmHg. Large LV and LA. Needs surgical repair of VSD. No need for cath prior to surgery.

Ahmed Al-Kam DOB 14/8/94.
6 y.o S/P repair of PDA in infancy and repair of Primum ASD in Amman at two years of age. He remains small and tires easily. Wt 15 kg.. P.E. LV lift, G IV/VI HSM at the LLSB and G II/VI diastolic at the apex.. Echo severe mitral insufficiency and moderate mitral stenosis with peak gradient 12 mmHg and mean gradient 6 mmHg. Mitral annulus measures 23 mm. Small residual ASD. Moderate subAS with peak gradient 64 mmHg. Mild AI. Suggest mitral valve repair/replacement with 21 mm St Jude and subaortic resection of subaortic obstruction.

CASES NEEDING SURGERY AND CAN BE DONE LOCALLY BY VISITING TEAMS:

Hatithem Al-Amoudi (DOB 31/8/91)
9 y.o with moderate large VSD. P.E G IV/VI holosystolic murmur at the MLSB. Echo shows 5-6 mm perimembranous VSD that is highly restrictive. This case may also be a good low risk case to send outside if the options are available.
Mohammed Aouni DOB 26/2/1996
4 y.o followed for coarctation and small PDA. Doing well. BP 115/90 in the right arm. +1 pulses in lower extremity. Echo coarctation with diastolic run-off and peak gradient 50 mmHg. Small PDA. Suggest repair of coarctation by either cath or surgery by future visiting teams.
Jihad Yacoub DOB 24/12/87
13 y.o with features of Noonan syndrome (inguinal hernias, short stature, facial features). Has a moderate size ASD. CXR prominent PA segment. ECHO moderate ASD with significant left to right shunt. Enlarged RV. Suggest catheter or surgical repair of ASD by future visiting teams. Alternatively can be sent abroad for that.

CASES TREATED BY CATHETERIZATION IN RAMALLAH:

Mohammed Abo Hamad (DOB 4/8/96).
Valvar pulmonary stenosis dilated with 18 mm balloon, annulus 12.6 mm, preballoon gradient 90 mmHg, after balloon 40 mmHg.
Sabir Zaanoon (DOB 23/71989)
Valvar pulmonary stenosis dilated with 2 balloons 14 mm balloon and 12 mm balloon, annulus 16 mm, preballoon gradient 125 mmHg, after balloon 30 mmHg.
Shirook Abo Warde (DOB 21/6/1995)
5 y.o with a moderate PDA. PDA measured 3.4 mm but was very short on angio. Coil occluded with 8 mm, 10 cm, 0.038 coil without residual. A loop and a half are noted in the LPA without obstruction.
Iman Edah (DOB 7/4/200)
7 month old infant with valvar pulmonary stenosis dilated with 12 mm balloon, annulus 8 mm, preballoon gradient 140 mmHg, after balloon 30 mmHg.
Mohammed Abo Ramilah (DOB 1/6/200)
Sever pulmonary stensois with peak gradient 85 mmHg. Severe tricuspid insufficiency with right to left atrial shunt and marked cyanosis at 65%. Attempted dilation but patient was unstable and was referred for surgery the following day for a BT shunt.

CASES NEEDING FOLLOW UP:

Tasneem Abo Hamde ( DOB July 2000)
7 month old with partially covered restrictive VSD, effective orifice 3.5 mm, pressure gradient across VSD 70 MMHG. Murmur G IV/VI. Needs follow up every 3 months.
Tasleem Al-Batran (DOB 6/10/99)
16 month old with tiny VSD and tiny PDA that is Inaudible. P>E G II/VI Holosystolic murmur at the LLSB. NO PDA murmur. No need for surgery.. Needs follow up every two years.
Shimar Al-Sayyed ( DOB 12/7/200)
6 momnth infant moderate ASD and VSD and not growing well. G II/VI high frequency murmur at the LLSB, +2 pulses in the lower extremities. By ECHO VSD is restrictive by 50 mmHg, unable to see arch very well and descending aorta is not very pulsatile. Needs further evaluation by next visiting team with repeat ECHO and possible Cath.
Sabri Arzikaat (DOB 5/5/96)
4 y.o followed for a small VSD and ASD. G II/VI holosystolic murmur at the LLSB. Echo tiny perimembranous VSD covered by tissue, gradient at least 70 mmHg. No need for surgery. Needs follow up every two years.
Mohammed Toukan (DOB 3/11/1997)
4 y.o followed for a VSD. G IV/VI holosystolic murmur at the LLSB. Echo 3-4 mm (effective orifice 2 mm) perimembranous VSD partially covered by tricuspid valve and part of the aoritc valve but no aortic insufficiency. Needs yearly follow up to assess for aortic insufficiency. No need for surgery at this point.
Fairouz Saber (DOB 13/11/2000)
3 month old previous report of pulmonary valve problem and pulmonary hypertension. Has obligatory oxygen need and CXR shows interstitial changes. P.E shows no murmur and soft P2. Echo shows normal pulmonary valve and no indirect evidence of pulmonary hypertension. Conclusion; No evidence of heart disease but needs work up for interstitial lung disease.
Afnan Tafesh (DOB)
7 month old followed for a Large ASD and a PDA. P>E GII/VI systolic murmur at the LUSB. ECHO large 10-13 mm ASD with large RV. No evidence of PDA.. Suggest follow up every 3-4 months. Will very likely need closure of the ASD whether transcatheter or surgery.
Nagham Khweireh (DOB 17/5/98)
3 y.o followed for mild-moderate PS. P.E. G II/VI SEM at the LUSB. Echo valvar PS, peak gradient 60 mmHg, mean gradient 40 mmHg. Patient will need follow up every year. Would recommend cath and balloon dilation if gradient exceeds 75 mmHg as peak or 50 mmHg in mean.
Namir Qadan (DOB 8/8/93)
7 y.o girl followed for a small VSD. P.E G II/VI holosystolic murmur at the MLSB. Echo 2-3 mm perimembranous VSD with no aortic involvement. Highly restrictive. No need for surgery. Needs follow up in two years.
Mohammed Barnakh (DOB 1996)
4 y.o followed for valvar AS. By echo gradient is 60 mmHg and mean is 30 mmHg. By cath the gradient was 45-60 mmHg but unresponsive to balloon dilation with 12 mm balloon (annulus 12 mm). Suggest continued follow up every 6 months may need further intervention if gradient exceeds 50mmHg mean on Echo.
Fadi Jaber DOB 21/1/1997
4 y.o boy S/P repair of VSD closure in Amman in 1999. Still tires easily. Wt 20 kg. P.E G II/VI high frequency murmur at the MLSB and G II/VI decrescendo at the LLSB. ECHO small residual VSD, moderate aortic insufficiency with enlarged LV. Diastolic retrograde flow in the transverse arch. Suggest afterload reduction with Captopril. May need surgery to attempt to repair aortic insufficiency with aortic valve replacement as a back up option

HIGH RISK CASES WITH POOR PROGNOSIS;

Majed Yameen DOB 28/8/200
6 month old infant with Dextrocardia/DORV/Severe sub/valvar PS. Has severe cyanosis with O2 sat 60%. Echo dilated IVC with extremely restrictive atrial septum. Atretic right sided AV valve. Unable to see pulmonary arteries well. As a palliative measure the patient needs atrial septectomy/septostomy and a BT shunt if the pulmonary arteries are visualized and good size. Prognosis is grim given eventual need for Fontan type repair in a patient who has probably prohibitively small pulmonary arteries.