William first sought medical care with Team heart in 2019. He was an 18-year-old from the Kimironko neighborhood in Kigali who first noticed body swelling and breathlessness three years earlier, when he was just 15 years old. He had been admitted to the hospital multiple times for fluid retention and difficulty breathing. His symptoms ultimately progressed to the point where he had to drop out of secondary school. He could no longer walk uphill due to shortness of breath, and even long conversations were difficult due to his breathing.
When William was first examined by Team Heart, he was so short of breath he could not lay flat. We performed an ultrasound of his heart (Echocardiogram) that showed severe rheumatic mitral valve disease. As a result, his heart had become enlarged and the pumping function was severely reduced. High pressures built up in his lungs, causing the right side of his heart to fail as well. This in turn led to liver congestion and signs of liver failure. William had advanced heart failure at just 18 years old.
Our first day of surgery was almost a week away, and William was so sick we worried he wouldn’t make it through a big operation. With the assistance of our Rwandan colleagues, we decided to admit him to a local hospital and start intravenous diuretics to hopefully relieve some of the fluid buildup and congestion.
William’s case was reviewed at our selection meeting. He was being considered for heart valve surgery (mitral valve replacement). If his mitral valve was not replaced, his heart failure would progress and ultimately prove fatal. He was brought to King Faisal Hospital for more testing, but ultimately it was decided that he was still too sick to undergo surgery at that time. He was placed on medical therapy for heart failure, but we knew this was only a temporizing measure. Definitive treatment with surgery was needed, and the clock was ticking. With each passing month the risk would grow, but William would have to wait.
In February 2020, the members of Team Heart returned anxious to see William. As he walked through the door he was notably thin, with muscle wasting from his chronic heart failure. But his beaming smile distracted from his underlying chronic heart disease and worry. Over the past year his heart failure symptoms were managed by Dr. Gloria Mukeshimana, one of just a handful of cardiologists in a country of over 12 million people. She expertly managed his condition; however, medical therapy was now failing. While his swelling had resolved, his lungs were frequently congested with fluid and his kidneys were now failing. It was now or never for William and he knew it. His heart would not wait another year or maybe not even another month. We decided that although William was high risk, he was medically optimized and now suitable for surgery.
On February 12, 2020 William underwent replacement of his mitral valve with a mechanical prosthesis and repair of his tricuspid valve. Despite the severity of his illness he recovered from surgery. At 19 years of age, William has undergone a successful open heart surgery and has a second chance at life. His symptoms are expected to improve, exercise tolerance increase, and we are hopeful that he will return to complete his schooling.