Mitral Foundation Children's Valve Project Update 2

Mitral Foundation Children’s Valve Project Update 2

Last July, my team and I returned to the Dominican Republic, where we worked with local pediatric cardiologists and cardiac surgeons to treat seven children suffering from life-threatening valve disease. This report tells the story of two of them: five- year-old Woodmylens and 18-year-old Suleika. As a surgeon who operates on hundreds of people every year, I found these cases especially moving, because the odds were so low that these children would ever get any surgery, let alone the complex valve repair they needed. Our success in saving their lives highlights the transformative impact that the Mitral Foundation makes on people’s lives—and how much more work we have to do. For children like Woodmylens and Suleika, your support makes all the difference. So I hope you will give generously—­ to help us save more young lives, to strengthen local expertise in mitral repair, and to continue raising the overall quality of mitral surgery around the world. Thanks again, David H. Adams, MD President, Mitral Foundation Cardiac Surgeon-in-Chief, Mount Sinai Health System

Mitral Foundation Children’s Valve Project Update / 2 33 Million People Suffer From Rheumatic Heart Disease In less developed countries this often leads to premature death. This is especially true in Africa, South Asia, the Pacific and the Caribbean. While the best medicine is prevention, the only hope in many advanced cases is to surgically repair or replace a patient’s damaged valves. Unfortunately, there is not a single hospital in the Caribbean that specializes in this lifesaving surgery—yet. Mitral Foundation Missions Save Lives The Mitral Foundation is a driving force in advancing the understanding of mitral valve disease, promoting the most effective mitral repair techniques, and elevating the quality of mitral surgery around the world. One of the Foundation’s priorities is to train talented surgeons in areas where they are needed most, and to establish corresponding Centers of Excellence in Mitral Surgery. We Need Your Help What would you pay to save your child’s life? Probably, just about anything. In the United States, surgery to repair a mitral valve can cost upwards of $150,000. In the Dominican Republic, we can perform the same procedure for roughly $9,000—a modest sum by American standards but one that is far beyond the reach of most families in the region. Why the difference? In part, it’s because our medical missions rely on in-kind donations from our partners in the medical industry, on volunteer teams from Mount Sinai, support from local nonprofits, and reduced rates from our host hospital—a top-flight facility with excellent operating rooms. Given these economies, every dollar you donate makes an especially big difference in saving young lives. Our goal is to perform lifesaving surgery on 25 children there in 2019, and in coming years develop a self-sufficient, high-quality program in mitral surgery at CEDIMAT Hospital in Santo Domingo. Please give generously, today. https://www.mitralfoundation.org/make-a-gift We are extremely grateful to Edwards Lifesciences Foundation and our other partners for sponsoring this life-saving work



Mitral Foundation Children’s Valve Project Update / 4 Meet Woodmylens A surgeon’s #11 blade is one of the sharpest on Earth, its cutting edge so extreme that a mere touch will draw blood. So as Dr. David Adams held his scalpel, about to begin a complex repair on a five-year-old boy’s mitral valve, he was already envisioning the sequence of incisions and sutures that would be necessary. He had to consider the challenge not in three dimensions, but four: how did he want the valve’s leaflets to move throughout the entire pumping cycle, and how should they perform over millions of heartbeats as the boy and his heart grew larger? The boy’s name was Woodmylens, and bad luck had been a constant throughout his short life. Born in a corrugated metal shack without electricity or indoor plumbing, high in the mountains of Haiti’s interior, he was only a toddler when he contracted a case of strep throat, or perhaps scarlet fever; with no clinic in his isolated hamlet, he never received a diagnosis, let alone the penicillin necessary to ward off rheumatic heart disease. Month by month, the disease had slowly degraded his heart’s capacity to pump blood. The chordae inside his heart—small tendons colloquially known as “heart strings”— began shortening and fusing. This entanglement in turn began restricting the proper movement of his mitral valve, allowing blood to regurgitate within the heart. Struggling to compensate, his heart pumped even harder, driving even more regurgitation—a degenerative cycle that left Woodmylens dizzy and out of breath. Eventually, Woodmylen’s mother, a street vendor named Nicole, had brought him to a local voodoo priest. The priest attributed the boy’s malady to an evildoer’s curse, but could not break the stubborn spell. Weeks later, down the mountain, doctors at a small hospital also failed to diagnose the boy’s problem correctly, but did take his family’s money for what turned out to be several months of in-patient treatment. When their cash ran out, Woodmylens was asked to leave. Left: Before his surgery, Woodmylens meets Dr. Adams and team members from the Mitral Foundation and Haiti Cardiac Alliance.

5 / Mitral Foundation Children’s Valve Project Update Desperate for help, his parents next sought out treatment at St. Damien’s, a hospital in Port-au-Prince serving indigent children. There, a visiting pediatric cardiologist determined that Woodmylens was suffering from rheumatic heart disease, and—with the help of the Haiti Cardiac Alliance (HCA), a nonprofit that helps poor Haitians seek cardiac care abroad—put him on a waiting list for surgery. Once back home, they waited for what felt like an eternity. As one month became two, then four, and stretched toward six, Woodmylens’ condition continued to deteriorate. For the HCA, matching patients with the right doctors around the world—sometimes even flying them to India for surgery—is always a challenge. Woodmylens’ case was especially so, as very few surgeons in the world were qualified to repair his diseased mitral valve. Finally, HCA was able to arrange the operation at CEDIMAT Hospital in Santo Domingo, just a day’s bus ride from Port- au-Prince. It would be paid for by the Mitral Foundation, thanks to a generous grant from Every Heartbeat Matters—a philanthropic initiative led by Edwards Lifesciences Foundation to educate, screen, and treat 1.5 million underserved people fighting heart valve disease . Better yet, it would be performed by the world’s top mitral surgeon— Dr. Adams—who would be flying into Santo Domingo on a medical mission, specifically to help indigent children like Woodmylens. Excited to share the good news, HCA Program Manager Kessy Acceme called Woodmylens’ parents, only to discover that their cell phone numbers were no longer valid. This was a serious and urgent problem, as the surgery had been scheduled for the following week. Without even a street address, which are rare in rural Haiti, Acceme had no way of contacting them. All he knew was the name of the district where they lived, which was home to thousands of people. Under the circumstances, it would have been easy to give up on Woodmylens altogether, and move on to the next patient on HCA’s long waiting list. Instead, Acceme got into his Jeep and started driving. If he couldn’t find the boy, so be it. But he had to try. Right: Dr. Adams and his partner Dr. Ani Anyanwu, with Physician Assistant Erica Guidicipietro, repairing Woodmylens’ mitral valve, while demonstrating the complex technique to Dr. Juan Leon (back) at CEDIMAT Hospital.





Mitral Foundation Children’s Valve Project Update / 8 Once in the area, he started showing a passport photo of Woodmylens to anybody who would pause to look, holding it out the window of his truck. “Do you know this boy?” he kept asking. Nobody did. Eventually, a young man on a mud- spattered motorcycle, learning of Acceme’s mission, offered to help. “If he lives around here, we can find him,” the man said. For the next hour or so, as this Good Samaritan and Acceme drove higher into the mountains, nobody they encountered recognized Woodmylens’ picture, or even his family name. Meanwhile, the roads were getting rougher. “I was starting to worry about the truck,” Acceme said. Finally, a woman said she recognized the boy in the photo—she thought he lived in the next village. So off they drove, tires struggling for traction on the rutted track. When they arrived, Acceme approached a house to knock on the door. As he did, he glanced over and saw a little boy, completely naked, playing in the dirt with a toy car made of twisted wire and old tin cans. It was Woodmylens. “I was so happy,” Acceme said. “I had actually found him!” Minutes later, he was explaining the urgency of his visit with Woodmylens’ parents: the need for pre-operative blood work in Port-au-Prince, how to secure a last-minute visa to enter the Dominican Republic, and other travel logistics. Five days later, Woodmylens lay on a gurney at CEDIMAT, wide-eyed under the bright lights of the operating room, awaiting sedation. His father, Jean, cried as he watched his son being wheeled off for surgery. “The doctors are very experienced,” Acceme reassured him. “They will do everything they can to save his life.” Even for Dr. Adams, with more than 30 years of experience in mitral repair, the operation would demand all of his skills and concentration. Several fused chordae would need to be separated, while others would need rerouting and reattachment. Every move would have to be very precise. As much as any other operation, open-heart surgery illustrates not just the complexity of modern medicine, but Left: Woodmylens’ father, Jean, feeds him juice after surgery.

9 / Mitral Foundation Children’s Valve Project Update also the teamwork it requires. Surrounding Dr. Leon noted that collaborating with Dr. the operating table are a dozen people, each Adams accelerates the learning process. with distinct yet critical roles—surgeons, “Working beside Dr. Adams, you get so much cardiologists, anesthesiologists, nurses, information that you can’t get from books, or physicians assistants, perfusionists and see in videos. He will explain every single step, others. This makes good communication and point out the different formations, and how collaboration imperative. to read and successfully repair the valve,” he said. “It’s really important to be efficient throughout the entire process, because the clock is In Woodmylens’ case, Dr. Adams untangled always ticking,” Dr. Adams said. “You have to several chordae, and reinforced the valve’s have a game plan and make good decisions, aperture with a small piece of tissue from quickly. You have to do everything once, elsewhere in the heart. Almost like an elastic correctly. You want to minimize time on the cuff, this reinforcement would enable better heart-lung machine, and under anesthesia.” closure, and grow with Woodmylens’ heart as he matures. Of course, everything is a tradeoff. Even though it is harder and takes longer, Ninety minutes and several #11 blades later repairing a valve is almost always preferable (they dull easily), Dr. Adams stepped away to replacing it. First, this is because good from the table, his work all but complete. mitral valve repairs should last a lifetime, “These operations are brutally difficult,” Dr. while replacement valves eventually wear Adams said. “While you have to go in with out. Second, mechanical replacement valves the right strategy, you also have to sort require patients to take blood thinners for out what you encounter, because pre-op the rest of their lives, medicine that is not just echocardiograms rarely show the complete expensive but requires constant monitoring. picture. The difference of just a millimeter or Third, if a patient is young and female, blood- two in a cut or a suture can tip the balance thinning medication precludes bearing between success and failure. In this case, children. Finally, the long-term outcomes of things went perfectly.” repairs are usually better than replacements. Of course, the surgery was far from over— Given all the advantages of repair, one of Dr. just the tricky part. When the surgical Adams’ primary goals on medical missions is to team restarted Woodmylens’ heart a short teach talented local surgeons how to perform while later, the echocardiogram revealed a such procedures, empowering them to help successful repair. “It looks great,” said Dr. even more patients on their own, with higher Adams, as he reviewed the pulsing imagery success rates at lower costs. This is especially with a group of CEDIMAT cardiologists important in regions like the Caribbean, where gathered around the monitor. rheumatic fever is endemic. Forty-eight hours after surgery, Woodmylens CEDIMAT’s chief pediatric surgeon, Dr. Juan was sitting up in bed in CEDIMAT’s cheerful, Leon, is a congenital heart specialist. Since brightly decorated Pediatric Intensive Care arriving at CEDIMAT in 2013, Dr. Leon has Unit. While still sore from surgery, his heart built a strong surgical team that now performs was pumping normally; instead of having heart procedures on approximately 200 just months to live, he would probably live children every year but is still mastering the for decades. His dad, though drained, was intricacies of mitral valve repair. profoundly relieved. “I thank God,” he said.

Mitral Foundation Children’s Valve Project Update / 10 Given his age, Woodmylens would probably never understand his remarkable good fortune in surviving this life-or-death saga—his parents’ dogged persistence in seeking help, Acceme’s determination to track him down in the mountains, the generosity of foreign donors, the support of CEDIMAT’s talented medical team, and Dr. Adams’ exceptional skills as a surgeon. That lack of understanding was just as well—no child should ever have to think about such things. And Woodmylens was already looking forward to going home. “I’m going to play with my car,” he said. For the first time in years, he too would soon be running smoothly, himself. ### Woodmylens was one of seven children from the Dominican Republic and Haiti whose hearts Dr. Adams and the Mitral Foundation and CEDIMAT teams repaired on this mission. Their surgeries were made possible with support from Every Heartbeat Matters—a philanthropic initiative led by Edwards Lifesciences Foundation to educate, screen, and treat 1.5 million underserved people fighting heart valve disease—and the David Ortiz Children’s Fund—providing essential support for children in the Dominican Republic and in New England who cannot afford the critical cardiac services they need—as well as support from CEDIMAT, Haiti Cardiac Alliance, Mount Sinai Health System, and the Mitral Foundation. Woodmylens sleeps after surgery to repair his mitral valve. He would recover at the CEDIMAT hospital for several days before returning home to Haiti with his family.

Profile in Teamwork: Mary Joy Santillan Mary Joy Santillan focuses during a mitral valve repair surgery with Dr. Adams, on a 2012 medical mission to Indonesia. To watch members of a surgical team In this role, she not only prepares his trays help each other don their sterile blue of more than 100 specialized surgical surgical gowns is to witness a form of instruments, but also passes each tool to medical ballet. Arms raised, one person him at just the right moment; swaps out pirouettes while the other secures the scalpel blades as they dull; refills syringes of gown’s drawstring around their waist. ice-water for cooling the heart; and tracks Not a word is exchanged, because the number of sponges going in and coming everyone knows the other’s next out—all without a single verbal prompt. move—quiet teamwork that extends through surgery itself. “Sometimes he doesn’t talk, he just gives you a look, or just opens his hand without This is especially true in the case of Mary even looking at all,” said Santillan, whose Joy Santillan, RN, BSN, MSHCDL, who for colleagues call MJ. “That’s why you have to nearly 20 years has served as a senior know anatomy, and know what’s coming next operating room nurse to Mount Sinai’s in the operation. You have to anticipate.” Cardiac Surgeon-in-Chief, Dr. David Adams. Typically, MJ stands at the foot of the

Mitral Foundation Children’s Valve Project Update / 12 operating table, diagonally across from Dr. Adams, adjacent to the instrument trays. Even if an operation lasts five or six hours, she never leaves her post, except when she turns to access extra supplies that Dr. Adams will need from an adjacent cart. Having performed an estimated 8,000 surgeries together, she and Dr. Adams are highly synchronized collaborators. “I can’t have someone passing me sharps who doesn’t know what they’re doing,” Dr. Adams said. “On mission trips, I won’t operate without her.” MJ, a native of the Philippines—a country Mary Joy poses with a grateful patient during a 2011 known for educating some of the world’s medical mission to Thailand. best nurses—joined the Mount Sinai team in New York in 1999. Dr. Adams joined Mount when Dr. Adams operates abroad. Knowing Sinai in 2002, arriving with a reputation for that every hospital has different equipment excellence and high expectations of those and resources, especially in developing around him. Offered the opportunity to assist nations, she always assembles and packs him in the Operating Room, she embraced all the instruments and materials that Dr. the challenge and responsibility. “He doesn’t Adams might end up needing—enough to remember this, but in our first operation fill an enormous black rolling suitcase that is together, I actually stuck him with a needle,” nearly as big as she is. she said. “Fortunately, it was sterile.” In addition to her daily work at Mount Sinai in New York, MJ plays an especially critical role “I’m an accountant by nature,” she said, explaining her dislike for surprises, missteps or potential oversights. “A scrub nurse is a backstop; I keep an eye on everything, including the monitors, and I like to be as organized as possible.” MJ is also charitable, often donating her vacation time to join Dr. Adams on medical missions around the world. Together, they have operated on children in Santo Domingo, Chiang Mai and Shanghai, among other places. Dr. Adams and Mary Joy in the operating room “I don’t have a million dollars to give,” she during a 2015 medical mission to Thailand. said, “but I do have talent, and I can give that. I just want these kids to do well.”

Why Mitral Valve Above: Dr. Adams Repair is Preferable visiting patients to Replacement during their recovery from Some patients have no choice—their mitral mitral valve repair valve is beyond repair and must be replaced. surgery. But in many cases, patients suffering mitral valve disease receive replacement valves unnecessarily, and at a significant cost to their long-term health. Why? First, few surgeons are skilled in the challenging art of mitral repair. Second, replacement surgery typically generates higher reimbursements from insurance companies, distorting incentives. Valve repair is preferable to valve replacement, especially in children, for four main reasons: 1. Repairing Valves Causes Fewer Complications and enjoys higher long-term success rates relative to replacing valves, even if those replacement valves are made of animal tissue. 2. Replacement Valves Typically Only Last between 8–10 Years. Subsequent surgeries to replace them become not only inevitable, but much harder and higher risk. 3. A Replacement Valve Won’t Grow as a Child Does while a repaired valve—their own tissue— will. If a child receives a replacement valve, he or she will need additional operations to resize and replace it in years to come. 4. People with Mechanical Replacement Valves Must Take Blood-Thinning Medication for the rest of their lives. In addition to the cost and a burdensome monitoring regimen, blood-thinners preclude any activity that might put that person at risk of bruising or bleeding. As a consequence, women on blood-thinners can’t risk getting pregnant, because they would bleed to death in childbirth.

Motherhood & Mitral Valve Repair For 18-year-old Suleika, getting her heart fixed was not just about surviving into adulthood, but seeing her two-year-old son Saelem grow up, too. “You have to keep a positive attitude,” she said as she lay in the Intensive Care Unit at CEDIMAT, recovering from surgery to repair her mitral and aortic valves. “Have faith. With God, it will all turn out okay.” Working as a house-cleaner to support her son had never been easy, but it had become physically impossible in recent months as rheumatic heart disease left Suleika feeling dizzy, feverish, fatigued and out of breath. The five-hour surgery to repair her valves should restore her health relatively quickly, and obviate the need for a lifetime of dangerous blood-thinning medication that valve replacement surgery would have required. Such blood-thinners preclude giving birth, making valve repair far preferable for girls and young women who might want to get pregnant in the future. “I already feel better,” Suleika said, just 48 hours after surgery, which was led by Dr. Anelechi Anyanwu, Professor and Vice Chair of the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai. As she lay in bed watching, of all things, an exercise show, Suleika said she missed her son and looked forward to getting home to him in a few days. She also noted that the surgery had changed her outlook on life, sparking her interest in a return to school and perhaps, eventually, a new career—as a doctor. “This is a big change for me,” she said. “Everything is possible.”

Dr. Toribio (front right) leads a case review before the team heads into the Operating Room for surgery. Profile in Leadership: Dr. Janet Toribio Fifteen years ago, Dr. Janet Toribio was frustrated. we needed good surgeons living and working here,” Working at a charitable foundation whose stated she said. “We needed government support. We mission was to improve health care for poor needed to change people’s expectations.” Dominican children, she saw a lot of bureaucracy but too few patients—and even fewer doctors with And in the ensuing years, she did. Year by year, the skills to save them. Dr. Toribio recruited a strong team of pediatric cardiologists and built a reputation for outspoken “We were sending patients to the United States advocacy on behalf of young patients. In 2008, for surgery,” Dr. Toribio said. “Kids died waiting as when the Dominican Ministry of Public Health parents raised money to pay for operations, or their and Social Assistance announced which medical conditions became inoperable. I saw a lot of children treatments it would cover, the list omitted about with rheumatic fever die.” 90 cardiac procedures for children. Outraged, Dr. Toribio reached out to a major newspaper to So in 2005, when she was invited to assume challenge the decision as arbitrary and unfair. leadership of a new pediatric cardiology team at a yet-to-open hospital called CEDIMAT, she set out “I don’t understand why children with heart disease not just to build a best-in-class team, but also to are not covered,” she said, especially given the high completely transform pediatric cardiac care in the incidence of rheumatic fever across the country. Dominican Republic. Overnight, her comments became a national story, disrupting some of her colleagues’ go-along, get- “I knew we couldn’t solve the problem of children along approach. dying by sending them abroad or just having foreign doctors come down here every three to six months; “When I got to work the next morning, the director

Mitral Foundation Children’s Valve Project Update / 16 wasn’t happy with me. But she also knew I was on pediatric mitral valve repairs and to develop right, and told me it was now my responsibility to the hospital’s capabilities in this challenging fix the problem.” specialty. The goal is to establish CEDIMAT as a self-sufficient regional center of expertise in And Dr. Toribio did, providing top health officials mitral valve repair. with evidence of the problem and data showing the efficacy of the omitted treatments. Eight “Valve repair is ideal for us,” Dr. Toribio said, months later, coverage was extended. “because valve replacement is just exchanging one problem for others”—a lifetime of blood— Dr. Toribio also worked hard to help recruit thinners, dietary and physical restrictions, and specialized talent that addressed gaps at the the likelihood of needing more surgery. For young hospital, including Dr. Juan Leon, a talented women, she added, going on blood thinners pediatric heart surgeon who had previously spent precludes having children, due to the bleeding a decade leading a strong pediatric program in associated with childbirth. “That’s why it’s so Guatemala. marvelous for us to be able to repair a valve, instead of replacing it.” Since his arrival in 2014, Dr. Leon—who specializes in fixing congenital defects—has Looking back, the landscape of pediatric continued to recruit, train and lead a team that cardiology in the Dominican Republic has now performs more than 200 pediatric heart improved dramatically over the course of Dr. surgeries every year. In a country where an Toribio’s career. Children with cardiac issues now estimated 1200 children are born with congenital have much better options for treatment, most heart defects every year, his skills have of which can be provided by local doctors. And made a big difference. “His arrival completely insurance or no insurance, nobody who needs transformed the care we could provide,” Dr. care is now turned away. Toribio said. “The panorama has changed completely,” she More recently, Drs. Toribio and Leon have been said. And while Dr. Toribio might be too modest collaborating closely with the Mount Sinai team, to admit it, that transformation would have been which periodically visits CEDIMAT to collaborate impossible without her leadership. Dr. Toribio (center) and the team gather to celebrate a successful round of surgeries that saved seven children.

17 / Mitral Foundation Children’s Valve Project Update July 2019 Patients Our July 2019 mission to Derek, 4 Woodmylens, 5 the Dominican Republic saved seven children’s Diagnosed with rheumatic Diagnosed with rheumatic lives. One patient, heart disease at 1 heart disease at 4 Suleika, is a mother herself and, shortly after surgery, returned home to care for her two-year- old son. Charianny, 12 Rosalinda, 12 Rosa, 17 Diagnosed with heart Diagnosed with rheumatic Diagnosed with rheumatic murmur at 11 heart disease at 11 heart disease at 15 Suleika, 18 Andreina, 18 Diagnosed with rheumatic Diagnosed with rheumatic heart disease at 7 heart disease at 12

Mitral Foundation Children’s Valve Project Update / 18 How to Help the Mitral Foundation Save More Lives The Mitral Foundation is working urgently to save lives, and we need your help. To support more research into mitral disease, develop local programs in mitral surgery and elevate the quality of mitral surgery around the world, please visit www.mitralfoundation.org/make-a-gift, and make your gift today. Thanks to donors like you, the Mitral Foundation was able to develop an expert program in mitral surgery at Maharaj Nakorn Hospital in Chiang Mai, Thailand, in 2014. As part of this initiative, attending cardiac surgeons Thitipong Tepsuwan, MD, and Chartaroon Rimsukcharoenchai, MD, completed advanced fellowships in valve repair at Mount Sinai. Surgical teams from Mount Sinai also operated alongside them in Chiang Mai. Dr. Tepsuwan now leads his hospital’s mitral surgery program, which performs more than 220 mitral operations every year—a caseload that continues to strengthen his team’s surgical abilities. The Foundation’s next goal is to establish an expert program in mitral surgery in the Dominican Republic, by developing the skills of a talented cardiovascular team at Santo Domingo’s CEDIMAT Hospital. Thank you for supporting this initiative with a generous donation at www.mitralfoundation.org/ make-a-gift, or by calling Mitral Foundation Administrative Director, Gideon Sims, at (212) 241-4119.

19 / Mitral Foundation Children’s Valve Project Update July 2019 CVP Volunteer Team Organizing a medical mission is David H. Adams, MD complex and demanding. Each mission requires a wide range of experienced President, Mitral Foundation personnel. Our volunteer teams include physicians, nurses, and support staff, ensuring that patients receive expert care in all aspects of their surgery. Hannah Adams Anelechi Anyanwu, MD Inventory Coordinator Cardiac Surgeon Jean Defay, CCP Erika Guidicipietro, PA-C Perfusionist Physician Assistant

Mitral Foundation Children’s Valve Project Update / 20 Ricardo Lazala, MD Medhi Oloomi, MD Director for Latin American Relations, Mitral Foundation Intensivist John Pollack Chartaroon Rimsukcharoenchai, MD Writer Cardiac Surgeon Mary Joy Santillan, RN Gideon Sims Senior Operating Room Nurse Administrative Director, Mitral Foundation

Global Impact Continues in 2020 The Mitral Foundation has multiple medical missions planned with our partners in the Dominican Republic and Thailand in 2020. • May 2020 - Santo Domingo, Dominican Republic • July 2020 - Santo Domingo, Dominican Republic • October 2020 - Santo Domingo, Dominican Republic • November 2020 - Chiang Mai, Thailand Right: Members of our clinical team with Rosa (17) after her mitral valve repair surgery. Bottom from left: Woodmylens (5) fist-bumps perfusionist Jean Defay post-surgery, Charianny (12) and her mom await surgery, Derek (4) recovering after surgery.



Support the Mitral Foundation The Mitral Foundation is working urgently to save lives, and we need your help. To support more research into mitral valve disease, develop local expertise in mitral valve repair, and elevate the overall quality of mitral surgery around the world, please visit our website or call Mitral Foundation Administrative Director, Gideon Sims, at (212) 241-4119. https://www.mitralfoundation.org/make-a-gift The Mitral Foundation is a 509(a)(3) supporting organization of The Mount Sinai Hospital and is exempt under section 501(c)(3) of the Internal Revenue Code. All gifts are tax-deductible to the fullest extent allowable by law. The Mitral Foundation has adopted a conflict of interest policy covering any dealings with any directors or company in which they have a financial interest.