National Hospital – Asunción, Paraguay

National Hospital: In this country of 7 million, one out of every five people lives in poverty. The vast majority of the population–children and adults–do not have access to heart care. — **National Hospital:** In this country of 7 million, one out of every five people lives in poverty. The vast majority of the population–children and adults–do not have access to heart care.

Deep in the heart of South America

One of only two landlocked countries in South America, Paraguay is relatively small, with a population of just under 7 million inhabitants. The endemic rheumatic heart disease here can be correlated to the high poverty rate; it is also directly linked to the high prevalence of valvular heart disease among adults young and old. Unfortunately, access to heart care is extremely limited. In 2019, Heart to Heart began establishing relationships with Ministry of Health officials and leading cardiac specialists in an effort to determine if we could collaborate to advance and expand heart care for Paraguayan patients of all ages with all forms of heart disease.

Exploring opportunities to collaborate on nationwide cardiac care

In April 2019, a Heart to Heart team consisting of 11 specialists traveled on an initial exploratory surgical-educational mission to Paraguay. The focus of our trip was to raise awareness about the treatment possibilities for patients with valvular heart disease as well as to assess the viability of a long term collaboration leading to nationwide cardiac care. Our team worked side-by-side at a national hospital located in the capital, Asuncion. The joint team was led by Heart to Heart founder and medical director Nilas Young, MD (UC Davis Medical Center) and Paraguayan cardiac specialists Sergio Cabral, MD and Adrian Ebner, MD (National Hospital in Asuncion). During the mission, the joint Heart to Heart-Paraguay team screened close to 50 patients and performed open heart surgery on four adults, replacing a total of six valves – three mitral and three aortic.

In addition to conducting our exploratory adult cardiac surgery training mission, we also conducted a second site assessment at a children’s hospital in the outskirts of Asuncion to better understand their capacity to diagnose and treat children born with heart defects.

Due to a scarcity of local resources, rather than forming an official collaboration, Heart to Heart and Paraguayan cardiac thought leaders opted to form an affiliation at this time. This arrangement will enable Heart to Heart to sponsor Paraguayan physicians to participate in Heart to Heart missions throughout Latin America, as well as to travel to leading centers in the U.S. to learn new techniques and observe the best practices of well established cardiac teams. We hope to enter into a collaboration in the future.