Heart surgery for Cambodian toddler called off

via CAAI News Media

By Greg Mellen, Staff Writer

Posted: 03/01/2010

Phin Ken holds his daughter, Socheat Nha at Sophy's Restarant in Long Beach last month. Socheat's heart condition is worse than originally thought and doctors have said the cannot operate. (Jeff Gritchen/Press-Telegram)

Monday was supposed to be a happy day. Instead, the family of Socheat Nha, a 2-year-old Cambodian girl scheduled for life-altering heart surgery, was dealt a devastating blow.

During a preoperation examination, it was determined the girl's condition was worse that initially thought and a donated surgery scheduled for Thursday in Las Vegas was canceled.

"This unfortunately is not going to be a feel-good story," said Dr. William Evans, the cardiologist who tested Socheat. "The risk (for surgery) is too great."

Shortly after beginning testing on the child, Evans had a sinking feeling.

An expected narrowing of the pulmonary tract between the heart and lungs was missing. This led to high pressure in the lungs from oxygenated blood flowing back into the lungs rather than out to the body and has already caused a significant amount of irreversible lung damage.

After consulting with other doctors of the Children's Heart Center and Sunrise Children's Hospital in Las Vegas, Evans had to tell the family that Socheat risked a better than 50 percent chance of dying on the operating table with the surgery.

That's a risk the doctors couldn't take.

"We have to do the right thing," Evans said.

Evans was part of the same team that in December 2008, performed open heart surgery on another Cambodian, 11-month-old Soksamnang Vy, but this time had to turn away a patient.

Vy's heart ailment was much less severe; the hole in his heart was smaller and he did not have the same lung damage as Socheat.

Evans said if Socheat were a U.S. citizen, she would likely be given oxygen and put on a list for a heart-lung transplant.

Evans said that option, even if available, would have its own set of drawbacks that might be worse than no treatment.

Among those are the long waiting list (about 16 percent die while waiting for a heart), the inability to receive care in Cambodia after the surgery, and the low prospects of long life expectancy after surgery.

Evans said it might be a blessing that Socheat is not an American where "we would be hard-pressed not to intervene."

Evans did his best to paint a positive picture and wouldn't give a life expectancy timeline. He said Socheat could live many years as have other patients of his with similar ailments.

Still the prognosis is grim.

There was some disagreement between Evans and Dr. Paul Grossfeld, who did the initial assessment in Cambodia about some aspects of Socheat's condition, but a variety of sources place her life expectancy to range between 20 and 40.

She will also suffer from cyanosis, or bluing of the skin from the lack of oxygenated red blood, shortness of breath and fatigue, that will increase as she gets older.

The daughter of a rice farmer from Southern Cambodia with family here in Long Beach, Socheat was the third patient brought to the United States for surgery by local nonprofit Hearts Without Boundaries.

Her condition, however, was by far the most severe. And this is its first failure.

Hearts Without Boundaries founder Peter Chhun could barely speak and blamed himself.

"We brought this family here with great hope," Chhun said in a halting voice.

The prognosis drove home the problem of trying to properly diagnose and treat patients from long distances, especially from a country that lacks proper facilities and technology.

"It's a humbling reminder of what we're dealing with," Grossfeld said. "When we did the original evaluation, obviously we had limited resources. At that time, the hope was that we could operate."

Kenha Heang, a cousin who accompanied Socheat and her dad, said he was stunned and deflated.

"We had so many plans and so much hope," Heang said.

Heang said Phin Ken, Socheat's father, held in his emotion when he heard the news, possibly because he had heard it before when Cambodian doctors couldn't begin to assess Socheat properly.

Still, for someone who had gone from despair and resignation to delirious hope, the setback had to be hard. He came to the U.S. where he believed "miracles" occur, only to face a sobering reality.

greg.mellen@presstelegram.com, 562-499-1291