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Right to the heart

When Dr. Beat Richner began his work in Cambodia in the early 1990s, the child mortality rate was around 12 percent. The most common causes at the time were malnutrition and infections, especially tuberculosis. "He worked consistently to improve the situation," says Prof. Dr. med. Oliver Kretschmar of the Children's Hospital Zurich. This means: Not only the acutely ill children were treated, but the whole family. So that they would not infect each other again. This approach soon showed results - child mortality fell steadily to 4.4 per cent in 2010. A close analysis of the data quickly revealed that most of the remaining deaths were due to heart disease. "At the time, we were able to make the relevant diagnoses but we had no treatments for them."

That was the starting point for Beat Richner's "Heart Project", which he launched with Oliver Kretschmar: They worked together to find out which heart conditions were most common and how the children could be helped medically. "His approach was to use as few invasive procedures as possible to achieve the greatest possible success”. This means using procedures that are as gentle as possible for the young patients and do not require open surgery. This led to the idea of building a cardiac catheterisation laboratory in Siem Reap - according to western standards and with the necessary equipment. For more serious cases, a surgical centre and a cardiac intensive care unit were added, with the help of the Swiss heart surgeon René Prêtre and Lucca Vricella from John Hopkins Hospital in Baltimore, USA, as well as experts from La Chaîne de l'Espoir in Paris, France.

Siem Reap began treating children with heart problems in 2011. Oliver Kretschmar, among others, trained the local specialists on site - this requires cardiologists with skilled hands and a good 3D imagination: "I was very impressed with how quickly all the people involved were able to learn and make progress". For example, the cath lab can be used to close holes in the heart, widen heart valves or blood vessels, and treat other milder congenital heart defects. However, open-heart surgery is still required for more complex malformations, which account for about a third of all heart defects.

Chamroeun Khema is the name of the girl who was the very first patient to undergo heart surgery in Phnom Penh on 2 August 2019. The opening of the centre was only the day before, on Swiss national day. Previously, all the children had been transported to Siem Reap for surgery, a journey of over 300km. Chamroeun Khema had a hole in the septum between her two atria, which the surgeons closed in a three-hour operation. Today, the 15-year-old says: "I am happy, I am doing very well."

By increasing capacity at the second site, the waiting list of around 1200 children has been steadily reduced. Oliver Kretschmar is impressed and proud of the local chief heart surgeon Pon Ladine and the entire cardiac team, which maintains a good exchange among themselves and has long since performed many operations independently: "In complicated or special cases, we discuss them together and try to talk about the limits of what is feasible." Since then, 1600 surgeries have been carried out in Phnom Penh and around 4000 in Siem Reap. Both heart centres perform an average of two operations a day. Oliver Kretschmar adds: "Not forgetting the follow-up checks, which are very important”. Up to 50 parents a day return to the hospitals with their children for these checks.

Today, Cambodia's infant mortality rate is around 2.3 per cent. This figure has fallen by almost 10 percentage points since the Foundation's hospitals were established. The clinics continue to invest in infrastructure; last year, for example, the cardiac catheterisation laboratory in Siem Reap was completely upgraded to the latest technology. Oliver Kretschmar's next visit is scheduled for December to discuss the possibility of extending the treatment and to perform complex procedures with the local team: "In particular, we would like to further develop the possibility of closing the holes between the pumping chambers - the so-called ventricular septal defects, which alone or in combination with other malformations are the most common heart defects".

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