Cardiólogo Intervencionista: Dr. Manfred Hermanni

En este bello programa estaremos hablando con el Dr. Manfred Hermanni quien es un cardiólogo Venezolano que atiende a los niños en Venezuela con cardiopatías.

Nos explica de las diferentes situaciones con los padres, dar herramientas para que puedan canalizar y entender el defecto del niño.

Es parte del equipo de la Fundacion Estrellita de Belen

Organizaciones mencionadas en nuestro programa:

https://masquemedicos.com.ve/cardiologo_valencia/dr-manfred-hermanni/
https://www.instagram.com/tucardiopediatra/
https://fundacionestrellitadebelen.org

Enlaces a las páginas de podcasts y redes sociales de 'Guerreros Del Corazón':

Instagram: @guerrerosdelcorazon
Facebook: https://www.facebook.com/Guerreros-Del-Coraz%C3%B3n-106786128027732
YouTube: https://www.youtube.com/channel/UCGPKwIU5M_YOxvtWepFR5Zw
website: https://www.hug-podcastnetwork.com/guerreros-del-corazoacuten.html

Conviértete en un seguidor de este podcast: https://www.spreaker.com/podcast/guerreros-del-corazon--4731556/support.

Episode Transcript

(00:04):
Welcome to your heart warrior program,fighting congenital heart disease. I am Marta
raquel Montero, one of the hostsof this program, and I am also
the mother of a warrior of heart. I am accompanied in this interview by
Belén Blanton, a warrior of heart. Today' s program is about a
Venezuelan cardiologist. Our guest is Dr. Manfred Heimeny, who received a doctorate

(00:31):
in Cardiology and Pediatrics from the Universityof Carabobo in Valencia. The doctor is
a specialist in interventional caldeology. Heis a member of the Venezuelan Society of
Cardiology and the Venezuelan Society of Pediatrics. The doctor provides low- budget procedures
for children with congenital caldiopathy. Inthe first segment we will talk about your

(00:54):
decision to study cateology, as wellas other specialties. In the second segment,
we' ll talk about your workin my comodin. In the third
segment, he will be answering themost common questions that mothers have when visiting
his office and in the hospital wherehe serves welcome heart warriors. Doctor,

(01:15):
thank you very much for the invitation, because for me a great pleasure and
I congratulate the initiative in helping informthe general population and give tools and tips
to parents who have children with heartdisease. And us. Thank you very
much, and we appreciate your time, because we know that it is not

(01:41):
easy to take your busy time forthis and we appreciate that you have given
us this opportunity you can tell usbecause you decided to study cardiology. Yeah,
see, it' s a longway where you first have to be
a pediatrician and do your pediatrics graduatea teacher and great friend. In fact,

(02:02):
she' s the mother of oneof my best friends. It was
in peace, rest I was acardiologist in the back and it was the
one that opened my eyes and encouragedme to take this great path understanding the
high frequency that there is, despitethe fact that the general population does not

(02:25):
know about congenital heart defects. Yes, the truth is a public health problem
that affects many children and that wellI wanted to enter this specialty to understand
and try to give the solution toas many patients as possible. Tremendous gift
of becoming a cardiologist. It isa great commitment, as you have just

(02:49):
explained, for which not much isknown, but there is a lot of
patient. But, apart from thefact that the diologist is interventionist, which
must involve more between, it canexplain a little more about what this specialty
is about. Yes, interventional cardiologyor demodynamics is another world within cardiology and
it is basically minimally invasive procedures withthe use of catheters and other tools to

(03:17):
make diagnostic procedures, especially in patientswho need cardiac surgery. And there are
some doubts, either of anatomy orof functioning, that is, of the
physiology of the heart. And,on the other hand, it is also
a tool that increasingly has a greaterfield, which is to do therapeutic procedures,

(03:42):
that is, intentions through different techniques, to perform interventions to cure those
hearts most of the time or,if not at least, to improve the
quality of life of patients. Whatadvice you have for those who decide this
alcardiology. Well to see the mostimportant thing, commitment, commitment, truth.

(04:09):
Paediatric cardiology is an extremely long specialty, that is, because the catalog
of heart disease is very diverse andvery different among each patient. My advice
is to make the commitment, likeall medical specialties, but I think that

(04:30):
this particular one is necessary to beup to date and to be on a
daily basis looking for information, updating, in our case, we have to
not only do medical work, butto do psychological support to the family,
make links and look for tools tofind some solution or the best solution for

(04:54):
our patients. But I insist themost important thing is the commitment to these
children who have this pathology. He' s met these typical daddies. I
say this to experience that you doknow the importance of conducting a study,
a surgery, but the fear ofwhat is going to be faced with that

(05:18):
child has had to be explained constantlythe same, the same because there are
dads. As if yes, butas if not yes yes to see,
the truth is that, in fact, in a first encounter, when,
then, the diagnosis of a heartdefect is made and to give that information
to the parents. The truth is, it' s one of the hardest

(05:39):
things we do. Yes, especiallywhen there is a complex congenital heart disease,
where you have to make him understandin detail what the defect is and
what the options are. Yes,usually parents and we fully understand it seek

(06:00):
different options from cardiologists, pediatricians.A second opinion, a third opinion,
because the truth is that the newsof knowing that your child has a heart
defect. The truth is quite complexthe issue of denial, which is a
normal thing, is a very noticeablephysiological thing in these parents. But,

(06:26):
well, what it is about isto be the clearest, the most concise
and the most explicit in relation towhat is the effect of what are the
resolution options of these patients? Andthe truth is that, thanks to God,
more and more news or solutions forthese patients are more encouraging, because

(06:49):
most of the time there are proceduresto perform, there are medical treatments that
can be optimized to mainly cure thepatient, but, in the worst case
or in some cases, to improvethe quality of life of patients and also
to give tools to parents such ascoping with this condition that the truth is

(07:15):
quite difficult. Definitely, that wifeis a cardiologist, too, yes,
right my wife, but pediatric,pediatric, or cardiologist or pediatrician. In
fact, we work together and,in addition to that, she choreographs the

(07:36):
processes of interventionism, that is,the carterisms that are made through modynamia.
Many times America in the support ofthe phagic suit cardiogram and she is the
one who routinely performs this procedure andin which it is vital to have experience,

(08:00):
because they are other eyes. Manytimes these experts have the capacity to
make decisions as important or more importantas the interventional cardiologist can make. So,
yes, it' s part ofour team at the consult and in
the moinami room. You are ateam in the whole sense of the word.

(08:20):
Yes, thank God, they havebeen in some difficult situation, having
to make a difficult decision. But, as a couple they have this trust
or it flows. Yes, thetruth is that knowing each other so much
is an additional plus in the mummyroom, because good to see sometimes with

(08:43):
simple gestures we can understand if theroute we are going through during catheterization is
the correspenta, because obviously we haveall the confidence of sight. It'
s time to stop. I don' t like how you use your device.
It seems to me that this routeis ideal for the patient in the

(09:07):
end, because all confidence is abenefit to make the best decision and that
I insist to form a team duringpediatric cardiology and mainly in a room of
moinamia, where not only the doctorsare, but the nursing staff. The

(09:28):
technician is something fundamental for the bestresult, whatever thanks to lack they are
admitted in a total pleasure. Thiscontent is not intended to replace diagnostic advice
or professional medical treatment. The opinionsexpressed in this podcast are not those of

(09:50):
Horge United Love, but those ofthe hosts and guests, and they intend
to generate a debate on issues withcongenital heart disease. Welcome. Again,
I' m a white nativity scene. We' re talking to Dr Manfrey

(10:13):
Germani. First of all, doctorcan tell us from his doctor' s
perspective, what health care is likein Venezuela. See, that' s
an extremely complex question with a lotof edges. Maybe I' m going
to focus on our specialty, whichis pediatric cardiology, understanding it' s

(10:39):
a very frequent pathology. It isshown that one in every 100 live newborns
comes with a congenital heart defect andin this country of approximately thirty million inhabitants,
it means that there are many patientswith congenital cardiographs and that every year
there are patients who say, addor add that list And it is not

(11:03):
only the frequency, but that theresolution of these patients is very complex,
because many need strict follow- upor need heart surgery, which are procedures
of high complexity that need to beperformed in tertiary centers or very specialized for

(11:24):
that purpose. And, on theother hand, these patients meditate or may
merit a diagnostic, pre- surgicalor therapeutic catheterization. So the truth is
that the approach to the management andparticularly the follow- up of these patients

(11:45):
has to be very strict, veryrigorous and involves an innumerable number of items
that is not only human personnel,but is an infrastructure, technology, scr
of materials and medicines, among otherthings. Yes, in fact, there
is a statistic that says that everyyear more than six zero children are born

(12:09):
in Venezuela with congenital carepathea. Thatis the last statistic I saw and what
is the biggest challenge for families ofchildren with congenital heart conditions in Venezuela and
throughout South America in our countries.Yeah, let' s see, maybe

(12:30):
the biggest challenge not just for patients, but for us. It is a
trend in many countries of South Americais the low availability of resources to resolve
patients. Yes, many times youhave the training, you know the technique,
but then there are limitations in accessto health systems that, the truth

(12:56):
makes it quite difficult to carry thecondition of these patients. So, good
to see what has touched us andmainly working as a team, is to
try to find all possible solutions andknock on all possible doors to solve or

(13:16):
try to solve as many patients.But yes, I believe that the greatest
limitation in our countries is access tohealth coverage. Understanding what procedures they need,
they' re expensive procedures, they' re procedures that need a whole

(13:39):
rather specialized infrastructure. He can explainto us the interventions that are carried out
and he would also like to knowthat he would explain the difference for all
the mothers who are listening to usbetween a cataterism of diagnosis and a therapeutic
cataterism. I' ll tell youwhat' s most common. The most

(14:00):
common thing we do is close shortcircuits. Which means there' s a
defect on one of the heart walls. There is a communication between the left
side and the right side that shouldnot exist either a building or a hole
or, for example, in thecase of the ductus arteriosus, it is
a blood vessel that communicates the hortathat are on the left side with the

(14:24):
common artery then it is of effectthrough the use of occlusors or as a
kind of plugs are used to closethose defects and cure the patient. That
' s what one of the mostprocedures to do. Another strapeutic procedure,
that is, healing procedures that weperform is to do dilations. For example,

(14:48):
stenosis in the valve is a narrownessin the valve of the artery that
connects the heart to the lung.That baluna doesn' t open well and
what we do is we pass throughthat valve and with a balloon it inflates
and releases its instruction. That's what we can do in the horde.
The other thing we' re dealingwith is something called a short-

(15:09):
term quartering, which is a horta. Let us remember the largest artery coming
out of the heart in one ofits narrow segments. So that' s
either through the use of a balloonor in larger patients we use a ben
that' s a mesh, thatwhat it does is that after it dilates,
it stays rigid and allows it notto tighten again. And the diagnostic

(15:33):
procedures that we perform, for example, in very complex heart diseases, that
is, that they have several effectswithin the same heart and either through echo,
tomography or resonance, we still havedoubts about which option or which tool
to offer the patient. So,those patients are subjected to cardiac catheterization that
is done in modynamic studies, whichis to take blood samples in the different

(15:58):
cardiac cavity, measure pressures in thosedifferent cavities or in the pulmonary artery or
in the same gallows or if,for example, we do it through the
catheters, we can go to veryspecific places where we think there is a
narrowness and we can inject contrasts.And that' s what you' re

(16:18):
going to do is paint or sayor you can see on a screen the
degree of tightness or anatomy. Soall of that data comes together with the
patient' s medical history and complementarytests, and that' s discussed with
a Carloaclors surgeon and a multidisciplinary teamand, for example, takes the behavior
look. If this surgery is thebest for the patient, then, in

(16:41):
the end, the diagnostic catheters areusually pre- surgical, that is,
patients who are going to have surgeryand we have some doubt from the point
of view of emodynamics from the anatomicalpoint of view. That, in short,
is what we do for more orless to explain more clearly for mothers

(17:02):
the diagnostic and the correct therapeutic.Note that it is important to clarify that
because many times we are referred topatients to make a diagnosis catheterization and it
is one of the main things thatone explains to the mother to look at
with this procedure we will not cureit. With this procedure, we'
re going to make a more accuratediagnosis and we' re going to have

(17:26):
a lot more information for that topresent to the surgeon and for the patient
to go to surgery. Let's say the therapeutic procedures and, thank
God, more and more are proceduresto cure the patient yes, we enter
the room and particularly I explain verymuch to the parents that our goal is
to do a healing procedure, thathas risks, that there are complications,

(17:51):
always exist, but the intention ofthose procedures is to cure the patient for
the patient who leaves the modynamia room, that does not have to take more
medical treatment and that always need follow- up. Most carpathies are going to
need lifelong follow- up, butthe only purpose is the complete resolution of
that effect. Now very important doctorthe cataterism of diagnoses and that I want

(18:21):
you to say it so that mothersknow it has a true expiration when it
is a while ago they can maintainthat cataterism so that they give it to
another doctor to see and you haveto operate it the type of operation that
is going to be done, becausewe have had many children who do the

(18:45):
cantaterism of diagnosis and practically lose itbecause they still have nothing fixed with the
surgery, because, of course,there is no money. You can explain
to the mothers that thank you,if you look at the ideal. It
is, for example, one ofthe things that is most repeated in the
world is that it enters the patientfor telling him something. Today, on

(19:07):
Monday, that patient makes you adiagnostic catheterization and in that same week that
patient goes to surgery, or evenis done the next day or Monday is
made the diagnostic catheterization for the patienton Tuesday to go to surgery. I
thought that' s ideal. Weestablish that if we are going to make

(19:30):
a diagnostic catheterization, it is becausewe know that the surgical option of the
patient is available in a short periodof time. If there is no surgical
option, actually, making a diagnosticcatheterization is not ideal. The ideal is
to do it when you have theavailability in a short term, which I

(19:52):
tell you, the ideal is thesame week. But if it isn'
t in the first month to doit for surgery, if there' s
no scheduled surgery, or if there' s no real option for surgery,
subject the patient to a diagnostic catheterizationthat involves risk. And particularly these are
patients who are most at risk,because they are more complex heart diseases that

(20:15):
have significant emodynamic impairments. Actually,our judgment doesn' t make sense.
Thank you doctors, Now what arethe most common congenital heart defects, where
hemodynamics is an option for treatment and, fortunately and increasingly accessible for more carleopathy.

(20:40):
But the most common thing is shortcircuits, i e inter- atrial
communications, interventional communications and the persistenceof the terious driver. This occupies the
largest number of procedures we perform dailyin a mobin room and could then follow
pulmonary stenosis, i e pulmonary vulvuloplastyand short- term quarters that are dilated

(21:04):
with a balloon. Or that isand is going to be like bread our
decade and, that is, intercuscommunications in order of frequency, communications between
headphones, persistences of the ductus arteriosus, closures of interventricular communications, bulbulplastes pulunares
and treatments of coartación of savings theother less frequent, balvulo, aortic plastias,

(21:30):
among others. It was very interestingto know about hemodynamics. We take
the time to ask several mothers whatdoubts they have and here we have the
most common. For example, mychild may get the covid 19 vaccine.
Yeah, yeah. No doubt,heart disease is a population at greater risk

(21:52):
for making respiratory infections and to becomecomplicated by covid and if they have to
vaccinate, it is the recommendation forall our patients it has been heartburning of
all ages. Well, following thepatterns of the general population, that is,
the same scheme that is used forthe general population is and so that

(22:14):
they do not have carlopathy. Itis the same scheme that is used for
patients with a risk effect. Theother thing they asked was how we can
keep the right weight on our cardedchildren. Well, that' s hard.
What we usually do is to givedietary recommendations and, as long as

(22:37):
there are resources, to manage thepatient in conjunction with child nutritionist, a
pediatric nutritionist, because these patients therequirements, in most short- terms,
the caloric requirements are higher. Thenwe must look for all the strategies to
make the greatest possible contribution, sothat these patients have the most optimal growth

(23:00):
and development within and depending on theircardiopathy. In particular, I imagine it
hanada to the situation of maintaining theright weight. They are concerned about the
fact that the rct is multivitamin andas they are, of low resources,
because it is not possible to buyit. There is some option they may

(23:22):
have to get this kind of multivitaminswithin those low- resource conditions. Yeah,
well, look, that' sone of the strategies we handle with
nutritionists. If the patient requires multivitamin. Well, nothing has to be done
through family members or through some systemof donations or help or support to get

(23:44):
the resources, but there are alsostrategies that are used to with the most
accessible foods, trying to provide themacronutrients and micro nutrients that these patients need.
But, well, if it's necessary multivitamin or there' s

(24:06):
another one that patients have to lookfor. Family members, in this case,
have to find a way to acquireit. Thank you, warriors of
the heart. It is a presentationof Hearth Unite de glob and is part
of h Cast Network Hot crea hugand are the acronyms of Horthy Night de

(24:30):
glob Horge a nighted Love is anon- profit organization dedicated to providing resources
to the congenital heart disease community toraise, empower and enrich the lives of
members of our community. If youwant to access free resources from the congenital

(24:51):
heart defects community, visit our website on w with genetl Heard Defex for
information about hospitals that treat children,summer camps, for survivors and much more
doctor How we can teach our childrenthat they are different, but you can

(25:15):
live with a heart that is differentfrom that of another person. You must
take the child to a medical noteto school by reporting from his condition.
A lot has happened, especially inschools. Bullying because you can' t

(25:37):
do this, you can' tdo the other thing. Then sometimes mothers
don' t know how to dealwith that situation. Yes to see,
at least from our daily consultation.It also depends on the heart disease.
Yes, for example, if it' s an atrial communication that he did
a catheterization and was completely occluded,that patient depends after six months, he

(26:00):
can have his life completely normal withoutlimitations. Or, for example, a
patient who had an arterious duct andwas implanted with a prosthesis, the patient
evolved well. That patient' snormal life, that is, after his
recovery from the procedure. Usually,the length of time we use six months
to a year, that patient hasno indication to restrict physical activity. Rather,

(26:26):
in fact, it is a recommendationthat to all cardiac patients or we
do not indicate that, the patienthas to do physical activity. The other
case is more complex heart disease wherethere is functional limitation, so, one
is well explicit in putting what activitiesyou can do and what not. In

(26:48):
this sense, it is important toraise awareness in the school, to raise
awareness among the mother, and toforgive the teacher in terms of providing support
to these patients. And another thingthat is a tool that is ideal and
that should be used in these patientsis psychological support, not only for the

(27:10):
child, but for the family,to cope with this condition in the best
way. We know that all casesare different, but, as I told
you before, sometimes there is alot of confusion how the child should do
his exercises, how he should playcould tell us what the recommended exercises are

(27:33):
or when the mother has to sayno more or if there is any way
there. For example, my mouthwas purple. How would it be for
the mother to be realizing that thechild, because the children children do not
pay, they will continue to play. Then how would mothers do to be
able to realize that. Yeah,yeah, look, that' s very

(27:56):
important. What you' re saying, you' re getting in the habit.
The warning signs are very important toexplain to the sea and the school
to those who are going to bemonitoring what are these warning signs, since
the patient is put on the indwellingor becomes cyanotic, the patient faints,
the patient says that the chest thatfeels the heart very fast hurts. One

(28:18):
recommendation that we make is above allthe biggest patients that we tell you look
you have to do physical activity,tolerance or other strategy that you can use
is when you can no longer lackyour breath for you to speak fluently.
There you go. For example,we put three patients with the same heart
disease. Surely, tolerance to thatdefect and physical activity varies greatly between each

(28:45):
individual and basically is to teach themto understand their limitations, because overloading the
heart or overstimulating the heart in thesepatients has a potentially, especially very bad,
risk. Then explain to them whatit is you tolerate and as I

(29:07):
tell you that tool of telling youlook when you feel that you can no
longer talk calmly or that it costsyou a lot to talk at that moment
you have to stop doctor. Ihave a very good question for you.
I would love you to tell ushow the future of congenital heart disease is
in our countries, especially those withlow resources. How can we, as

(29:33):
you know, have a foundation,as a foundation, be able to continue
to advocate for congenital heart defects,be able to make people understand that this
is a silent disease, which isinvisible. We' ve had a lot
of trouble getting donations because children don' t look sick. Actually, I

(29:56):
don' t look sick. Sohow do you think we could do to
continue advocating and making congenital cariopathy takeinto account and what are you willing to
be for all those Venezuelan children whoneed us so much? I think it

(30:22):
' s one of the most importantthings and it' s good in the
sense we' re doing. It' s this talk, it' s
sensitizing. I believe that one ofthe errors worldwide, or I tell you
at least inside Venezuela, is thelack of information, the severity or the
problem involved in having a child witha congenital carteopathy, or not just a

(30:45):
child, not because, at leastin his case, an adult with a
heart disease with great. I thinkone of the most important things is to
raise awareness, it is to report, because with stranger we are going nowhere
and the more people get involved orthe more people know what this condition is

(31:10):
about, because or the intention isthat there are more options, there are
more people involved in providing solutions orin supporting the resolution of these carpathies.
As for the resolution, I'm going to tell you about my trench

(31:30):
or our trench. We gave arelooking for all the options to solve as
many patients as possible, and theseoptions involve making alliances with doctors. At
least in our case, we goto different cities of the country to treat

(31:52):
those patients just to make these patientsdo not have to move to a central
center or be worth redundancy or aspecific city, but we also give the
option with teamwork with doctors in thesedifferent cities, or state of providing solution
to patients And we are increasingly tryingto make more alliance to try to solve

(32:17):
as many patients. Sometimes it's not the number we want to do,
or it' s not the numberof patients we want to do,
but one at a time it addsup. And because at least that is

(32:37):
in our competence the solution that wecan start. We firmly believe that teamwork.
We have made alliances with private centresto make social costs more accessible,

(32:57):
not only from consultations, but inprocedures. And besides that, well,
nothing like that is only private inpublic. Obviously, the best tool to
guarantee access to the largest number ofpatients, as we are also here.
In fact, I work in ahospital in Caracas and, well, we

(33:21):
firmly believe that, with commitment andgiving every day our contribution and our work,
I say dedicated or focused to givingthe solution to our patient. Thank
you, Doctor, well, youknow that our foundation can count and I

(33:42):
know that we count on you.So, well, a lot of thanks
to the order a lot of tasteand good, I will always be here
to make known as much information aspossible and, above all, information that
is digestible or that is understandable forour parents or for parents with children,

(34:08):
with congenital garden disease that are,as you say, true warriors. Thank
you so much. Thank you verymuch to Yousgermani and for being on our
program and sharing your advice experiences withus. Thus I conclude this episode of
warriors of the Heart. Thank youfor listening. Today you enjoyed this episode.

(34:30):
Please leave a review of our podcaston our websidew club units and remember
friends never give up. Thank youagain for joining us this week. We
hope that you have been inspired andempowered to become an advocate of the heart

(34:53):
defect, congenital and estuary community,with your hosts plankton jenefer Inguina and Marta
Montero. It is produced monthly andcan be heard wherever you have access to
PRDCAST. The new episodes are broadcaston the second Saturday of the month