An adult mitral valve is about the size of a quarter, making its repair a delicate operation under the best of circumstances. When the patient is a baby, the valve is no bigger than a dime – leaving no room for error. Fortunately for Yailin Rincon – a one-year-old born with congenital heart defects – her surgeons were both highly skilled and absolutely determined to save her life.
“When you’re operating on a young child, everything is smaller, and everything is more delicate,” said Dr. David Adams, President of the Mitral Foundation and Cardiac Surgeon-in-Chief of the Mount Sinai Health System, who led a team that operated on Yailin and seven other children on a recent medical mission to the Dominican Republic. “This was life-saving surgery.”
Part of the Mitral Foundation’s Children’s Valve Project, this trip was the latest in a series of medical missions to the Dominican Republic over the past five years, where untreated rheumatic fever – endemic to poor tropical nations – often damages children’s hearts. The goal of this mission was to perform heart surgery on children from Haiti and the Dominican Republic.
Due to the COVID-19 pandemic, patient-related visa challenges stemming from instability in Haiti, as well as operating room schedules at the host hospital, this particular medical mission was organized on short notice. To complete the eight surgeries, two surgical teams operated simultaneously in different operating rooms for two days – an intense push, but not atypical on such trips abroad.
Such operations can feel especially meaningful, not just for the patient’s worried family, but also for the team that performs them. “When you are operating on a very young child, it is high risk – they haven’t had a life yet, so it feels there’s a lot more at stake,” said Dr. Aarti Patil, a Mount Sinai surgeon who operated on Yailin alongside Dr. Adams and Dr. Juan Leon, a congenital heart specialist and chief pediatric surgeon at CEDIMAT hospital, in Santo Domingo.
Over the past eight years, Dr. Leon has built a strong pediatric surgical team at CEDIMAT, which now performs heart procedures on approximately 200 children every year. “What a tremendous resource he is for the Dominican Republic,” Dr. Adams said.
Another patient receiving surgery that day was Miranda Martinez, a 12-year-old Dominican girl whose rheumatic mitral valve and resulting regurgitation had increasingly prevented her from any significant exertion.
Dr. Anelechi Anyanwu, working in tandem with Dr. Percy Boateng, not only repaired her mitral valve, but ended up replacing her aortic valve, too. “Initially, her case looked relatively straightforward, but ended up being quite complex,” Dr. Boateng said.
According to Dr. Mehdi Oloomi, the Mount Sinai intensivist who oversees patients after they emerge from surgery, Miranda’s first words after waking up from surgery were: “I am so happy. I am so happy. I am so happy. Now I can dance again!”
Yet another patient was 17-year-old Emmanuel Martin from Haiti, on whom the Mount Sinai team had first operated in 2019. Over the past several years, his repaired mitral valve had stiffened again, which is not uncommon among patients suffering severe rheumatic heart disease.
Emmanuel’s surgery was made even harder because the team was operating without all the advanced imaging and surgical equipment typically available in Mount Sinai’s operating rooms. Even some of the surgical supplies they had shipped from New York to CEDIMAT as a contingency had not yet arrived.
“It was very challenging to do the procedures under these circumstances, but one has to be adaptive and creative,” said Dr. Anyanwu, noting that the team replaced Emmanuel’s tricuspid and mitral valves. “I don’t get stressed out. Given my training, I ask: what can I do with what I have?”
By the next day, Emmanuel was stable. Two days after surgery, he was sitting up in a chair expressing his thanks to the nurses and doctors. Without surgery, he would have been confronting a terminal decline, but now his prognosis is quite good, Dr. Anyanwu said. “With children, these are not life-long operations,” he said. “We are trying to buy time. If we can extend their heart’s function for a few more years and push them to the next stage, they will have more options.”
Thanks to the expert care they received, all of the children are now out of the hospital and recovering well at home.
Reflecting on the trip, Dr. Patil said “This is why I went to medical school to be a doctor – to help people without access to medical care get the treatment they need. And when you help children, you’re giving them a chance at life. It’s probably among the most gratifying work I’ve done in my whole medical career.”
In addition to the team members mentioned above, medical mission volunteers included Dr. Ricardo Lazala (Director of Latin American Affairs), Dr. Cesar Rodriguez (Anesthesiologist), Mary Joy Santillan (Lead OR Nurse), Loedita Lorenzo (OR Nurse), Lowella Ughoc, (OR Nurse), Jean Defay (Perfusionist), Christine Gutierrez (ICU Nurse), Adonis Lantigua (Medical Supply Coordinator), and Gideon Sims (Administrative Director, Mitral Foundation).
The mission was funded by Every Heartbeat Matters – a philanthropic initiative led by Edwards Lifesciences Foundation to educate, screen and treat underserved people fighting heart valve disease. Additional support was provided by CEDIMAT, the David Ortiz Children’s Fund, Haiti Cardiac Alliance, Mount Sinai Health System, Artivion, BD, Delacroix- Chevalier, MAP International, Scanlan International, Vitalitec, and individual donors to the Mitral Foundation.
“These partnerships are really important because without this cooperation among different organizations and disciplines, it would be impossible to achieve what we do,” Dr. Lazala said. “Together, we make a great team, bring great resources to people in need, and give these kids a new chance at life.”