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Heart valve surgery successful for 4-year-old with a fondness for pizza

ALBUQUERQUE, N.M. — Denis Rivas Claros will celebrate his fifth birthday March 3, and there’s no doubt it will be way better than his first four birthdays and involve his new favorite food – pizza.

Ingrid Rivas, right, helps her 4-year-old son, Denis, get some post-surgical exercise with a walk through the halls of Presbyterian Hospital, assisted by registered nurse Cherie Sanborn. (Adolphe Pierre-Louis/Journal)

Ingrid Rivas, right, helps her 4-year-old son, Denis, get some post-surgical exercise with a walk through the halls of Presbyterian Hospital, assisted by registered nurse Cherie Sanborn. (Adolphe Pierre-Louis/Journal)

Little Denis, who was flown to Albuquerque from El Salvador, received life-saving open heart surgery last week at Presbyterian Hospital. He is expected to be released from the hospital later this week. When he returns to his village of Ciudad Candelaria on March 13, he will be markedly healthier than when he departed and ready to enjoy the normal life of a little boy.

Denis and his mother, Ingrid Rivas arrived in Albuquerque in early February under a program sponsored by the Southwest Chapter of Healing the Children. The nonprofit organization with chapters across the U.S. arranges free medical services for severely ill children from 100 countries around the world.

In the days leading up to the surgery, Denis and Ingrid stayed with a host family and had an opportunity to see a little of Albuquerque and taste the local cuisine, which for Denis opened a whole new world with his discovery of pizza, which he’d never eaten before, said his mother.

Speaking through a translator at Presbyterian Hospital, Ingrid said that when Denis was just 15 days old, doctors in El Salvador told her they detected a heart murmur, an irregular sound or heartbeat.

“Anything that had to do with the heart I knew must be serious,” she said. “At first they thought it might get better by itself, but later they said he would need surgery.”

The first four years of Denis’ life were difficult. He was chronically tired, couldn’t play like other children, did not have a healthy appetite and his skin, particularly his lips, had a bluish tint, Ingrid said.

The child’s condition eventually came to the attention of Regalo de Vida (Gift of Life), a Salvadoran agency that works with Healing the Children. After consulting with doctors in the United States, it was determined that Denis had a rare congenital condition called double outlet right ventricle, which in non-medical terms means the boy had a hole between two chambers of his heart, there wasn’t enough blood going to his lungs via the pulmonary artery and his pulmonary valve was abnormally small.

With less blood being oxygenated in the lungs, Denis’ overall oxygen saturation level fell to 69 percent “and you end up with a blue baby,” explained Dr. Bill Stein, the pediatric cardiac surgeon who operated on Denis.

“Over time, the heart works less and less efficiently and eventually young people with this condition die from some type of heart failure,” Stein said. “Some make it to early adulthood, but their quality of life is poor. Denis’ case was so extreme, I’m not sure he would have even made it to early adulthood.”

The good news, Stein said, “it’s completely treatable,” although some people with this condition must undergo a procedure every 10 to 15 years to replace the pulmonary valve between the heart and the lungs. Most of the time, it can be done through a catheter fed into a vein in the groin.

The bad news is the surgery Denis required and any follow up valve replacements he may need are still largely unavailable in El Salvador, even if the family could afford to pay for it.

In Ciudad Candelaria, Denis and Ingrid share a home with her 13-year-old brother and her mother. The home has electricity but no running water, which has to be retrieved from a nearby river. The family’s single source of income is from Ingrid’s supermarket job, where she earns about $2,400 a year.

The hope is that other organizations will come forward should additional surgery be required, although Healing the Children has, in the past, made arrangements for a child’s follow-up care before the age of 18.

Denis’ four-hour surgery was a team effort, as was the care the boy got in prepping him for the procedure and during his recovery, Stein said. Presbyterian Hospital donated the entire cost of medical equipment, services and team member compensation, which included the surgeon, surgical assistants, anesthesiologist, perfusionist, pulmonologist, radiologist, intensive care doctors, nurses and others. Tricore Laboratories also donated its services.

Today, Denis acts like any fidgety four-year-old and Ingrid is a relieved mother.

With an oxygen saturation level now in the 90s and his skin a healthy pink color, Denis lies in his hospital bed waiting to be released to his host family. In the meantime, he is surrounded by plush toys, Play-Doh, some videos and the anticipation of his fifth birthday, which will definitely involve “pizza,” he said with a broad smile – something easily understood in any language.

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