PEDIATRIC HEART SURGERY & INTERVENTIONAL CARDIOLOGY MISSION
SANTO DOMINGO, DOMINICAN REPUBLIC
August 25-29, 2025

The Dominican Republic is the second-largest nation in the Caribbean, with an estimated population of 11.5 million people, approximately one million of whom reside in the capital city, Santo Domingo. Christopher Columbus landed on the island in 1492, establishing the first permanent European (Spanish-ruled) settlement in the Americas. Following three centuries of Spanish rule, including periods of French and Haitian control, the country became independent in 1821.

Tourism is the nation’s predominant industry, attracting over 10 million visitors in 2023. With such a heavy reliance on this sector, it leaves much of the population vulnerable to extreme weather patterns, natural disasters, and pandemics. Consequently, a significant proportion of Dominicans remain at or below the poverty line. Persistent national challenges include unemployment, corruption, and marked income inequality, particularly in access to healthcare. The infant mortality rate remains high at 27.3 per 1,000 live births, and the leading causes of death are ischemic heart disease and stroke.

Partnership with Fundación Heart Care Dominicana

Fundación Heart Care Dominicana, a nationally recognized charity, invited CardioStart International’s pediatric cardiac team to address congenital heart disease among the country’s poorest communities—those least likely to receive care for complex congenital cardiac conditions. The mission also focused on training and skill transfer, working directly with local cardiovascular surgeons to enhance their capabilities in complex congenital heart lesion repair and palliative procedures.

In addition to the surgical team, CardioStart had an interventional catheterization team to assist with diagnostic assessments for both surgical and nonsurgical pediatric patients. All procedures were performed at Clínica Corazones Unidos in Santo Domingo. This mission marked CardioStarts twelfth pediatric cardiac mission to the Dominican Republic.

Clinical Collaboration and Case Selection

CardioStart’s team worked side-by-side with the local medical staff at Hospital Corazones Unidos to provide comprehensive care—preoperative evaluation, surgery, intensive care, and postoperative management—for pediatric patients who otherwise would be unable to afford treatment for severe congenital heart disease.

Patients were first identified and screened by Fundación Heart Care Dominicana, using stringent clinical criteria to ensure long-term success and sustainability. More than 20 cases were presented for consideration; ultimately, 9 highly complex congenital heart cases were selected for surgical intervention. All cases underwent dual evaluation by local cardiologists and by CardioStarts visiting cardiac surgeons and pediatric cardiologists.

Mission Execution

The CardioStart team worked extraordinarily long hours—often up to 18 hours per day—to maximize impact during the one-week mission. The operating room team collaborated directly with the local pediatric surgeon and staff, frequently working in conditions that were below standard for high-complexity congenital heart procedures. As routine operations at the clinic are typically limited to basic monthly procedures, CardioStart supplied specialized surgical instruments and select medications necessary for advanced repairs.

Significant camaraderie developed between the local and visiting surgical teams, strengthened by shared long hours, high-intensity cases, and unprecedented surgical challenges. The catheterization team evaluated numerous pediatric cases, while the ICU physician and CardioStart nurses provided exceptional support to local intensivists and nursing staff.

Cardiology

Eight Transesophageal Echocardiograms were completed, and thirty-six transcutaneous echocardiograms were done either as outpatient or in the ICU as follow up.

Clinical Outcomes

This mission was regarded as highly productive by both CardioStart and the local medical team. Clinical outcomes were remarkable:

• All patients were extubated in the operating room
• No re-intubations
• No postoperative complications
• Average ICU stay: 1–2 days
• No chylous effusions
• No postoperative heart block
• No wound infections

These outstanding results reflect the expertise of the visiting team and the effective collaboration with local healthcare professionals. All patients presented with complex, high-risk congenital heart disease and could be highlighted. The surgical list included:

Notable Cases

20-year-old with Marfan syndrome

Álvaro is a 20-year-old young man from San Cristóbal, living with his mother and grandmother in a low-income household. Despite financial hardship, he is a quiet, thoughtful young man who dreams of finishing his studies and helping provide for his family.

For years, Álvaro’s health declined slowly: fatigue, shortness of breath, and chest discomfort limited his ability to attend school consistently or help at home. His family, with extremely limited economic resources, had no access to advanced cardiac care. A life-saving open-heart surgery of this magnitude was financially unobtainable.

When Álvaro was diagnosed with a giant 7–9 cm aortic root aneurysm associated with Marfan syndrome and severe aortic regurgitation, Ejection fraction of 35% he faced an imminent risk of sudden death from progressive ventricular dysfunction or aortic rupture. Without surgery, he would not have survived.

Through HCD’s mission, Álvaro received care at no cost, including surgery, hospitalization, medicines, food support and follow-up—lifting a life-threatening burden from his family. Despite the exceptionally high surgical risk he was successfully extubated in the OR and demonstrated excellent postoperative recovery.

3-year-old S/P VSD and now with severe AI

Ángel is a 3-year-old boy from a humble community in La Romana, raised in a family facing significant economic limitations. His mother noticed early signs of distress—difficulty feeding, rapid breathing, fatigue—but had limited means to access specialized care.

Ángel had already undergone open-heart surgery for a VSD and aortic valve repair earlier in the year. Despite this, he developed severe recurrent aortic insufficiency, which placed him at risk for heart failure and long-term disability. For a family living well below the poverty line, a second complex open-heart surgery was unthinkable financially. Their only option for survival was access through HCD’s mission.

His mother expressed profound worry that her son might not survive long enough to receive help. Through HCD and CardioStarts collaboration, Ángel obtained a second valve-preserving operation, postoperative medications, and the month of nutritional support that HCD ensures for every vulnerable family.

Fundación Heart Care Dominicana serves patients from across the Dominican Republic, many of whom have previously undergone cardiac surgery or catheter-based interventions during prior CardioStart missions. During this mission, a CardioStart pediatric cardiologist evaluated numerous returning patients. This follow-up proved invaluable, as several children exhibited post-surgical changes requiring further management—either surgically or, in one case, through a catheter-based intervention in the cardiac catheterization laboratory.

Teamwork makes dream work

For volunteers who have returned to Santo Domingo over the years, as well as for the local clinical team, it was deeply meaningful to see these children again. Even those who will need additional procedures are growing, developing well, and thriving—an encouraging testament to the lasting impact of prior missions and ongoing collaborative care

Catheterization Lab

Due to time constraints only one catheterization case was done. This was an 8-month-old who had a Right and Left heart cath. Pressures were obtained and recorded for surgical evaluation.

Acknowledgments

Allie Pesche for vital catheterization lab supplies.

Mrs. Ruth Seeger for patient hygiene supplies.

NZS Worldwide Shipping for logistics and shipping of container.

Thank you to all our volunteers who generously donated their time and Dr. Kaushal for financing his 6 team member flights to make this mission possible and to our Fundación Heart Care Dominicana liaison, Mary Carmen, who worked tirelessly to ensure the success of this mission.

CARDIOSTART TEAM

Sunjay Kaushal, MD, PhD Pediatric Cardiac Surgeon

Eric Vu, MD, Pediatric Cardiac Anesthesiologist

Steven Robertson, Perfusionist

Nicolette Dupuis Pediatric and Adult Cardiac Surgical Technician

Abraham Rothman, MD, Pediatric Cardiologist

Barbara Ferdman, MD, Pediatric Cardiac ICU Physician

Breon Koenig, RN Pediatric Cardiac ICU Nurse

Anniless Dicus, RN Pediatric Cardiac ICU Nurse

Amber Galer, Respiratory Therapist

Avni Kaushal Mission Coordinator

A special thank you for assistance of this mission to members of the CardioStart Cardiac Team who brought suitcases of medical equipment to donate to the mission.