Fabiola Ramos loves drawing, math and science. If she has her way, she will be an architect someday.
Or a doctor.
Why not both, asks her mother.
When it comes to dreams, there are no limits for this 15-year-old Honduran girl.
In physical activity, however, Fabiola has less freedom. She has lived with restrictions on exercise for five years, ever since learning she’d been born with a congenital heart rhythm problem.
If she exerted herself physically, she could get an extremely rapid or irregular heartbeat. Sometimes, she fainted.
She felt a sense of relief when she learned, as a high school freshman, that doctors could fix her heart. But the good news came mixed with uncertainty.
To fix her heart, she had to travel to Grand Rapids, Michigan, where she would receive care at the Congenital Heart Center of Spectrum Health Helen DeVos Children’s Hospital.
The journey would take her far from her home in San Pedro Sula. Far from her mother and father, Rosie Ramos and Elvin Valle, and her 11-year-old brother, Isaac.
“At first I was really excited,” she said, with the help of an interpreter. “I was encouraged there was a resolution to my problem. But then I started to feel a little sad.”
The Michigan-Ohio chapter of Healing the Children made the arrangements to bring Fabiola to West Michigan on Oct. 30, 2018. She met her host parents, Kim and Tom Vredevoogd, and their children, 10-year-old Ellie and 8-year-old twins, Olivia and Arie.
“She has a quiet personality,” Kim said. “She has been a joy to have here.”
Kim, who speaks Spanish, translated for Fabiola as she discussed her medical journey. She and Fabiola sat in a sunroom of their Byron Center home, looking out over farm fields, pine trees and a backyard swimming pool.
A light dusting of snow covered the landscape—the first snow Fabiola had ever seen. Asked what she thought of winter, she laughed.
“Mucho frio,” she said. Very cold.
She kept in close contact with her family through a mobile app. But she also missed her friends.
“I am a person who has a few close friends,” she said. “They were very sad I was going to leave them and be here.”
Her trip so far had been fun, but she felt nervous about the treatment scheduled for the next day.
The illness surfaces
As a young child, Fabiola seemed as healthy as the next kid. The first sign of a problem surfaced at age 10.
At school one day, in a noisy classroom brimming with 100 students, she began to feel ill. She tried to tell the teacher she felt sick, but she fainted.
After many doctor’s visits and tests, conducted at her mother’s insistence, Fabiola learned the cause.
She had a congenital heart rhythm problem called Wolff-Parkinson-White syndrome. Additional electrical pathways are present in the heart. They can trigger an abnormally fast heartbeat or changes in heart rhythm.
The first symptoms can show up even before birth, but they usually occur when a young person reaches the teen years, said Christopher Ratnasamy, MD, a Spectrum Health pediatric cardiologist specializing in electrophysiology.
In rare cases, it can lead to cardiac arrest and death. Fabiola said her great aunt died from the condition.
Fabiola played some sports, but only for short periods and never at an intense level. She would have liked to play competitive basketball and soccer, but the risks to her heart were too great.
She once suffered an extremely rapid heart rate for an hour—and that was scary, she said.
Although Wolff-Parkinson-White can be life-threatening, it is not usually fatal. It is treatable and curable, Dr. Ratnasamy said.
Treatment involves a minimally invasive procedure called catheter ablation.
Fabiola underwent the procedure early one November morning in the cardiac catheterization lab at Helen DeVos Children’s Hospital.
First, Dr. Ratnasamy mapped her heart using a GPS-like system in which catheters in her blood vessels sent signals to stickers on her chest. The system created a 3D image of her heart, the image displayed on a large monitor over the operating table.
The GPS system has an advantage over fluoroscopy—a system that uses X-rays to map the heart—because it does not involve radiation, Dr. Ratnasamy said.
Fabiola had multiple extra connections. Dr. Ratnasamy ablated some areas using radio frequency, or heat.
But he took a different approach with the extra connections that lay close to the AV node, the electrical connection that is part of the heart’s natural pacemaker. He used cryoablation to freeze the tissue.
“With cryoablation, the effects are slower so they can be performed with more precision and without damage to normal electrical connections,” he said. “The effects are reversible in the initial part of treatment.”
This slower but more precise method allowed him to perform the procedure with “extremely minimal risk of damage to the normal electrical connections.”
A week after the procedure, Fabiola returned with Kim to the Congenital Heart Center for a follow-up visit. The access sites for the catheters, in her neck and legs, were healing well.
“The EKG looks good, which is the most important thing,” Dr. Ratnasamy told her, with help from an interpreter.
He showed her printouts of EKGs taken before and after the ablation to show how it has changed.
The visit left her feeling much calmer, Fabiola said.
She looked forward to returning to her home in Honduras. She especially missed her pink and purple bedroom, where she likes to draw. But she added she would miss the U.S., especially the food—and most especially the cherry candies from Cherry Republic.
Dr. Ratnasamy wants her to have another EKG in six months to a year.
“If that’s normal, she is pretty much cured,” he said.
He expects Fabiola will soon be able to run, exercise and be as active as she pleases without fear of triggering any problems.
“Now she can do all those things,” he said. “She can do sports without any problem.”