Article
Down syndrome and heart defects
Angel was born in a town of 40,000 people in North Dakota, with Down syndrome and a congenital heart condition called atrioventricular septal defect. But there were no children’s hospitals nearby – and Angel needed open heart surgery soon.
“I did some research online and found a children’s hospital near some family of mine in California – and I hired a private jet to fly him there,” says Angel’s dad, Luis.
At just 2 months old, Angel underwent successful open heart surgery. He had a second surgery at 10 years old to replace a leaking valve.
“After Angel’s two heart surgeries, I thought we were out of the woods,” says Luis, Angel’s dad.
But Angel’s biggest health scare was yet to come
A stressful Thanksgiving week
It was around Thanksgiving in 2025, and Luis was busy preparing for the holiday with 10-year-old Angel and his two siblings. Luis noticed that Angel wasn’t moving his left arm very much.
“It caught my attention. But it was happening mostly at night, so I told myself I’d wait to see how it went the next morning,” says Luis.
The next day, Angel stopped moving his left arm altogether, one of the signs of stroke.
Luis drove Angel to their local emergency room. There, doctors determined that he had experienced a stroke and stated him on blood thinners.
For several days, Angel’s care team monitored him in the hospital. On the fifth day, an MRI of his brain showed that Angel only had one artery supplying blood to his brain. Most people have four.
“The doctors told me that having only one artery supplying blood to his brain meant my son should be a vegetable,” says Luis.
A few days later, Angel was referred to Children's Health℠ Center for Cerebrovascular Disorders in Children for specialized care from a team focused exclusively on pediatric stroke cerebrovascular care.
Getting to the root of the problem
The care team immediately placed Angel in a neck brace to prevent him from bending or twisting his neck in a way that could block the only artery supplying blood to his brain.
They also gave him blood thinners and medications to prevent blood clots while monitoring his recovery from the stroke. They also worried that Angel might have a condition called bow hunter’s syndrome (BHS), which happens when turning the neck 45 degrees (like a bow hunter before shooting a bow) causes vertebrae to press on an artery and reduce blood flow to the brain.
To check for BHS, Rafael De Oliveira Sillero, M.D., Pediatric Neurosurgeon at Children’s Health and Assistant Professor at UT Southwestern, performed an advanced imaging test called a cerebral rotational angiogram.
Bow hunter’s syndrome is scary because it can cause strokes. “But for Angel, it was especially scary because he only had one vertebral artery supplying his entire brain,” says Michael Morgan Dowling, M.D., Ph.D., Pediatric Neurologist at Children’s Health and Professor at UT Southwestern.
The angiogram confirmed it: Angel had BHS. If his only artery became compressed, his brain could be deprived of oxygen.
The team knew they had to do everything they could to keep Angel safe.
The team began planning surgery to fuse two of Angel’s cervical vertebrae, creating a permanent internal “brace” for his neck.
“We knew we needed to fuse his neck – to keep his one lifeline open,” says Dr. Dowling. “Otherwise, he would be at risk of blood clot or loss of blood flow, which can be fatal.”
Protecting his sole artery
Angel had fusion surgery two weeks later with Bruno Perocco Braga, M.D., Pediatric Neurosurgeon at Children’s Health and Associate Professor at UT Southwestern.
Before he was wheeled back to the operating room, Angel’s dad asked, “So, what happens if something goes wrong during surgery?” He’ll never forget the response: “Everything needs to go right.”
Thankfully, everything did go right.
To this day, I'm still shocked that my son is alive. And if you were to look at him, you could never tell he is living off of one artery – or that he had a stroke.
Luis, patient parent
Creating a bigger blood supply to his brain
Angel has made an incredible recovery and his family is deeply grateful his care team figured out why he had a stroke. But Angel's care won't end there.
Now the team is making a plan to create other branches of blood flow to his brain through revascularization surgery. During this surgery, neurosurgeons will bring an artery from his scalp and place it directly on to his brain’s surface. In time, that artery will sprout branches to provide new sources of vital blood, oxygen and nutrients to his brain.
“The doctors told me the surgery would give Angel alternate routes for blood to travel, in case there’s a traffic jam on his main highway. After surgery, he’d have backup routes, his body wouldn’t have to work so hard and he’d be far less likely to have future strokes,” says Luis.
Luis also recalls how Angel’s doctors and nurses patiently answered his questions and how they always made him and Angel feel at ease.
“Angel is a ball of energy,” says Jesse Vallejo, RN, Manager of Neuroscience Clinic Services at Children’s Health, and one of Angel’s nurses. His connection and empathy for the kids and families he cares for has deepened after surviving having his own stroke.
“I now know what it’s like to go through a stroke and not be able to swallow or move your arm. I know how truly scary that is,” he says. “And if it was scary for me as an adult, I can only imagine what it’s like for a non-verbal kid like Angel.”
Vallejo smiles when describing how revascularization surgery will help Angel continue sharing his joyful personality with the world.
A miracle child
Seeing that joy – after all Angel has been through – is part of what makes Luis believe his son is a living miracle.
“Angel has always preferred to sleep on his right side. But doctors told me that if he had slept on his left side, one day he might not have woken up,” he says.
Looking back, Luis remembers being told his son was at higher risk for stroke because of having Down syndrome and a heart condition. But, like most parents, he never imagined it would happen to his child.
He’s incredibly grateful that Angel’s been given a second chance and a healthier path forward.
“I know God's got a big plan for Angel because the odds have been totally against him,” says Luis. “And he’s always been the happiest boy ever.”
Learn more
The only program of its kind in Texas – and one of only a handful in the country offering a pediatric neurovascular fellowship – the Center for Cerebrovascular Disorders in Children brings together pediatric neurosurgeons, neurologists, interventional radiologists and neuroradiologists with deep expertise in childhood stroke and rare cerebrovascular conditions.
Our expert team treats and evaluates every possible stroke – within the first critical hours – with the latest treatments and clot-busting medicines. And every year, we diagnose dozens of rare cerebral vascular disorders in kids, including Bow hunter’s syndrome. Each child treated at our center also receives post-stroke follow-up, including rehabilitation with physical, occupational and speech therapists, emotional coping support and support for returning to school. Learn more about our programs and services.
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