Extra Heart Vessels: Key Questions for Parents

An additional blood vessel in the heart?

Hello Dr.
Liu,
My son is seven years old.
During a recent cold, I noticed that his heartbeat was irregular, sometimes fast and sometimes slow.
I specifically asked the doctor to check during our visit, and after a referral, we were informed that he has an additional blood vessel in his heart.
He has not yet undergone a 24-hour Holter monitor test, as the doctor mentioned it would be done before a catheterization procedure.

I would like to ask Dr.
Liu the following questions:
1.
At what age is it better to perform this surgery?
2.
Can medication be used to manage the condition before the surgery?
3.
Are there any lifestyle changes we should be aware of before and after the surgery?
4.
From a technical standpoint, is it better to access the heart through the thigh or the arm?
5.
Most importantly, what is the success rate? I have heard it is 99%, but I am concerned about that 1% and would like to know what the risks are.

I apologize for the many questions, and I hope you can provide concise answers.
Thank you, doctor.

jerry hsu, 30~39 year old female. Ask Date: 2008/10/01

Dr. Liu Duying reply Cardiology

Dear Mr.
Jerry Hsu,
Before addressing your questions, let me briefly explain your son's condition:
1.
Your son is complaining of irregular heartbeats, which falls under the category of arrhythmias.
There are various types of arrhythmias in children; some do not require treatment, some are suitable for medication, and others may warrant surgical intervention.
Therefore, clinically, it is essential to first conduct tests such as a 24-hour Holter monitor to determine the specific type of arrhythmia before deciding on the appropriate management.
2.
Regarding what other physicians mentioned about an additional "blood vessel" in the heart, it is likely a misunderstanding.
It probably refers to an extra myocardial fiber capable of conducting electrical activity, informally described as an additional "wire." The so-called "catheter ablation procedure" may involve electrophysiological studies combined with ablation techniques to identify and eliminate the extra myocardial fibers, aiming to treat the arrhythmia associated with these fibers.
It is important to note that the presence of these "extra" fibers does not necessarily mean that there will be arrhythmias, nor does it imply that your son's arrhythmia is related to these fibers.
Thus, it does not automatically necessitate intervention.
Now, I will address your specific questions one by one:
1.
Electrophysiological studies and ablation can be performed at various ages; however, for a seven-year-old child, due to their smaller body size, the examination and treatment should be conducted by a pediatric cardiologist and electrophysiologist.
2.
The effectiveness of medication depends on the specific type of arrhythmia.
3.
In terms of surgery, after the procedure, it is advisable to avoid significant movements and vigorous activities involving the injected limb for a short period.
4.
The catheters used in electrophysiological studies are generally not introduced through surgical vessels; therefore, unless in special circumstances, they will not be used in the hand.
5.
Success rates can vary between hospitals and are generally rough estimates.
Thus, a 1% risk indicates that medical (or therapeutic) interventions are not without potential risks and the possibility of treatment failure.
Therefore, it is crucial to have a thorough discussion with the physician before deciding on treatment.
The above responses are based solely on the information you provided.
If you have further questions, please feel free to email or consult in person.
Sincerely,
Dr.
Liu Duying

Reply Date: 2008/10/01

More Info

Understanding extra heart vessels, particularly in children, is a crucial aspect of pediatric cardiology. When a child is diagnosed with an additional coronary artery or any vascular anomaly, it raises several important questions for parents. Here, I will address your concerns regarding your son's condition and the potential surgical intervention.

1. Optimal Age for Surgery: The timing of surgery for congenital heart defects, including the presence of extra vessels, often depends on the specific anatomy and the symptoms exhibited by the child. Generally, if the additional vessel is causing significant symptoms or complications, intervention may be recommended sooner rather than later. In many cases, pediatric cardiologists prefer to perform surgery between the ages of 1 and 5 years, but this can vary based on the individual child's condition and the recommendations of the healthcare team.

2. Medication Management: Before considering surgery, some children may be managed with medications, especially if they are asymptomatic or if the extra vessel is not causing significant hemodynamic issues. Medications may include beta-blockers or other agents to help regulate heart rate and blood pressure. However, the decision to use medication should be made in consultation with a pediatric cardiologist, who can assess the specific needs of your child.

3. Lifestyle Considerations: Prior to surgery, it is essential to maintain a healthy lifestyle for your child. This includes regular check-ups with the cardiologist, monitoring for any symptoms such as chest pain, shortness of breath, or unusual fatigue. After surgery, the child may need to avoid strenuous activities for a period of time as they recover. Your healthcare provider will give specific guidelines on physical activity and lifestyle adjustments post-surgery.

4. Access Site for Surgery: The choice of access site for catheterization (either through the femoral artery in the thigh or the radial artery in the wrist) depends on several factors, including the child's anatomy and the preference of the cardiologist. Both approaches have their advantages. The femoral approach is more traditional and allows for easier access to the heart, while the radial approach is less invasive and may lead to quicker recovery times. Your cardiologist will discuss the best option based on your son's specific situation.

5. Success Rates and Risks: The success rate for catheter-based interventions in pediatric patients is indeed high, often cited around 99%. However, it is important to understand that no procedure is without risk. Potential complications can include bleeding at the access site, infection, or, in rare cases, damage to the heart or blood vessels. The risks associated with any procedure should be thoroughly discussed with your child's cardiologist, who can provide a detailed overview based on your child's health status and the complexity of the procedure.

In conclusion, while the diagnosis of an extra heart vessel can be concerning, many children with such conditions lead healthy lives, especially with appropriate medical management and surgical intervention when necessary. It is essential to maintain open communication with your child's healthcare team, who can provide personalized advice and support throughout this process. Please feel free to reach out with any further questions or concerns.

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