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By any account, Dylan Larimore has had a record-breaking year. In less than 10 months, the teenage athlete has gone from having open heart surgery to finding openings in the defense on the football field.
His story began three years ago at about age 12, when he mentioned to his pediatrician that he was uncomfortable going shirtless because of an indentation along his sternum, or chest bone. His doctor explained that the condition, known as pectus excavatum, could be fixed with cosmetic surgery that could be done at his convenience if he chose to have it.
Because he was a three-sport athlete, Dylan and his family delayed making an evaluation appointment for the corrective surgery for about nine months, but when his football season was cut short last fall due to a broken leg, they considered using his downtime to have the repair.
Dylan’s mother, Rhonda, did some online research and discovered that pectus excavatum can also put pressure on the heart, so she quickly decided to make the appointment. Rhonda, who is a vice president of human resources and support services at Children’s Hospital of Pittsburgh of UPMC, knew exactly which doctor to call, and she made an appointment for Dylan to be seen by Dr. Peter Wearden, a cardiothoracic surgeon at Children’s Hospital.
At Children’s, Dylan received a full cardiology workup for pectus excavatum, including chest x-rays, and an echocardiogram, which were followed by an electrocardiogram (EKG) and a stress test.. Because he had never had any symptoms and his physical examination was normal, the family was expecting to hear that his condition was not a big deal—so they were surprised to learn that the tests showed Dylan had a congenital heart defect known as anomalous origin of the right coronary artery from the left sinus of Valsalva.
But what shocked them was when Dr. Wearden explained that the defect can cause sudden cardiac arrest and that Dylan not only had to restrict his activity immediately, he also needed to have open-heart surgery to correct it right away.
“At the appointment, I understood the part about having a heart defect, but I didn’t really get what the doctor was telling me—that I had to have open heart surgery. So when that sunk in, I kind of freaked out,” Dylan says. “My mom explained it to me and it took me a few days to work through that.”
In the heart, there are two coronary arteries—one on the right side and one on the left—that rise from the aorta. What Dylan had was a defect in which the right coronary artery rose from the wrong side of the aorta and actually passed between the great blood vessels. The danger from his condition is that, during exercise, as the pressures in the vessels go up, they expand, which could compress the coronary artery, a condition that has been associated with sudden cardiac arrest.
The family scheduled the surgery for Nov. 1, 2011, two weeks later. By that time they all had emotionally processed the reality of the surgery, but on the day of surgery Dylan became very anxious. “I kind of freaked out again because I was really scared—but in the prep room, they gave me some medication to calm me down and that really helped,” he says. “Next thing I knew, I was waking up in the CICU after the surgery.”
Dylan’s parents, Rhonda and Jason, however, remember vividly the four hours they spent in the family waiting room while he was in surgery and on a heart-lung bypass machine, eagerly anticipating updates on their son’s condition. During the surgery, Chief of Cardiothoracic Surgery Dr. Victor Morell took the coronary artery off the aorta and reimplanted it on the other side in the normal position, creating at the point of implantation a “cuff” of tissue to prevent obstructions later.
After the successful surgery, Dylan spent 24 hours in the CICU and the next day was moved to a regular patient room, but was immobilized. Two days later, however, the nurses had Dylan sitting up, then walking and beginning his rehab therapy. “At first I was afraid of getting up and moving around because my chest hurt, but I started to heal pretty fast and moving around really helped,” he says.
Four days after surgery he was discharged to home, and within two weeks Dr. Morell had given him the go-ahead to return to school—although he was not allowed to carry a backpack and had to duck out a few minutes early to avoid being bumped in the crowded hallways between classes.
Within 10 weeks, Dylan got the green light to return to sports, and rejoined the basketball team with the season already in progress. “I was really excited to get back into sports,” Dylan says, “but a little nervous, too—not really because of my heart, but because I was out of shape! I worked really hard that season to get back into top condition for sports.”
The biggest test of his conditioning and recovery came this past August when he started summer football training sessions. After weathering that well, his next hurdle was donning the pads and preparing for full contact and the inevitable first tackle since his surgery. “Once I got that first hit out of the way, I wasn’t nervous anymore,” he says. Dylan now is a running back and cornerback for the junior varsity Freeport Yellow Jackets football team.
Although his heart defect is rare and there is not much data on it, Dylan is down to annual visits with his cardiologist, Dr. Stacey Drant, although he may need further heart imaging studies in the future to make sure his coronary artery remains open. “The good news for patients with Dylan’s defect is that echocardiography technology has come such a long way in the last five or six years that we are able to evaluate the coronary arteries as part of normal echo studies in ways we couldn’t before—so we’re finding these conditions incidentally,” says Dr. Drant. “Then, based on the patient’s lifestyle, we know what type of intervention to take—or not.”
Dylan says his experience was bittersweet—he actually had fun at the hospital, but not for the reason he was there. “The doctors were awesome and the nurses were great,” he says. “I wouldn’t want to do it again, but it wasn’t as bad as I thought it was going to be.” For the time being, he’s had enough surgery and doesn’t plan to have the cosmetic pectus repair.
For his mother, though, it was an eye-opening experience. “As a mom, it was tough to go in there with what I thought was a healthy kid and be told that not only does he have a serious heart problem— he needs open heart surgery,” Rhonda says. “The scariest part is that we might never have known about it at all until something bad happened. But I see the amazing work that takes place at Children’s every day from an administrative side. Being on the other side—as a parent—is a totally different experience and I now have a new appreciation for the things we do.”
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