In April 2011, amma had an acute aortic dissection and came very close to death. She was 72 then.
Amma’s aorta had torn owing to high blood pressure.
I wouldn’t be surprised if you had not heard of the aorta – I would have been skeptical myself had someone told me I had an aorta in me.
Aorta is the artery that carries blood from the heart to the rest of the body. It is a large blood vessel that starts from the heart’s left ventricle, ascends until it reaches an arch, and then descends ending at the abdomen. Along its route it supplies blood to various arteries that carry blood to different parts of the body. Any significant damage to the aorta can thus affect blood supply to many organs, or worse, cause death.
Aortic dissection, in which there is a tear of the aorta, is not as common as other cardiovascular problems. In fact, as is the case with aorta itself, most people hear about aortic dissection for the first time when someone near or dear to them has been unfortunate enough to be a victim of this serious ailment.
Every year worldwide, 1 in about 300 people have a heart attack. 1 in every 500 have a stroke. 1 in about 30000 people have an aortic dissection – it is less than one fiftieth as prevalent as other cardiovascular problems 2. Even its records in the annals of medicine are significantly more recent compared to its more popular relatives such as heart attack. 3
Aortic dissections are typically more prevalent in those over 60 years of age and with hypertension. Interestingly, women are only half as vulnerable as men. 4
For amma, the ascending part of her aorta – starting from the heart’s left ventricle until the aortic arch – had been dissected. This was unfortunate, as the ascending portion is considered more sensitive to rupture post a dissection.
Fig 1: Ascending aortic dissection: In amma’s case, the tear in the ascending aorta started close to the root of the aorta and proceeded all the way to the proximal arch which is the starting point of the aortic arch.
Aortic dissection of the ascending type (called the Stanford A Type) is thus a critical medical emergency, needing immediate, high-risk surgery. The death rate for this type of aortic dissection is 1-2% per hour for the first 24-48 hours. You are as good as dead if you are not operated within three days from the start of the dissection.
The doctors at a prominent cardiac specialty hospital in my city almost missed identifying amma’s dissection, a common problem with aortic dissection as it gets mistaken for heart attack in many cases. 5,6 But once the dissection was diagnosed for amma, the doctors were not very hopeful. The extent of dissection was complicated in itself. Complicating matters further were two other challenges: one, the dissection had extended to the right coronary artery that supplies blood to the heart, and two, amma’s weak heart owing to her somewhat dysfunctional left ventricle might simply not be able to withstand the trauma of a major open heart surgery.
The expert team’s inference was that she had a 30% chance of survival, and even if she did survive, she had only a 50% chance of leading a normal, healthy life as there was a reasonable chance that blood flow to her brain could get affected post the surgery. 7 In other words, she had only a 15% chance of full recovery.
In the counseling room, the chief doctor asked me to make a decision on whether to go ahead with the fairly expensive surgery to repair the aortic dissection and reimplanting the dissected coronary artery, given the surgery’s high cost and its low chance of success. 8
I looked at my dad. He said he would go for it at a 5% chance of success.
I remember standing outside the emergency room when they wheeled amma out on the way to the operation theater. I could see her face, in agony from the dissection pain. She looked up at me from her stretcher and feebly said, “Take me home”.
It has been almost ten years since that day, but I still recall my terrible sadness on hearing this – getting her back home seemed such a remote possibility. I just kissed her hand before she disappeared into the operation theater for a four hour long complex surgery.
The operation was a thorough success and she recovered completely.
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2. Nienaber, CA; Clough, RE (28 February 2015). “Management of acute aortic dissection” – https://doi.org/10.1016%2Fs0140-6736%2814%2961005-9
3. The earliest recorded case of heart attack is in an Egyptian princess who lived between 1580 and 1550 BC. The earliest recorded case of aortic dissection is that of George II, King of England who died in 1760 AD.
5. Aortic dissection is not properly diagnosed in many cases as it is not as common as other cardiovascular diseases. The dissection may not show up in the standard echocardiogram tests and a CT scan is needed to identify it. Even in amma’s case, the doctors diagnosed her dissection only one full day after her admission, a close call. Many have not been so lucky. Even a celebrity like Hollywood comedian and actor John Ritter sadly had his aortic dissection misdiagnosed in 2003 and died as a result.
6. The symptoms of an aortic dissection can be difficult to distinguish from those of other heart conditions, especially a heart attack. Chest pain and pain in the upper back are the most common symptoms of this condition. There’s typically severe pain, coupled with a feeling that something is sharp or tearing in your chest. Unlike in the case of a heart attack however, the pain usually begins suddenly when the dissection starts to occur and seems to move around.
8. Done through an open heart operation, it mainly involved inserting a graft with a stent to repair the dissection.
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