Dilation dilemma

We did not know whether this dilation at the arch was present starting from 2015 when she had her recurrent aortic dissection, because we unfortunately did not have this particular intelligence in our earlier CT scans. 69

Conservatively, one then had to assume that the dilation was new and recent. If that were the case, there was a high likelihood that it was still progressing, could dilate further in the near future, and that can be disastrous.

Saving amma’s life now meant keeping two ticking bombs – not just one – from exploding.

I was keen on getting the endovascular surgery done – it will repair the entire leaky pipe once and for all. And I would not have to live in fear of any ticking time bombs.

But taking the final decision was not easy. For one, it was expensive, but this was not the biggest challenge – if I wanted amma alive, I was willing to pay the price for it. I was more worried about the risks involved in such an operation undertaken on a 79 year old lady with a weak heart. I could not find any past histories in India of such a surgery having been done for someone so old. 70

I had trust in the hospital (one of the most reputed in India) as well as in the doctor’s competence, but was not entirely sure if I wanted amma to be a pioneer in contexts such as these, especially when the conservative management seemed to be holding up.

My sister was completely against the endovascular repair operation. She would rather have amma live a surgery-free, pain-free life at her old age, even if it was for just a year.

I was torn between my sister’s opinion and my original intentions and concerns – for me, amma should be saved.

Finally, I took a decision that was midway. I wouldn’t immediately do anything but continuously wait to see if amma developed any symptoms indicative of the deterioration of the aortic arch or the descending aorta. If there were any, I’d immediately rush her to CMC. As I had already connected with the cardiology expert on WhatsApp, there was the comforting feeling that help was immediately at hand.

Honestly, I do not know if this was a prudent decision. I’m an entrepreneur and in my business too, I take some risks, but not too many. This character spilled over to my decisions for amma as well and as a result, she never underwent the endovascular surgery for the arch dilation and descending aorta dissection.

Post her death, I was reviewing her latest CT scans of aorta taken during her final hospitalization.

There were absolutely no changes in dissection anywhere in aorta from its status almost three years earlier. More important, the maximum diameter of the aortic arch had not expanded at all from what it was three years earlier. In fact, it was 5.5 cm, almost the same as the 6 cm that it was about three years earlier. The dilation of the arch had hence most likely existed from the time of her recurrent aortic dissection in 2015. 71

Essentially, amma’s ticking time bombs had not exploded five years on.

There is no doubt in my mind that it really was amma’s discipline in taking the prescribed medications, her simple but healthy diet habits and her relatively active life that kept the ticking bombs at bay for over five years. I’m sure luck played some small role too, as it seems to have done in amma’s case on so many occasions.

For those who are having a conservative management of aortic dissections and other critical ailments, and for relevant medical experts, I hope her history is of some help and value.

Amma never knew about the ticking time bombs. She was just told she had a serious heart problem.

I never told her about my visit to CMC.

Just as well. Ignorance is bliss, especially if you can afford it.

A second ticking time bomb <= Dilation dilemma => Landing with a thud in my heart



69. The scanning center that had taken her scans in 2015 and 2016 had unfortunately not kept records of scans beyond a year, so there was no way to get this intelligence. This begs the question: Given the really low cost of data storage, perhaps medical scans at such centers and at hospitals should be maintained for ten years or even higher?

70. The cardiologist from CMC had done some excellent surgeries, but none of these were for people as old as amma.

71. Post her death, I was reviewing many of her records. Data from a chest X ray taken in 2015 suggested that her arch already had a diameter of 5.5 cm. While chest X-ray data are not as conclusive as CT scans, this input most likely confirms the hypothesis that the arch was already dilated by 2015, at the same time when the rest of the recurrent dissection happened. Somehow, all of us – including the doctors – had missed seeing this data point!


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