While the doctor said that management through medications could work for years, he also said there was no guarantee.
Managed well, she could survive even 10 years, but if there are complications, it could even be 10 days, he said. I do not recall asking – or having the guts to ask – him what he thought was the probability for the 10-day survival.
Once outside the doctor’s room, I looked at the colorful but gory CT scan representation of amma’s aorta that showed how extensively it had dissected.
My heart leapt out.
Imagine a two-layered, meter long vertical tube with a moderately viscous fluid flowing inside 24×7. Now visualize the inner layer developing a tear for over three quarters of its entire length and fluid accumulating between the two layers for this entire length.
How long do you think before the outer layer too developed a leak? I would think – not very long.
Replace the tube with the aorta and the fluid with blood. 52 You get a picture of amma’s recurrent aortic dissection. It looked literally gory. You could see blood accumulating in the middle layer for almost the entire length of the aorta. In one of the views that presented only the new channel where blood from the dissection flowed (called the false lumen), it looked as if almost her entire aorta was soaked in blood.
Fig 18: Illustration of amma’s false lumen alone. The false lumen is the new channel formed for the blood flow after there’s a tear in the inner layer of the aorta. The blood starts flowing through this channel which is between the outer and inner layers. It can be seen that amma’s false lumen extends all the way from her aortic arch until the end of the aorta, also extending into renal arteries and beyond the aorta, into the iliac (leg) arteries. This view was the one that really made me scared, as it appeared as if her entire aorta was soaked in blood!.
When I looked at the extent of dissection from the CT scan images, 53 the real feeling I had was deep fear. If this was how her aorta looked, I felt she would not survive even 10 hours. My sister, working as a nurse in the US, did not disagree much.
But as my further reading and research showed, and as amma’s own progression showed, the doctors had reasons for their optimism. 54
Even today, when I look at amma’s original recurrent aortic dissection CT images taken in 2015, I wonder how such a torn and tattered structure could last even a few hours, leave alone years! At the same time, the status of amma’s aortic dissection over the subsequent five years also taught me an important lesson about conservative health management – it certainly works well for specific scenarios, if the rules are strictly followed.
Out of this traumatic experience, I also learnt something about the aorta’s robustness. Even though the aorta’s outermost layer (called the adventitia) is a thin layer, its rich collagenous content gives it excellent tensile strength. The fellow might look thin, but he’s made of stuff that can withstand a good amount of pressure.
Appearances indeed can be deceptive – and in amma’s case, I did not mind the deception except that it gave me a real fright.
52. Unlike a tube with a constant diameter, a human aorta has different diameters at different portions, with a gradually decreasing diameter in the descending portion of the aorta.
53. A CT scan of an aorta is called a CT aortogram.
54. It is a bit difficult to get a precise estimate for the expected number of years survival for conservatively managed aortic dissection patients, owing to the many dependencies involved. But studies have shown that under well-managed conditions, for patients with few other life-threatening diseases, survival rates of up to 75% for 5 years and about 50% for 10 years are possible.
Read Amma the fun way!
Do you know that you can read specific chapters alone of Amma depending on who you are and what interests you? So, we have selected chapters that could be of interest to young, middle-aged and old men & women, to medical and white collar professionals, to those wishing to know specifically about heart problems, blood pressure or leg ailments, medical management of seniors & elders, and even those interested in reading some fun and humour.
We even have a treasure hunt designed for you to ferret out 100+ interesting facts.