A 42 year old patient with a tear in the inner layer of the aorta came to Dr. Manoj Daga, Cardio Thoracic Surgeon at BM Birla Heart Research Centre. Medically this is termed as an aortic dissection but for the layman it meant the patient was bleeding into the false layer of the blood vessel with a risk of rupturing at any moment.
The aorta is the main blood vessel that supplies blood to the rest of the body and a rupture would mean almost certain and immediate death. The tear in this patient extended up to the head branches and the branches supplying the lower limbs. When the patient arrived at BMB, the valve was leaking and the prognosis did not seem very good.
Cases of aortic dissection are very rare. It is relatively more common in colder areas of the world where the blood vessels are subjected to sudden fluctuations in pressure. In the subcontinent, cases of aortic dissection are comparatively less.
Dr Daga instantly recognised the acute emergency and took him to the operation table immediately. Ideally the patient should have been operated soon after diagnosis, but he had arrived at BMB 7-10 days after his diagnosis at another hospital.
After a 6-hour surgery, during which the aortic valve was replaced with a mechanical valve and alsothe entire dissected pipe was replaced. Then head blood vessels had to be implanted to restore normal blood supply to them. A graft replacement of the entire ascending aorta (aortic arch and the upper part of the descending thoracic aorta)with a synthetic tube was also done. After such a massive procedure the patient took some time in post-operative but as of now his vitals are normal. He has resumed normal life.
Dr Daga said, “While an aortic dissection is always an emergency the surgical complications can be reduced if the patient is brought to the hospital within the first two hours of the aortic dissection. According to research 90% of patients die within 2-3 days, if unattended.”
The most visible sign of an aortic dissection is acute and excruciating pain arising from the back and coming to the chest or going towards the back. The pain is similar to a heart attack and in both cases the patient should be rushed to a cardiac care centre without any delay. Cases of aortic dissection are also noticed in patients with uncontrolled blood pressure.