In his 24 years of practice, Dr Z S Meharwal cardio-vascular surgeon at Escorts hospital had never seen a case of aorta (largest artery in the heart) rupture go home alive.
Mehrauli resident Prem Kumar, 49, developed mild chest pain and went for a routine check-up to Escorts. Doctors advised him ecocardiogramme (ECG) and CT Scan.
“After undergoing an Echocardiogram, I was on my way to get a CT Scan done when I blacked out,” said Kumar. His ECG reports suggested dissection of aorta, when a split line in the wall of the heart is seen where 50 per cent patients die within 48 hours.
“We immediately called for his ECG reports, which showed a clear case of dissection of aorta. Hence suspecting an aorta burst he was rushed to the operation theatre and we were at our task within minutes,” said Dr Meharwal, who with his team did a 10-hour surgery to save Prem Kumar.
The doctors replaced the aorta with a synthetic graft. “If he was not in the hospital at the time of the rupture, he would have possibly died. Death from aortic rupture is as high as 90- 95 per cent,” said Dr Meharwal.
“Mostly patients die within three-five minutes of acute rupture as it is always an emergency situation. Even in case of aortic dissection, patients should be rushed to the operation theatre to avoid rupture,” said Dr AK Bisoi, cardiac surgeon at the All India Institute of Medical Sciences (AIIMS), which receives the most number of aortic dissection and rupture cases.
Kumar, who has a history of heart ailments underwent an aortic valve replacement and aortic valve bypass surgery four months ago. “A lot of time, dissection in the aorta occurs after valve replacement surgeries, which could have been a cause for this rupture,” said Dr Bisoi.
Since his echocardiography showed aortic dissection of ascending nature, he was referred for CT angiography, which confirmed the diagnosis.
Aortic ruptures usually result in shock and death, say experts. The condition is usually fatal because of excessive bleeding.
A patient needs to be operated on immediately after diagnosis. Kumar has recovered well and his post-operative echocardiography is normal.
What causes aortic dissection?
The cause of aortic dissection is still under investigation. However, several risk factors associated with aortic dissection include hypertension (high blood pressure) connective tissue disorders, degenerative disease of the aortic wall aortitis (inflammation of the aorta) atherosclerosis, existing aneurysm bicuspid aortic valve (presence of only two cusps, or leaflets, in the aortic valve, rather than the normal three cusps) trauma coarctation of the aorta (narrowing of the aorta) hypervolemia (excess fluid or volume in the circulation) polycystic kidney disease
What are the symptoms of aortic dissection?
The most commonly reported symptom of an acute aortic dissection is severe, constant pain, sometimes described as “ripping” or “tearing,” and located in the chest, the middle of the abdomen, the lower back, or the pelvis area. The pain may be “migratory,” moving from one place to another, according to the direction and extent of the dissection. The symptoms of aortic dissection may resemble other medical conditions or problems. Always consult your physician for more information.