A 53-year-old, hypertensive UAE resident was successfully treated for a high risk cardiac emergency at Zulekha Hospital Sharjah by Dr. Mohamed Ahmed Helmy, Consultant Cardiac Surgeon. The condition, Acute Aortic Dissection type A (AADA), is a life-threatening vascular condition which affects three in every 100,000 patients and has a very high mortality rate.

This rate is up to 50% before the patient reaches the hospital and a higher mortality rate is expected as soon as the patient reaches the hospital. Worryingly, the mortality rate in the first three days is 60% and is calculated on an hourly basis with an incidence of 1% increase on chance of death every hour for the first three days. Zulekha Hospital Sharjah is the first private hospital in the Emirate to have accepted and successfully carried out this critical procedure.

The patient was admitted with a bicuspid aortic valve. The AADA happens often in patients with a weakened and enlarged aorta, ones experiencing a Marfan syndrome, or other rarer conditions associated with weakening of the walls of the blood vessels. About 20 percent of people with thoracic aortic aneurysm and dissection have a genetic predisposition to it, meaning that it runs in the family.

The patient developed severe chest pain and immediately further investigations and a Multislice CT angiography was done to confirm the diagnoses as an acute ascending aortic dissection. The cardiac surgery team transferred him immediately to the ICU (intensive care unit) where instant surgical interference by an expert team of doctors was essential for the success of such high risk procedure on the same day of admission.

The team of surgeons used a heart-lung machine to circulate and control the blood flow during the procedure, but during repair of the proximal part of the Aortic Dissection  which is a very critical period, the circulation was stopped intentionally maintaining a body temperature of 22-24 degrees, in order to reduce the oxygen needs and metabolic rate, ensuring the body is protected during this total circulatory arrest. The replacement of dissected ascending aorta with a Dacron graft needed to be done just in 20 minutes to avoid brain injury during the procedure.

Commenting on this case, Dr. Mohamed Ahmed Helmy said: "Prompt diagnosis was the need of the hour as time was scarce. There is a high possibility of several complications with such cases which include bleeding, re-exploration, neurological disorders, renal failures and prolonged ICU stay.”

 “After a highly complex and risky procedure, we’re pleased to see the patient make a full recovery,” he concluded.

The symptoms for the Acute aortic dissection range from pain related to the acute event, collapse due to aortic rupture or pericardial tamponade (this happens when fluid in the pericardium (the sac around the heart) builds up and results in compression of the heart), or manifestations of organ or limb ischemia. In this case, the tear begins in the ascending aorta and progresses throughout the vessel, often extending as far as the arteries in the leg.

The patient was discharged after an eight-day stay at the hospital inclusive of a three-day stay in the ICU and is now resuming normal day-to-day activities with regular follow-ups.

 

Source: Four Communications