For Amarjit, 2010 started with the news of a large financial loss in his business. Barely had he come to terms with this loss, 41 yrs old Amarjit was struck by a bolt out of the blue on 02 Jan 2010. During his morning ablutions, he developed a sudden excruciating pain inside his chest. He became breathless and did not have the energy even to dress himself up. Somehow he called out to his wife, who realizing that something was seriously wrong, rushed him to a nearby nursing home.
She was told that Amarjit was having a heart attack and should be taken to the nearby Super Specialty Hospital. By the time Amarjit reached the Hospital, he was in deep trouble. He was severely breathless at rest and his blood pressure was very low.
He was seen by the cardiologist immediately upon arrival. Although the ECG suggested that Amarjit was, indeed, having a massive heart attack, somehow his clinical picture had some gaps. Instead of rushing him to the Cardiac Catheterization laboratory for angiography and stenting, an urgent echocardiography was done in the emergency room. What this revealed was that Amarjit had been struck by something much more complex than a simple “heart attack”. He had Acute Type I Aortic dissection with severe leakage of the Aortic valve and compromised blood supply to the heart muscle. A death sentence, practically. His only chance to live was immediate open heart surgery.
In this condition, due to high blood pressure and certain deficiencies in the wall of the Aorta, the inner lining of Aorta tears partially. The shearing force of the blood quickly extends this tear upwards, downwards and all around the aorta. During this process arterial branches that arise from the Aorta, including coronary arteries themselves, get pinched off and blood supply to the dependent organ reduces or stops. This condition is a prominent cause of sudden cardiac death all over the world and is more commonly seen in patients with Marfan’s syndrome and high blood pressure.
Amarjit was rushed to the cardiac operation theatre without any further delay. The Femoral artery and vein in the groin were used to put him on the heart lung machine as the main artery (aorta) was torn from within and required replacement. A complex operation was carried out in which the entire root of the Aorta, as it arises from the heart, along with the Aortic valve was replaced with a composite graft and an artificial aortic valve. The origins of both coronary arteries were removed from the torn aorta and implanted on the new graft. This is a complex and delicate operation that requires a very high degree of surgical skill and post operative care in order to be successful. Amarjit’s operation lasted 11 hrs. He needed six days of ICU care and 35 units of blood and blood products in the post operative period. He recovered well from the surgery and was discharges after 2 weeks.
