Aortic Dissection Awareness Day It is an annual event held on September 19 to raise awareness about aortic dissection, a life-threatening condition that affects thousands of people each year. Aortic Dissection A partial tear in the wall of the aorta causes it to split into 2 lumens, a true and a false lumen. This tear spreads along the length of the aorta causing problems in the blood supply to vital organs such as the brain, intestines, kidneys, bowels and limbs. If this tear occurs in the first part of the aorta, in front of the chest, it is called a type A dissection. It may progress towards the heart causing a leak in the aortic valve and bleeding into the chest cavity which can be life threatening. If it occurs in the aorta at the back of the chest it is a type B dissection.
Aortic dissection can affect adults of any age. Risk factors for acute aortic dissection are hypertension, atherosclerosis, smoking, and pregnancy. Certain heart conditions such as bicuspid aortic valve, family history of aortic dissection, presence of Marfan syndrome, presence of pre-existing aortic aneurysm make individuals more susceptible to aortic dissection.
Symptoms of acute aortic dissection may be
⦁Rapid onset, severe shooting pain in the chest that may radiate to the neck, back, and resembles a heart attack
⦁ Neurological symptoms due to poor circulation, fainting spells, strokes (hemiparesis/hemiplegia) Change in mental status
⦁Abdominal pain (with bowel ischemia)
⦁Acute limb ischemia
⦁ In severe cases, the patient may suffer cardiac arrest followed by aortic rupture or sudden death
Diagnosis
This condition can be diagnosed by echocardiography to look for the presence of tears in the aorta. CT scan of the aorta shows the exact nature of the tear and the extent of the deformity and the organs involved. These 2 investigations are essential to plan the treatment of patients when aortic dissection is suspected.
Treatment of Type A dissection requires emergency open-heart surgery. The diseased aorta is removed and replaced with an artificial graft (artificial blood vessel). If the valve at the opening of the aorta is involved it needs to be replaced. The aortic arch may have to be partially or completely replaced depending on the nature of the diseased segment. These are extremely complex aortic surgeries and require special care and technical expertise. Although the number of operations for Type A dissection is increasing, very few patients are able to undergo surgery who can be saved. This is usually due to incorrect or delayed diagnosis, lack of awareness about the disease and infrastructure.
Patient Story 1
Mr. Nitin, a 38-year-old farm labourer from a small town in North Maharashtra came to a local cardiologist with a complaint of chest pain. Initial treatment revealed abnormal findings in the echo and he was referred to a nearby facility for a CT scan. The CT scan showed acute aortic dissection. As surgical expertise was not available to operate on such a condition, the patient was shifted to Jaslok Hospital Mumbai in a critical condition. He underwent an extremely complex surgery to replace the diseased aorta, aortic valve and aortic root. The outcome of his surgery was very good and he is now leading a normal life. Anticipation of acute aortic dissection and timely surgical care by a team of experts could have given him the gift of life.
Patient Story 2
37 years 8 months ago, a pregnant woman named Sandhya from suburban Mumbai was suffering from chest pain and shortness of breath. She was diagnosed with Type A acute aortic dissection. She had very high blood pressure due to pregnancy, which led to this catastrophic complication. Realising the seriousness of the condition that was risking the life of the mother and the baby, the aortic surgery team at Jaslok performed emergency heart surgery to replace the aortic valve aortic root and ascending aorta. The baby was born thereafter. In such a situation prompt referral, alert and caring specialised aortic surgery team can save lives.
Patient Story 3
The 48-year-old man had to undergo emergency surgery for acute aortic dissection 2 years ago, he had 2 younger brothers. One of them suffered chest pain and had a sudden cardiac arrest while travelling in a train, possibly due to aortic dissection. The younger brother suffered chest pain at the age of 37 and was rushed to Jaslok Hospital, where he was diagnosed with acute aortic dissection. He underwent successful aortic surgery and survived. Aortic dissection tends to run in families and early recognition of aortic pathology helped save the lives of the younger siblings in this case.
Untreated type A acute aortic dissection has a very high mortality rate, with more than 80% dying within 24 hours of developing symptoms. Type A aortic dissection should therefore be suspected in patients presenting with chest pain, diagnosed early and referred for prompt surgical treatment. Overall in-hospital surgical mortality is 4-11% for stable patients with type A dissection and 15-18% in unstable patients at initial presentation. Survival is better in high-volume aortic surgical centers with technical expertise of the aortic surgical team
(Author: Dr. Upendra Bhalerao, Consultant Cardiovascular and Thoracic Surgery and Heart Transplantation, Jaslok Hospital and Research Centre)
