Complete Aortic Dissection
4 May 1997
On March 25, 1994 at 4:50 pm I felt a excruciating, tearing sensation in my upper left chest. The tunica intima of my descending aorta, just below the arch, had torn. The pain and force of the sensation dropped me to my knees. The shift at the plant where I worked had ended at 4:30; there was only one other person in the building. I breathed a one sentence prayer, stood up and walked out of my office, down the ramp and around the corner to her office. Setting down on the floor, I leaned against the door jamb and asked her to call the local ER. I told her something was terribly wrong in my chest. The pain kept coming in waves; the force of each heartbeat was pumping blood between the tunica intima and the tunica media. The dissection continued through the abdomen into both iliac arteries. A flap of torn intima closed off the circulation to my right leg. By the time the paramedics arrived, my leg was losing feeling.
The paramedics began treating me for a heart attack. I listened to the stats they called out; I related my symptoms and repeatedly said I was sure it was not a heart attack. They began to morph me; it really didn't help. I was taken to the local hospital. At the emergency room, they could not diagnose me. They even told my wife they didn't know what was wrong. By now my right leg was becoming grey in color. For some inexplicable reason, the ER doc had not called for the Lifeline Helicopter. After a heated exchange between my wife, the doc and the paramedics, the rescue helicopter was called.
When the nurse from the copter came into the ER, she leaned over me and asked me to swallow something. She then inserted a portable transesophogeal scope into my throat. She called out "Aortic dissection", turned around, snapped two commands to the ER staff then said, "I mean stat, we are transporting in thirty seconds." The pain was still agonizing and coming in waves.
In transit to the trauma center at Methodist Hospital in Indianapolis, IN, I began to have new pain. When I told the nurse setting at my head, she took my right hand and said "Just hold on and stay with us" She then said something into her helmet mike then told me "We are going to have a rough landing. We're going to come in hard and fast; we have to get you inside." The dissection was now traveling from the origin, through the arch and ascending aorta, toward my heart. When it reached my heart, my aortic valve was irreparably damaged. The dissection stopped at the valve. We landed around 6:30 pm. I was conscious from the first ripping sensation until I was put into the C-scan unit; the last thing I remember was "Put your arms over your head."
The next morning, I was awakened and told I would be having surgery. I was given a fifty percent chance of survival and was told a stroke was a strong possibility. I said I was a Christian and ready to go, but wanted to see and pray with my wife and son before I went to surgery. In surgery, I had a St Jude heart valve put in, a Dacron resection of a part of the ascending aorta and a small reinforcing Dacron patch sewn on the aorta. My aorta was only repaired to just above the renal arteries. No other surgery was performed. I was on the heart/lung bypass for four hours and in surgery a total of eight hours. During the operation, a second surgical team was brought into the OR; if the circulation in my right leg did not return when my heart was restarted, it was to be amputated. Circulation to my right leg returned, with no side effects from twenty hours without blood. When I awoke, I thought a tree limb had been shoved into my throat; I was on a ventilator.
My recovery has been miraculous. The dissection occurred on a Friday afternoon. The surgery was done Saturday morning and afternoon. I was up walking Monday evening. I returned home on Friday morning, then went to Easter Service on Sunday. In six weeks, I began part time work at home and returned to work full time on June 6th, 1994. Fortunate to be alive does not begin to adequately describe this experience.
For a four to six month period after the operation, I experienced partial and full loss of sight to my left eye. The incidences of loss of sight would last from fifteen to twenty seconds to several minutes. It is thought microscopic emboli were the cause. These symptoms ended in early 1995 and have not returned as of this writing. No other complications or detrimental side effects have occurred. I am taking Coumadin, alpha and beta blockers, a diuretic and baby aspirin daily. I thank God for every day! Some days are better than others, but every day I draw breath is a GOOD DAY! :)
Update 20 Apr 2000
G'day to my family and friends. "Thank you" to everyone for your concern and prayers. Today I visited with the cardiovascular thoracic surgeon. We discussed the aneurysm in my ascending and descending aortic arch. At this time, Dr. Halbrook feels the risks outweigh the benefits of any surgery. At this stage , he feels it is not life threatening and surgery poses a greater risk to my cardiovascular system; i.e., clots forming and affecting blood flow to vital organs or 25%+ possibility of a stroke during surgery. We are taking a wait and observe stance. Dr. Halbrook suggests a semi-annual or annual CAT scan and a transesophogeal echo gram to monitor the aneurysm. He considers a diameter greater than 6 centimeters something to possibly consider for surgery. Doc says the aneurysm may or may not grow larger, only future 'looks' will tell.
My daily routine and meds will remain the same. The only caution is not to do any 'strenuous' work. So there goes the luaus and 'All You Can Gorge' buffets; I really did work up a sweat participating in those. [grin] Doc does want me to do daily exercise of a non load bearing type. He suggested a stationary bicycle or swimming. AND to get my big butt in gear and lose weight. That is gonna be the hardest goal for me. Anyway, thanks again for your concern, prayers and thoughts for Diane and I. See everyone on the net!!
Update: 2 Jun 2003
G'day again to my aneurysm support family!
Thank you for all your thoughts and prayers. The Lord has been so good to me. The following will bring up to date on what transpired and what is coming in the next few months.
The last week: Last Monday evening, May 26th, a chest pressure began again. I have been experiencing these discomforts the last couple of years and they usually lasted a minute or so. This discomfort sustained itself thru the night and the next morning I was admitted to the ER at Methodist Hospital in Indianapolis. A few tests later, including a heart catheterization, a blocked artery was located: the left ascending diagonal. I came home Friday evening and am now on a severely restrictive diet with a targeted loss of 50 pounds by August 1st. I will then meet with my cardiovascular surgeon, Dr. John Fehrenbacher.
What's coming: About 3 years ago, another aneurysm was discovered in a routine CT scan. It showed a continuous aneurysm, ballooning, from the resected section, thru the arch and into the ascending aorta. Ct scans and Transesophageal Echocardiograms (TEE's) were done periodically to track the progress of the aneurysm. Six weeks ago, a CT scan revealed the aneurysm was continuous from the resection, Dacron tubing, clear thru the abdomen to the lower GI. It ranges in size from 6.0 cm in the ascending, to 5.2 cm thru the arch, back to 6.0 cm in the descending and then narrows to a final 4.2 cm as it transverses thru the abdomen.
Sometime in August or the first of September, I will have the first of two procedures: open heart surgery. I will be placed on heart-lung bypass and the entire aorta, from the ascending, thru the arch and most of the descending will be replaced with Dacron tubing. The appropriate bypass of the blocked artery will probably be done at this time also. Then comes 10-12 weeks of recovery.
When the surgeon deems I am ready, he will enter my chest again, this time from the left side, and continue the aortic replacement from the descending to the GI area. Then comes several more weeks of recovery. Sometime in early 2004, I will have, with the Lord's Will, a completely artificial aorta. Period. This procedure has been becoming normal practice for the last 3 - 4 years.
The surgeon, Dr. John Fehrenbacher has performed over 100 of these aortic arch replacements. If you are interested, click on the following html code, or paste it into the address window of your browser and you can get info on the medical group and my surgeon http://www.corvascmds.com/
Until my chat with Dr. Fehrenbacher last Wednesday, I was not aware the aortic arch was replaceable with such success: 96+ %. I had accepted the reality of my aneurysm eventually bursting and not surviving another incident. It still could burst between now and the surgeries.
I have read that 97+ % of individuals who have spontaneous dissections as I experienced, die within minutes to a few hours after rupture. I have been truly blessed with over nine years of additional life. That is why my motto is
"Every day is a good day. Some are just better than others!"
Thank you in advance to everyone for your continued thoughts and prayers. Please, please remember my wife Diane. Two more times, she is going to have to step into the breach and take responsibility for everything for awhile. God has truly blessed me with a loving, caring, adoring mate. What a lady!!
I will update after the first surgery. See you on the net!
Update: 25 Sep 2003
G'day to all! First, I want to give thanks to God for giving me this day and every other.
Monday, September 8, 2003 was "Fillet Day 1". By that day, (103 days), I had lost 67+ pounds. I checked in at Methodist Hospital, Indianapolis, IN, at 5:00 AM. At 6:00 AM, I was taken to the operating room. The surgeries lasted 12 +/- hours. There were: a bypass of the LAD artery on the heart, the balance of the ascending aorta replaced, a complete replacement of the aortic arch and an "elephant trunk" extension of artificial aorta inserted into the descending aorta.
My stay in cardiac intensive care lasted six days. It took 62 hours to bring me out of the anesthesia. Sunday afternoon, the 14th, I was transferred to a regular cardiac care room. On Saturday afternoon, the 20th, I went home. I will be home recovering approximately 3 months.
In more detail, accessing through the sternum, the surgeries performed were:
- The LAD, (left anterior descending), artery was bypassed using a vein from my left calf.
- Connecting to the Dacron artificial aortic root piece installed in March, 1994, the balance of the ascending aorta was completely replaced.
- The entire aortic arch was also replaced.
- A long, "elephant trunk" extension of Dacron tubing was placed into the descending aorta. This was done in anticipation of "Fillet Day 2", sometime in the Spring of 2004.
All of the feeding arteries, such as the cardiac, subclavians, carotids, etc... had to be severed from the natural aorta and then reconnected to the artificial, Dacron aorta. Once the natural, feeding arteries were sutured to the new aorta, their connection points were sealed with BioGlue®. BioGlue® Surgical Adhesive (BioGlue) is a two-component surgical adhesive composed of purified bovine serum albumin (BSA) and glutaraldehyde. This "glue" is an epoxy-like adhesive allowing for almost instantaneous sealing and pressurization of the cardiovascular system.
I am looking forward to returning to work sometime in December, 2003. Then, in the Spring of 2004, the rest of the aorta, from the "elephant trunk" left in the descending aorta to the bifurcation at the iliacs, will be replaced. When all of the surgeries are completed, I will have a completely artificial aorta, from the St Jude valve I have had for 9+ years, to the bifurcation, "Y", at the arteries going into the legs.
Should anyone desire, I would be glad to answer any questions or give more particular details.
"God bless each and everyone of you!" Thank you for your prayers, your thoughts and support, especially for my wife, Diane.
Update: 19 June 2004
"Fillet Day II" has been delayed! Since "Fillet Day I", I have recovered extremely well. I am in better physical condition than in the last 25 years! I am enjoying doing things I haven't done for years: yard work, walking, chores, etc. The operative word is enjoying! Much of this has to do with losing 120 pounds. I am still dieting and continuing to lose even more. By "Fillet Day II", I hope to be nearly "half the man I used to be". :-)
After a CT scan June 10th, and consultation with my surgeon Dr. John Fehrenbacher, the second surgery to replace the balance of my aneurismal aorta from the thoracic area to the bifurcation at the iliacs, has been scheduled for September 7th. The last aneurysm in my chest, 6.0+ cm, has not increased since scanned just before the September, 2003 surgery. God has been so good to me!
The reason for my delaying surgery? Some family members would be making a supporting trip for my surgery this month. Then, with our son getting married on September 04th, they would be returning to Indianapolis to attend the wedding. Why not, if it was safe for me, accommodate them with one trip to Hoosierdom? The surgeon has given his blessing! :-) Sometime in November or December, with a completely artificial aorta, heart to legs, I will send an update.
"Thank you!" to all who have kept Diane & me in your thoughts and prayers. Each of you is in ours.
Update: 28 October 2004
G'day to all. Once again, I want to give thanks to God for giving me this day and every other.
I finally feel like sitting at my 'beast' and typing this up. Tuesday, September 7, 2004, Fillet Day II, was a success!! For those keeping track, I had brought my weight down to 286 pounds. (On May 29, 2003, I had weighed 417 pounds.) Even so, this recovery has been more arduous than the other two open heart surgeries and more uncomfortable! But who's complaining?? "Everyday is a good day, some are just better than others!"
The last aneurysm is gone! I am now totally artificial, aortic-wise, from the Saint Jude heart valve to just above the renal arteries. After making a thoracoabdominal incision on my left side, Dr. Fehrenbacher removed a 2 cm piece of my 5th rib and a 3 cm length of the costal margin in the 5th intercostal space, He then got into my 'sandbox' and picked up where he left off September 8, 2003. He removed the final aneurysm and aneurismal aorta. Then pulling down the 'elephant trunk extension' he left in pace last year, he completed the artificial aorta replacement to the celiac arteries.
The only natural aorta now left is from the renal arteries to the bifurcation at the iliac arteries. Dr Fehrenbacher also decided, after opening me up and actually seeing the aneurismal aorta below the renals, not to replace the balance of my aorta. He felt the minimal aneurismal amount of this last section of aorta, the numerous artery connections required and the risk factors, when considered together, outweighed going ahead and replacing it. An annual CAT scan will be done to monitor this last section of "real" aorta.
This was my first thoracoabdominal incision; I have experienced the sternotomy twice. In my humble opinion, the thoracoabdominal incision is much more invasive and uncomfortable than the sternotomy. I still sleep at least one half of the night or longer in my recliner. I am able to lie in bed up to three hours and then I must move to the recliner. I visited with Dr. Fehrenbacher last week and he said some people would experience 'discomfort for six to nine months from a thoracoabdominal incision.
He also said I was at least two to three weeks ahead in my recovery of where he thought I would be. I am walking from .4 to .7 mile a day, depending on how I feel physically. I am now allowed to drive. And I have his blessing to return to work, at my choosing, after the first week of December.
Should anyone desire, I would be glad to answer any questions or share particular details
"Thank you for your prayers, your thoughts and support. God bless each and every one of you!" And a special "Thank you!" to my wife, Diane, who took five weeks off from her job to baby sit me.
Discussion, comments, or questions: David Wilson
© Copyright 1997 David Wilson
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