A little over three months ago, Joan Wright, 86, was generally healthy, enjoying gardening, doing volunteer work and spending time with her family, including two granddaughters who “keep things very lively.” Then one day, she would be rushed by her daughter to Baptist Hospital and would undergo open-heart surgery that involved “deep hypothermic circulatory arrest” — when the body temperature is brought down to about 18°C (66 °F).
The initial diagnosis that led to her surgery could hardly be more urgent: an aortic dissection, a medical emergency in which the inner layer of the large blood vessel branching off the heart (aorta) tears.
Moreover, it was deemed a “type A” dissection, the type of tear that is located closer to the heart and can be life-threatening. It usually requires immediate repair of the first segment of the ascending aorta where the tear started — and that’s the life-saving surgery that Ms. Wright underwent by team of specialists at Baptist Health’s Miami Cardiac & Vascular Institute, led by cardiothoracic surgeon Marco T. Bologna, M.D. (Ms. Wright and Dr. Bologna are pictured above.)
The rush to life-saving surgery started with mostly routine diagnostic testing and a computerized tomography (CT) scan after Ms. Wright complained about a persistent cough and chest pain.
“I knew the situation was serious when I was told to go directly from the CT scan appointment to the Baptist Hospital emergency department with no stops,” she recalls. “Thank goodness my daughter had driven me to the appointment.”
Dr. Bologna explains that Ms. Wright’s condition turned out more complicated than initially thought. Preliminary testing a few days before her trip to the ER did not raise any red flags because she was probably suffering from an intramural hematoma, somewhat of a precursor to a dissection.
Causes of an aortic dissection, or aneurysm (a bulging, weakened area), include uncontrolled hypertension or degenerative disease that causes a breakdown over time of the aortic wall tissue.
“It was likely an intramural hematoma that had dissected by the time she was taken to the ER — and fortunately it was caught,” says Dr. Bologna. “Keep in mind, that an intramural hematoma and an aortic dissection are treated equally because they’re both acute aortic events, and they are like family in the ascending aorta. They’re mainly diagnosed through CT scans or MRIs.”
‘I Felt Very Confident That All Would Be Well’
In order to replace a vital segment of her ascending aorta, Dr. Bologna’s team would put Ms. Wright in the “deep hypothermic circulatory arrest” to protect all her organs, but most importantly the brain. That’s the most delicate part of the surgery with a tight time-frame. The procedure stops blood circulation and brain function for up to one hour. It is used when blood circulation to the brain must be stopped because of surgery on large blood vessels that lead to or from the brain. It also provides a better visual field during surgery due to the cessation of blood flow.
Recalls Ms. Wright: “While the situation was critical, Dr. Bologna was very reassuring with his warm, friendly manner as he explained my problem and I felt very confident that all would be well.”
While circulatory arrest lasts no more than an hour, the full surgery is closer to six hours. Despite the urgency of her condition, the surgical team was able to replace the damaged section of Ms. Wright’s aorta.
Repairing the Ascending Aorta
“With the ascending aorta, you have to intervene as soon as possible because that bleeding and rupture can move into the pericardium (the membrane enclosing the heart) and doesn’t let the heart beat and you can die because of tamponade (compression of the heart by an accumulation of fluid), or you die because that dissection flap goes into the coronary artery and causes a heart attack.”
Dr. Bologna adds that a fighting spirit and a positive attitude are big factors in getting through such a surgery at 86, and plowing forward through a long but steady recovery.
“In certain patients, even at an advanced age, we can perform complex surgery and it’s important to create awareness about aortic disease and other cardiovascular issues,” said Dr. Bologna. “Don’t ignore symptoms. And if you need to go through something this complicated, it helps to have such a positive attitude as Ms. Wright does. She’s been putting in the work and she’s been progressing. When I last saw, she looked well and she has still has a very positive attitude.”
A grateful Ms. Wright is back at enjoying her favorite things.
“I love to garden and belong to a garden club,” says Ms. Wright. I volunteer, enjoy friends and spend much time with my family. I have a son and a daughter who are the pride and joy of this 86-year-old grandmother. I live near my daughter and son-in-law who are ever attentive. Two wonderful grand-daughters keep things lively. Life is great, and I am so happy to be here to enjoy it.”