PUNE: Two years ago, a 60-year-old man from Ghana had suffered from a life-threatening heart condition. A bulge in his artery threatened to rupture unless medical action was taken. Thereafter, a surgery in the Philippines helped him restore his active life after a stent was inserted into the artery. A couple of years later, his condition re-appeared, making it worse for him. Surgeons of the city-based Ruby Hall Clinic’s Department of Cardiology had begun doing wonders in this very field when the Ghanian resident visited them for further advice.
Treating surgeon, Dr CN Makhale, Interventional Cardiologist, Ruby Hall Clinic said that they discovered that the patient had previously suffered from an aortic aneurysm.
“In fact, this time it had gone a step further and was now presented as an aortic aneurysm with a dissection. An aneurysm is a balloon-like bulge in an artery that can be formed in arteries of any size. It occurs when the pressure of blood passing through a part of a weakened artery forcing the vessel to bulge outward. An aortic dissection is a serious condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, the condition is often fatal,” said Makhale.
The doctors further added that aortic dissection is not common. It affects 5 to 30 people out of every one million each year. Virtually everyone who has an aortic dissection experiences pain - typically sudden, excruciating pain, often described as tearing or ripping, known to act as a time bomb.
Other symptoms may include shortness of breath, sudden difficulty speaking, loss of vision, weakness or paralysis of one side of the body or even something as small as persistent leg pain and difficulty walking.
Dr Dhanesh Kamerkar, Senior Vascular Surgeon, Ruby Hall Clinic said that diagnosing aortic dissection requires high precision, as it may mimic other more common conditions that cause chest pain.
“Prompt diagnosis is the key, as it requires emergency evaluation and treatment for optimal chances of survival. Although this condition is rare, if not treated in time, it can indeed turn fatal or even pose severe neurological deficits,” said Kamerkar.
Dr Rahul Sheth, Vascular Interventional Radiologist from Mumbai, commented that there are two possible surgery methods for aortic dissection repair.
“The first is standard open-heart surgery which is a conventional technique. The second one is the less-invasive endovascular surgery which is as effective. It entails a host of benefits including faster recovery, shorter hospital stay, no large scars and lesser chances of mortality and morbidity. The patient goes home faster and recovers better,” said Sheth.
Talking about the further course of action for this particular case, Dr Makhale added that diagnostic results revealed that the previously inserted stent had dislodged from its position.
“Moreover, there was a leak along the side of the old stent graft. An endovasular aneurysm repair done with a catheter through the groin was the best solution. We re-enforced both aneurysms with two stents, one in the aortic arch and the other one below it. Usually, stents last for years together and often hold good through life. Either the second aneurysm or the fact that the patient was overweight, probably triggered the slight collapse of the former stent,” said Makhale.
Dr PK Grant, Managing Trustee and Senior Cardiologist at Ruby Hall Clinic concluded that the patient is recovering. “This is now one of those many cases that represent a paradigm shift in the heart care space in the country. Throughout the years, we have worked to establish a reputation as leaders in cardiac care, with emphasis on diagnosis, and treatment of all cardiac ailments,” said Dr Grant.
