Cardiac surgeons at Ruby Hall Clinic were faced with a dilemma when Shivaji Satpute, 45, was diagnosed with a tear in the main artery arising from the heart, leading to a condition called dissecting ascending aortic aneurysm. A surgery for such an acute aortic dissection is challenging and has an unpredictable outcome.

Despite a successful surgery, the patient can die from uncontrolled bleeding. Also, the surgery and the postoperative management can be quite expensive.

Thus, when Satpute was wheeled into the operating room, doctors faced a major challenge as the patient was unconscious and owing to the unpredictable nature of the recovery of the brain considering it was deprived of blood for 24 hours.

Satpute, an employee of the Maharashtra State Electricity Distribution Company Ltd (MSEDCL), Junnar, was at work when he experienced excruciating chest pain and fell unconscious. The tear had blocked off the origin of the blood supply to the brain and had also leaked into the pericardium (covering of the heart) compressing the heart, as diagnosed by cardiologist Dr Jagdish Hiremath.

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Cardiac surgeon Dr Sameer Bhate, to whom the case was referred, decided to go ahead with the surgery as the patient was relatively young, following a discussion with his relatives. By the time Satpute was brought into the operating room, his condition had deteriorated further and when the operation commenced, the aorta had completely ruptured and had also torn the aortic valve and the origin of the right coronary artery.

After an eight-hour operation where the aortic valve was replaced with the ascending aorta using an artificial valve and a Dacron graft and a bypass to the right coronary artery, the patient was shifted back to the intensive care unit. Though Satpute made good recovery from the surgery in terms of heart condition, he showed no neurological recovery and in fact was feared to be brain-dead.

The patient slowly recovered and was weaned off the respirator on the 15th day post the surgery. Satpute was discharged after 2 months of hospitalisation . “After three months, he is moving all his limbs and is walking with help and his memory is also fine,” Bhate said.