He never had a chance.
That’s the consensus among leading cardiology experts after longtime U.S. diplomat Richard Holbrooke died on Dec. 13, just days after undergoing 20 hours of surgery to repair an aortic tear and the resultant internal bleeding.
“When an aortic-dissection patient is in surgery that long and receives as much blood (20 units) as he did, there’s not much likelihood of recovery,” says Dr. Mark Sims, a Jupiter cardiologist.
The aorta, which is the body’s largest artery and connects to the heart, consists of three connected layers: inner, middle and outer. If the inner layer tears, blood enters the vessel, weakens it and then surges into the middle layer.
This can cause the inner and middle layers to separate – that is, “dissect.”
“Picture pulling apart two plies of tissue paper,” Sims explains.
At this stage, the patient’s life is in danger because of the following possible complications:
•massive internal bleeding;
•compromised blood flow throughout the body;
•internal-organ failure due to compromised blood flow.
If the outer aortic wall is breached, the condition usually is fatal.
“Repair of an aortic dissection is always an emergency situation,” says Sims. “And it’s as complex as cardiac surgery gets.”
Symptoms, causes and prevention
Further muddying matters for doctors is that aortic-dissection symptoms – which include severe chest and/or upper back pain, shortness of breath and loss of consciousness – often mirror other cardiac conditions, such as cardiac arrest.
“The quickest way to determine an aortic dissection in the emergency room is via a CT-with-contrast scan,” Sims explains.
(A computed-tomography – i.e., CT – scan uses X-rays to create cross-sectional images of the body.)
What’s more, Sims says, the chest pain associated with this condition usually radiates vertically, as opposed to the more horizontal spread of a heart attack.
According to the Mayo Clinic, of the nearly 2,000 annual aortic dissections in the U.S., most occur in men between the ages of 60 and 70.
“The most prevalent cause is hypertension – high blood pressure,” Sims says.
Other causes include hardening of the arteries, defective and/or constricted aortic valves, severe bodily trauma (such as an automobile accident) and certain genetic conditions such as Marfan syndrome (a connective-tissue disorder) and Turner’s syndrome (a chromosomal condition that affects women).
Sims recommends that people with the above risk factors take steps to get them under control. In addition, he advises, “Have your cardiologist test you for an enlarged, or dilated, aorta. That way, you can plan surgery to repair it – before it dissects and becomes an emergency.”