Billy Smith, 47, underwent emergency heart surgery in November to repair an aortic dissection — a tear in the aorta that often is fatal. Instead of flowing through the artery, his blood was leaking into the walls of his artery.
“He had what I consider a true life-threatening event,” said Dr. R. Chance DeWitt, heart surgeon at Louisiana Cardiovascular and Thoracic Institute LLC in Alexandria. “Fifty or 60 years ago, nothing could have been done.”
The condition often is misdiagnosed as a heart attack or other issue because patients present with chest and back pain, which is how it started for Smith. He started experiencing pains while stacking boxes at Christian Outreach Center, a Natchitoches church where he’s served as music minister for the last 24 years.
After a CT scan at Natchitoches Regional Medical Center confirmed the diagnosis, Smith was rushed to Christus St. Frances Cabrini Hospital in Alexandria for the first of two surgeries.
“It’s a blessing that the right people were in the right place,” Smith said.
Smith’s first surgery was to drain blood that had accumulated around the heart.
“The aorta tears coming out of the heart,” DeWitt said, explaining an aortic dissection. “The blood begins to leak around the heart and accumulate and cause problems with blood pressure.”
The second surgery was an emergency heart bypass, which DeWitt said is different from a common bypass surgery. In this case, Smith’s body was cooled down to 18 degrees Celsius — about 64 degrees Fahrenheit or 34 degrees lower than a human’s average body temperature.
Next, more of Smith’s blood was drained to allow the surgeon to repair his aorta without further complications.
DeWitt replaced the tear with an artificial graft in the surgery that takes about three to six hours. He described the process as connecting wet toilet paper to wet toilet paper, which can be ruined if pulled too tightly or held too loosely.
“The surgery is one where every step is critical,” DeWitt said. “Putting the graft together is technically difficult. If you pull too tight, it tears … not tight enough, it leaks.”
Smith’s body had to be warmed again, which was another technically difficult process. Warming too quickly can harm the body, and warming too slowly can cause brain damage.
Smith’s chest was left open overnight to ensure bleeding had stopped. Then they put Smith “back together” and took him off the bypass machine.
“The big thing then is to wait to see if they wake up,” DeWitt said. “Some are brain dead.”
Smith also experienced a collapsed lung and is working on rebuilding his lung capacity.
“It’s like everything was trying to go wrong all at once,” he said.
DeWitt said Smith had a 50 percent chance of dying. But Smith said he never thought about that.
“Death didn’t even cross my mind,” he said. “I was just thinking about getting better. … The first person I thought about was my wife. I prayed she would be strong.””
Technically, Smith did die. His heart stopped and had to be shocked right after surgery.
“It’s an experience that has totally changed my life,” he said.
His eating habits are just one of the serious changes he’s made. He’s lost 52 pounds in the month since his surgeries. He also is implementing a walking regimen and spending time with family and friends.
“When you go through a situation like this, you have to have a strong support group,” Smith said, pointing to his wife and several members of his church, including his pastor. “And I had it. … They visited me. They prayed for me. They were there for me.”
When Smith was in the hospital the Rev. Carl Means notified his congregation and called for prayer for Smith and his family, reminding God of his faithfulness, Means said.
DeWitt is one of the first to admit that the prayers worked.
“I think people wonder nowadays ‘Where’s the miracle?'” DeWitt said. “This is a miracle of modern medical care and prayer.”
As a young and healthy person without pre-existing heart issues, Smith did not expect anything like this. That’s the way of an aortic dissection, which is hard to prepare for or catch.
Some contributing factors are uncontrolled hypertension or the genetic disorder Marfan Syndrome, a condition that weakens connective tissue. It is more common in older patients.
DeWitt said the aortic dissection condition is becoming more common, which could be a result of more awareness and ability diagnosis in emergency rooms. He said, between the three local cardiac surgeons, the previous average of about three cases a year has increased to about one or two a month over the last few years.