After being referred post-haste from hospitals across the state including Palakkad, Perinthalmanna and Kochi, four patients have successfully undergone surgery for the repair of Type A aortic dissection at Amrita Institute of Medical Sciences within a span of just 10 days (January 03 – 12, 2019)
An aortic dissection is a tear in the inner lining of the aorta (the largest artery in the human body which arises from the heart, and from which all other blood vessels arise). The tear in the aorta wall occurs just above the aortic valve which separates the heart from the aorta. Blood enters inner layers of the wall of aorta through the tear, and passes downwards, sometimes all the way to the legs. Death occurs due to the rupture of the aortic wall because of the pressure of the blood, or extension of the tear backwards to the aortic valve, causing a leak. Sometimes, the tear can extend to vessels supplying blood to the brain and trigger a brain stroke.
‘Type A’ Aortic dissection is a life-threatening medical emergency with a patient mortality of almost 100% within a few days, if a cardiac surgery is not performed. The condition is not very common and many patients die even before reaching the hospital. Very few hospitals in Kerala, or even in India, have the capability to conduct such surgery, and four such surgeries in a span of ten days is almost unheard of. One of the reasons for such success is that Amrita Hospital has established a dedicated Centre for Aortic Diseases and Marfan Syndrome to cater to patients with all kinds of aortic diseases.
“Type A Aortic dissection has a high mortality if not treated surgically, with half the patients dying within 48 hours of the tear occurring in the aorta. It is a rare disease with the incidence of around 3.5 persons per 100,000 people. Due to this, diagnosis is usually delayed at hospitals that do not commonly see such cases. They treat the condition as a heart attack or problems arising due to acidity or gas. The most common symptom of Type A Aortic dissection is severe chest pain, which the patients typically describe as the worst-ever pain they have ever experienced in their life. Diagnosis is by echocardiogram or, more definitively, with CT scan of the chest.”, observed Dr. Kirun Gopal, Associate Professor, Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi.
“The only effective treatment for type A aortic dissection is surgery. However, it is a major operation which involves replacing the aortic valve, the aortic root and the ascending aorta and re-implanting the coronary arteries into the graft. The surgery is done using a technique called total circulatory arrest. This involves cooling the patient to 18 degrees and shutting off the circulation completely for a short period, including the heart bypass machine, so that the aorta can be repaired. The operative mortality is higher compared to standard cardiac surgery, varying from 17-26%. The patients need to be operated as soon as they arrive at the hospital, as mortality increases with each passing hour. At Amrita Hospital, we have experience of patients having a cardiac arrest in the casualty or even while being shifted to the operating theatres,”added Dr. Praveen Varma, Professor and Head, Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi.
“The surgery for Type A aortic dissection typically takes around six hours and the mortality rate is relatively high. But, we had conducted five cases of acute aortic dissection last year with no mortality at all! Recently, we have achieved a rare feat by successfully completing four surgeries within 10 days. This is really a great achievement as this surgery is not done in most cardiac surgery centres due to the high mortality rate. It is a ten-hour surgery that costs between Rs 4 to 5 lakhs,” Dr. Praveen went on to say.
The four patients who successfully underwent surgery include Mrs. Jayanthi, a 43-year-old housewife from Wayanad and Mr. Subramaniom Potty, a 59-year-old retired temple Santhi from Kochi. Both of them were operated by the surgical team one after the other without a break. The other two patients were Mr. John S, a 55-year-old ex-serviceman and Mrs. Krishnaveni, a 59-year-old retired teacher.