Two Aortic Ruptures Nine Years Apart: Survival chances bleak, man lives through 2nd open heart surgery

The 34-year-old man was turned away by two private hospitals in the capital due to the complexity of the problem, and given the mortality is as high as 90 per cent.

Written by Kaunain Sheriff M | New Delhi | Published:June 29, 2017 5:30 am

Aortic rupture, which can cause breakage of the largest artery in the body, is considered a rare and extremely dangerous condition, doctors say, with mortality rate for such a rupture as high as 90 per cent. If a patient suffers from such a rupture for the second time — especially if it occurs near a previous aortic valve replacement — the chances of survival are even more bleak. But doctors in the capital achieved a rare feat recently, when they conducted a second open heart surgery to replace the ruptured aorta of a 34-year-old man from Bhatinda.

“In this case, the first aortic rupture had occurred nine years ago, and the patient had undergone aortic valve replacement. The second rupture was just above the valve that was repaired earlier. So, the reconstruction had to be made at the place where the patient had been operated. It is a rare case, and any small mistake could have resulted in massive internal bleeding… Such cases have only been reported in medical literature from the US and Europe till date, and such a surgery has never been reported in India before,” said Dr Ganesh Shivnani, chairperson, department of cardiac surgery at Sir Gangaram Hospital (SGRH ).

The patient had found himself short of breath. “Initially, it was found that the aorta, which supplies blood to other organs, was ‘dissected’. It had to be immediately replaced,” Dr Shivnani said. The 34-year-old man was turned away by two private hospitals in the capital due to the complexity of the problem, and given the mortality is as high as 90 per cent.

However, when he was referred to SGRH, the patient was no longer found to be suffering from “dissection of the aorta”; instead, the aorta had “ruptured”. “A rupture is a lethal situation, where all blood drains out from circulation in less than a minute. He was surviving because this rupture was contained by tissues, which had developed because of previous open surgery (adhesions),” Dr Shivnani said.

The doctors said the surgery took almost 12 hours and required more than 25 units of blood. “While handling the heart, the aorta gave away at one weak point… However, by that time, we had already put him on the safe cardiopulmonary bypass machine. Hence, there was no major blood loss as we collected all the blood and circulated it back through the machine,” the specialist said.

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