An injury to the inmost layer of the aorta may result in flow of blood between the layers of the aortic wall. It makes the layers apart to cause Aortic Dissection. At the onset, a victim of the disease suffers from a severe chest or back pain, often expressed as tearing in character. Apart from these symptoms, the patient may have vomiting, sweating, and lightheadedness. Other symptoms like stroke or mesenteric ischemia may be caused by decreased blood supply to other organs.This disease may be fatal for a victim many a times.
Both surgically and medically, dire Aortic Dissection can be treated. The area of the aorta with the intimal tear is resected in surgical process and the same is supplanted with a Dacron graft.
Signs and Symptoms
Symptoms of aortic dissection are similar to those of other cardiac problems, for instance a heart attack. Distinctive signs and symptoms of aortic dissection include:
- Unexpected acute pain in chest or upper back, expressed as a tearing, shearing or ripping sensation, whichspreads to the neck or down the back
- Loss of consciousness
- Unyielding abdominal pain
- Breath shortness
- Sudden difficulty in speaking, vision loss, paralysis of one side of body
- Immobilized pulse in one thigh or arm compared with the other
- Pain in leg
- Difficulty in walking
Causes for Aortic Dissection
Following may be the factors which trigger off Aortic Dissection.
- Blood pressure
- Surgical problems
- Bicuspid aortic valve
- Ehlers-Danlos syndrome
- Marfan syndrome
- Turner syndrome
- Use Of Cocaine
It is difficult to detect an aortic dissection because the symptoms are akin to those of an array of health problems. Doctors often diagnose an aortic dissection if the signs and symptoms said below are found with a patient:
- Unexpected tearing or ripping chest pain
- Broadening of the aorta on chest X-ray
- Difference in blood pressure between right and left arms
- Computerized tomography (CT) scan- Cross-sectional images of the body are produced by this scan.
- Transesophageal echocardiogram (TEE)- High-pitched sound waves are used by this test to produce an image of the heart.
- Magnetic resonance angiogram (MRA)- Magnetic field and pulses of radio wave energy are used by an MRA to make pictures of the body. This technique is used by an MRA to study blood vessels.
Types of Aortic Dissection Repair Surgery
Several ways are there to repair or replace the portion of an aorta damaged by a dissection. The method to be used depends upon factors as where the dissection is located, how much of a patient's aorta needs to be repaired or replaced, and on the whole the state of the victim's health. The surgeon is the right person to determine the most appropriate procedure a patient requires to get operated on.
- Open-heart surgery- Repairing an aortic dissection involves in making a 7" to 10" cut over the middle of the sternum or breastbone and then dividing the sternum to allow access to the heart. In certain cases, a less invasive method, having a slightly smaller sternal incision, is viable. In either way, the real repair includes replacing the damaged portion of the aorta with a graft that is a tube the same size as of the aorta, made of a long-lasting artificial material for example Dacron, which is sewn into place.
- Valve-sparing surgery-This can be taken into consideration for operations on the part of the aorta nearest to the heart, the aortic root. This method involves replacement of only the damaged portion of the vessel, not of the aortic valve in addition.It is thus suitable only for patients whose aortic valve is integral or repairable. The alternate is known as a multifactorial graft, and it encompasses not only supplanting the dissected portion of the aorta but also supplanting the aortic valve with a mechanical valve.
- Endovascular surgery- This minimally invasive surgery is done in cases where there is dissection of the descending aorta. Small incisions are made in the blood vessels of the patient's groin. Catheters are inserted through these vessels to the point where the patient's dissection is located. A little mesh tube called stent graft is placed in the affected area with the help of long, thin instruments passed through the catheters guided by X-Ray support. Endovascular surgery can sometimes be done with the patient under local rather than general anesthesia. It does not also require hypothermic circulatory arrest or aid of a heart-lung bypass machine. As this method doesn't have a need to open the chest at all, it generally gives rise to much quicker recovery.
Before The Procedure
- Patients having any allergic problem should discuss it with the doctor.
- Information of any loose teeth, bridges, crowns, or other types of dental problem should be shared with the doctor.
- All medicines being taken by the patient including over-the-counter and prescription medicines should be discussed with the doctor. Vitamins, herbs, and other supplements are also to be taken into consideration.
- The doctor may have other instructions for patients based on their medical condition.
During The Procedure
Surgery for repairing an aortic dissection is very complicated.
- A patient is given general anesthesia to avoid pain and make a patient sleep during the procedure.
- Care is to be taken to watch a patient's vital signs, like heart rate and blood pressure, during the process.
For Open-heart surgery:
- An incision is made in the patient's chest or abdomen. The suitable area depends on where the dissection is found.
- Pumping blood is taken over by a heart bypass machine around the heart and lungs.
- Once the tear is traced, synthetic grafts can replenish the damaged parts of the aorta. If the aortic valve is damaged, the surgeon may also place a replacement valve.
- After all the repairs are made, the surgeon removes the heart bypass machine and closes the incision.
For Endovascular surgery:
- A synthetic graft is attached to the end of a catheter. The graft is a combination of metal and polyester. The catheter is placed into an artery in the leg.
- X-ray images are used to guide the surgeon to thread the graft through the artery, to the troubled part of the aorta for the repair. X-ray dye is used to find the best positioning of the graft and its accurateplace.
- The catheter is removed subsequently. The doctor closes the incision and puts a small bandage over the wound.
After The Procedure
In the hospital:
- At least 1 month time is required to recover from the surgery.
- Until the vital signs are stable, patients has to stay in the intensive care unit.
- They have to move to the regular nursing floor to recover before going home.
- They may need medicines for nausea, pain, and discomfort during the hospital stay.
- Attendants should accompany patients to drive them home. It is not safe for a patient to start driving immediately after the surgery.The surgeon advises a patient when to drive again.
- It may take a few months to fully recover after the surgery.
- A patient should take good rest, and take enough calories and nutrients to improve energy.
- One may have to take blood pressure medicine as stress is caused by high blood pressureon the incision wall and on the heart.
- If the surgery is met with a valve replacement, the surgeon may also prescribe blood-thinning medicine to reduce the risk for blood clots.
- A patient may need to follow up with the surgeon every 6 months.
- A patient has to be careful while doing strenuous physical activities after an aortic dissection repair.
- The surgeon would tell the patient what type of food is required after the surgery.
- As prescribed, the patient should take medicines subsequent to the surgery
- A patient's risk would vary, considering factors as age and overall health status,
- The average mortality from repair of an aortic dissection is about 15%.
- Problems, such as a stroke, may also occur in a certain percentage of cases, varying on the severity of the dissection.
- This surgical procedure involves a very small risk of infection.
Factors affecting the Cost of Aortic Dissection Repair Surgery
- The standard of hospital chosen by a patient
- Fees meant for surgeons
- Cost meant for tests and diagnostic processes
- Cost of surgery
- Cost of medicines required after the surgery
- Cost of additional care required