June 22, 2009
“Aortic dissection by itself, and particularly in the setting of a prior aneurysm, indicates a very grim prognosis and is a high mortality risk. We have the fortune to work closely with excellent vascular and cardiac surgeons and nurses,” said Hani Jneid, M.D., interventional cardiologist (above right). “Our multifaceted team approach to clinical care is essential to enhancing patient care and saving Veterans’ lives.” Also pictured from left, Carlos Bechara, M.D., vascular surgeon, Danny Chu, M.D., cardiothoracic surgeon, and Veteran Richard McWharter. PHOTO: Shawn James, Media Section
HOUSTON – Health care providers from the Anesthesiology, Cardiology, Cardiothoracic, and Vascular Surgery departments at the Michael E. DeBakey VA Medical Center used a multidisciplinary approach to successfully treat a 57-year-old Veteran from Houston suffering from a thoracic aortic aneurysm complicated by dissection and rupture into his left chest.
Veteran Richard McWharter had a pre-existing thoracic aneurysm, a ballooning of an artery in his chest. Because of uncontrolled high blood pressure, he also suffered a tear in the inner wall of the artery splitting it into two lumens. This means two streams of blood were traveling down the same artery. The second, new lumen is dangerous because it can thin the vessel wall and possibly lead to a rupture of the artery.
“Mr. McWharter did suffer a rupture of the artery and had a dramatic reduction in his blood pressure, making his condition a complex aortic pathology,” said Hani Jneid, M.D., interventional cardiologist. “It was clear his medical problem needed to be identified, diagnosed, and treated expeditiously; otherwise, death was imminent.”
Jneid rapidly involved the necessary surgical specialties. The patient was admitted to the Coronary Care Unit for close monitoring and optimization of medical therapies.
“Aortic dissection by itself, and particularly in the setting of a prior aneurysm, indicates a very grim prognosis and is a high mortality risk. We have the fortune to work closely with excellent vascular and cardiac surgeons and nurses,” said Jneid. “Our multifaceted team approach to clinical care is essential to enhancing patient care and saving Veterans’ lives.”
Jneid consulted Danny Chu, M.D., cardiothoracic surgeon, for surgical repair evaluation. Historically, open surgical repair of this complex aortic disease has more than 40 percent mortality and more than a 20 percent risk of paralysis of the legs and lower part of the body.
The Veteran was also seen by Carlos Bechara, M.D., vascular surgeon, for evaluation for minimally invasive surgery. The patient was deemed high risk for open surgical repair and the consensus was to perform a salvage endovascular procedure. In this type of procedure, the surgeon places a stent inside the artery to reroute the blood flow, stop the bleeding into the left chest, and protect the problem area of the artery.
McWharter was immediately taken to the operating room equipped with fluoroscopic imaging technology. He was placed under general anesthesia and a spinal drain was placed by the Anesthesiology Team to reduce the post-operative risks of paralysis. In addition, Prasad Atluri, M.D., Anesthesiology Service Line acting chief, performed an intraoperative transesophageal echocardiography to guide the operating team into the correct lumen for successful stent placement.
The operating team consisted of Chu, Peter Lin, M.D., vascular surgeon, and Carlos Bechara, M.D., vascular/thoracic surgeon.
The procedure was performed by exposing the left femoral artery, then threading wires, catheters, and stents through the vessel. The right femoral artery was accessed through the skin using an ultrasound. A catheter was placed to inject contrast, see the diseased artery, and identify the areas needing treatment. After careful imaging and planning, the stent was deployed in the correct area to cover the aneurysm and stop the bleeding.
“Because of the skill, dedication, and expertise of the entire team including the Surgical Intensive Care Unit nursing staff and technicians who did a fantastic job, the patient did very well post-operatively. He did not suffer from any complications,” said Lin. “Mr. McWharter was seen in clinic recently and is doing very well.”
“I will always remember my VA docs and nurses in my prayers for saving my life,” said Veteran McWharter.
“This was a very serious and deadly condition. The successful outcome for this Veteran was due to the collaborative effort of four different disciplines,” said Bechara. “As a result of our multidisciplinary approach and cutting-edge technology, we are able to offer treatment to our nation’s heroes for such complex and fatal diseases. This success story is yet another accomplishment we can contribute to Dr. Michael E. DeBakey, our namesake who invented a classification for this disease and who played a pivotal role in advancing Veteran health care.”
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