Wednesday, November 30, 2011

One Day In December: A Window into the World of Thoracic Aortic Aneurysm and Dissection (TAAD)

Aorta has the
shape of a
candy cane

Disclaimer: This account describes what happened to three individuals with Thoracic Aortic Disease (TAD) on the same day in December 2004. The TAD details are factual, but the personal details and timeline are altered to protect privacy. Any similarity to actual individuals and families is unintended.

Aortic valves in the heart
are often
involved in TAD
This is what happened on one day in December to three men, close in age, and their families. They did not know each other, and they did not know they had something in common. Something called Thoracic Aortic Disease (TAD). 

5:30 AM
In a large medical center in a southern state, it is 5:30 AM. This is the day, the hour, the moment so carefully planned. It is time for a fireman, accustomed to protecting and saving others, to place his own life in the hands of a highly-skilled surgical team. Today, they will remove the aneurysm in his chest. Today, they will save his life.

In this same southern city, another man and his wife will soon be awake and begin their day. He will leave for the office, and a little later she too will go to work. It looks like just an ordinary day ahead.

In the suburbs of a city in a northern state, it is also 5:30 AM. A man, his wife, and their children are all still sleeping. This man stayed home from work yesterday. He has never missed worked because of sickness before. He had a vague discomfort in his chest, enough to keep him home but not enough to really alarm him. He spent a restless night, but is sleeping now.

8:00 AM
The fireman is in the operating room, and surgery has begun. The surgeon will soon be removing the aneurysm in his ascending aorta. How did they find this aneurysm? This man, an active outdoorsman and athlete, had never really been sick in his life. But one day he felt something strange in his chest. No pain, just pressure. This feeling of pressure was there day after day. It did not go away, so he found himself in the doctor's office. They checked him out and found the aneurysm. Two different physicians said it wasn't big enough for surgery yet, and he was told they would watch it. But this man saw his own father die suddenly.  His Dad never made it to the hospital, and he wonders now if that sudden death could have been a ruptured aneurysm, not the heart attack it was assumed to be. Not satisfied, he sought out an aortic surgeon, who told him that if, even with blood pressure medicine, the pressure remained in his chest, it would be time for surgery. The pressure feeling did not go away, and now he is in surgery. His aortic valve will also be replaced.

Far to the north, the family has now started their day. Because her husband still doesn't feel well, his wife has just told him he must see a doctor today. He agrees, saying that he will be ready to go in a little while. Then, he doubles over in severe pain and at this moment is being rushed to the local emergency room, just a few minutes away.

Returning to our southern city, the third man has just started his workday, reading email at his desk. He is feeling well and looking forward to the day. When he awoke this morning, he remembered how fortunate he was to be alive and well. Nine years ago, he had surgery on his heart. They replaced his aortic valve, giving him a mechanical one in its place. The valve has worked perfectly. It has been nine good years he would not have had without that artificial valve, softly ticking like a watch in his chest. He and his wife are grateful to have their health and each other.

This is how this day in December started for three men. All three of them are under 50 years old. All three of them have an aneurysm in their chest, but only one knew about it as they started their day.

At the end of this day, what has happened to each of them?

5:00 PM
The fireman is in intensive care now. His family has seen him, and they are now in the waiting area.  He is starting to come out of the anesthesia, and everything is looking good. His family will soon be allowed to briefly see him again. The surgery was over about 2:00 pm. The surgeon told the family that the aneurysm had grown in just the last month, and the tissue was very thin. This man's aorta may not have held together much longer. That feeling in his chest was an important messenger. Surgery was a necessity, and today was the right day. This family has an additional reason for the stress they feel. When the surgeon spoke to them, he looked at this man's younger sister and told her that she needs to be checked too. They understand now there could be other family members who also have TAD.

In the same waiting room, there is another family. This is the wife and parents of the man who began his day at his desk, reading his email. They never expected to be here today, waiting while the doctors try to save their loved one. His wife is in shock. She remembers how well her husband was when he left for work this morning. How could anything be wrong with his heart? Everything has been just fine since they replaced his valve nine years ago. They told her something about an aneurysm, somewhere in his heart. How could that be? She thought aneurysms were in the brain. She got a call this afternoon at work, saying that her husband collapsed at the office and was rushed to the hospital. She was told to come immediately. She has no idea what is happening. She thought her husband's problems were over when his valve was replaced nine years ago.

Many miles to the north, a woman and her children are back in their home, surrounded by family and friends. The man who left home in terrible pain this morning, their beloved husband and father, is not there. He will never be with them, never walk through their door again. He left them forever this morning, in the emergency room of their local hospital. Alive when he arrived there, after only a few minutes he slumped back and was gone. His children's last memory of him is the terrible pain he had as he left home. 
There was no time to say goodbye.

Three strong apparently healthy men, all affected by one life-threatening condition, Thoracic Aortic Disease.

Did the man still in emergency surgery survive?  His family was told it was not looking good. If he did live, how much damage did the dissection of his aorta cause to his body? Some people do survive a life threatening tearing of the ascending aorta, but many do not.

The fireman recovered well and went back to work. His sister has been checked, and she too has an aneurysm. Other family members are being screened also.

The third family remains in deep grief. This husband and father was always so strong and healthy, and in a moment he was gone. His children, brothers, and sisters all are being scanned for aortic enlargement.

Three strong, seemingly healthy men, who all had ascending aortic aneurysms. Prior to that day in December, they all needed what only one of them received:  a CT scan or an MRI of their aorta, followed by elective aortic surgery. An echocardiogram also might have found these aneurysms, if its images included the ascending aorta.

Every day, through out the United States and the entire world, variations of what happened to these men and their families continue to take place. Increased awareness of the aorta in the chest, proactive screening, and elective surgery are needed to prevent the tragedies caused by TAD. 

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