Hyderabad:  Aortic dissection is a condition caused by a tear in the inner lining of the aorta.  Aortic dissection is a potentially life-threatening condition in which there is bleeding into and along the wall of the aorta, the major artery carrying blood out of the heart. The pain experienced by the patient is the first symptom of the condition.  And this pain is unique.  The pain starts suddenly.  It is usually described by the patient as “tearing, ripping or stabbing”.  This is in contrast to the pain normally associated with heart attacks.

Aortic dissection is the commonest catastrophe of the aorta.  When left untreated, 33% patients die within 24 hours, 50% in 48hours. It is a medical emergency that is potentially fatal.  Best of medical care and treatment may not save patients.  Aortic dissections resulting in rupture has 80% mortality rate.  50% of patients die before they even reach the hospital.

Hence, lot of attention and importance is attached to it. In an unusal effort, Cardiac and Vascular Surgeons at Star Hospitals performed a unique and highly risky Hybrid Surgical Stent Procedure for the first time in the state of Andhra Pradesh on a forty years old patient from Kukatpally in the city.  This new procedure is a combination of surgery-cum-stent one.  It requires good technical expertise and team work.

Addressing a Press Conference at its premises today Dr. M. Gopichand Chief Cardiothoracic Surgeon and Managing Director of Star Hospitals informed that Aortic dissection is a rare, but potentially fatal condition in which blood passes through the inner lining and between the layers of the aorta. The dissecting aorta usually does not burst, but has an abnormal second channel within it. The aorta is the large blood vessel that leads from the heart and carries blood to the rest of the body. The aorta has a thick wall, with three layers of muscle that allow the blood vessel to withstand the high pressure that is generated when the heart pumps blood to the body.

The three layers are the tunica intima, tunica media, and the tunic adventitia. In an aortic dissection, a small tear occurs in the tunica intima (the inside layer of the aortic wall in contact with blood). Blood can enter this tear and cause the intima layer to strip away from the media layer, in effect dividing the muscle layers of the aortic wall and forming a false channel, or lumen, a new blood channel. This channel may be short or may extend the full length of the aorta. A distal (further along the course of the aorta) tear in the intima layer can let blood re-enter the true lumen of the aorta. This can lead to heart attack, strokes, abdominal pain, and nerve damage. Blood may leak from the dissection and collect in the chest and around the heart. Aortic dissections require immediate surgery to repair the aorta, he informed.

Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs.  If the dissection reaches 6 cm, it calls for an emergency surgery.

The incidence of aortic dissection is not very common.  Middle aged men in the late forties and fifties are victims of the aortic dissection.  Aortic dissection occurs in approximately 2 out of every 10,000 people. It can affect anyone, but is most often seen in men aged 40 to 70. Approximately 2,000 cases of aortic dissection occur yearly in the United States added Dr. P.C. Gupta.

Stating further Dr. P.C. Gupta added that there are many reasons for this condition.  Aortic dissection is associated with hypertension (high blood pressure) and many connective tissue disorders. Most cases (over 70%) are associated with high blood pressure (hypertension). Vasculitis (inflammation of an artery) is rarely associated with aortic dissection. It can also be the result of chest trauma. 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension.

The highest incidence of aortic dissection is in individuals who are 50 to 70 years old. The incidence is twice as high in males as in females (male-to-female ratio is 2:1). Half of dissections in females before age 40 occur during pregnancy.

Under this new procedure the risk of life is minimised.  It is a safe and established but not routine procedure.  It is now established procedure abroad, but, not many tried in India.  Only few cases have been treated in India with this technique. It has less mortality.  The cost of the procedure may range anywhere between Rs 13 lakh to Rs 15 lakh depending on the condition of the patient.  About ten patients with similar conditions are reported at Star Hospital annually. But the number is rapidly increasing.  If the number goes up, the costs may come down, informed Dr. Gopichand.

This disease was first described long ago almost 200 years back. But new challenges have arisen since the advent of advanced diagnostic and therapeutic modalities. The clinical manifestations are diverse, making the diagnosis difficult.  Utmost skilled surgeons can only handle such surgeries.