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Wednesday, December 26, 2018

A Precise, Unexpected Diagnosis Makes A Life-Saving Difference

Posted By: Advancing Care

Surgeons at Good Samaritan Hospital treat a dangerous heart condition called aortic dissection in the nick of time.

By David Levine

Michael Weisgarber, a special-education teacher at Orange Ulster BOCES, had just finished teaching summer school and was looking forward to his two-week vacation.

But, at his Suffern home on Sunday, August 12, 2018, he felt a pain in his chest that quickly escalated. “I could tell it was more than just heartburn,” says Weisgarber, 51. He had trouble catching his breath and experienced pain and weakness in his legs.

A neighbor drove him to Good Samaritan Hospital, a member of the Westchester Medical Center Health Network (WMCHealth), a few miles away. Quick evaluation in the Emergency Department, including a CT scan, revealed he was not having a heart attack but was instead suffering from an aortic dissection, a rare and even more life-threatening problem that requires immediate surgery.

Luckily, cardiothoracic surgeon Chirag Badami, MD, was working that Sunday. He knew how serious the situation was.

Dr. Badami called his colleague, cardiothoracic surgeon Cary Passik, MD, to come in on his day off because this complex operation required the expertise of more than one surgeon. (He also called his wife. “It was her birthday, and I told her I couldn’t take her out to dinner,” Dr. Badami says.)

An aortic dissection occurs when a tear forms in the inner layer of the aorta, the largest blood vessel in the body. As blood flows through the tear, it causes the layers of the aorta to separate, or dissect, and fill with blood. The resulting obstruction can block blood vessels and blood flow in and out of the heart, as well as cause blood leakage that can lead to shock. If this channel bursts, it can cause quick and fatal blood loss.

According to the U.S. National Library of Medicine, aortic dissection occurs in about two out of every 10,000 people. “It’s not terribly common,” Dr. Passik says. “The problem is that mortality without an emergency operation goes up about 1 percent per hour for the first 48 hours, so there is a need to get going as quickly as possible.”

Weisgarber’s situation, however, was complicated. When his aorta split, Dr. Passik explains, blood flow to his lower body was affected. This caused Weisgarber’s leg pain and weakness. If repairing the dissection did not restore blood flow to his legs, he would need more surgery.

During the procedure, his chest was opened, and his body was supported by the heart-lung machine. Utilizing a technique known as deep hypothermic circulatory arrest, Weisgarber’s body temperature was lowered to about 65°F, so that his brain and other organs could safely withstand a lack of blood flow for up to 30 minutes while the diseased, torn section of the aorta was replaced with a synthetic graft. “The patient actually has no vital signs during this portion of the operation,” Dr. Passik says. In Weisgarber’s case, it took just 14 minutes before he was back on the heart-lung machine.

Weisgarber handled the six-hour surgery without a problem, and blood flow returned to his lower extremities. He woke in the ICU that same day, was up and walking the next day and was discharged five days later.

The cardiac surgical group at Good Samaritan Hospital has over 40 years of combined experience. We knew our team could handle it. We have the capability to do complex procedures here. You don’t need to go down to the city.” – Cary Passik, MD 

He slowly built his stamina and strength by walking. “In a few months, I may be able to run and lift things, but not yet,” he said in October. But he can drive and hopes to return to work soon.

Risk factors for aortic dissection include uncontrolled high blood pressure, a genetic predisposition like Marfan’s disease, a preexisting aortic aneurysm, drug use that leads to high blood pressure, and heavy weightlifting, among others. None of these applied in Weisgarber’s case, and there was no family history of heart disease. So, the cause of his rupture is ultimately unknown but presumed to be genetic.

“Luckily, he came in as soon as he didn’t feel well,” Dr. Badami says, though he does advise anyone who thinks they may be having a heart attack to call 911.

“The cardiac surgical group at Good Samaritan Hospital has over 40 years of combined experience. We knew our team could handle it,” Dr. Passik says. “We have the capability to do complex procedures here. You don’t need to go down to the city. For the most part, people don’t have to look any further than this hospital for their cardiovascular care.”

Weisbarger concurs. “How lucky for me that you can walk into a hospital on Sunday and a cardiothoracic surgeon is right there to say, ‘We have to take care of this right now,’” he says. “I got outstanding care at Good Sam. The doctors and nurses, the whole staff, were instrumental in getting me on my feet, out the door and back home.”

To learn more about cardiothoracic surgery at Good Samaritan Hospital, call 845.368.8800.

Photo By John Halpern